Sunday, October 30, 2011

Of Kitsch and Kitchens

When I'm not busy with my internship I am planning a wedding. Until recently I'd put off certain low priority items. Like a gift registry.  I wondered what it was about getting married that suddenly necessitated additional appliances and dishes. Both of us have been living on our own for years and have acquired and accrued plenty of the basics in that time. We've cooked meals and entertained guests and lived lives like normal people and having lived without so many items until now, we felt no pressing need to get a lot more. Still, friends and family made the convincing argument that a registry at least provides a guide for guests who want to give a gift. This way you get gifts that you really need, or at the very lease might actually use. So I sucked it up, tried to maintain a healthy perspective and I registered for some essentials.

I was thinking about this today when I saw the kitchen exhibition at the Henry Ford. On display were four kitchens, dating from the 1700s to the 1930s. The first thing I noticed was how little I understood about how they might actually be used to prepare a meal. The second thing I noticed was how modest and simple they were. 

Kitchen from 1700s

Kitchen from 1830s

Middle class kitchen from 1890s
Middle class kitchen from 1930s

Finally, having spent some time working at a museum years ago, I couldn't help but wonder about the intention of the curator. I imagined the ways in which an educator might present these kitchens - asking visitors to compare them, to look at the details and what they tell us about the family who lived there, what that tells us about the economics of the time, the types of meals they prepared. But as a simple visitor I found the place lacking vision. Something I'm sure Henry Ford would not have appreciated.

The Henry Ford, as it's known, is a giant complex that boasts a museum, research center, factory, historic village, IMAX theater and high school. It's just one of a long list of Ford venues in the Great Lake state of Michigan. Both Henry and Gerald Ford have lent their names to Ford Field, Ford Lake, Ford Road, Ford library and Ford airport. I'd heard about it this summer and was waiting for the right time to visit.  On this sunny and warm autumn day, my daytime plans fell through and provided the perfect window of time to take a trip back in time.

After paying $22 admission, you can pay another $10 to ride the train 
Housed in an enormous building with poor lighting, the museum is divided into various sections that highlight inventions and imagination in the American experience. One section focused on agricultural innovations over time. Another had several dozen stoves. Still another showcased dollhouses from the past hundred years. One of the strangest sections focused on American pop culture beginning with the early 20th century and featured items from my own childhood, like Speak and Spell, Simon and the Mr. Professor calculator.  It all really seemed more like an elaborate private collection than a museum exhibition.

Many of these are Chanukah gifts I received as a child.
Now they are artifacts in a museum.

I was looking forward to an area called "With Liberty and Justice for All" which featured the women's suffrage and civil rights movements, among others. I sat on the Rosa Parks bus and listened to a recording of Ms. Parks telling her story. And I looked around for copies of Ford's notoriously antisemitic Dearborn Independent, which surely must feature into this section of the museum that displays KKK attire. Its absence was upsetting but also not surprising. It was just another example of how this museums offered lots of kitsch but no real content, commentary or substance.

Classic or kitsch?
I had a great day at the Henry Ford in spite of my inner critic.  After a day surveying American life - everything from nickelodeons to 8 tracks to planes, trains and automobiles and - while I'm not sure if this was the curator's intention - I was reminded how much of our history is told through objects. Objects we invented and used until they faded into obsolescence with the next great invention.   They tell of what we did or hoped to do. So I came home and realized that while I would like to stick with a wedding registry that sticks close to what I could really use, maybe not everything needs to be so essential.

Wednesday, October 26, 2011

(Factory) Farm to School

It's National Farm to School Month and last Friday I attended a fantastic Farm to School workshop through MSU's Extension Program. The workshop consisted of two very thorough presentations, a basic intro and then a more advanced nuts and bolts of getting farm to school programs off the ground in Michigan. Many school food service directors were in attendance but also a school nutrition consultant for the state's Department of Education, members of FoodCorps, reps from Detroit's Eastern Market, concerned parents and local food marketing strategists. The group had lively discussions and the four hours seemed to fly by with substantial ground covered.

Many schools have already initiated farm to school programs. The school district where I am currently working has a relationship with some local farms and occasionally gets produce from them. Introducing fresh produce in the school cafeteria on a regular basis is great. But at the end of the day most of the food served is not fruit and vegetables from local farms but from beef and poultry from factory farms.

I asked about this at the end of Friday's presentations. While I recognize the value of (and need for) increasing fruit and vegetable consumption among students, after observing cafeteria eating habits these past four weeks, I have seen that most students opt for meat and cheese-laden foods - these being important components of the reimbursable meals - and wondered if there were any efforts focusing on local farms for sourcing meat and dairy.

The answer was yes and no. Yes, there are certain dairy farms that are responding to the needs of school food service directors. For example, schools are required to serve fat free milk in a certain serving size and specific type of bottle that was hard to find on the market and a local Michigan dairy responded by making that product available. So clearly school food service directors can impact the supply chain. But no, there is no effort looking at the quality of that dairy or the types of practices used on those dairy farms or on any other farms for that matter. Why is this significant? Because in 2009-10, 31.6 million U.S. children participated in daily school lunch programs. That's a lot of buying power. I couldn't help but wonder how that could be harnessed to improve the food system even further than getting a local vegetable to feature on a school menu once a month. Besides, fresh produce presents a tremendous challenge for many school food service facilities that lack the labor, the facility, the time or the know-how to prepare fruits and vegetables properly or in a desirable way. Just this morning I was assisting in a school kitchen, laying frozen burgers that barely resembled beef out on trays, and filling bags with pepperoni, which had few traces of actual meat content.  I was then asked to cut up several dozen zucchini and squash which I was later horrified to watch being steamed to mush and served in such an undesirable fashion that even I did not care to try them. They didn't stand a chance on pizza day. (Need I mention that the pepperoni pizza sold out first?)

This evening I came across a post on Mark Bittman's website that shared a letter from a chef to his colleagues in the restaurant world offering the reasons they should strongly consider sourcing their meat from reputable, ethical, healthier farms. Beyond the health concerns of hormone and antibiotic use, of animal cruelty and corporate monopolization that the letter cites, the EPA lists "enteric fermentation" (ie. gas emitted from animals related to digestion) as the second highest contributors to U.S. methane gas emissions (climate change, anyone?). Number five on the list, "manure management" is an even greater problem because it also poses a food safety threat, as evidenced by the unusual (although increasingly usual) recent spate of produce cross-contaminated with e. coli.

Farm to school programs continue to grow, thanks in part to increased funding and grant opportunities (stipulated under the Healthy, Hunger-Free Kids Act) and to the birth of FoodCorps and that is exciting to behold.   Given the size and buying power of schools I hope that in the future, the programs expand to include considerations toward where they source their beef and dairy and move away from factory farms. While the supply does not currently exist for most schools to purchase all their animal products from non-factory farms, such efforts might, at the very least, put more pressure on the industry to create a healthier, more sustainable model. And it would certainly put a better product on the lunch line.

Thursday, October 20, 2011

Minding my Peas and Q's

When I was in elementary school I begged my mother to take me off the school lunch program and pack my lunch at home. It was partly because I disliked school lunch, partly because I hated waiting in line but mostly because all of my friends brought lunch from home and I wanted to sit near them. I remember the feeling of relief when she finally sent me with a bagged lunch. I didn't care what it was and I don't know if I ever really ate it. So is eating school lunch as bad as I remembered?

Earlier this month I read about the release of Fed Up With Lunch, the expose written by a school teacher working in a Chicago public school who anonymously blogged about (and photographed) school lunch over the course of the school year under the pseudonym Mrs. Q.  I wondered how representative her experience was eating school lunch. But I didn't really have to wonder for very long. When I started this rotation is school food service my preceptor told me we would be eating lunch at the schools. As an insider on both ends of the lunch line I can now say this about school lunch: it's complicated! Oh, I've said that before? Well if I didn't convince you before, maybe I will now.

To start with I am certainly not the target demographic of the school lunch program. I don't eat meat, only eat kosher poultry and I avoid gluten and dairy among other things. Dairy is big in schools. HUGE. 'Got milk?' posters are ubiquitous and students are offered "white" milk and chocolate milk at all meals. So I was nervous about relying on school lunch given these restrictions so I packed myself a few snacks and figured my day is over at 3pm so worst case scenario I pick up some lunch on my way home. I was pleasantly surprised on the first day when I found Spanish (brown) rice, vegetarian beans, and a salad bar. Not the type of elaborate seasonal salad bar I'm used to - it included shredded (iceberg) lettuce, sliced tomatoes, pickled peppers, onions and cheese - but vegetables nonetheless. I ignored the sour cream, took some guacamole (which I later learned had yogurt in it to keep costs down and to add some nutritional value) and considered my lunch fairly healthy and satisfying.

Some days were better than others. One day the only remotely suitable options were brown rice, applesauce and lettuce. Yesterday I ate a baked potato, a bowl of mushy dark colored reduced-sodium peas, package of carrots and sunbutter. On those days I go home and eat leftovers as fast as I can. But other days I've been pleased to find treasures like quinoa, roasted vegetables and stuffed acorn squash. With Try-it Tuesdays and Why Not Wednesdays introducing new foods to the lunch line there more whole grains, vegetarian and vegan options available. Despite these healthy options I don't want to make this sound like some Midwestern miracle because here's the catch: most students don't choose these foods. They opt for the hot dogs, the burgers, the pizza, the french fries, the chicken nuggets and anything with cheese. Not all students, but most. And why are these foods sold in school cafeterias? Let's just say it has to do with dollars and cents.

Here's the breakdown from a typical school: Students pay $2.25 for a full-priced lunch. The government will reimburse $0.27 with an additional $0.26 in commodity values for total revenue of $2.73 per meal.

Now let's look at the costs:
    1. Milk - $0.22
    2. Fruit - $0.25
    3. Grain - $0.30
    4. Protein - $0.65
    5. Vegetable - $0.25
    6. Labor - $1.04
    7. Indirect - $0.27
So while $2.73 is generated in revenue, the total cost for a lunch meal is $2.98. I'm no economist but I know that when costs exceed revenue you end up in the red. And that's what happens when the only food offered is the reimbursable meal, one which meets the USDA guidelines and offers at five food groups of which students must take at least three. Some cost can be saved if students choose less than the five items to which they are entitled, but that doesn't quite fix the hole. Interestingly, while the same imbalance exists in breakfast programs, many states reimburse the difference. So why not raise the price of lunch? Because when schools raise the price even 25 cents, students tend to opt out, parents send lunch from home and the only kids buying school lunch are those at free and reduced price. Instead, most school food service programs rely on other revenue generating means such as a la carte sale of chips and cookies and "healthier" snacks, vending machines, catering school events and providing box lunches for sports teams.

More and more schools have fruit and vegetables on the menu. Many schools are sourcing locally when possible. School food service and nutrition staff care about nutrition but they also care about feeding kids meals they will eat that will also qualify for reimbursement. They are forced to balance very tight budgets and provide items that meet the outdated government standards. They care about school lunch and they eat school lunch and they get very defensive when criticized for the role of school lunch in childhood obesity, citing shorter lunch periods and decreased activity as far worse offenders. They now find themselves at the center of a heated national debate. "They" are represented by giant organizations like the School Nutrition Association and the National Food Service Management Institute but they are individuals serving different communities and some have more leeway than others when making changes.

All of this might sound very discouraging. And there is definitely a lot of work to be done to change the current system. But the other day I went to a meeting with other school food service directors that was hosted by Gordon Food Service, a giant food distributor that many of the schools use. I asked those sitting around me if the field has changed since they started working in schools ten or twenty years ago. "Oh yes," they told me. "It has changed dramatically over the years. There was a time when we were behind the times by 10-15 years. Now with all the spotlight on school lunch we've had to catch up very quickly."  So while it's important to remember that the healthy school lunch pioneers (like Ann Cooper) have been at it for years, many of us have neglected to consider the state of school lunch until Jamie Oliver brought it to prime time and people like Mrs. Q started to blog about it. And with the spotlight on school gardens and cooking and celebrity chefs in the cafeteria and whole grains and physical activity, good things are happening.

Beyond the kitchen and lunch line, I can't say that I understand the social dynamics of the modern school cafeteria. Today I watched a girl from the lunch line as a girl sat alone at the end of her class's table in an area reserved as peanut-free and wondered how she felt. Do you think kids still judge the lunches their friends eat? I'm sure they do. As for me, I've had my fill of school lunch for a while. And I can't wait to bring my own lunch from home again.

Sunday, October 9, 2011

To Serve and Defend: School Lunch in the U.S.

This week I started my rotation in food service, working with some local school districts.  Before my rotation started my preceptor told me she likes to have interns read about the history of the National School Lunch Program, so she loaned me a book called School Lunch Politics: The Surprising History of America's Favorite Welfare Program. As it turns out, not only was the school lunch program a welfare program providing many students with perhaps their only meal of the day, it was also a matter of national security. While early versions of the program date back to the pre-war era, when America entered world wars I and II it became clear that malnourished children grew up to become malnourished soldiers. Feeding the nation's youth was the best defense. There were concurrent concerns among American farmers about the fluctuating prices of their crops. In a brilliantly flawed move that created a giant conflict of interest and decades of debate, the National School Lunch Program was passed in 1946, and the program was designated under the auspices of the USDA. The Department of Agriculture would use surplus crops and commodities to feed the nation's youth, keeping prices steady and bellies full.  From the onset, the program also had a strong connection to the War Food Administration (and later to the Department of Defense, which it currently relies upon for much of its fresh produce).

Image from The Food Museum's online exhibit  on School Lunch

"What has been will be again, what has been done will be done again; there is nothing new under the sun."  While reading about the history of the school lunch program I couldn't help but think of the words of Ecclesiastes. Every major issue confronting the program today has been their since its very inception... the surplus commodities, the lack of proper equipment or trained food service workers to prepare nutritious meals, the tensions between running school food service as a business vs. as a public health program. And yet, what is most amazing is how this welfare program has endured despite these deep-rooted flaws.

What once constituted a "good" lunch -
not so different from the current USDA requirements
I would be remiss if I did not also mention the important role of the school lunch program in legitimizing the field of nutrition. Many of the earliest pioneers of the program were women who wanted to seriously pursue science but could not gain access to any advanced programs. Home economics was a "safe" way for women to study and apply the science of nutrition and also provided women with a point of entry into government jobs. The program also contributed to the standardization of the American diet - for better or worse.

The National School Lunch Program is "arguably the most regulated, thought-about, fought-over and highly planned meal in America."  There are so many competing interests and considerations, from cost to labor to reimbursement requirements to dietary guidelines to picky eaters, not to mention the regulations at the federal and state level and from the Department of Health as well. Furthermore, I find this ongoing connection to the DoD, with nutrition and war somehow becoming inextricably linked at once fascinating and troubling. I don't know if a month's time is enough for me to learn the ins and outs of this absurdly complicated program but it's an exciting time to be working in the field and to gain greater insight into the challenges of school lunch.

Wednesday, October 5, 2011

Big Fish

I didn't know what real salmon was until I moved to the Northwest. When I ordered grilled salmon for my first dinner in Seattle I was shocked to see the bright pink fish that arrived on my plate. During my three years living there I ate wild Alaskan salmon raw, grilled and poached, but mostly I enjoyed eating it smoked. This was especially surprising to me, raised Jewish in New York City where I had mistakenly believed that thinly sliced salty lox was the only smoked salmon out there. The salmon I discovered in the NW was thick and flavorful and widely available. I didn't eat it with cream cheese and a bagel. I preferred eating it with my hands. So when I visited Seattle last weekend to celebrate the Jewish New Year with my fiance and friends,  I had the perfect excuse to visit the Ballard Farmer's Market where I was handed heavenly samples of wild Alaskan king salmon smoked in brown sugar and garlic or maple and wine. I bought a piece and saved it for my last dinner before heading back to the Midwest, recognizing that it's one of the local foods I'd sacrifice by moving this long distance.

But somehow Seattle fish followed me back to Michigan. Yesterday I attended a school district meeting in a small town outside of Ann Arbor where someone referred to the "World Famous" Pike Place Market and it's "fish" philosophy. It wasn't the first time I'd heard about this. Back in July when I began my rotation in long term care I started each morning by attending the daily management meetings. I learned that the head administrator had started only a month or so earlier and was eager to bring some energy and enthusiasm to what was a pretty drab place. On my first day he asked me to select the winning "fish." He laid out a bunch of folded notes on the table and I selected one. I had no idea what these "fish" were for. He explained that they were complimentary notes that residents and staff could fill out, commending a staff member's performance or positive attitude. "You're from Seattle, you must know the Pike Place Fish Market." I nodded. I thought of the busy tourist attraction where the fishmongers would toss the purchased fish to one another in a call and response manner, every so often throwing a fake fish at an unsuspecting person in the crowd. It was a cute shtick but I had no idea what this had to do with anything. Apparently there was some greater philosophical underpinning, but I wondered if anyone present at the meeting had actually been there. 

After yesterday's meeting I was in my preceptor's office and noticed the Fish! book on her shelf, so I borrowed it and read it last night. It's one of those Who Moved My Cheese? types of self-help for the workplace books that is annoyingly oversimplified, perhaps a total lie but ultimately well-intentioned and a good motivational device that asserts four main ideas: Choose your attitude, Play (have fun while you work), Make their day (engage with those you work with and work for), and Be present. These concepts are all based upon the Pike Place Fish Market, and I think they're pretty good principles to incorporate into the workday.

When it comes to actually buying fish, I'll take Ballard over the Pike Place Market any day. But while I'm living 2500 miles away, turning my nose up at the ubiquitous farmed Atlantic pathetic excuse for salmon, counting down the weeks until I'm back in the NW (8!), these small references to Seattle make my day. Until then I certainly can work on being present, taking time to play and choosing a positive attitude - all good skills to develop when working in schools.

Tuesday, October 4, 2011

On Indigestion

Last week I wrapped up my time in the clinical setting. I conducted assessments of patients, most of them presenting with IBD (inflammatory bowel disease) flares. These conditions cause inflammation of the GI tract that can lead to abdominal pain, diarrhea, ulcers, bleeding and weight loss. As a result, many patients have nutrition-related concerns and are at risk for malnutrition and malabsorption. Going on rounds with the team gave me insight into how doctors think, how they assess, diagnose and treat these conditions. Endoscopies, colonoscopies, flex-sigmoidoscopies, double balloon enteroscopies were daily rituals in the unit. Sometimes surgery was discussed and many patients already had various -ectomies and -ostomies and had this -itis and that -itis. Allergies to steroids and antibiotics, bacterial infections, narcotic addictions, MRSA and C.diff were all part of the daily discussions. These were very complicated cases.

But the way doctors think is not the way dietitians think. After rounds with doctors I would later meet with patients to gather the bits of information that were rarely, if ever, discussed. I wanted to learn what they typically eat, what foods they avoid, what foods are triggers, and how their condition impacts their energy and level of function. I would observed their physical appearance to see if they showed signs of wasting, weight loss and malnutrition using a host of indicators under what is called a "subjective global assessment." I would keep an eye on how many days they were NPO (nothing by mouth). I would lament the Skittles, Rice Krispie treats, Goldfish crackers and Coca-Cola on their trays, but didn't have the courage to suggest that after landing in the hospital with severe GI distress these were perhaps not the best choices for healing foods. I would provide ADA handouts on the types of foods recommended for Crohn's and ulcerative colitis, even though I disagreed with some of their suggestions. I realized that my thought process is much more outpatient-oriented, thinking along the lines of "what dietary recs can I provide this patient to help them maintain remission so they do not end up here again?" while an inpatient dietitian has to consider the patients' needs right here and now. In time I began to speak up and share more patients' nutrition concerns with the doctors, who freely admitted they did not usually take such things into account. And by the end of my rotation I hoped that maybe, just maybe, the two dietetic interns who followed these attendings, residents, interns and medical students around for several weeks made enough of an impression that they will consider consulting with a dietitian in the future to optimize patient care.

The experience certainly made me wonder when diet became so separated from medical care. During my time in the GI unit I also worked with several interns on an unrelated project, researching the history of popular beliefs about health and diet in the Janice Bluestein Longone Culinary Archives at the Clements Library at U of M. We put together a presentation to introduce a talk given by Harvard School of Public Health's Eric Rimm who served on the advisory committee for the 2010 U.S. Dietary Guidelines and came to speak about the process.

A short list of our discoveries:

1. We've known for a long time that eating too much can cause indigestion.

"If more than ordinary quantity of food be taken, a part of it will remain undissolved in the stomach, and produce the usual unpleasant symptoms of indigestion." The physiology of digestion considered with relation to the principles of dietetics (1836)

2. Whole grains are far superior to refined grains

"Flour of the entire wheat is without doubt the purest flour in the world, and makes the best bread now known to housekeeping or culinary science, because it contains...all the bone, mucle, brain and nerve feeding elements of the wheat kernel, so unfortunately lacking in white flour..."The Boston Cooking-School Magazine of Culinary Science and Domestic Economics (1898)
3. We eat too much meat.

"The spirit as well as the letter of this book is universally needed. Overeating of meat has had its day, and left us as a reminder much sickness and sorrow."  Mrs. Rorer's Vegetable Cookery and Meat Substitutes (1909)

There was a time when the connection between food and health was undisputed. Now it's often dismissed as lacking sufficient evidence. I've been wondering how we got here, and having just started my next rotation working with the National School Lunch Program I think I have some ideas. Stay tuned.