Restaurant Food

Gayathiri, the main dietitian of KMC, has to yell at nurses frequently.  When I ask her what she is saying to the nurses, she always replies “I am shouting.”  She says this so calmly that I almost cannot believe that she is angry, but I guess she has more practice at sounding angry in Tamil.  The reason that she shouts is that the nurses make mistakes in the feedings nearly every day.  I am not sure of the education level of the nurses, but Gayathiri informs me that it is not very high compared to the other staff.  Some of the dietitians and every doctor speak English well.  Conversely, only the head nurses speak English.  The other hundreds of nurses speak very little English, if any at all.  This leads me to believe that their education level is not as high as the doctors and dietitians.  Most of the nurses are also very short, while the doctors are, generally, taller.  I have noticed that height correlates with English ability.  My giant assumption is that taller people were born in richer, higher castes and had better nourishment while growing up.  Because these taller, richer, more well nourished people also have more opportunities, they have higher positions, higher pay, and better English abilities.  Anyway, Gayathiri yells at nurses daily.   Sometimes, they use the incorrect artificial powder for the tube feedings.  This can be detrimental to the patient if they have special needs.  For example, some powders are high in sugars to supply calories, but if a diabetic patient receives this powder frequently, one is giving them an easily digestible, processed sugar that will spike their blood sugar.  If someone is already in the ICU, aggravating his or her diabetes will not help anything!  Another patient became hypoglycemic because she was not fed through the tube at all for many hours.  Because she was in critical condition, she could not really do much about this.  Things like this happen daily, and it can be dangerous for patients.  Most of the patients in the general wards get diet counseling and information, whether or not they listen to the dietitian.  The patients in critical care, though, are dependent on the dietitian’s prescription and on the nurses to carry it out. 

I found out that the hospital has no kitchen, whatsoever.  Nurses mix the artificial powders given to patients in critical care, but all of the other food given to all patients in critical care and the wards is prepared by an independent restaurant next to the hospital.  While this is great business for the restaurant, this is horrible for patients!  Patients in the wards have to have their loved ones bring them food.  This is sometimes from home but usually from the restaurant.  No wonder the dietitian has to try the foods prepared each day.  She has to make sure that the unskilled cooks did not make something that the patients cannot tolerate.  I just cannot believe that the hospital has no kitchen.  A restaurant makes all of the food going through the tube feedings! A restaurant makes all the food given to general patients!  It is crazy to me that this is so accepted that waiters are actually allowed in with trays for the dietitian to try in her office.  It is common in Indian workplaces for tea to be served periodically throughout the day.  I receive tea each day from women who come around with huge canisters of it.  I always thought the hospital prepared this tea for their employees.  Apparently, the restaurant across the street has a running tab of all the employees and the tea they drink.  This is just insane!  For a patient to eat, their family has to go to this restaurant to buy food or have it delivered; there is no hospital service.  Maybe I am going overboard about this, but I have not heard of any large US hospital that admits hundreds of patients that has no food service to provide them or the workers with food.  On my first day, when I was told I would have to go out to this restaurant or pack food from BHC and share with the dietitians, I figured this was because the food service at the hospital was small and meant for staff and patients only.  Apparently, it is because it is non-existent.  Gayathiri has been interviewing potential dietitians.  The dietitians are already overworked and do not have enough time to see all of the general patients each day.  Thankfully, the dietitians have convinced the hospital to construct a diet kitchen (this phrase “diet kitchen” sounds very similar to “dietitian,” and I was confused for a very long time while Gayathiri was explaining all this to me).  A diet kitchen here means a food service owned and operated by the hospital that specializes in patient diets.  The reason more dietitians are being hired is that they will be checking EVERY SINGLE MEAL before it is served to patients because the nurses make so many mistakes each day.  The kitchen will prepare food for all critical and general patients.  They will even mix the protein and meal replacement mixtures so that all the nurses have to do is poor it down the tube, removing several steps during which they might make mistakes. 

While Gayathiri tries the food prepared by the restaurant, they still do not have to do anything she tells them to do.  If the patient food is too spicy, and she tells them to tone it down, who would know if they just ignored everything she said?  I have tried some of the foods myself.  There is usually a huge difference in the spice between the patient and normal foods.  Although, Gayathiri does sometimes instruct them to change some aspect of the patient food.  I never see the waiter again, so who knows if this alteration happens?  I am so glad to hear that the hospital has plans to construct a kitchen.  Two things I learned today tells me how undervalued nutrition is here in patient care.  The first is the lack of the hospital kitchen.  If the dietitians cannot walk into the kitchen and train chefs on how to prepare different diets and make sure everything is correct, so many mistakes could be made.  With the addition of this kitchen, there will be many more therapeutic diets that will be made.  No wonder I think all the patient diets she prescribes are boring; they are basically the menu from the a restaurant!  The second thing came up when Gayathiri was interviewing potential dietitians.  I asked how they could possibly fit a fifth dietitian working full-time in this tiny, 30-square-foot room.  She mentioned that they used to have a large office that the four dietitians shared.  Currently, one of the doctor’s offices is undergoing renovations, so they moved FOUR workers into a tiny room so that ONE doctor could have the large office.  I understand that a hospital could not run with only dietitians, but this would have been a huge slap in the face to me.  

The interview process at the hospital was intense.  The woman interviewing had her M.Sc (the abbreviation here for M.S.) in Nutrition and Dietetics.  She had several years of experience at other locations.  She was definitely qualified.  When she came in, though, the dietitian gave her a stack of papers and told her to go fill them out in the waiting area.  This stack of papers was a test booklet!  The interviewee sat out with waiting patients and took this test where several case studies were presented, and she had to fill out diet prescriptions and was asked questions about why she chose what she did.  She then had to sit in front of Gayathiri while this test was graded in front of her.  This would have totally jangled my nerves.  Luckily for her, Gayathiri mentioned to me that she did very well (though her face was blank for the whole interview) and that she would be hired. 

I made clarification on what seemed to be an outrageous recommendation I have been hearing.  When Gayathiri tells renal patients or normal patients to consume five and eight grams of salt per day, respectively, she means five and eight grams of sodium chloride.  She means five or eight grams of salt.  In the US, the terms sodium and salt are often used interchangeably because anything that contains a significant portion of sodium is probably a packaged food.  Even if it is just plain table salt, the salt box will tell you how many milligrams of sodium are in 1/4 teaspoon.  My confusion also stemmed from the fact that we measure salt by teaspoons and sodium by milligrams.  Here, everything is measured using the metric system, so when she said eight grams of salt, she meant salt while I thought sodium.  In five grams of salt, there are 1.94 grams of sodium; in eight grams of salt, there are 3.1 grams of sodium.  This is because, while there is a 1:1 ratio of sodium to chlorine, chlorine atoms weigh more, thus making up a larger portion of the weight of five or eight grams.  These values are still higher than the recommendation and UL of 2.3 grams of sodium for a normal patient back home, but they are very similar.  This all makes more sense.  Lastly, concerning sodium, most people here eat all of their salt directly from the salt shaker when they are cooking.  Most of our salt comes from packaged and processed foods.  Here, despite the infiltration of Western foods and lifestyle patterns, most meals are still home-cooked.  So, it makes more sense to tell people the amount of salt to use for cooking rather than the amount of sodium.  In the US, it makes more sense to say 2,300 milligrams of sodium because every significant source of sodium comes on a packaged food with a food label.  

Last notes: the American culture has infiltrated India.  Sometimes when I walk past the downstairs lobby, people are watching WWE on the television.  The word selfie is well known, even among non-English speakers.  Lastly, the Malaysian person who moved in last week is so nice.  He has let me borrow a lock and clothes pins as well as let me try Malaysian desserts.  He made sure that I was comfortable to eat by myself before he went upstairs for the night after dinner.  I have met some very nice people here. 

No interesting pics from today, so here is some food packaging, India-style.