There are no sirens or flashing lights in the kitchen at Vancouver General Hospital, but their staff — and several key people — are addressing an emergency: the food.
Not the food that visitors and staff buy, but rather the food that is delivered to VGH’s hundreds of patients daily, each of whom is healing from any number of conditions covering a wide spectrum of nutritional needs.
Hospital food, with its rep for being boring, basic and bland, has been a long-overlooked component of patient care.
“We cannot afford to not talk about it,” says Ned Bell.
The Vancouver-based chef, known for his commitment to fresh, seasonal ingredients, including sustainable seafood, has been working with VGH for the past few years by way of a pilot program to modernize the hospital’s food program.
Patients said they wanted more diverse and meatless options
While VGH has always served healthy food that meets nutritional requirements, over the years, patients have expressed a wish for the hospital’s roster of largely Western-based meals to better reflect the diversity of its diners. That means more plant-based options and more global flavours, all in the name of health.
Bell didn’t have the state of hospital food on his plate for most of his culinary career until his wife began spending more time at VGH as she underwent cancer treatment. The timing was crucial, as conversations were in the beginning stages of implementing a pilot program to study how food could be improved and factor in cultural and dietary diversity, as well as more eco-friendly choices.
And, of course, being a chef, Bell was keen to find out if hospital food could actually taste great.
Joining a team led by Dr. Annie Lalande, surgical resident and PhD student in the Institute for Resources, Environment and Sustainability at the University of British Columbia (UBC), and Tiffany Chiang, director of food service transformation and strategic projects at Vancouver Coastal Health (VCH), Bell, along with key VGH staff like registered dietitian in acute care Elaine Eppler, got to work on developing new recipes.
Though the pandemic put a hold on the fieldwork, in 2022 the team regrouped to get the Planetary Health menu pilot up and running.
Revamping hospital food menu not the same as in a restaurant
Given the scope of the hospital’s food program, and its limitations, as well as the highly specified nutritional requirements each meal has to meet, tackling the menu at VGH wasn’t anything like revamping a restaurant menu.
“I had to learn a ton,” shares Bell during an in-person menu tasting and info session. “My learning curve was steep.”
Starting with an initial batch of 53 recipes, Bell explored all the ways by which he could dial up the flavour, sustainability, and overall deliciousness of existing dishes in the VGH food program.
The working list was narrowed down to about 20 or so lunch and dinner dishes (the team soon realized breakfast items needed the least attention for the time being) and Bell sought ways to make minor adjustments, asking question after question along the way.
Where could ground beef be subbed for ground turkey or lentils? Which ingredients could be sourced from within B.C. at a lower price point, to boot? What could be made in-house rather than brought in packaged? Could a sauce or dressing import offer more flavour in a meal?
Adding garnish a game-changer
But it was the simple addition of garnish to the pilot program’s dishes, a practice often reserved for restaurants, that emerged as a game-changer.
What might seem like a minor detail to some has proven to be a significant catalyst in transforming not only the visual appeal of hospital meals but also the overall satisfaction and well-being of patients.
“Sauce and a bit of garnish made a good dish better,” explains Lalande.
Lalande explains that the pilot program began by gauging patient feedback through multiple means to discover what people most wanted to see improved. “More flavour,” was the dominant response, recalls Lalande, adding that patients spoke up about wanting the ingredients to be fresher and the recipes “more culturally diverse,” with more seasoning and texture.
Recognizing that crafting scratch-made meals for six to 700 patients a day is no small feat, Lalande says it was essential for the pilot program to look at meaningful solutions with significant impact.
“Unless we take this time to stop and embrace the complexity, it’s hard to come up with something that isn’t a band-aid solution,” she adds, noting that change in hospital systems is so often reactive and not proactive.
Looking at hospital food programs in North America and even as far away as Lebanon for inspiration on how to be more plant-forward and eco-conscious, the changes in the works at VGH are likely “the most progressive in Canada,” attests Lalande.
Subbing in plant-based proteins for meat – without shouting about it
While cost is, of course, a factor, the pilot program made certain to keep ingredient choices within the budget, even finding ways to save by using a plant-based protein source over an animal one. Chickpeas, generally, are cheaper than chicken.
“Plant-based proteins do tend to be less expensive,” says Lalande.
Oftentimes, offering a meatless version of a familiar dish didn’t yield objections.
“We don’t scream from the rooftop that the Sloppy Joe is vegetarian,” says Bell.
It simply is vegetarian, which makes it an option for more patients than a beef version.
Popular new meals include a chickpea curry and trout with tomato miso dressing
A not-so-coincidental side effect of embracing more plants, whether it be fresh vegetables alongside a moist piece of fish or lentils in a Sloppy Joe, is that the impact on the environment is lessened. Even shifting to leaner animal proteins, like turkey or trout, are lower-impact options.
It’s not exactly an off-label use of the food program, but it’s a way VGH has of “giving the planet a seat at the table,” explains Lalande.
Bell, who has long championed a “globally inspired, locally sourced” approach to his cooking, says he’s never worked so hard on perfecting so many recipes in his career.
Some of Bell’s dishes that have emerged as popular favourites have been the Steelhead Trout with Tomato Miso Dressing; Creamy Coconut Chickpea Curry with Cauliflower and Cashews with Mango Chutney; and the Korean Gochujang Bowl.
During the study, patients answered surveys about the meal, and the team kept an eye on how empty the plates were when they came back to the kitchen.
Eppler calls the Planetary Health pilot program “probably the most exciting thing I’ve ever worked on in my 36-year career.”
Food is more than nutrients: ‘there’s also the emotional feeling’
The longtime dietitian describes the constant and nuanced challenges of working with patients who not only have specific dietary needs but also various struggles to eat. Many hospital patients are unmotivated to eat or do not have the strength for rigorous chewing.
However, having food that looks appetizing and hints at the taste and care of home, can go a long way in getting a patient excited about meal time.
What Bell calls those “little touches of home-made,” can wind up “encouraging people to eat,” describes Lalande.
“Nutrients help with the physical — but there’s also the emotional feeling,” elaborates Eppler. Food encompasses so much, she continues: “It’s comfort, memory, healing, companionship, building relationships, respecting culture.”
With the pilot program concluded, VGH is preparing to implement a variety of improvements to its food system in the facility, starting with adjustments to its meal ordering and distribution system to work on a hub or satellite model to shorten the distance between patients and their food.
The plan is to continue “with a few of the recipes right away and introducing [some of the] recipes to other VGH hospitals,” explains Chiang.
“This work matters,” says Bell, who adds he is extremely proud of the recipes he and the team have produced. “There is an opportunity for us to make changes and that is so incredibly powerful.”
VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.
Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.
In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.
The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.
Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”
Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”
This report by The Canadian Press was first published Sept. 16, 2024
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
