If you took a trip to the grocery store recently in Lewiston, Maine, an old northern mill town, you might have come upon a group of Somali-speaking women in colorful hijabs and scarves, heatedly discussing whether a carton of orange juice is, indeed, 100 percent juice.
These women were taking a grocery store tour as part of a nutrition and health education program called Kaaley Ila Kari, which loosely translates to "Come Cook with Me." Led by peer educators, Kaaley Ila Kari provides culturally relevant education to Lewiston's African refugee population. It is one of several initiatives housed at St. Mary's Nutrition Center that aim to improve community health through preventive strategies focused on food access and nutrition.
Predominantly rural, Maine is one of the nation's least racially diverse states, with a 96.9 percent white population as of 2012. The city of Lewiston, population just over 36,000, is a small city by national standards. However, together with its sister city Auburn, across the Androscoggin River, Lewiston makes up the second largest metro area in the state.
Lewiston shares a story similar to other post-industrial cities in the Northeast. Once a thriving mill community, it saw significant decline in the 1960s and 1970s, as industry migrated south and then overseas. While the Lewiston-Auburn area has attempted to revitalize its economy, it faces significant challenges, including large, empty mill spaces, a challenged downtown housing market and the reputation of the Androscoggin as once being one of America's most polluted rivers. These challenges are reflected in some shocking statistics:
- The poverty rate for children under 5 years old is more than 43 percent, nearly twice the state average.
- Food insecurity is widespread. In 2012, about 19 percent of Maine residents received food stamps. In Lewiston, during that time, 32 percent of residents were food stamp recipients.
- In 2012, Lewiston's 71 percent high school graduation rate was 3rd lowest in Maine.
Lewiston has taken a unique journey since 2001, for approximately 6,000 African refugees have settled in the area. This in-migration of Somali and Somali Bantu families resulted in a nearly 730 percent increase in the city's black/African-American population over the last 10 years. The transformation of the city's demographic and cultural landscape is evident on the city's main commercial street. Once-vacant storefronts have been filled by small, African-owned stores with colorful window dressing, and more recently, by other entrepreneurs committed to bringing a renaissance to Lewiston's downtown with new restaurants, shops and upper-level apartments. Those living and working in Lewiston have had an opportunity to approach this progression with compassion, curiosity and humility.
NUTRITION AS MISSION
Based in Lewiston, St. Mary's Health System's mission is to continue the healing ministry of the Catholic Church in the spirit of St. Marguerite d'Youville by providing preventive, curative, restorative and supportive services with compassion and respect for everyone. Beginning in 1888 with the arrival from Quebec of three Sisters of Charity of St. Hyacinthe, there have been many moments in St. Mary's long history demonstrating the care of the poor and vulnerable as integral to the mission.
In 2006, the health system founded St. Mary's Nutrition Center to promote community health and a viable food system through organizing, advocacy and education across the greater Lewiston/Auburn area. Establishing such a center with a public health focus and community-based approach was no far departure for a health system traditionally attuned to community need.
Located in a previously vacant, beautiful brick school building in the midst of Lewiston's most diverse and economically challenged neighborhoods, the nutrition center serves families, youth, adults, elders and refugees who have limited incomes and an increased risk for food insecurity and poor health. Most of the participants involved with nutrition center programs live in public housing or in the two downtown census tracts where individual poverty rates are 67 percent, the highest in Maine.
A complex web of social, economic, community and environmental factors determine a person's health. The nutrition center has become a true community center that builds individual and community capacity to grow, choose and cook nutritious foods. Key programs include community gardens for low-income families; summer and winter farmers' markets; garden education programs for children; intensive job training programs for teens; emergency food distribution; hands-on cooking and nutrition education programs for all ages; school garden programs with the national nonprofit organization FoodCorps; and collaborative, community-based assessment and planning activities.
Key to the nutrition center's success over the years has been to listen and learn, to be active in the community and build connections, and to regularly reflect and adjust the approach. These strategies proved valuable when embarking upon engaging and serving Lewiston's new population.
Community garden programs gave St. Mary's Nutrition Center its first engagement with Somali residents. Community gardeners learn how to grow vegetables, a lifelong skill that can ensure access to healthy food and can generate income, and the gardens themselves add to the vibrancy of Lewiston's neighborhoods.
In 2013, 115 families cultivated plots in 12 community gardens. In addition to raising healthy food, maintaining vacant lots as active community gardens reduces blight and changes the face of the surrounding neighborhoods. The gardens have proven to be a safe space to learn and, as gardeners work side by side toward common goals, people naturally start to break down communication barriers.
In 2002, Mumina Isse was the first Somali woman to start gardening. A confident young mother, she had never had her own garden and wanted to learn. Her quick smile made it easy for other community gardeners to talk with her — they were curious about the Somali refugees, and they asked many questions: "Why did they come here?" "What language do they speak?" "Are all Somalis Muslim?"
Unoffended by the questions, Mumina gracefully served as ambassador and as a scout for her community. The next spring, an additional dozen Somali women joined as gardeners. Mumina soon became a resident garden coordinator for the nutrition center, serving as an educator and liaison to the growing number of Somali-speaking gardeners.
Now, more than 60 percent of the adult gardeners are New Mainers, the term Lewiston residents use to describe the local African immigrant and refugee population. They bring a wide spectrum of farming knowledge, ranging from those who had their own farms back home to those who have never gardened before. All appreciate having the space and support to grow much needed fresh vegetables for their families.
Gardens became a place where youth from diverse backgrounds could learn to talk about and navigate difficult situations in constructive ways. For example, conversations about respect and diversity might arise from observations about how much variety is needed for a good garden, or from exploring foods of many cultures in a cooking session.
The children's garden and cooking programs are held in after-school settings such as public housing complexes and the public library, as well as within the schools. Nearly 200 children participated in these programs in 2013; 70 percent were from the New Mainer community.
One such program is at the downtown Longley Elementary School. Longley ranks last out of 271 elementary schools in Maine. The school has the highest rate of free or reduced-cost lunches in the state, 98 percent. Nearly two-thirds of the students are immigrants or refugees, and nearly 100 percent are in poverty.
For the children, parents and teachers, the school garden and related programs are a valuable opportunity to grow, prepare and cook fresh vegetables while also encouraging essential leadership and team-building skills. Last year, the school district's food service director became very excited about the potential of this approach. She enlisted the after-school cooking club as partners in developing and testing recipes to help create healthy menus that would be more widely accepted by the student body. From January to May of 2013, the cooking club met weekly to hone their cooking skills and try out kid-friendly recipes slated to be integrated into the district's school lunch menu.
The nutrition center's youth programs annually provide meaningful training and work for nearly 40 youth ranging in age from 14 to 20. Almost all have grown up in low-income households and are at increased risk for hunger. Typically they never have been employed before. The programs teach job preparedness, how to create positive change in the community, how to garden and how to cook healthy food. The programs are a stepping stone, helping participants develop the tools they will need to find steady employment.
Bringing diverse youth together to create positive change in their community is an important goal at St. Mary's Nutrition Center. Many of the youth most affected by inequality have not yet discovered passions that can propel them into leadership. They can lack the kind of tools and support that permit them to speak up; they have limited opportunity to be engaged in changing the system around them; and they often have challenging relationships with adults. The nutrition center aims to foster a space where youth develop their unique and collectively powerful voices as they build relationships with adult leaders and with youth doing similar work in Maine and beyond.
DESIGNING A PROGRAM
High risks of hunger, obesity and nutrition-related diseases such as diabetes cross cultural and class lines, but there is a clear need for culturally appropriate responses. As new arrivals to the United States adapt to a different food environment, many struggle to be well nourished.
Research conducted in partnership with the University of Southern Maine's Muskie School of Public Service found that 67 percent of Lewiston's recent Somali and Somali Bantu immigrants had difficulty accessing culturally appropriate, nutritious food.1 A 2011 study published in the Maine Policy Review noted:
"Although nearly every element of life is dramatically different in Maine, among the most profound differences for Somalis involves food, which is also a primary embodiment of religious and cultural practice. African immigrants are accustomed to eating different foods, fruits, vegetables, and spices in their diet than they are able to easily access in Lewiston. They are used to shopping differently for food, preparing food differently and consuming food differently — all factors which must be considered in accessing food availability in Lewiston. These qualitative factors influence access to food for Lewiston's immigrant population."2
In response to such research, the St. Mary's Nutrition Center established Kaaley Ila Kari, its first nutrition education program for adults within the New Mainer community.
Staff at the nutrition center turned to women from the Somali and Bantu communities for guidance and leadership, including Mumina Isse, a trusted partner. The nutrition center hired a group and trained them as community nutrition aides to provide peer education to other New Mainer women. While most of these aides had little formal education, let alone a degree in nutrition, they were well respected by their peers, deeply committed to the well-being of their neighbors and brought their own varied expertise and community connections.
Such imbedded knowledge of the community is invaluable when designing a program — the women knew the owners of the Somali-owned halal (foods that are religiously permitted) stores in Lewiston, the leaders of ethnic-led organizations and what times were best to conduct outreach. They also helped the nutrition center staff learn some valuable lessons: The concept of "nutrition" can feel both foreign and inconsequential to New Mainers. To someone who lived in a refugee camp and is struggling to find food, worrying about cholesterol can seem frivolous.
Similarly, staff learned to explore their own assumptions about what encourages women to eat healthier. Being healthy enough to take care of one's children is a key motivator. Being slender or weight-conscious isn't, when back home, a plump body was a sign of health.
And, we on staff were reminded of the importance of building trust and not letting our agenda to "teach" get in the way of real learning — thus, we learned to start classes with a casual tea time.
Kaaley Ila Kari now runs a mix of cooking-based classes and grocery-store tours in partnership with Cooking Matters (a national program that is part of the organization Share Our Strength's No Kid Hungry campaign). These programs approach the participants as adult learners who have much to offer, but who need some guidance in navigating their new food environment, budgeting their food dollars and shifting food choices to reflect their new lifestyle. More than 200 participants have graduated from the classes.
Here is an example of how critical these programs can be:
An African family arrived in Maine and the mother became disabled, leaving her husband responsible for preparing food for himself, his wife and their 11 children. He was brave enough to reach across his culture's traditional roles and ask for help, for he didn't know where to find familiar foods and he didn't know how to cook.
With the support of Kaaley Ila Kari, he learned some simple tricks and techniques. He was in tears after learning to cook sukuma wiki (braised collards, a dish whose name translates into "stretch the week"), because he felt that with the familiar dish, he could start to take care of his family. He took home a full armful of extra collards at the end of the class.
FUNDS AND PARTNERSHIPS
Undertaking an enterprise such as the nutrition center takes patience, with an up-front investment in design and relationship-building that pays off in the long run. Core operating support from St. Mary's, as part of the organization's community benefit strategy and its deep commitment to mission, serves as critical leverage for raising grant funding from private and public sources to support ongoing work and new projects.
The St. Mary's Nutrition Center also has been able to rely upon a combination of local partnership (with the city, housing authority, school departments and ethnic-led organizations) and participation in broader efforts such as the national Cooking Matters program and the state's SNAP-Education work plan (education provided to SNAP/food stamp recipients).
The nutrition center's progress in serving refugees and immigrants in Lewiston reflects the improvement the city is making as a whole — recognizing both the contributions of New Mainers to the greater community and the unique opportunity that comes from cross-cultural learning.
When done well, this shared learning gives us the opportunity to look at our mission and our work with fresh eyes — an amazing gift.
KIRSTEN WALTER is the founding director of the St. Mary's Nutrition Center. She began her community health work in Lewiston, Maine, in 1999.
- Jigna M. Dharod, Jamar E. Croom and Christine G. Sady, "Food Insecurity: Its Relationship to Dietary Intake and Body Weight among Somali Refugee Women in the United States," Journal of Nutrition Education and Behavior 45, no. 1 (2013): 47-53
- Michelle Vasquez Jacobus and Reza Jalali, "Challenges to Food Access among Lewiston's African Immigrants," Maine Policy Review, Special Issue: Maine's Food System 20, no. 1 (2011): 151-58.
Copyright © 2014 by the Catholic Health Association of the United States
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