For parents and caregivers, taking care of a sick child in the hospital is a nightmare. But for many families, they also must contend with the specter of hunger.
Prof. Stacy Lindau leads a program to help combat hunger called Feed1st. With six food pantries located throughout Comer Children’s Hospital, it is serving a profound solution in the fight against a condition known as “food insecurity.”
Stacy Lindau: The challenge is that we might deliver hundreds of thousands of dollars of medical care and then unwittingly send a child in their family home to starve.
Andrew Bauld: Dr. Stacey Lindau is a professor at Pritzker School of Medicine in the departments of OB GYN and medicine geriatrics. Were in Comer Children’s Hospital at the University of Chicago in one of the five food pantries that are part of a program Stacy runs called Feed First. The pantries are serving a profound solution for families already dealing with a nightmare come to life.
Stacy Lindau: How can we ask parents or caregivers to do the hard work of taking care of a sick child, which is the scariest thing in the world, while starving.
Andrew Bauld: From the University of Chicago, this is Knowledge Applied. A podcast where we go inside the research reshaping everyday life. I’m Andrew Bauld. Dr. Stacey Lindau is a respected physician scientist and practicing gynecologist. She’s also the director of the Southside Health and Vitality Studies and runs Lindau Labs, which conducts population studies, clinical studies and ethics search around health equity.
Stacy Lindau: My work and my way of seeing the world has been at the interface of the individual, the body and society.
Andrew Bauld: Stacy’s research has led to innovative solutions for some of the most pressing health problems facing urban communities today. But in 2009, a hospital chaplain at Comer came to her with something new. The chaplain was witnessing firsthand parents and caregivers going hungry at the bedside of their sick child.
Stacy Lindau: And she witnessed the kindness of a nurse who handed over a sandwich or a medical student who gave a person who was hungry, a $10 bill to get some food but she was really distressed by the indignity of it. So Feed First, although it wasn’t known as Feed First at the outset it was just the hospital based food pantries, Feed First started 2009, 2010. In fact, my son became an inpatient at Comer Children’s Hospital shortly after the program started. And that only deepened my concern for this issue and my commitment to try to solve it.
Andrew Bauld: And the issue wasn’t just hunger, but an economic and social condition known as food insecurity.
Stacy Lindau: Food insecurity is a technical term, and it means that an individual, over a period of time, can’t reliably get access to basic nutritional sources or meet their nutritional needs in socially acceptable ways.
Andrew Bauld: One in five households with children in the United States are food insecure. Food insecurity can lead to poor physical and mental health, and often means a parent deciding between paying for a meal or paying for basic goods like medical bills or housing costs.
Stacy Lindau: So a person who has to steal in order to eat would be considered food insecure. Not all people who are food insecure are hungry all the time. We see a high overlap between food insecurity and obesity, for example. Well, how is that? People who are food insecure are more inclined to eat low cost, high calorie, high sodium foods, fast foods, for example. And so while they may not feel hungry, they also are not well nourished.
Andrew Bauld: Although there had been extensive research conducted around household food insecurity, little was known at the time about food insecure in the hospital setting.
Stacy Lindau: This enabled us to establish for the prevalence of hunger in our children’s hospital and for the first time to describe what we call hospital based food insecurity. What we learned is that there’s a subset of people who are not food insecure at home, but who become food insecure during the hospitalization.
Andrew Bauld: And what Stacy found was beyond troubling.
Stacy Lindau: A parent of a sick child is really reluctant to leave the child’s bedside. So even going down three floors or stepping out of the hospital and walking a few blocks to get food was a non option. People who had hospital food insecurity were more likely to indicate that they were not confident that the child would be okay if left alone. And the food insecurity also comes from not wanting to eat in front of the child. Many children who are sick, can’t eat, they’re not permitted to eat, or they’re physically unable. And a parent empathize with a child and so wouldn’t want to eat and increase the child’s suffering
Andrew Bauld: Rather than follow a traditional route of setting up a survey and conducting an in-depth study, Stacy decided she had to address the problem sooner, rather than later.
Stacy Lindau: It was my feeling that this was an instance of real humanitarian need, where we needed to respond first, feed first, believe the chaplain, and then do our science. Sometimes a scientist, we have to take a humanitarian stance. And by the way, I think our science has been better off for that approach. At the essence of what we were trying to do, which was work together with the surrounding community to improve the health and vitality of the community, if we couldn’t solve the problem of hunger in our children’s hospital, for goodness sake, how could we really do anything else?
Andrew Bauld: Partnering with the greater Chicago food depository to supply food to families and patients, the program began with a single pantry.
Stacy Lindau: We grew from a few square feet in the chapel closet to now five self-serve pantries, four on inpatient floors and one in our pediatric emergency department. And to my knowledge, especially the emergency department pantry, is the only self-served 24/7/365 food pantry in a hospital emergency department. Other hospitals have implemented food distribution or food pantry systems, but they require vouchers or prescriptions or some kind of permission. That didn’t work for us. We felt that a hungry person is already suffering an indignity in addition to the discomfort of being hungry and that people in our hospital who are hungry should be able to access the food whenever they need it and without any special permission.
Stacy Lindau: The principle is self-serve. People help themselves. They’re invited to take as much food as they need home. And some people have asked us “Well, aren’t you worried people are going to steal the food or people who don’t need it will take it?”And really to the contrary, what we see is people who need the food, take it and actually many of them try to find a way to give back. They’ll contribute food back, they’ll bring in plastic bags that others can use to take the food home, they’ll help unload the truck of food and stock the shelves. People who don’t need, the food really don’t take the food.
Andrew Bauld: Feed First uses sensor based technology to quantify how often the pantries are used without compromising the dignity of the people accessing the space. The program also who relies on the volunteer help of medical students who keep the pantry stocked and who receive their own benefits.
Stacy Lindau: We haven’t studied this systematically, but from anecdote, I do believe the pantries alleviate a great deal of moral distress for the healthcare providers. It’s a terrible feeling to watch somebody go hungry. One of the most painful experiences the chaplain shared with us was not seeing the nurses and the medical students hand over their sandwiches and their money, but seeing those rare occasions, when a doctor, nurse, medical student who was asked for help, had to decline. Had to say, “ No, I don’t have money for you. I don’t have a sandwich.” That was just distress all the way around.
Stacy Lindau: I know from being a medical student myself, the first two years, it’s a lot of taking and not a lot of opportunity to give. So medical students are so eager in those first two years to have a reason to belong in the hospital, to feel like they’re doing something to help and heal other people. The food pantry is a perfect outlet for that.
Andrew Bauld: Feed First has been a huge success and a valuable resource across the hospital. And it’s continuing to grow with a new pantry recently opening in the outpatient cancer care area. Parents and caregivers have given positive feedback since the beginning. And there have also been some happy unintended outcomes.
Stacy Lindau: We’ve had several instances of people who have never gone hungry in their life, becoming aware of the problem of hunger by virtue of coming across these pantries in our children’s hospital. And some of those have become really valuable contributors to this program. I’ll never forget a parent who posted an anonymous letter, maybe the day before Christmas Eve, a few years ago. And what the parent said was they themselves had no idea what a big problem hunger was, but by virtue of their child being hospitalized for 30 days for radiation treatment, they came to understand it. This family had asked all of their friends and family to prepare food and bring food that then was donated to the pantries and the parent said pay it forward. It was a call to action to future parents who’ve come in.
Andrew Bauld: After nearly a decade of operation, the pantry has grown to be more than just a source of food for patients. It is also providing critical data for future study.
Stacy Lindau: The evolution of the program, in addition to increasing the number of people we serve and the pounds of food we move about the hospital, includes the science. I mean, like I said, we started with a feed first asked questions later approach. We’ve used some very simple epidemiological methods to study the prevalence of hunger in our hospital. We just published a new study, looking at the most impactful way to screen people for hunger in the hospital setting. And we’ve been using, really experimenting with these passive sensor technologies to understand not only how the pantries are being used, but these data can help us design the optimal pantry. If other hospitals are going to adopt the work that we do, we need to be able to put it in a box. They need to understand what are the specifications, what’s the smallest amount of space we can allocate and have the maximal impact.
Andrew Bauld: The findings of the program have already appeared in the American Journal of Public Health, including an experimental study this past fall testing the American Academy Of Pediatrics guidelines for screening for food insecurity, which Stacy and her team found missed about 25% of food insecure people.
Stacy Lindau: The American Academy of Pediatrics was one of the first professional associations to put out a call for attention, even screening patients in healthcare settings for food insecurity. This raises a bigger set of questions, which is, should we screen for food insecurity at all? Or should we just make sure everybody who comes into our hospital knows where they can get food if they’re hungry in the hospital and where they can connect to food based resources should they become food insecure? So my group has become very interested in helping to inform the broader field. When should we screen? When should we just make sure everybody knows where to go for these basic needs? What are the pros and cons?
Andrew Bauld: Stacy believes hospitals can prevent hunger in patients, but that the real challenge is helping reduce food insecurity once those patients leave.
Stacy Lindau: Ultimately the way we prevent and eliminate hunger in the hospital has a lot to do with how we prevent and manage hunger in the community so we need new solutions for how we manage hunger in the community. And one of the biggest barriers to that is people who are hungry have to travel a distance at a certain time to get the food they need. One of the biggest problems to solving hunger is our logistics around it.
Andrew Bauld: Stacy thinks she might have a solution.
Stacy Lindau: I have an idea. Every time I pass a Divvy bike stand, I wish we had a 24/7/365 modular pantry where people in the community could both contribute safely and of course, receive food. I think this is doable. And one of my hopes is that by studying the problem of hunger and how people who are hungry access our pantries in the hospital, we might develop insights that would make it actually doable to solve the hunger problem in our community with this 24/7/365 self-serve idea.
Andrew Bauld: Knowledge Applied is a production of the University of Chicago. To learn more, visit us at news.uchicago.edu. You can listen to this episode and all of our episodes on iTunes, Stitcher, and wherever else you get your podcasts. And stay tuned for our next series coming this spring. It’s called Big Brains where you’ll hear interviews with transformative thinkers, changing the way you see the world. Thanks for listening.
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