|Last November, I was fortunate to have the opportunity to finish my integrated internship at McGill University with a six-week community rotation at St. James’ Settlement (SJS) in Hong Kong. Though I have visited my birthplace every couple years since I immigrated to Canada at the age of 3, I was eager to find out how dietitians in Hong Kong approach nutrition education. A quick look at SJS’s website showed that the organization offered a variety of community services, so I knew there would be lots to learn!
Most of my work at SJS involved a series of workshops for families with children aged 4-10 years in a low-income community. My main duties were to gather and compile data for our reports to the grant that funded this project, and I was also able to help out and participate in the different activities that were planned for each session. Some of the workshops were presentations given by the dietitian, while others were more interactive, including a Tai Chi class, a grocery store tour, and a cooking class.
Unlike some programs I have seen where the focus was just on one food group, the purpose of the workshops was to increase participants’ general nutrition knowledge as well as to improve their overall eating habits - a tall order! One of the tools we used was a food pyramid published by the Hong Kong Department of Health (The Government of Hong Kong Special Administrative Region Department of Health, 2003); it is very similar to the former US food pyramid. This surprised me somewhat as milk and dairy are not major parts of the traditional Chinese diet. This was reflected by the fact that dairy intake was low amongst workshop participants, though this may also have been due to the melamine scandal. To address this issue, we advised participants to drink milk from suppliers known to be safe, and we used the workshops as a forum for the participants to try dairy alternatives such as plain yogurt, low-fat cheese, and fortified soy milk.
Although the general nutrition messages were the same as they would have been in Canada, there were differences in the details. Food availability and traditional foods were considered, and some of the food combinations and preparation techniques that we recommended (such as tuna salad with corn and raisins, and stir-fried cucumber) might not sound appetizing to some Canadians.
I also learned to view fibre a little differently. In Canada, people associate fibre with whole grains, but in Hong Kong where white rice is a staple, consumption of whole grains is less common. White bread is also preferred for its soft texture, perhaps because traditional breads are steamed. As a result, vegetables, fruit, and legumes are viewed as the main sources of fibre, although some people are beginning to incorporate brown rice and Thai red rice into their diets as well.
The phenomenon that was the most interesting was how concepts from Traditional Chinese medicine were integrated into the health practices of the families I worked with. At home, I experienced this on a small scale. My mother always told me to avoid eating fried foods because they are full of “hot air” and can cause acne and sore throats. I could not help but be tongue-tied when some workshop participants asked me if infant formula was unsafe because of its “hot air”, and if it is safe to boil different types of meat together in a broth.
There is a strong “food therapy” component in Traditional Chinese medicine where certain foods are believed to have specific healing properties. I felt that this was a barrier in teaching clients to eat a balanced diet because they wanted to learn about foods that were the “best” to eat in large amounts, and foods they should avoid instead of eating a variety of foods in moderation. I learned that there is even a word in Chinese for “eliminating foods from the diet”!
As an ethnic minority in Canada, I was always a little put off by diversity seminars and workshops where I felt that I was essentially being told by someone else how I would like to be treated. However, learning so much about my own culture during my internship made me realize that people from different cultures do have different needs. Although having knowledge of various ethnic foods is a start, my placement in Hong Kong showed me that this alone is inadequate. I believe that in order to enhance the effectiveness of our practice in a multicultural setting, we as dietitians need to take the time to learn about the food customs and health beliefs of different cultures so that we can provide counseling that goes beyond meeting only the nutritional needs of our clients.
The Government of Hong Kong Special Administrative Region
Department of Health. (2003). 6-12 years old food pyramid. Hong Kong:
Department of Health.
Vincci Tsui, RD
Provital Health & Wellness
T: (403) 771-4534
Reprinted with permission from Dietitians of Canada’s quarterly publication- Practice, Issue 46, Summer 2009.