NOV 14 was a significant date in Malaysia for two interlinked reasons.
Firstly, it was World Diabetes Day. Malaysia has the highest incidence of diabetes in South East Asia, which has now become a major public health concern. Over 20% of adults above 30 have type 2 diabetes, which affects 2.8 million people. This figure will only increase, unless we can come up with some robust strategies to reverse the trend.
The high number is caused by different factors, but poverty is one of the key indicators.
In previous generations, people living in rural areas did not earn high incomes but the incidence of diabetes was far lower.
This brings me to the second event that happened on Nov 14 – The Lost Food Project launched their second PPR Feeding Programme in the low cost flats in Lembah Pantai, Kuala Lumpur.
Federal Territories Minister Khalid Abdul Samad launched the weekly programme alongside Lembah Pantai MP Fahmi Fadzil.
During the launch, over 8,200kg of food (over 26,000 meals) were rescued and distributed to 850 families.
This feeding initiative is targeted at the urban poor. A report commissioned by Unicef earlier this year highlighted the conditions many children living in Kuala Lumpur’s low cost housing have to endure. The study finds that about 15% of children below the age of five living in the low cost flats surveyed have stunted growth and 22% are underweight. Another 23% are either overweight or obese, (which is six times higher compared with the Kuala Lumpur average of 4%)
Many of us might associate diabetes with over-eating and gluttony – an affliction of the richest members of our society. However, this is not always the case.
People living on a limited budget cannot afford to acquire all the food needed for a balanced diet. Often the cheapest foods are largely composed of starchy carbohydrates, like rice or noodles.
They are very filling but offer little nutritional value. The body gets used to high levels of glucose and children prefer eating unhealthy snacks rather than nutritous alternatives.
Buying foods high in protein and vitamins can prove to be too expensive for many families. Of course, every so often a family will have a treat – but a takeaway or fast food will likely increase our level of glucose and fatty deposits, which is one of the main contributing factors to diabetes, along with genetics and physical inactivity.
If we really want to reduce the incidence of diabetes in the poorest communities, we do have to address many issues.
Firstly, we need to enable people to eat nutritious food. The food programme just launched in PPR Lembah Pantai is a good example of sustainability and nutrition working hand in hand.
The food that have the shortest shelf life (so generates the highest level of surplus) are fresh fruits and vegetables, milk, meat and other proteins.
In comparison, grocery products have a longer shelf life. The Lost Food Project recently announced they have distributed over two million meals in two years. So food banks can be an amazing source of nutrition.
Recent figures showed that over 85% of food rescued by The Lost Food Project were fresh fruit and vegetables.
If they were not rescued by charities like The Lost Food Project and other NGOs, it would simply go to landfill which is expensive to the public purse, and the landfill gases create an environmental hazard.
Of course, giving PPR households fruit and vegetables is not a one-stop panacea.
We also to provide education on nutrition and a lot of other support to these communities.
Beneficiaries from the first PPR feeding programme in Gombak, Kuala Lumpur, has reported monthly savings of up to 50% on their food budget.
Their diet is not only healthier, but the money saved could be used for other essential needs such as education, clothes and healthcare.
This is why it is very appropriate that the PPR launch and World Diabetes Day fell on the same day.
Love Food Hate Waste appears in print on the fourth Thursday of every month in collaboration with Suzanne Mooney, who is the founder of The Lost Food Project. It’s the first food bank in Malaysia to have professional contracts with a number of supermarkets, manufacturers and a wholesale market. They distribute 50,000 meals a month to over 40 charities, composting any donated food unfit for human consumption. E-mail: TLFPcomp@gmail.com
Read more at https://www.star2.com/food/2018/10/24/love-food-hate-waste-are-foodbanks-a-curse-on-sustainability/#PuKFLWbeXKLGeK4h.99
Lindsay Gasik has been living in Malaysia and travelling around the region for about six years, but she still gets curious looks from locals wherever she goes – and it’s not because she’s Caucasian.
It’s because she’s a durian expert who conducts tours in Malaysia and around Southeast Asia for those who love the fruit and want to devour the different varieties.
“People always think I’m just a tourist and they want to know when I’m going home, but I don’t feel I have a home,” says the 29-year-old.
Since she arrived in Asia in 2012, Gasik has been living out of her backpack, going from one country to the next on her durian trail. Her blog, yearofthedurian.com/blog, has a wealth of information about the fruit with tantalising photos to boot!
It all started in 2009 at a vegan food fair in her hometown of Central Point in Oregon, United States.
“I transitioned to a vegan diet in 2007 but I was experiencing some health issues, and it so happened there was a vegan festival in my hometown and I decided to check it out.
“When I got there, there was this weird smell wafting through the festival grounds. I didn’t think it was bad but it wasn’t something I’d tried before. I couldn’t figure out what it was,” she shares.
“I asked people about it and found out it was from this fruit, the durian. The people I spoke to described it as some ‘magical’ fruit that would change my life and open my chakras. I wasn’t sure about that, but it made me very curious about the fruit.”
Gasik has done extensive research about durian for her blog, yearofthedurian.com. Photo: Lindsay Gasik
And so began Gasik’s hunt for durian. She found frozen durians at a Chinese grocery store and she fell in love with the creamy, rich flavour of the fruit. “I had never tasted anything like it. It was so different, and I needed to understand it,” she says.
Oregon was facing a recession at the time and Gasik, who’d just graduated from university, couldn’t find a job. Her father suggested that she travel for a year until the economic situation got better.
“I wasn’t interested in the usual tourist attractions, but when my father suggested I travel I decided to track down this fruit,” she says. That brought her to Indonesia, and then other countries in Asia where she has been for the most part since.
“I found out through online research that durians were in season in Sumatra, so I booked a ticket to the biggest city and just asked a lot of questions and found my way to some farms. It was a lot of luck actually, but I had to overcome my shyness and start talking to people,” she shares.
Gasik charted her travels and experiences with durian on her blog, which was meant to be a journal for her family and friends to know what she was up to. What she didn’t expect was for her blog to gain traction among durian lovers.
“One day I looked at the analytics for my blog and realised I got about 1,000 views daily. I was getting emails from people asking me questions about where I was going next and asking me if they could go with me.
“I realised then that my blog was sort of a resource for people and I thought, this could be my purpose,” says Gasik, who has travelled to 13 countries including Thailand, Singapore, Brunei, Sri Lanka, India, Myanmar, Vietnam, Cambodia and the Philippines,
Gasik’s blog is now a well-known resource for durian fans keen on hunting down the best fruits and trying the varieties that are specific to different countries. She has extensive knowledge about the “king of fruits”, which she has gained from conversations with farmers, horticulturalists and durian fans.
“My purpose is to help people find their best durian. If you tell me you want a durian that’s sweet and dry, I will find it for you. I think of myself as sort of a durian sommelier,” she says.
Gasik with a group of people she guided on a tour in Thailand. Photo: Lindsay Gasik
Apart from her durian tours, Gasik also writes about durian and her travels for magazines and online sites, and gives presentations about durians too – how to choose a fruit, how to open one and where to find a durian to suit a person’s taste preference.
“I get tired of eating it sometimes, but I love learning about the fruit and the people. It’s about meeting and learning from people, particularly farmers. Comparing the fruit in every country, learning about the people and how they experience flavours – that’s what’s really interesting.
“It was never just about tasting the fruit but a way of exploring a bigger topic,” she explains.
In early 2018, Gasik wrote a book, The Durian Tourist’s Guide To Penang, which focuses on the varieties of durian in Penang, featuring 65 farms in the state and a pictorial identification of about 25 varieties.
“I’m currently working on another book – telling the stories of all the durians in Malaysia. I’m also trying to work with local guides to see how I can combine nature and cultural tours with a durian tour,” she says.
Gasik’s tours are gaining traction among tourists from all over the world, which keeps her busy throughout the year. “There are a lot more people into exploring places in a different way, and that’s really cool,” she says.
(Also read: Off The Beat: In search of the rare and elusive Durian Kura Kura)
She was diagnosed with Stage Three breast cancer but getting treatment was not a priority for Nalini.
A single mother with three young children, the 49-year-old was declared bankrupt after defaulting on a housing loan.
Nalini lost her home and was blacklisted by the bank.
She and her children were dependent on her brother-in-law, who was a low wage earner, for room and board.
Ironically, Nalini had a stack of her late husband’s pension cheques. But because she could not open a bank account, she could not bank in the cheques.
Even though she was afraid of dying, her immediate worry was that there’d be no one to care for her children when she had to undergo treatment or get warded.
That’s when the patient navigators from Hospital Tengku Ampuan Rahimah’s (HTAR) Pink Ribbon Centre, Klang, stepped in.
“We had to do something because she had no way out of her situation. We contacted the bank and worked with Insolvency Malaysia and lawyers to appeal to the High Court for special consideration, given her medical situation. And we won the appeal. She was granted a waive of goodwill for the RM80,000 that she owed the bank. She was also able to re-open a bank account and deposit all her cheques.
“We found donors for school bags and stationary for her children and also enrolled them in a food programme so they could have breakfast and lunch in school.
“With all this sorted, Nalini completed her treatment in 18 months and continues to come for follow-up check-ups at the hospital,” shares Cancer Research Malaysia’s Maheswari Jaganathan, who co-ordinates the patient navigation programme for HTAR.
This, in essence, sums up what patient navigation is all about: helping patients overcome barriers of cost, fear, misinformation about the disease, so they would begin treatment as soon as possible.
This is crucial because the quicker treatment begins, the better the patient’s chances of survival.
As a nurse navigator, Hani looks into the welfare of her patients, which sometimes includes buying groceries for their families.
There are six navigators in the Pink Ribbon Centre who act as the patient’s point-of-contact each time they come for treatment or check ups.
“This goes a long way as patients feel comfortable seeing the same nurses who know their history throughout their cancer journey,” explains Maheswari.
A landmark programme in Malaysia, the HTAR patient navigation programme is a pilot project by Cancer Research Malaysia (CRM), in collaboration with the hospital.
Its singular aim is to improve the survival rate of breast cancer in Malaysia, which is currently among the lowest in the Asia Pacific region with a five-year survival rate of 49% compared to 92% in South Korea, 83% in Singapore, over 60% in China, 53% in Thailand and 52% in India.
Malaysia’s low survival rate, explains CRM lead investigator Prof Dr Teo Soo Hwang, is largely due to late presentation of the disease and poor adherence to recommended treatment.
About 50% of breast cancer patients present themselves when they are at Stage Three or Four. And up to 50% who have a suspicious diagnosis never show up for treatment.
“Survival is very dependent on what stage the disease is caught. At Stage Zero or One, breast cancer is very curable but at such a late stage, treatment is more complex and chances of survival are lower.
“We really need to seriously look at how we can encourage early screening and also make sure that once screened, women come forward for treatment as soon as possible,” says Dr Teo.
Blame, she cautions, should not be placed solely on women who present themselves late. It’s also partly due to the failure of health services to respond effectively to women.
“We shouldn’t really be putting the blame on women for late presentation. It is actually a fault in the system. Are patients empowered to make the best decisions about their treatment?
“Improving the outcome for breast cancer is a community responsibility and we all have a duty to do what we can to change this,” says Dr Teo.
Improving the outcome for breast cancer is a community responsibilty and everyone has to play their part, says Prof Teo.
Treatment beyond medicine
The patient navigation programme is a holistic approach in helping patients access treatment.
“We can’t just treat the disease. We cannot treat the cancer when the patient has so many other things going on in her life that is preventing her from adhering to treatment.
“Only when all these other factors are addressed can we make a real impact with treatment.
“And this is why the Patient Navigation programme is so important,” says CRM’s head of community programmes Dr Jana Kanapathy.
The concept of patient navigation is not new. It was introduced by American oncologist, Dr Harold Freeman, in 1990 at the Harlem Hospital Centre in New York City to reduce disparities in accessing cancer treatment, particularly among the poor.
In Malaysia, although aspects of patient navigation have been adopted by a few hospitals, the comprehensive programme at HTAR is the first of its kind.
It was conceptualised by Dr Teo and her team and they found a partner in HTAR. Head of surgical services with the Health Ministry, Datuk Seri Dr Mohamad Yusof Abdul Wahab and HTAR’s head of surgery, Dr Azuddin Mohd Khairy were already working to improve patient outcomes and they felt the navigation programme would help.
“We now have a cohesive relationship and have built a roadmap of where we want to go with this programme. We don’t encroach on the hospital’s services but what they don’t have – the ability to hire nurse and community navigators or funding to run the programme and train the navigators – we provide. There is no one-upmanship in this relationship which is crucial. We have a joint problem that we are both trying to fix,” shares Dr Teo, who spearheaded the navigation programme.
The programme costs RM200,000 to set up and run annually, and is currently being funded by CRM’s main funder, Yayasan Sime Darby, through funds raised by their Ladies Professional Golf Association.
A one-stop centre
Currently, HTAR is the only government hospital to have a one-stop centre for breast cancer, called the Pink Ribbon Centre.
All breast cancer patients at the hospital come to the Pink Ribbon Centre — this negates the need for them to go from clinic to clinic for various appointments, which can be a draining experience.
They work from a small space but it has not dampened the enthusiasm of navigators Nurlia (standing), Hani and Kavita (back) in getting HTAR’s breast cancer patients the best care possible. — Photos: LOW BOON TAT/The Star
The centre, which was converted from a meeting room, is tiny. It’s just a 27sq m space with a small consultation room for medical officer Dr Hidayati Zainab, who plays a significant role in seeing to all patients, and workspaces for navigators Norlia Rahim, Nurul Ain Tajudeen, Hani Zainal, Kavita Muniandy, Inderavathy Wallayan and Maheswari Jaganathan, who co-ordinates the patient navigation programme.
“When we started, we were just glad to be given this space. Our job was to produce results and not to ask for the stars. The space may be small but we are focused on our goal,” says Maheswari.
On their first visit upon diagnosis, patients have a consultation with a nurse navigator. The purpose of this is for the navigators to find out more about the patients and the challenges they face that may prevent them from seeking treatment fast. They find out if the patients have family support, are they able to come for treatment and if not, what the barriers are.
As a cancer diagnosis is life-changing, navigators also offer emotional support to patients and their family. Patients also get an idea of what their cancer journey could be like.
From here, the navigators draw up a plan of action together with the patient, such as finding necessary solutions to enable her to go on treatment.
The Patient Navigation team works on a strict timeline: patients go through all their diagnostic tests (mammogram, ultrasound, biopsy) within seven days of screening, are informed of their results within two weeks, go for surgery within 44 days and treatment within 65 days.
Dr Hidayati, the medical officer in charge of the centre, works with the oncology department of HKL to plan all clinical management.
Most of the breast cancer patients at HTAR come from low-income households and face challenges when treatment begins.
More than 50% of their breast cancer patients are mothers with children younger than 17 years old; 47% have non-communicable diseases such as hypertension or diabetes; 34% believe in alternative medicine; 34% had life crises, such as a death in the family, divorce and so on; 27% live more than 15km away from the hospital and about 8% have had less than favourable experiences at healthcare institutions.
This data, which is collated by the navigators, informs the kind of interventions that need to be in place for the women to seek and keep to their treatment.
“Their challenges range from not having the transport or money for transport to come to the hospital regularly for treatment; unable to pay for child care during treatment or admissions, other existing financial constraints, lack of emotional support from family, prioritising family responsibilities over their healthcare,
“We work with community partners to try and work through their barriers.
“Our navigators are trained in palliative care and we do home visits for patients who live outside the coverage of Hospice Klang. It is very challenging but our common goal is to get these women to treatment fast and make sure they complete treatment,” says Maheswari.
The success of the patient navigation programme at HTAR has drawn the attention of hospital administrators from other states, and CRM is in the process of setting up similar programmes in hospitals in Kota Kinabalu, Seremban, Melaka and Kuching.
Popular Singaporean cook and television food host Sarah Benjamin has a Master’s degree in Sociology and Politics. Yet one wonders why she chose to be a television cooking show host.
“It’s a misconception that when you study politics, you want to be a politician. It’s about understanding the world. I never wanted to be a politican,” she said, in an interview with Star2.
Actually, she studied sociology because her parents are sociologists. She began her career in television when opportunity knocked on her door.
“Both my parents (her father Geoffrey Benjamin is British, and her mother Vivian Wee is Chinese Peranakan) are sociologists and I grew up following them on field trips. My father studied about the orang asli in Kelantan and my mother’s field work was based in Riau, Indonesia,” said Benjamin, 29, who speaks fluent English, Malay, Mandarin and Cantonese.
“I was exposed to different cultures when I was about three or four years old and it was an immersive experience. I come from a multicultural background, and it’s very interesting to see the interaction between different cultures. Food is the result of cultural interactions,” she said.
After she graduated from the University of Edinburgh, Scotland, she returned to Singapore at the end of 2013. She joined Lo & Behold Group (a restaurant group) doing marketing and public relations.
In August 2014, a friend encouraged her to join the first Food Hero competition by Asian Food Channel (AFC) and Food Network Asia that was looking for a new food show host.
She was reluctant initially as she had never been in front of the cameras before. A day before the competition deadline, she asked a friend to produce an audition video, which she submitted the very next day. As it turned out, she was one of the four finalists, and went on to win the competition.
“I didn’t expect my life to take this turn,” Benjamin said.
Benjamin was recently in Kuala Lumpur to launch the Foldover Your Leftovers campaign which was about using leftover foods and repurposing them into healthy and nutritious meals using Asian products.
She has been involved in television for four years now. Her first show, Must Try Asia, saw her travelling around Asia, eating and interacting with locals. The 30-day shoot in six cities was “fun but pretty tiring”, she said.
Some of her cooking shows include Cooking For Love, Simply Special With Sarah Benjamin, Yummy Desserts, Must Try Asia, GR848, Fresh Off Japan! and Best Of Portugal.
Benjamin is an adventurous foodie. She enjoys different cuisines and likes to try new foods. Her comfort foods are noodles, whether it’s Asian style or Western pasta.
“At home, I cook something complicated or new if friends come over. Otherwise, the day-to-day fare is simple and nutritious.”
She was in Kuala Lumpur recently to celebrate World Food Day with Mission Foods, one of the world’s largest producers of tortilla, flatbread and corn flour, and to be part of the #ZeroWaste movement.
Together with Mission Foods, she kicked off the Foldover Your Leftovers campaign which was about using leftover foods and repurposing them into healthy and nutritious meals using Asian products.
Leftovers develop their flavours the longer they are kept, she said. Instead of discarding them, “new meals” could be made with the leftovers, and this could help to curb food waste, she said, adding that Malaysia generates over 15,000 tonnes of food waste daily.
Benjamin’s 12 recipes using leftovers, such as Chicken Curry, Rendang and Ayam Masak Merah – which she considered “a remix of leftover dishes” – were compiled into a cookbook which will be published later this month.
Publishing a cookbook has been one of her dreams. She is currently also working on her own cookbook, which takes inspiration from different cuisines. She hopes to finish the cookbook by next year.
During her university days, she learnt to cook when she could not find many options for Asian food. She said she felt empowered when her first dish, Hainanese chicken rice, turned out well. She substituted ingredients she could not get, like Italian anchovies for belacan and salted fish.
“I’m more about food tasting good. Food does not need to stick to the rules. One needs to cook from the heart, something that tastes good.”
Sarah Benjamin followed in her parents’ footsteps by studying sociology but began her career in television when opportunity knocked on her door.
When she was about nine or 10 years old, she asked her Filipino nanny to buy her a balut (boiled egg with a developing bird embryo), back in the Philippines. She ate it but didn’t finish it. She wants to try balut again if she goes to the Philippines at the end of the year.
“I’ve not tried fried crickets or grasshoppers. I would be open to try them but I would never, ever eat cockroaches.”
She said: “I’m very close to my parents. Growing up as the only child, you’re allowed to do more things. I was allowed to cook when I was about seven or eight. With assistance from my father, I once cooked a three-course meal.”
Her father, a good cook, would sometimes prepare roast lamb, devilled kidneys and roast potatoes. Her mother cooks a few dishes well, including the Hokkien dish, Kong Bak (braised pork belly).
Benjamin has two female cats – named after foods, no less – Porridge and Sambal. They were adopted when they were kittens two years ago.
From her open-plan kitchen, Benjamin gets that feeling that her cats would watch her cook from the sofa.
“My cats meow for their food but they eat very well. They’re very picky with food. For some reason, they don’t like fish but are meat lovers. Sambal loves chicken, and her dinner is free-range cooked chicken breast. She eats better than us,” she quipped.
Nowadays, Benjamin does TV food show hosting on a part-time basis. “I’m AFC’s in-house chef. They only call me when there’s a show to be filmed,” she said.
She keeps herself busy with other jobs such as emceeing at food-related events. She is also an avid food photographer, blogger and Instagram-mer. She said she has no regrets putting her PhD studies on hold. Perhaps some day, she might do her PhD – in sociology.
For the past two years, a non-profit in San Ysidro, California, the United States, has trained some 40 youth to become baristas. The hope has been to equip them with skills and experience to land a job.
But there’s a problem: barista jobs are scarce in San Ysidro, which is home to a single Starbucks store and one Coffee Bean location.
Now, Casa Familiar, the social services non-profit that runs the barista programme, has opened a coffee cart to create jobs for young adults who complete the training.
In addition to providing jobs, the cart will help fill a “need” for more coffee shops in San Ysidro, said Estella Flores, Casa Familiar’s youth programme supervisor.
The cart, named El K-Fe (pronounced “el cafe”), is located outside the San Ysidro Health Center. The hope is the location will be one of more to open across the predominately Latino and low-income community. The cart has employed eight individuals.
The creation of jobs is important in San Ysidro, where about 36% of teens ages 16 to 19 are unemployed and about 27% of 20- to 24-year-old adults are jobless, according to US Census Bureau data.
Casa Familiar launched the barista training programme in 2016 to address common issues young job-seekers face when trying to land their first jobs, such as a lack of experience.
The idea was to give trainees “a little bit of a competitive edge”, Flores said.
Barista training, held at a kitchen at the San Ysidro Civic Center, includes coffee roasting and extraction, and milk steaming and foaming. Participants also make trips to local specialty coffee houses and roasters, such as Bird Rock Coffee Roasters locations in San Diego.
The three-month programme also includes workshops and one-on-one coaching on resume-building, interview skills and financial literacy. Casa Familiar selects San Diego residents between the ages of 14 and 24 who come from low-income families.
Flores said the barista training programme, which she oversees, allows youth to get a feel for the coffee industry and decide if it’s a line of work they’re interested in. Regardless, she said, the skills they gain, such as customer services and teamwork, can be applied in other types of jobs.
Casa Familiar also runs a training programme that helps youth become so-called art docents, or guides who lead art museum tours.
A former barista trainee, Francisco Dominguez, said the programme was “essential and really helpful”.
The 19-year-old was hired to work at Casa Familiar’s new coffee cart. It’s one of two jobs that helps him pay for college.
Dominguez, who attends Southwestern College, works at the cart for four hours between classes on Tuesdays and Thursdays and a full shift on Fridays.
He said the flexible schedule “works with the schedules of students in the community”.
Flores said Casa Familiar hopes to open other coffee carts across San Ysidro, perhaps at the non-profit’s art gallery, The Front, and a small-scale housing development that will break ground in December.
“There’s a lot of potential with the programme,” an optimistic Flores said.
Casa Familiar might also consider opening coffee carts at other San Ysidro Health clinics. The non-profit, which provides affordable health services, has other locations in National City, Chula Vista, El Cajon and elsewhere in San Diego.
“There aren’t coffee shops available near our San Ysidro facilities for our patients or staff,” San Ysidro Health CEO Kevin Mattson said in a statement. “El K-Fe does much more than fix that problem. Most people can remember their first job and how important the lessons they learned were to them. We are proud to invest in this project benefiting our community.”
Dominguez, who helped set up the coffee cart before it opened on Sept 14, said he wants to be around “a long time” – long enough to help the programme expand to other locations. – Tribune News Service/The San Diego Union-Tribune/David Hernandez