EAST PALO ALTO, Calif. -- On a recent Tuesday afternoon, Sosepa Tulua, Mele Olini Tamale, Fusi Laisenia and Mele Fangaiuiha planted tomato, squash and string beans at a recently established community vegetable garden. Unlike other community gardens, however, this one isn't located at a neighborhood park or a reclaimed empty lot, but rather on the grounds of an innovative health center in East Palo Alto.
The gardeners too, are unique. All women from Tonga, they are patients at Ravenswood Family Health Center (RFHC) who suffer from chronic health conditions such as hypertension, diabetes and high cholesterol. They've been told that eating right is one way of keeping their health conditions in check, and the clinic is helping them to do it.
Collective Roots, a non-profit organization based in East Palo Alto, partnered with the clinic a year-and-a-half ago to organize the classes.
“We believe that through engaging in the process of growing your own food there is higher awareness about your food choices and how they influence your health, how they influence the environment and how they influence social justice issues,” said Nicole Wires, a coordinator for Collective Roots.
The entire program consists of six cooking lessons and six gardening lessons. The latter covers topics like seasonality, composting, water conservation and organic pest management. The cooking classes concentrate on affordable substitutions for unhealthy food, like using brown rice instead of white, and using olive oil instead of lard.
Marta Escobedo, the "Latino patient health navigator" at Ravenswood, said the goal of the classes is to show patients that they “can eat delicious in a healthy way and with not a lot of money.”
At the garden, silently and with diligence, the four women follow the instructions of Neha Bazaj, the teacher from Collective Roots. As they replant over 50 seedlings, the silence is broken by occasional comments in Tongan, and by more instructions from Bazaj. The instructions are translated by Ana Tuipulotu, the clinic's Pacific Islander Patient Health Navigator, to ensure that all the participants understand.
Making Unhealthy Food Choices in East Palo Alto
In California, about one million people live in communities characterized as "food deserts," or areas with little or no access to healthy food. That may not quite be the case in East Palo Alto, but residents are finding it hard to eat healthy nonetheless.
“There is food available here in East Palo Alto,” observed Wires, referring to the big grocery store called Mi Pueblo and other corner stores that exist in the community. “But we still are experiencing much higher incidents of diet related diseases than other communities in the area.”
That could be because the availability of grocery stores has little correlation with diet quality or fruit and vegetable intake, possibly because supermarkets offer both healthy and unhealthy food options, according to one study published last year in the Archives of Internal Medicine.
“Just because food becomes available doesn't change whether the people have the money, or the time, the knowledge, or the cultural practices to be making those choices,” Wires said.
For her, the partnership with Ravenswood is one of the most successful they've embarked on as an organization. “[Ravenswood's] chronic diseases self-management program [is] looking for long term holistic solutions to diet related diseases,” Wires said. “[The health center's] interest aligns really well with our interest of making healthy food more accessible and affordable.”
Ravenswood's patients are mostly Latino, Pacific Islander and African American. Nearly all of them are either on Medi-Cal – California's name for Medicaid -- or have no insurance at all. The number of patients at the health center with diabetes has increased by 29 percent between 2006 and 2009, and 63.7 percent are obese.
“There is something going on, but it's a much more complicated issue than physical access,” Wires said.
According to Ravenswood’s Latino patient navigator Escobedo, Latinos attribute their unhealthy eating choices to their low incomes. “We tell them if the only thing you have is canned food, you can rinse it and use it, or if you find the frozen food is affordable for you, use it,” she said.
In the case of the Pacific Islander population, the problem lies in eating excessive quantities of food, Tiffany HauTau, Pacific Islander patient health navigator, explained. It is a choice related to their culture in which food is central to every festivity.
“We tell them think about how much money you are spending on the unhealthy food, and how much money you will spend because you don't have any insurance,” she said. “Bills pile up.”
Learning to Love Greens
After their gardening class, the group of women prepared two different kind of salads, one of them using kale grown in the garden.
“Salads are popular in our class” Tulua said. “Every day we have two or three salads.”
The main goal of the program is to change patients' poor eating habits, while trying to respect their culture.
An example of that approach is the popular curry lentil soup that they cook with every Pacific Islander group. The recipe uses a can of coconut milk – a popular staple in their diet, but not healthy when consumed in excess -- but includes a lot of other ingredients, like split peas, lentils, onions, carrots, spices, hardly any salt and a home-made vegetables broth, that balances the dish.
“It's okay to splurge on the calories in a couple of places if you are careful about the rest of your meal,” Bazaj said.
“I went to the doctor and I think the doctor sent me here to learn how to eat and how to cook my food,” said Fangaiuiha. “I learn in this class I don't have to eat too much. We can eat a little of the Tonga food, but we can learn to eat more vegetables and fruits.”
“The key for us is to introduce a lot of new foods like grains, whole wheat, collared greens,” said Hauhau. “Our patients were just eating the simple vegetables. [Those] are good for us, but you can get more nutrients from other places.”
Mele Olini Tamale, 39, can speak very little English, but she looked at Bazaj every time she explained something and then listened to Tuipulotu's translation. Tamale said she has learned to plan her meals better, shop for healthier food and look for vegetables that are in season, because of the training she's received from Bazaj.
Since the cooking classes begun in late 2010, more than 100 Latinos and 100 Pacific Islanders have gone through the program. The present track has three active groups, one with Pacific Islanders and two with Latinos.
“We have patients that have lost many pounds,” Escobedo said. “They are getting real control with their [blood] sugar and cholesterol levels.”
According to the health navigators and class teachers, their main goal of changing eating habits is slowly showing results, but other important changes have come out of the program as well. “They are being more active in their [medical] appointments,” Hauhau said. “They are asking questions to their providers, they are more empowered, more involved in their health.”
Wires, who mostly teaches Latino groups because she speaks Spanish, said the classes have also helped the participants to get to know their neighborhood better and create new social networks that make them feel like they belong to a community. “I think it's important, when you are trying to have a lifestyle change, to have a community of people who support you,” Wires said.
Now the organizers of the program are looking at the next step in this unexpected process of empowerment.
“One of my biggest goals is to get participants from our classes trained so that they can actually get paid to teach the classes themselves,” said Wires. “One of the biggest barriers to (making) healthy lifestyle choices is (lack of) employment.”
NAM health editor Viji Sundaram contributed to this story.