Practice Blog

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


Bridging the divide: Key qualities and attitudes for working in remote areas

Cynthia Fallu, MSc, RD holds a Bachelor of Science degree in Nutritional Sciences from McGill University and a Master of Science in International Nutrition from the University of Montreal. Over the years, Cynthia has worked in clinical roles, primary care and in international nutrition. She was also a research coordinator for a food, nutrition and environment study with First Nations populations in British Columbia and Ontario. She has spent time in Tanzania volunteering with a medical caravan. Cynthia currently lives in Montreal and enjoys the outdoors while biking, hiking, camping and skiing. Connect with her on LinkedIn.

  

Travelling and learning about different cultures have always been key interests of mine. During my undergraduate degree, I had the opportunity to take courses in social studies of medicine in which health and nutrition were viewed through an anthropological lens. The different ways other cultures perceived and adopted approaches to nutrition and health were especially interesting to me. Cree and other indigenous cultures were high on this list.
 
I was fortunate to get a placement at the First Nations and Inuit Health Branch during my dietetic internship, which led to my first job as a dietitian on a First Nations reserve in Northern Ontario. As the sole dietitian for the west coast of James Bay, my practice touched on many aspects of dietetics from clinical work to hospital menu changes and facilitating workshops. It was thrilling to put my freshly acquired skills into practice while travelling to various communities and experiencing life in the north – including taking a helicopter to work!
 
I subsequently decided to broaden my experience with vulnerable populations to a more global perspective and went on to complete a Master of Science in International Nutrition at the University of Montreal. From there, I worked on various contracts with First Nations and non-governmental organizations (NGOs) internationally, most of which were related to nutrition research. Initially, I participated in a project with First Nations which involved implementing all aspects of data collection. This included food recalls and food frequency questionnaires conducted by First Nations research assistants. Afterwards, I was engaged with HealthBridge, an international NGO, travelling to Ethiopia and Zimbabwe to evaluate a maternal and child health and nutrition program. I also travelled to Ecuador to help in the development of a nutrition study involving children in rural communities.
 
These experiences have been quite diverse but I’ve identified a few key qualities and attitudes that were consistently valuable when working in remote areas at home or abroad.
 
Adventure



 Aboriginal Day in Northern Ontario – geese cooking over the fire in a teepee (photo credit Paul Lantz)

Packing a sense of adventure is an obvious must when working in nutrition in remote areas or abroad. You could be called on to do things you’ve never imagined. I was asked to participate in aboriginal day festivities during my time living in Northern Ontario. My task was to prepare a goose for the evening feast – empty its innards, roast the feathers off, skewer it for cooking over the fire in a teepee, all while being filmed by the local TV station, not to mention being watched by people on site. It was intimidating to have community members observing and poking fun as I tried this new task, but my local colleagues were great coaches and I ended up with a well-cooked bird!
 
Grit



 In the field in Ethiopia

Working in any new setting has its challenges. Unfamiliar customs and culture can add another layer of difficulty. Everyday tasks that my team can complete quickly in our usual settings can take much longer as we figure out the ins and outs of our new surroundings and can require effort, patience and creativity to accomplish. It can sometimes take perseverance – true grit.

Training research assistants and getting data collection started on a First Nations nutrition study was a good example of this. Each time I visited the community, I had a great plan to kick off the study, only to have unexpected hindrances pop up every time. An amazing team leader told me, “I think most people would have given up by now,” just as I was about to throw in the towel. This was precisely the encouragement that I needed to give it another try. On my next community visit, I discovered that the community’s lack of interest in the project was mostly related to a cultural faux pas. Unbeknownst to us, during a previous workshop, a staple traditional food had been described using a degrading slang term. Once we realized this, our team quickly started damage control with an apology and a meeting with Chief and Council, who pledged their support to get the project completed.  
 
Trust

 

Stuck in the mud in Ethiopia

At home, it’s easy to trust your bus driver to get you to work every day. In fact, it’s likely not even a conscious feeling. When you are working in an isolated area half way across the world where you don’t speak the local language, your situational awareness increases exponentially. Trust in your local partners is required for many day-to-day activities.

When conducting a baseline evaluation for a maternal and child health and nutrition program in Ethiopia, our local team needed to travel to remote villages (2 hours on bumpy, dirt roads from the closest city). We had about ten research assistants in a van and a jeep with length boards precariously strapped to the roofs of the vehicles. It was during the rainy season and the roads on one particular day were muddy and difficult to travel. About an hour and a half into the trip, the van ahead of us got stuck in the mud. Knowing we had limited time to complete the data collection and feeling responsible for it and the team, I started strategizing alternative plans (with a slight sense of panic). Could we do a few trips with the jeep to get everyone there? Was the village within walking distance? But then, everyone got out of the van and started pushing. People living nearby began to come over to help out. One of the interviewers simply told me that if we waited a bit, the sun would quickly dry out the mud and we could be on our way. My colleagues knew their surroundings well and had much simpler solutions to our predicament.
 
Adapt
 
Travel is often planned at the last minute. With HealthBridge, we knew we would be travelling to Ethiopia and Zimbabwe sometime in February or March for five weeks. Suddenly, in early February, Malawi was added and, with it, an extra two weeks of travelling. This destination was eventually dropped. In the end, our departure date was set about two weeks in advance. We had to move fast to get flights booked, arrange visas, etc. Thankfully, our food and nutrition questionnaire was ready. With work travel, departures can be last minute, which can make it difficult, at times, to plan anything on a personal level. With good work preparation, a pre-made packing list, a half-packed suitcase and willingness to adapt, taking off at the last minute can be a bit easier.
 
Appreciate



 Lending a hand at the market in Riobamba, Ecuador

Days working in the field can be long and stressful. It can be easy to disconnect from where you are. Taking the time to appreciate nature, meeting local people and having unique experiences can make a hard day fade away. I have great memories of seeing the beautiful northern lights on James Bay, threshing quinoa with an elder in Ecuador, lending a hand at the local market and watching beautiful sunsets over the desert-like mountains in Ethiopia.
 
Working with First Nations and internationally is not a common path in dietetics. It’s deeply rewarding, but I’ve sometimes found it quite difficult. Gabrielle Scrimshaw, a prominent voice in aboriginal affairs, spoke at the Dietitians of Canada conference this year and told a story I really appreciated. In the story, an elder is walking in the snow with his grandson. The little one notes that it is much easier to walk in the elder’s footsteps than to make his own tracks. In my experiences in the field, I often found I was making fresh tracks in the snow.
 


Editor’s note: I loved Cynthia’s story about preparing the goose! I am not sure I would have pulled it off as well as she did. Every dietitian working in international nutrition (or remote areas) that I have spoken with is full of incredible, humorous and awe-inspiring stories. Do you have one to share? Are you interested in working in this area and making your own tracks in the snow?

Please share your thoughts and comments below! 


Note: DC’s Aboriginal Nutrition Network published a great role paper in 2012 that can be used to advocate for funding to build community capacity for nutrition services to help promote the heath of Aboriginal people. View the full paper here, or read a summary here.
  1. Hi Shavonne,

    It sounds like your experience in Peru was memorable.

    Like you point out, I also found there were not many dietitians working in international nutrition. There is a focus on nutrition in international health like in the Millennium Development Goals or in movements like Scaling Up Nutrition (SUN). I feel there is room for more dietitians in this field. Many people I met working in international health had some training in public health or had a strong background in nutrition research (i.e. PhD).

    The field experience, like you have done, is a great asset.

    Cynthia
  2. Hi Cynthia,
    Thank you so much for sharing your experiences. After volunteering in Peru last summer I fell in love with the field of international health and nutrition care. I am currently completing my MHSc/dietetic internship and would love to have a career that involves working abroad, however I haven't heard of many dietitians that do this. It great to see that you've been involved in some amazing opportunities. I'll definitely be looking into some of the resources that you posted.

    Thanks again for sharing.

    Shavonne
  3. Hi Madison,

    It's so great that you are interning in a rural area-so much to learn!

    For a short term experience, check out CACHA (http://www.cacha.ca/). I volunteered with them in Tanzania helping out mostly with logistics but providing nutrition support when needed. It was well organized and safe.

    Here are other organizations that offer volunteer opportunities in nutrition:
    Foreign Affairs, Trade and Development Canada's youth internship program (http://www.international.gc.ca/development-developpement/youth-jeunes/ivo_seventeen-psb_dixsept.aspx?lang=eng)
    Cuso International (http://cusointernational.org/)
    Doctors Without Borders (http://www.msf.ca/en)

    My experiences in international nutrition were volunteer-based at the start. Networking is really important -- all the experiences I mention in the post were obtained through connections and talking with people (just like you are doing now!)

    I hope this is helpful for you!

    Cynthia
  4. I love this story! Good for Cynthia! I am currently a dietetic intern doing a rural community placement on an Aboriginal reserve in Northern Ontario. I am extremely interested in pursuing a career in international dietetics but am not sure where to start/where to look! I'm not really aware of any resources. Any suggestions for me?

    Thanks again for the post! Very inspirational.

    - Madison

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