As I work on this blog post, in the comfort of the living room of my family home, my summer internship seems like a very long time ago, though it ended less than a week ago. Funny. [As I finish writing this while getting my oil changed, it’s been three weeks. Time flies! :D] Anyway, I gave y’all a little taste of some of the things I did in the beginning of the summer and right as the internship began, but I thought I’d give y’all a taste of what an intern in public health nutrition does.
Let me start by saying that my preceptor (preceptor= supervisor of dietetic internship. Has to be an RD) was super cool! She was the WIC director. WIC stands for Women, Infants and Children and is a federal nutrition program that ends up providing food for half (!) of the children born in the US at some point in their early childhood. It provides breastfeeding support for moms as well as infant formula for infants whose mothers choose not to breast feed. It also provides vouchers for healthy food for pregnant and postpartum women and children up to age 5. I spent a lot of time shadowing the WIC nutritionists and seeing what they did all day. Part of the program (unlike some other feeding programs like food stamps) includes nutrition education. I was excited about that, because I really enjoy the exposure I’ve had to patient counseling. However, because such a huuuuge number of people participate in the WIC program, counseling by necessity is brief. Let’s be real- these people have had to haul themselves to the health department (and the town I was in did not have public transportation, boo) and they have had to do it in the middle of the work day (since health departments generally aren’t open on weekends or evenings) and generally they wanted to get their vouchers. The nutritionists did a good job of trying to impart a few key nutrition messages, but the program is definitely more about screening for serious concerns (and making referrals to other health professionals as needed) than counseling people for minor concerns.
WIC recently (in the past year) required that participants only use their vouchers for skim or 1% milk for adults or children over the age of 2. People were upset about it, as many of the families were used to getting 2% or whole milk. The North Carolina nutrition website suggested that WIC departments to do a milk taste test to convince people that they really could drink and enjoy the lower-fat stuff. So, I led a milk taste test in the WIC lobby!
As my professor pointed out when I mentioned this project to her, the evidence is actually rather weak that choosing low fat milk is superior to 2% or whole. After all the years of demonizing saturated fat and telling people to keep sat fat out of their milk, a lot of evidence is showing that the complete package of milk– with its combination of protein and vitamins and minerals and who knows what else — is healthy, regardless of its fat content. You can read a rather dense article about that here.
With that being said, WIC’s national office sets the policies, and it’s what the local WIC offices have to do. So, if peope are getting vouchers for low-fat milk, you gotta get them excited about low fat milk! We don’t want food insecure people throwing away their vouchers and losing a source of calories and nutrients each month.
The way the taste test worked was I gave everyone a blind tasting from cartons labeled “Flavor A” and “Flavor B”, and asked them if they liked them, which one was their favorite, and which one they thought had more fat.
The surprise was that there was no whole milk offered- the milks were just 1% and 2%. As you can see, in a blind tasting, people like ’em both! And more people actually thought Flavor A (the 1% milk) had more fat than Flavor B (the 2%)- in fact, several people swore up and down that Flavor A was whole milk… Including a few flabbergasted health department employees 🙂 More things that were interesting, in no particular order:
Spanish! The nutritionists were quick to let me start teaching the Spanish prenatal class. Where I’m doing WIC, they do group appointments for prenatal clients. In other words, the pregnant women all come together, get weighed, get counseled together, and get their vouchers at the same time. This is much more efficient. It also hopefully creates a supportive environment for the mamas to get to chat together. I would do the first half of the presentation (about basic nutrition, foods to avoid during pregnancy, exercise, etc.) and then one of the breastfeeding peer counselors would do a long presentation about breastfeeding.
Breastfeeding peer counselors are the coolest! WIC started this program- the idea is that a mom (often a WIC mom) who has successfully breastfed her own kids can help other WIC moms do the same, and get paid for it! I’ve noticed that the relationships people have with their BFPC is very different than with the WIC nutritionist. Our BFPCs go to the hospital a few times a week to check in on their mamas once they’ve delivered. They also go to rooms and tell women about WIC who may not have known they could get its services. Anyway, there was one woman who the IBCLC (certified lactation consultant) at the hospital couldn’t get to pump, but then one of the BFPCs went in and just listened to the mom talk about her fears and anxieties and was a supportive person, and made some progress- by the end the mom sounded more amenable to pumping. Which is great, because especially for preemies, breastmilk is liquid gold!
Another thing that’s great about the BFPCs is that they are fully bilingual in English and Spanish. I have sat in on all-Spanish appointments with them and have picked up an extremely specialized vocabulary about boobies 🙂 When I talk to them it’s usually in Spanglish.
Also, they have all kinds of fun visuals. One I’ll call “Breast stuffed animals”. They’re amazing. They also have little marbles and ping pong balls to show the size of a baby’s tummy. Fun fact: a newborn infant’s stomach can hold a whopping teaspoon of milk.
On the subject of breastfeeding, I spent some time at a local clinic and saw some booklets they gave to expectant mamas that had BEAUTIFUL pictures of embryos and fetuses and really good information about pregnancy and development. However, it was written by Enfamil which means there was some NONSENSE in it- no, your feeding options are not formula or breastfeeding supplemented with formula. Your options are exclusive breastfeeding (BEST OPTION! FREE AND BEST FOR MAMA AND BABY!) or some amount of formula feeding. Sheesh.
More on breastfeeding- I shadowed the nutritionist/breastfeeding specialist from the WIC office in in her other capacity as a lactation consultant at the hospital! “Christina” got her IBCLC (International Board Certified Lactation Consultant) and continues to work at the hospital once or twice a month in order to keep her clinical skills fresh (and earn a little extra $- no surprise, the hospital pays better than WIC). She has been AMAZINGLY supportive of all my interests in breastfeeding at WIC and was kind enough to offer me this opportunity. We had a jam-packed day!
Christina had twelve patients (really 24, since they were mother/child dyads) on two different floors. For contexts, each nurse handles just four/eight patients. I accompanied her as she did a wide variety of tasks going from patient to patient. She checked in on a mother of a premature infant to see how her supplemental nutrition system was going. She helped a mother use a pump successfully for the first time (flange size is key!). She helped multiple mamas improve their positioning and the baby’s latching, and helped rouse several extremely sleepy babies to motivate them to feed. She talked to moms about what to expect with engorgement, and how to relieve discomfort (cabbage leaves!)
It was a very hands-on job. She always asked permission, but she touched several patients’ breasts. It made me realize that when doctors talk about not thinking it’s a big deal to see naked people anymore, it’s really true. For me, a bare breast is now just… a milk holder. It’s now a non-event for me to see a topless woman.
She also gave me a tour of many different areas, including the NICU (which was surprisingly dim, quiet, and peaceful) and the storage room for breastfeeding/bottle feeding supplies (infant formula is hidden like it’s contraband).
All Things in Moderation Part 1: The Dietitian and the Dietitian in Training. For lunch, she got fried chicken and mac and cheese, and I got a piece of pizza. We both got Diet Cokes 😀
Along with having fun hanging out with babies, I also hung out with seniors. I had so much fun sitting in on some congregate meals. If you don’t know what those are: the federal government has an Elderly Nutrition program which you can read about here. The idea is that older folks are more at risk of malnutrition for a variety of reasons (such as lack of money to buy food, physical impairments that make cooking difficult, medications that affect appetite, illnesses that make it difficult to eat, etc.) so there are meals offered in community-based centers. The folks who visit get a chance to eat and also a chance to socialize. Most of the congregate meals also offer some educational/socialization opportunities. I went to a super fun exercise presentation (a chipper recent kinesiology grad led us in stretches using resistance bands) followed by a congregate meal at one senior center. This was the meal.
It was pretty salty but fairly well rounded.
Throughout the summer I did a fair number of presentations. At one at a senior center, I talked about antioxidants, exercise, and hydration. Then I did a cooking demo (well, “cooking”- I microwaved sweet potatoes and made a toppings bar!) The woman who ran the congregate meals said a lot of people just used their microwave to heat stuff up, so I figured I wouldn’t fight that but would offer some more nutritious options.
Sweet potatoes with broccoli (frozen pre-chopped for ease), shredded cheese (reduced fat), salsa (organic, which is typically lower in sodium), and low fat cottage cheese. A lot of people just put a little bit of everything on their sweet potatoes!
Also spent some time in the schools (one of the requirements by the Academy of Nutrition and Dietetics is that students get experience with school nutrition). We helped pack up lunches for various summer programs (having food available at schools in the summer is SO IMPORTANT! A lot of families really depend on their kiddos getting a big balanced lunch at school so food insecurity spikes during the summer) Of course Chapel Hill/Carrboro schools have hippie posters everywhere!
One student for whom we prepared lunch required mechanically altered food (s/he likely had difficulty swallowing). We made a variation on the meal: chopped up chicken nuggets. We started preparing the corn but then the manager at the school cafeteria found out from the RD that corn would be a choking hazard for this student, so instead we made some pears.
More required stuff: I had to do a Big Important Presentation both for my class grade and to fulfill the Academy of Nutrition and Dietietics requirements. The milk taste test didn’t count, my preceptor couldn’t come to the presentation at the senior center… it was a mess! Finally, I scheduled a presentation at a child care center. Off I went… but not before Siri took me on a long detour into the middle of nowhere! Instead of being 15 minutes early I was 10 minutes late! FUN! Cool thing: this child care center was going to build a garden with a grant from SHAPE-NC (a program funded by Blue Cross Blue Shields that encourages physical activity and healthy eating at child care centers). To help them prepare, I designed a presentation about feeding children (responsive feeding, natural satiety cues, and encouraging children to try vegetables) and incorporating gardening and food-based activities into the curriculum. I’d also created an additional section on healthy cooking for the teachers (knowing how little they get paid) and while I had to cut it from the presentation due to time constraints, I made a handout with quick tips (including meal-planning apps and ways to spend less money on meat) and led a discussion at the end of the presentation. Here are some of the nice resources I found!
Random interesting thing: I went to a TOTALLY FASCINATING Safe Kids International meeting.One of the folks there, a representative from the fire department had SO MANY interesting things to share. Key point, friends- you should have a smoke detector in your ROOM, not just in your HOME. People lose their sense of smell when they sleep (!) and in the event of a fire you could pass into a carbon monoxide induced coma before the fire ever got to you. Also, children these days are so desensitized to noise (because, they think, of all the screen time they get) that traditional smoke detectors don’t wake them. What does seem to work is getting a smoke detector with a recorder attached and recording the child’s mother (!) saying something along the lines of “WAKE UP THE HOUSE IS ON FIRE GET OUT NOW KID”.
Another thing I did: planned a series of nutrition classes that’ll be held at the local Housing Authority. I’m stoked about what I planned- lots of cooking and physically active games interspersed with the Powerpoints!
Final thing: there was a lot of free junk food at the health department!
(I was stressed by the other intern this day and ate WAY TOO MUCH JUNK FOOD)
Morale building free outdoor picnic lunch provided by the health department:
And so my summer write up concludes! I learned a lot and stressed a lot and can’t believe it’s already time for me to go back to school.