Practice Blog

To share practice related stories, create connections and engage readers in the amazing diversity of dietitian experiences.


Dietetics in the land of the midnight sun

TLheadshot2.JPGTabitha Lichty is the Regional Dietitian and Certified Diabetes Educator working at Inuvik Regional Hospital in Inuvik, Northwest Territories. She works in many areas in the region, providing services from clinical in-patient and out-patient to prenatal and community work. She works in 13 small, remote communities in the Western Arctic ranging in size from 126 to 3500 people. Most communities are accessible only by plane, so travelling has its challenges! Tabitha has learned a great deal about adapting to and understanding a new culture through these experiences. She previously worked three years as a diabetes educator at an Aboriginal health access centre in Kenora, Ontario prior to moving North. She can be contacted at tabitha_lichty@gov.nt.ca and would love to hear from other dietitians working in remote communities.

  
“Tell me what you eat, and I’ll tell you who you are,” wrote renowned gastronome Jean Anthelme Brillat-Savarin in 1825.

I have always been fascinated by different cultures. Perhaps that is inherited by many Canadians as we grow-up in such a diverse and multicultural country. As a dietitian, I tend to look at food though a health and nutrition lens, but I also understand that food is so much more than that, it is deeply entrenched in our culture and identity.

Since moving to my new home in Inuvik, Northwest Territories last fall, I have been exposed to the distinct and rich cultures and food traditions of the Inuvialuit, Gwich’in and Dene in this corner of the Western Arctic. I learned quickly that I needed to become familiar with the food traditions of the North in order to be effective in my work as the Regional Dietitian. Little did I know about the huge variety of “country foods” that are still eaten on a daily basis including caribou, musk ox, whale, seal, berries (akpiks, blueberries, currents, cranberries, etc), geese, arctic char, ducks, arctic hare, and much more. Most of which I had never tried before moving to the North.

Local food traditions, such as berry picking, hunting, fishing, and processing animals, are taught at a very young age and are very much valued as an essential life skill. Many indigenous residents of the northern communities use the word harvesting rather than the word hunting. This highlights the difference between hunting for sport versus harvesting animals for a significant food source. Store bought foods are available in all communities now, but country foods remain an important, low-cost, and nutritious part of traditional diets in the North.

From a dietitian’s perspective – here are some of the things that I have learned about how to practice effectively in small, remote communities above the Arctic Circle.

1. Interpreting nutrition recommendations in a cultural context
Sometimes in practice, nutrition guidelines contrast cultural food traditions and need to be interpreted to clients with caution. For example - in a culture where clients eat raw muktuk (skin of a whale) and quak (meat/fish that is frozen raw and then eaten), how would I communicate the recommendation by Health Canada that pregnant women should avoid all raw fish during pregnancy? Instead of rejecting the tradition, I have a discussion about the rationale of the recommendation and a frank discussion about the risks of eating raw fish. I encourage her to know where the fish is coming from and make sure it has been handled and stored correctly.

2. Extrapolating from Eating well with Canada’s Food Guide
A dietitian using Eating Well with Canada’s Food Guide to assess the diets of traditional northern eaters, would note some deficiencies, such as milk and milk alternatives. Many adults here are lactose intolerant and do not consume many milk products. Because of this, I have begun to learn the nutritional content of country foods. Traditional sources of calcium include baked fish heads, raw arctic char skin, caribou stomach or caribou stomach contents. I asked an elder once if she ate the stomach contents of a caribou (as it seemed strange to me) and she said, “Oh that’s the best part!”…and ultimately would be contributing to strong bones.

3. Get out of the health centre
I learned quickly that a one-on-one counselling session is typically not an effective approach for disseminating nutrition information in communities. Instead, one needs to think “ouIMG_6674.JPGtside the box”! I use hands-on or interactive teaching such as nutrition bingo, grocery store tours, radio shows, cooking circles or storytelling. One time I realized that my cooking class was scheduled at the same time as community bingo, and therefore would have almost no participants. Instead, I arranged to go on the radio before bingo, as almost the whole community would have their radios on waiting for bingo to start. Suddenly the entire community was listening in to my nutrition messages and calling in with questions! In some communities, I have found it is useful to have the radio show (or counselling sessions) translated into the traditional languages. Having everything you say translated will certainly teach you to keep your nutrition messages concise, simple, and to the point.

4. Be aware of your own biases and opinions
Hunting and eating a seal or whale might seem offensive to you - but seal meat and seal blood, for example, might be highly nutritious and culturally important foods for those living on the Arctic Ocean. These foods are especially important in the midst of food insecurity and very high food prices. As dietitians – we may look at food through a nutrition lens, but consider that food and animals are a source of identity, comfort, culture, economy, and survival.  It is good to be aware of our own biases and opinions so we do not unintentionally translate these to our clients.

5. Be flexible
I try to coordinate community visits around the hunting/harvesting schedule. Clients will not come back into town from their whaling camps to see you about their diabetes, even if you deem it important. Visit a community at the wrong time, and the town is almost empty. Life is not planned by a calendar set well in advance; it is flexible, connected with the land, its seasons, and the weather.

6. Introduce new foods slowly
When introducing foods in a cooking circle, I try to use country foods merged with less-familiar foods. A fellow dietitian in Inuvik shared a “Muktuk Salad” recipe with me. This salad pairs traditional muktuk, dry meat and dry fish with vegetables. Instead of regular salad dressing, whale oil is used. See the recipe below.

TLMidnightSun2.JPG               
I would love to hear ideas and strategies from other dietitians working in remote communities. What works well for you? What are some challenges that you have overcome?

Ricky’s Muktuk Salad – served at a Nutrition North Canada cooking circle in Paulatuk, NWT
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“One lady in Sachs Harbour had some tourists over to her house. She made a regular green salad. Instead of using olive oil she used seal oil for dressing.” – Beverley Esau

INGREDIENTS:
  • 1 cup cooked cubed muktuk (beluga whale skin); cut off fat and put aside
  • 1 cup bite sized dry meat (caribou, whale, ugyook, or whatever is available)                                                                            
  • 1 cup dry fish (smoked or not, white, coney, Arctic char, or whatever is available)
  • 1 cup raw cut up bite size pieces of carrots
  • 1 cup chopped cabbage bite sized pieces
 
INSTRUCTIONS:
  1. Using a meat tenderizer, pound dried fish and dried meat to soften to bite size pieces.
  2. Put all ingredients in a large bowl, toss.
  3. Place a piece of whale fat in your hand, squeeze the oil in your hand drizzling over the ingredients and continue to toss until everything is coated.

Editor’s Note: Tabitha's experience in the Western Arctic clearly demonstrates the value of adapting to and understanding a new culture. I loved reading about how she learned to connect with the communities! Do you have a similar experience you would like to share or other strategies for effective dietetic practice in remote communities? Please share below.

View Dietitians of Canada's tool that showcases the vital role dietitians play in aboriginal communities here.

 

  1. Amazing story! How you have adapted the art and science of dietetics in such a unique setting is a true example of client centred care. Keep up the great work!
  2. Hi Tabitha
    Thanks for this share your experiences in Canada's north with us. Its wonderful to hear that rich, cultural traditions are thriving.

    Congratulations to you to being so adaptable to different cultural ways.

    Karen
  3. I really enjoyed reading this post and learning about Tabitha's experience living and working in a remote community. I think it's especially important for dietitians to recognize the cultures and beliefs of our clients and patients and to tailor our teaching to this. Tabitha outlined some great strategies for connecting with a new community.
    Thanks for this post!
  4. What a fabulous article. Thank you for sharing you experiences with us. Your sensitive approach to integrating nutrition messages with community values is an excellent exame of good practice and your efforts to understand the local food supply is commendable. You are a true dietitian.
  5. Wow !! interesting story !!
    I especially like your idea of being aware of your own biases and opinions... Isn't that so true that we look everything through our own tinted lens... Every culture has its own rationale behind its customs and which are working for them.. would those work for others as well?
    Thank you for sharing !!

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