Hospital food: it's complicatedby andrew.mcnulty
Food served in hospitals has to not only satisfy the hunger of patients but also help them get better.
Hospital food. Second only to airline food, usually, for gross-meals-I-have-had stories. But a two-month stint in Auckland Hospital last year was enough to show me that the relationship between patients, their care and the food is more complex than simply getting fed. Nicky Moore, a dietitian and food services contract manager for the Canterbury District Health Board, says the goal is “to provide meals to patients that help them get better”. Moore has been in the business for about 20 years, since tongue in parsley sauce was on the menu, and her simple description of the job belies a staggering logistical exercise.
Moore is based at Christchurch’s Princess Margaret Hospital, which, since the Canterbury earthquakes, has expanded to become a 300- to 350-bed hospital. Catering staff provide meals for patients with every dietary requirement imaginable, from health-related needs, such as allergy-free, diabetic, dairy-free or heart-friendly meals, to cultural or lifestyle choices, such as vegetarian dishes. In addition, they must keep track of patients moving around wards, and dietary needs that can change from meal to meal – for instance, a pregnant woman diagnosed with gestational diabetes will find jelly and ice cream has disappeared from her dinner order.
But hospital food, particularly for a long-term patient, becomes far more significant that just what’s for dinner. Meals add structure to a day that can otherwise seem completely random, as doctors and nurses arrive at unpredictable intervals to take vitals or blood. Even the nana-ish 5.30pm dinner time is eventually welcome: being sick is exhausting and an early dinner grants you license to go to sleep early as well.
Long-term patients have a far greater choice of menu: a couple of options not just for dinner, but for breakfast, lunch and snacks, too. Being able to control your own diet can be as important as what it is, and that’s why choice is offered, Moore says. Indeed, it made all the difference to me, as it meant I could avoid the one item of hospital food I had real trouble with: the tomato sandwich. Floury, fridge-cold tomatoes on white bread. I wasn’t the only one – on tomato sandwich day, the patient kitchen was littered with discarded lunches. It sounds ridiculous now, but when your day boils down to three meals and a steroid shot, one grotty sandwich can really bum you out. Equally, having the run of the menu returned a little of my autonomy and, therefore, sanity.
Frontline catering staff, who deliver the meals, routinely work 12-hour shifts, says Moore, so they are often the person with whom the patient has most contact. And, she adds, they represent “something you enjoy, rather than having pain inflicted on you”. It’d be easy to make a crack about the meals being their own special kind of pain, but considering the demands on a kitchen that must serve thousands of meals a week, delivered practically simultaneously to every ward, the food is really not that bad, tomato sandwiches notwithstanding.
“The chefs do take pride in what they cook”, she adds – which is doubly important when it comes to serving patients whose food is more a part of their treatment. As Moore puts it, “Food’s only nutritious if it’s eaten.” Last year, 56 hospitals across Australia and New Zealand monitored what their adult patients ate – and didn’t – for 24 hours, and found a third of the study participants were malnourished.
Just over half of those malnourished patients ate less than half the food provided to them in those 24 hours, most commonly saying they were simply “not hungry”. It’s understandable, says Moore, that patients who are in pain or sick will not feel like eating, which is why frontline staff are so important. She says their attitude affects how much a patient will eat. Certainly, the staff at Auckland’s maternity ward couldn’t be faulted. They brought my partner unclaimed meals when he had set up camp next to the bed. They brought me extra yoghurt or fruit when they decided I simply hadn’t ordered enough to eat. (It was summer; I had a cupboard full of Vogel’s and avocados. And chocolate.)
For their troubles, Moore says, staff get verbal abuse and the occasional food tray chucked at them. It just takes a little understanding for patients to understand the hospital diet, and what staff can achieve within the limitations of the public system, she says. The earthquakes provided the perfect example of that. Patients would joke: what, no roast? “That’s a little difficult without power.” And yet, all 350 patients were fed.
A swathe of new studies into vitamin supplements are starting to return troubling data. Hot on the heels of a study that found links between multivitamins and poor health in older women, the results of a trial of supplements and prostate cancer was published this month in the Journal of the American Medical Association. A study by the Glickman Urological and Kidney Institute into whether vitamin E and selenium could prevent prostate cancer found that selenium seemed to have no preventative impact, but vitamin E actually increased the risk of prostate cancer. For every 1000 men taking the placebo, 65 got prostate cancer, compared with 76 taking vitamin E. The link is not well understood, but the study authors say it merely serves to underscore the need for medical advice before taking supplements – and that there’s little evidence to support someone with a good diet needing them at all.
TB CASES FALL
For the first time In the fight against TB, the World Health Organisation has announced that the number of cases reported worldwide has dropped. From a high of nine million in 2005, the number who fell ill with the disease last year dropped to about 8.8 million, the organisation says. Officials are still concerned about the spread of drug-resistant TB caused by patients not completing their treatment.
MIGRAINES AND EXERCISE
A Swedish study of migraine sufferers compared regular exercise, stress-relieving techniques and drug treatment and found that 40 minutes’ exercise three times a week was as effective as the common drug topirimate at relieving symptoms. The study’s authors said all migraine patients should be “strongly advised” to start a decent exercise routine – with their doctor’s approval.
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