Meet the Dietitian: Community service series

Chat Leave a comment May 30, 2019 nutritionadsa

An unforgettable community service experience in the ‘forgotten province’…

By Inarie Jacobs

Health should not be taken for granted – a lesson I learned as a child whilst being very ill due to my poor lifestyle and dietary habits. After this experience, I decided to study dietetics at the North-West University of Potchefstroom to share this lesson as far and wide as possible.

I started my community service journey in December 2018 at a small rural hospital in the beautiful Transkei area of the Eastern Cape – a.k.a. “the forgotten province”. The challenges seemed a bit overwhelming at first as I had to trade my luxurious lifestyle habits for much simpler ones. Not only was the hospital an hour away from where I lived but it also never had a dietitian or a dietetic department before. No equipment and no supplements together with a huge language barrier made counseling with patients nearly impossible. To be honest, the tunnel did not seem to have light at the end.

However, after a few weeks of feeling really sorry for myself, I noticed how heavily the burden of wasting, obesity and poverty weighed on this community. The effects of the nutrition transition were clearly visible in this rural area which made me realized how badly nutrition intervention was needed. This led me to change my perspective and strategy towards this year and soon my challenges transformed into endless opportunities.

I get to build and establish a whole new dietetic department to promote our profession – an opportunity few community service dietitians have. I’m forced to improvise and to be more creative with cost-effective tools and methods to educate and treat patients – a skill I would have never developed if things were easy. I’m forced to reach out to the surrounding dietitians for help – a network of professional colleagues I would have otherwise not built.  I’m also trying to learn the beautiful isiXhosa language to interact with patients – a privilege I would have otherwise not had.

In short, comfort does not enhance growth! I’m grateful to be pushed beyond my comfortable limits as it is teaching me more than any book ever will!

I encourage all future and current community service dietitians to rise to the opportunity to lead, to influence and to inspire others with your attitude, deeds, and knowledge. To Quote Anne Frank: “You don’t always know how great you are, how much you can accomplish and what your potential is”. Dare more boldly, walk that extra mile and give it all you have!

A few rural survival tools:

• Breathe…
• Rural is never a textbook case.
• Be culture sensitive and respect different views/religions.
• Get to know local indigenous foods, what traditional foods are and how they are prepared.
• Ask for help as much as possible. You don’t have to know everything, just be willing to learn.
• Know that change doesn’t happen overnight and that some may be very resistant towards it.
• Be kind and treat people with respect, no matter their background, title or position.
• Be gentle and patient with yourself, your progress and setbacks.

 

ABOUT ADSA
ADSA, the Association for Dietetics in South Africa, is one of the country’s professional
organizations for registered dietitians. It is a registered non-profit organization served by qualified volunteers. The Association represents and plays a vital role in developing the dietetic profession so as to contribute towards the goal of achieving optimal nutrition for all South Africans. Through its network of ten branches, ADSA provides dietitians with the opportunity to meet and network with other professionals in their provinces. Through its comprehensive Continuing Professional Development (CPD) system, ADSA supports dietitians in meeting their mandatory on-going learning, which is essential to maintain their registration status with the Health Professions Council of South Africa (HPCSA). Visit: http://www.adsa.org.za

Meet the Dietitian: Community service series

Chat Leave a comment May 13, 2019 nutritionadsa

“The best decision I’ve made in my life…”

By Bonnie Evert

“TPN? Food in arteries?” These were my thoughts, as a very inexperienced 17- year- old girl, when the Registered Dietitian (RD), who was assisting a very close family member of mine in the ICU, explained what all the little bags hanging above the bed were in aid of.

My perception that RDs only help fat people lose weight was destroyed and the profession fascinated me. I canceled my application for the air force and immediately applied to study B.Sc. Dietetics at the NWU Potchefstroom Campus – which has been the best decision I’ve made in my life, thus far.

Five years later, I am working at a psychiatric hospital to complete my community service year. It is not quite the same as the acute setting we became familiar with in our 4th-year internship. This psychiatric hospital specializes in patient-care for the intellectually disabled patient, rehab for mood disorders, substance abuse or both, and a rehab unit that accommodates patients with spinal cord as well as brain injuries.

When starting anything new, there are a few challenges and opportunities. Here are a few of mine as a new Comm-serve.

1. Opportunity

Working in a psychiatric hospital is very interesting and different to an acute hospital. Not a day goes by where an opportunity doesn’t arise to learn something new, read up on a rare condition or have a heart-warming encounter with a patient.

2. Multi-professional team

I have realized the importance of working together in a multi-professional team, including the occupational-, speech- and physiotherapists, and how important each unique role is regarding nutritional management and overall patient care. I have come to understand that one cannot be a one-dimensional dietitian: yes, we are the nutrition experts, but it won’t hurt to learn more about all the complex medical aspects of different patients. In fact, it will improve your nutritional decision-making.

3. To err is human – it’s okay to make mistakes

This is only relevant IF we use our unintended mistakes as learning curves and IF they do not harm anyone, of course. I have often felt as though my opinion is not worthy or helpful until I realized that if I don’t speak up immediately and take a stand for my patients (who often cannot speak for themselves), a greater risk is imposed on their healing and well-being. However, it is our responsibility to be updated with the latest evidence-based guidelines and medical nutritional therapy to support our opinions.

4. Separate your work from your private life

In our line of work, it is our job to be empathetic towards patients and to remain professional. I learned that to keep my emotions from getting the better of me at work, I will have to find a way to debrief – and believe me – it is important to talk about your feelings. Thankfully, I have the best support system at work and an absolute role model as my supervisor who taught me this: It is important to be empathetic towards patients, but so is protecting yourself and ensuring the quality of your work.

Some of the highlights I have enjoyed about this year include the opportunity and privilege to help others and actually make a difference. The possibility of improving my knowledge as well as my work ethic – which includes earning a salary – has been outstanding.

My heartfelt message to anyone reading this article is NEVER to underestimate yourself, treat others the way you would like to be treated, stay up to date with the latest research, be positive and most of all enjoy the journey, it passes all too quickly!

ABOUT ADSA
ADSA, the Association for Dietetics in South Africa, is one of the country’s professional
organizations for registered dietitians. It is a registered non-profit organization served by qualified volunteers. The Association represents and plays a vital role in developing the dietetic profession so as to contribute towards the goal of achieving optimal nutrition for all South Africans. Through its network of ten branches, ADSA provides dietitians with the opportunity to meet and network with other professionals in their provinces. Through its comprehensive Continuing Professional Development (CPD) system, ADSA supports dietitians in meeting their mandatory on-going learning, which is essential to maintain their registration status with the Health Professions Council of South Africa (HPCSA). Visit: http://www.adsa.org.za

Sesame chicken

Chat 1 Comment May 3, 2019 nutritionadsa

This mouth watering sesame chicken recipe was created by the lovely Cheryl Meyer, registered dietitian and food blogger from Dish and Delight.

Serves 4

INGREDIENTS

1 tablespoon olive oil

4 skinless, deboned chicken breasts, cubed (approx. 125 g each – 500 g)

3 tablespoons low-sodium soya sauce

2 tablespoons apple cider vinegar

2 tablespoons honey

1 teaspoon crushed garlic

1 teaspoon crushed ginger

1 teaspoon corn flour

⅓ cup finely chopped spring onion (optional – extra to garnish)

2 teaspoons sesame oil

1 teaspoon toasted sesame seeds, to garnish

salt and pepper, to season

 

METHOD

1. Season chicken cubes with salt and pepper.
2. Sauté chicken in olive oil, stirring occasionally, until the chicken is cooked through.
3. While chicken is cooking, whisk together the soya sauce, apple cider vinegar, honey, garlic, ginger, and corn flour until combined.
4. When the chicken is cooked through, add the spring onions and soy sauce mixture to the pan and stir to coat the chicken – the sauce will thicken quickly.
5. Stir in sesame oil, then remove from heat and enjoy.

 

SERVING SUGGESTIONS:

Serve over cooked rice, cauliflower rice, zucchini noodles or quinoa with steamed broccoli, stir-fried mixed veggies or cooked green beans topped a sprinkle of toasted sesame seeds and spring onion slices.

 

We Love:

This is simple Asian cooking at its best, a quick dinner that tastes like takeout but you control the ingredients, you control the flavor.

 

What the dietitians says:

Tip: measure the olive oil in your tablespoon before the honey, so it slides out easily.

 

Nutrition Information: Per serving

Energy: 1017 kJ Protein: 29.8 g Carbohydrate: 10.8 g Of which, total sugars: 8.7 g Fat: 11.4 g Fibre: 0.5 g Sodium: 556 mg

Making the best food choices for HIV & TB

Chat Leave a comment May 2, 2019 nutritionadsa

Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) and Tuberculosis (TB) are two of the most prevalent infections in South Africa, and both conditions present nutritional challenges that must be met to effectively treat these diseases.

“HIV/AIDS and TB patients are not just eating to maintain their normal bodily functions, like moving their muscles and the pumping of their hearts,” says Chantell Witten, a registered dietitian and spokesperson for ADSA (Association for Dietetics in South Africa). “When you have a disease, it becomes even more important to  maintain good nutrition because you often need additional energy and nutrients to effectively treat the disease, maintain a healthy weight, help the medication work optimally and support the body to repair damaged cells.”

According to Yzelle Watermeyer, a clinical dietitian working at the coal-face at the Kopanong Hospital in Vereeniging, one of the most serious challenges many patients face is the danger of getting caught up in a vicious cycle of malnutrition and an impaired immune system.

“Sickness and some medications can cause loss of appetite, malabsorption and an altered metabolism (increased nutrient needs).  This, together with a lack of access to quality food may result in a vicious cycle of weight loss, decreased immunity and worsening of the chronic infection (HIV and/ or TB).”

The significant link between healthy eating and wellness is at the heart of an ongoing Department of Health (DoH) message to broadly increase awareness that what we choose to eat and drink really matters.  “South Africans needs to be empowered with the knowledge of how nutrition impacts on their health, and their lives,” says DoH Director of Nutrition, Rebone Ntsie.  “With information and understanding, people can take responsibility for their wellness by making small lifestyle changes that can have a big impact. For instance, if you have money to buy a packet of chips as a snack; this money would be more wisely spent on fresh fruits which are packed with vitamins, minerals and fibre. If you have money to buy a fizzy, sugary drink; again you can make a better choice by choosing to drink life-giving water instead. You can reduce intake of unhealthy fat (saturated fats and trans fats) by buying a good quality piece of meat with no visible fat, grilled chicken or fish rather than fried ones.  This is how every South African can make better food choices and improve their wellness, and it is particularly important to people living with HIV/AIDS and TB.”

So, what should South Africans infected with HIV or TB eat?

The experts are unanimous that basic healthy eating guidelines as per our South African Food Based Dietary Guidelines apply to all, regardless of your HIV or TB status. Whilst, some medications may present challenges due to malabsorption and/ or nutrition-related symptoms, sticking to the rule of following a healthy diet made up of a variety of foods goes a long way.

“As we would advise healthy individuals, it is equally important for those affected with HIV/ TB to eat a variety of foods that will supply their body’s with much-needed nutrients,” points out Witten.  “Eat foods that are minimally processed which will provide you with a good dose of micronutrients (vitamins and minerals), as well as a  good quality macro-nutrients (protein, carbohydrates and fats).  We encourage everyone to eat plenty of fresh vegetables and fruits; wholegrains and legumes (such as beans and lentils); good quality meat, chicken or fish as well as eggs and unsweetened dairy products. These whole foods will help you  manage the disease and build and repair damaged cells.”

Watermeyer emphasises that eating fermented, probiotic-rich products like yoghurt or maas every day helps to support gut health, which is often compromised by HIV and TB. “Try to stick to the unsweetened/ plain dairy products because, with infections like HIV and TB, patients have a propensity towards developing thrush. Adding excessive amounts of sugar to the diet may worsen this. So whilst sugar is energy dense and may help you gain weight, it should be consumed in moderation as it may worsen side effects and is considered a nutrient-poor choice as it does not contain any additional vitamins and minerals to support the body,” she says.

What foods should HIV and TB Patients avoid?

Watermeyer says:

• Avoid unpasteurised dairy products such as milk, yoghurt and cheese (always check the label if unsure, almost all dairy products sold in supermarkets are pasteurised, but milk bought directly from the farm, although more cost effective is not always pasteurised, so rather be safe than sorry!)
• Alcohol (increases risk-taking behaviour and can exasperate malabsorption)
• Raw or partially cooked animal products (can be a source of potentially harmful bacteria like Listeriosis)
• Do not use anything past its expiry date
• Limit tea and coffee as they affect some nutrient absorption and are not beneficial to the body (for example iron)
• Avoid sugary coldrinks and energy drinks (these are high in sugar and low in nutrients a.k.a nutrient poor.)

Witten adds: “Avoid processed meats like polonies, viennas and corned tinned meats.  Although you may think these taste good, they are often high in salt and saturated/ trans fats which is not ideal for your health.) If you can’t afford fresh meat, chicken or fish every day, rather than buying processed meats daily, save up for a piece of good quality piece of meat once or twice a week and remember that legumes such as beans and lentils, eggs and tinned fish like sardine’s and pilchards are wonderful and healthy alternatives.” 

Top tips to help patients access safe, healthy foods that are more affordable include:

• Make a vegetable garden at home and grow your own fresh vegetables
• Legumes (like beans and lentils), soya mince, eggs and tinned fish are fantastic sources of good quality protein
• Shop at the most affordable stores, be price-aware and look out for the specials
• Buying in bulk is often cheaper, share the cost and produce with family, friends and neighbours
• Do not buy and eat cracked eggs (check them before you buy them)
• Be vigilant about keeping your hands and food preparation surfaces clean at all times.

ABOUT ADSA

ADSA, the Association for Dietetics in South Africa, is one of the country’s professional organisations for registered dietitians. It is a registered non-profit organisation served by qualified volunteers. The Association represents, and plays a vital role in developing the dietetic profession so as to contribute towards the goal of achieving optimal nutrition for all South Africans. Through its network of ten branches ADSA provides dietitians with the opportunity to meet and network with other professionals in their provinces. Through its comprehensive Continuing Professional Development (CPD) system, ADSA supports dietitians in meeting their mandatory on-going learning, which is essential to maintain their registration status with the Health Professions Council of South Africa (HPCSA).  Visit: http://www.adsa.org.za