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Demand Grows for End-of-Life Doula Training at UVM

By Kymelya Sari
Seven Days

Roberta MacDonald guffawed when she remembered a riddle her friend once asked her: What’s the No. 1 cause of death? No, it’s not heart disease or cancer, as one might typically guess. “It’s birth,” said MacDonald. “That was Paula’s line — I love that.”

Paula Fives-Taylor, professor emeritus of microbiology at the University of Vermont, died in January 2015. In the last few months of her life, MacDonald moved into the octogenarian’s house to be her primary caregiver while still working full time at Cabot Creamery Cooperative.

The two women had met years earlier at a hospice volunteer training course led by Fives-Taylor. Through her own experience as her former teacher’s caregiver, MacDonald discovered gaps in end-of-life services. She decided she wanted to educate others on how to support individuals in their final months or days — as an end-of-life doula.

“Doula” comes from the Greek word doul, which means “female servant or slave.” In modern usage, the word refers to a nonfamily member who provides nonmedical emotional, spiritual and physical support during major life transitions, particularly birth or death.

In 2016, MacDonald approached UVM Continuing and Distance Education proposing an end-of-life doula program.

Read the full story in Seven Days.

UVM Student Gets Another Chance at Medical School

UVM’s Medical Science Degree Program gave Kristina Valentine a second chance at getting into medical school.

The McGill University graduate wasn’t accepted to medical school when she first applied two years ago. But this fall, she is heading to the UVM Larner College of Medicine with the goal of working in the primary care field.

We talked to Kristina about her plans for the future and how the Master of Medical Science Degree Program helped make her a desirable candidate for medical school.

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After not getting into medical school the first time around, what made you decide to enroll in the Master of Medical Science program

Not getting into medical school last time was definitely tough, so I was able to think about my options and reaffirm that medicine was definitely what I wanted to do. I received feedback on my application and did some soul searching. One of my biggest problems was that I applied very late in the cycle and I did not understand how much that can affect your application. Some of my undergraduate grades may have given some admissions committees pause, too.

Beyond that, I also knew that it would definitely help my medical school application to have more experience in upper-level science courses to show that I could do the work. I also knew that I was much more equipped to excel in difficult science courses at this point in my life. After researching, the UVM Medical Science Degree Program seemed like the perfect fit for me.

What will you be focusing on in medical school?

As of now, my goal is to work in a primary care field—internal medicine or family medicine—and I see myself working in a community health center or other entity where most patients have difficulty accessing health services. I would also like to spend time working in a jail or prison.

You’re interested in serving the justice-involved population. Can you talk about why you are passionate about this particular area?

I became passionate about this particular area through my boss, Dr. Tom Simpatico, who works with justice-involved populations at MHISSION Translational Systems. I have met individuals who were either coming out of incarceration or going into jail diversion, and I heard so much about their often traumatic and heartbreaking pasts. Many of them just weren’t given the tools to succeed and had the cards stacked against them. Though many have done bad things, Dr. Simpatico treats them as people who deserve care. That really sparked a fire in me. I have seen that a lot of times that if individuals are provided with a supportive environment—including support from their physician—they can do much better overall.

Was the UVM Larner College of Medicine Your First Choice?

Yes. I ended up getting five interviews in all, and went to two other interviews besides UVM. I got accepted to one other school and withdrew from the other before getting my decision because I knew I wanted to go to UVM and was accepted early on.

How did the MMS program prepare you for getting into medical school?

It helped in so many ways. For one, I was able to talk to advisors and really get an idea on when I should have my application in and what I should focus on. The biggest thing, however, was probably that I excelled in my classes. I worked really hard, but also had great support from all of my teachers and fellow students. Whenever I didn’t understand something, I would go to office hours and talk it out with my instructor and talk to my other classmates. I now feel like I demonstrated that I can handle the science coursework that is required in medical school and feel much more comfortable because of all of the things I’ve learned.

What were some of the challenges you experienced?

Gross anatomy was really difficult for me at first because I had trouble understanding what I was looking at in the body. But now I won’t have to deal with that learning curve in med school as I’ll be able to pick up where I left off more or less. The same goes for physiology and biochemistry. I have the basics down and will be able to comfortably build on that in medical school.

What was one of the most helpful things you learned from the Master of Medical Science program?

The program gave me a lot of time to think about how to articulate why I want to work in medicine and what got me to this point. Being able to talk to advisors and other students and to think about my journey helped me write my med school application’s secondary essays and personal statements in a way that clearly showed my path and the type of physician I want to become.

Learn more about the UVM Master of Medical Science Degree Program

UVM Is: Connie Tompkins Raising Awareness About Food Addiction in Teens

Little is known about food addiction in adolescents, so UVM Associate Professor Connie Tompkins and her colleagues set out to learn more.

An expert in the prevention and treatment of childhood and adolescent obesity, Tompkins co-authored a study, Food Addiction: A Barrier for Effective Weight Management for Obese Adolescents, that was published in the December issue of Childhood Obesity. The purpose of the study was to explore the prevalence of food addiction and food addiction symptoms in obese adolescents entering an outpatient, weight management program.

Despite a willingness and desire to lose excess weight, adolescents with food addiction may be unable to decrease their drive to eat, resulting in the possibility of interventions directed solely at healthy eating and physical activity to be less effective.

“These eating behaviors are really having a negative impact on several aspects of these children’s lives. Symptoms including the ‘inability to cut down’ and ‘continued use despite problems’ indicate that they are struggling and need help,” Tompkins says. “I hope that obesity and, in particular, obesity in childhood and adolescence, will not simply be attributed to a lack of willpower. I hope that people can view obesity not as a consequence of the individual but one of the modern day, food environment.”

Tompkins and her fellow UVM researchers—Associate Professor Jennifer Laurent  and Associate Professor David Brock—found that one-third of adolescents entering the weight management program in the study met the criteria for food addiction and 50 percent reported three or more food addiction symptoms. In addition, the percentage of adolescents dropping out of the weight management program was higher in those with food addiction compared to those without.

As far as Tompkins knows, the UVM study is the first investigation of the prevalence of food addiction in adolescents seeking outpatient, behavioral treatment for obesity.

Tompkins has been involved with pediatric weight management programs for most of her career, and it was Laurent that approached her about incorporating an assessment of food addiction with adolescents and their parents. Brock has been one of Tompkins’ close collaborators since she first arrived at UVM, and Tompkins says she relies on his guidance and expertise in obesity and the trajectory of obesity from childhood to adulthood.

What is Food Addiction?

The term ‘‘food addiction’’ has been used to describe a cluster of eating behaviors similar to behaviors associated with drug-related addictive disorders.  Although food addiction is not currently recognized as a clinical diagnosis, the central behaviors associated with substance addiction, such as craving and withdrawal, are also key factors in disordered or problematic eating and overeating.

Food addiction is somewhat of a controversial topic and it is still inconclusive as to whether it is indeed a distinctly different pathological eating disorder, Tompkins says.

“We don’t exactly know when these eating behaviors may begin but I would propose that it is during childhood before puberty,” she says. “In fact, we saw an increase in the number of symptoms with age. In that case, as the number of symptoms increase, the harder it may be to help these children with weight loss and/or they may require more intense treatment.”

Food addiction may be difficult to treat in adolescents, and it also differs from how adults are treated.

Tompkins explains that as an adult, you may have some control on your food environment. That’s not the case for children and adolescents.

“They are subjected to food environments that are for the most part out of their control, including at school and at home. This places a large responsibility or even burden on these adolescents to develop strategies to manage their eating behaviors in these challenging situations,” Tompkins says.

Tompkins says further research is necessary to identify potential effective interventions or treatment strategies for adolescents with a higher number of food addiction symptoms and/or those meeting the criteria for food addiction diagnosis.

If food addiction follows the same trajectory as substance addiction, then these eating behaviors may likely persist into adulthood, become increasingly difficult to treat using current treatment programs, and result in greater morbidity and earlier mortality.

What does Tompkins hope the research will accomplish?

“Obesity is a complex condition and is not simply due to a lack of willpower or a child being weak and unable to resist unhealthy foods. I hope this brings some attention to—and awareness of—food addiction and the symptoms associated with food addiction,” she says. “These addictive-like eating behaviors are real and negatively impacting these children’s lives.”

-The “UVM Is” series celebrates University faculty, educators, and the campus community.

To learn more, visit UVM Continuing and Distance Education at learn.uvm.edu.

Why Shawn Logan Wants to Be an End-of-Life Doula

A family story sparked Shawn Logan’s interest in end-of-life care. The story was so moving that Shawn, who is pursuing a career as a mental health clinician, decided he had to learn more.

We talked to the Kentucky resident, who enrolled in the UVM End-of-Life Doula Professional Certificate Program last year, about death, dying, and why he wants to help others with end-of-life care.

 Tell us the story about your family.

A couple of years ago, I had a conversation with my grandmother. She was planning her final wishes and the conversation turned to her brother, Alton, who died at age 3 from diphtheria. She went on to explain that while Alton was actively dying, the entire family gathered to hold vigil for Alton; they provided care to him but also support to each other. Her father and brothers built a small coffin and when Alton died, they cleaned him and put on his church clothes. They went to the family cemetery and dug out the grave and they even carved out a gravestone. This conversation was profoundly moving to me and it made me think about how our views on death and dying have radically changed in a relatively short period. My grandmother and all of her siblings were delivered by a midwife, and this was an incredible connection with end-of-life care.

uvm doula program

What was one of the most important lessons you learned in the UVM doula program?

That death and dying is such a deeply personal experience. In the program, we were provided a solid set of skills to utilize but we also learned that each client is going to be uniquely different. They will be faced with their own struggles, denials, and hopefully, acceptance. As a doula, our goal is to ensure that each dying client has the best possible death for him or her; not what we want and not necessarily what their family wants. Equally important is that our clients’ families and loved ones also go through their own stages of grief. While a doula’s top priority will always be their dying client, we also have to provide support to family and loved ones.

What is the biggest misconception about end-of-life care?

Fear. In the last century or so, we, as a society, have grown to fear death. We avoid talking about it because we fear it. When a death occurs, we are often left with the burden of trying to guess what a family member or loved one would want when they die. It goes beyond planning for a funeral, though that is also very important. We often fail to be cognizant of events that can happen immediately preceding death from an accident, stroke, or cancer. Do we want life sustaining measures to be taken? Do we want life support to be maintained? Would we prefer home care instead of placement in a long-term care facility? These are all conversations we need to have sooner rather than later.

How do you think the doula program will help you help your clients?

One of the lessons we learned is that doulas should be fully present with their clients, without judgement, without bias, and without any agenda. When we open ourselves to clients, amazing things can happen. It can be a long silence or maybe they want to talk about growing up. Whatever they want, we learn to be there for them and hopefully make the transition from one life to another less stressful or frightening.

What are your career plans?

To continue practice as a mental health clinician but also provide end-of-life doula services on a volunteer basis. I live in a very rural area and being able to provide doula services for the community I’ve grown up in is quite important. No matter where I end up, my long-term goal is to provide my services on a volunteer basis.

Mental health clinicians encounter clients at all stages of the grief process and this program has afforded me a unique set of skills that I can utilize in clinical practice. While my long-term goal is to practice independently as an end-of-life doula on a volunteer basis, it should be noted that both professions are uniquely different and independent. While I can potentially utilize skills from both, each has their own ethical and governing laws.

Learn more about the UVM End-of-Life Doula Professional Certificate Program.

 

UVM Public Health Student Competes in 2018 Winter Games

Like most graduate students, Ida Sargent finds pursuing a master’s degree to be a juggling act. But Ida is not your typical student. She’s a member of the U.S. Ski Team who is competing in the 2018 Winter Olympics.

A student in the UVM Master of Public Health online program, Ida is a lifelong Vermonter, 2014 Olympian, and World Championship skier.

We talked to Ida about her Nordic racing career and why she wants to work in public health.

How did you become interested in this particular career path?

As an elite athlete, I am very grateful for my health. Sports has given me the opportunity to be fit and strong, and I believe that good health is one of the most basic rights in life. It scares me to see the rising levels of childhood obesity, and the physical and mental burdens that it places on young children. I’m involved with several non-profit organizations that use sports and physical activity to build confidence, self-esteem, community values, and healthy habits. This is mostly volunteer work, but it has given me the opportunity to share the values and building blocks of a healthy lifestyle, which I believe is key to our future.

As an Olympic athlete, how to manage to find time to go to school?

Online courses are my only option. I spend at least half the year on the road with training camps during the summer and fall. From November through March, I am traveling around the globe with the U.S. Ski Team and racing World Cups almost every weekend. I often will be in four or more countries in a single month, so being in an actual classroom would be impossible for me. While I have a busy schedule, it’s great to have some balance on the road and to take my brain off of skiing.

Why did you choose UVM?

I’m a Vermonter through and through, and it’s a place that I care about deeply. UVM offers such a strong Master of Public Health program. It’s great to connect with many professors, public health professionals, and students who also have strong ties to Vermont and our communities. These connections can help us all make a difference improving the health of our population.

More information about UVM’s Ida Sargent (courtesy of TeamUSA.org)

Birthplace: Newport, Vt.

Hometown: Craftsbury, Vt.

High School: Burke Mountain Academy (Burke, Vt.) ’06

College: Dartmouth College ’11, Biology and Psychology

Team/Club: Craftsbury Green Racing Project

Olympic Experience

  • Two-time Olympian (2014, 2018)
  • Sochi 2014, 19th (sprint freestyle), 32nd (10K classic)

World Championship Experience

  • Most recent: 2017 – 24th (sprint freestyle), 43rd (10K classic)
  • Years of participation: 2011, 2013, 2015, 2017
  • Top finish: 24th – 2017 (sprint freestyle)

Personal: Daughter of David and Lindy Sargent…Has one brother, Eben, and one sister, Elsa…Started skiing as soon as she could walk…Aspires to be a physical therapist…Hobbies include running, practicing yoga, mountain biking, hiking, canoeing, reading and gardening.

Learn more about UVM’s Master of Public Health Program

 

After UVM, Christina Supino Sets Her Sights on Working in Emergency Medicine

Christina Supino runs with children in Ghana, Africa, during her public health fellowship.

Christina Supino’s family doctor in New Hampshire inspired her to pursue a career in medicine. The positive relationships he developed with patients made such an impression on Christina that she later decided to work for him as an intern.

“That’s when I knew medicine was for me,” she says. Christina received a bachelor’s degree in environmental studies and Italian from Dartmouth—where she was also a track and field athlete—and went on to earn a master of public health from University of South Carolina. She eventually came to UVM to complete the Post-Baccalaureate Premedical Program, and is now in her first year at the University of New England College of Osteopathic Medicine. She hopes to eventually work in Emergency Medicine.

We talked to Christina about gaining experience in patient care, developing a water purification center in Africa, and her medical school scholarship with the U.S. Air Force.

Can you tell us a little more about how you became interested in medicine?

Our family friend who is our family doctor really made an impact on my life. My parents were his first clients when he opened up his own practice. They liked him so much that they brought the rest of our very large Italian family to him, and now everyone goes to him. Going to the doctor’s office didn’t feel like a chore, and we actually really enjoyed it. Even my grandmother would always bring him her homemade Italian food. I was really impressed at how he was able to maintain this kind of relationship with almost all of his patients and also provide them with a very important service to maintain their health.

Tell Us About Your Fellowship in Africa.

I did a fellowship with Saha Global in Ghana, Africa, after I finished my master of public health in South Carolina, and it was really an incredible experience. We worked in a small village for a month and helped construct a culturally appropriate water purification center. We taught the women in the village how to run it since women are the traditional water gatherers in those communities. It was my first time in Africa and really gave me a better perspective on life. I remember finishing each of the long hot days by racing the kids in the village down the road. No matter how tired or exhausted I was, I always made sure to do that because even though we couldn’t understand each other in terms of language, it was something we could still share with each other.

While in the UVM Post-Bac Program, What Kind of Work Experience Did You Receive?

I worked at Home Instead Senior Care doing patient care-centered work. I picked up shifts with numerous people over the year and half I was there and fulfilled vastly different needs. I also worked as a personal care attendant for two private clients as well. I felt that these experiences helped diversify my skills to fit the needs of different patients. I would help with daily activities such as getting up, dressing, bathing, using the bathroom, preparing meals, transportation to and from grocery stores or doctor appointments, cleaning, preparing for bed, medication reminders. For some clients, I was there to accompany the hospice nurse for end-of-life care. Some shifts also required me to spend the night to ensure the client was safe.

Can you talk about research papers you published regarding physical activity and cardiorespiratory fitness?

I was part of two papers during my master’s program at USC. Both were with one of my favorite professors who taught biostatistics. The first is titled “Differential association of cardiorespiratory fitness and central adiposity among U.S. adolescents and adults: A quantile regression approach.” Published in Preventative Medicine in March 2016, we discussed how using regular linear regression analyses to analyze the relationship between cardiorespiratory fitness and waist circumference might not be the best method. Instead, we used quantile regression to get a better picture of the existing trends. In fact, we found it to have a differential impact across waist circumference quantiles, which you wouldn’t have seen with regular linear regression analysis.

The other is titled, “Fitness adjusted racial disparities in central adiposity amongst females in the US using quantile regression” and was published in Obesity Science and Practice last June. This paper also used quantile regression instead of linear regression to analyze the impact of racial disparities in women across waist circumference quantiles. This was a pretty interesting paper because it shows the differential impact of waist circumference across quantiles for women of different ethnicities.

Tell us your scholarship with the Air Force.

When I was thinking about how I was going to pay for school, it was pretty overwhelming. Neither of my parents went to college and they just recently retired, so I knew I would be on my own in terms of the financial burden. With the Air Force, I am free to pursue whatever specialty I want, I just have to give them years after residency. I chose the Air Force specially because I have two friends that are in that branch and they told me what a great experience it was, and also my dad was an aircraft mechanic for 40 years, so aviation has always been something that’s part of my family. I have also heard from other students that are doing the same program that military service will give me great experience, especially if I do end up going into emergency medicine. Lastly, I think in the future I’ll be really proud to use my skills to help those who fight for our country.

What do you find most rewarding about your studies and practicing medicine?

I think one of the most rewarding things about medicine is the ability to make connections with people. Through my time as a personal care attendant experience, I have met and cared for so many different people and have enjoyed hearing their life stories. Knowing who a person is and how they function really helps me to be better prepared as their caregiver. Sometimes just listening to people helps them feel better emotionally. Health is a very equalizing factor, and whether you are young, old, rich or poor, the fact is we all need to tend to our health. As a doctor, I’ll meet people from all walks of life and be able to do something for them to help improve their day-to-day life. Ultimately, I hope to be useful to community in the same way our family doctor has been pivotal in my small hometown in New Hampshire.

Learn about the UVM Post-Baccalaureate Premedical Program.

 

Truth and Compassion Are at the Core of End-of-Life Care

 “Companioning is about going to the wilderness of the soul with another human being; it is not about thinking you are responsible for finding the way out.” -Dr. Alan Wolfelt

By Francesca Arnoldy

My initiation into this realm happened unexpectedly when my grandfather was dying. It was my first time sitting vigil through a person’s death. I showed up unprepared for what I was walking into (which is actually the case for all doula work, honestly—we don’t know what will be asked of us or how to best serve, which is why setting the intention for each person’s “greatest good” is so important).

My grandmother was exhausted and happily handed over the care to me so she could sleep. I stepped up and stepped in, having had no real preparation. My grandfather was already in his deep coma sleep so he was uncommunicative (verbally, aloud). His appearance and labored breathing begged the questions: How are you still alive? And why?

I sat by his side in that quiet house that night, reading a book that was coincidentally perfect and contained his favorite prayer, “Make me an Instrument of your peace.” I spoke to him on a spiritual level with comforting words. I gave him the tiny amounts of prescribed oral meds at prescribed intervals. He slept, did not move, and rarely breathed. I was sure he was working, though. It seemed like hard work. Mysterious work. Working through something…working on something…working toward something. I encouraged his efforts and held him in compassion and love.

For his wife and children (one of whom had not been able to visit for a length of time because it was too upsetting, and one of whom only entered the room for the final breaths), it was excruciating to get through this period as it continued on, much the same, the next morning. This was something I noticed but did not share in their sentiment. Because of my birth work, I was comfortable with the unknown—intrigued by it—an eager student of it. This is what death asks of doulas. Can settle into this liminal space?

End-of-Life Care: Can Death Be Beautiful?

We seem to afford birth more ups and downs, while still calling it “beautiful.”  But birth is also work (“labor”). It asks for all of a woman—all of her strength, determination, and trust. We puke, we have diarrhea, we have flashbacks of abuse and trauma, we scream, we beg for it to end, we moan like animals, we bite on things, we cry. Not always, not all of it, not for everyone every time. But they’re normal aspects, and yet birth is still “beautiful.” And it is.

So, without casting our yearning for perfection and control, can death be beautiful, too? Can we hold steady through the ups and downs? Can we companion people into the “wilderness of the soul?” Can we “doula?” I say, yes. We can. Not without apprehension or doubt—that isn’t reasonable. But, with trust—trust in the humanity that lives in our core, and trust in our compassion and intention. We can, with unwavering, prevailing trust.

Learn about UVM’s End-of-Life Doula Professional Certificate Program.

-Francesca Arnoldy developed and facilitates the End-of-Life Doula Professional Certificate program to strengthen an individual’s resolve as they enter into this sacred realm of service. She’s currently working on a memoir inspired by her years as a doula. She lives in Hinesburg with her husband and their two kids. 

Amy Trubek Examines What Cooking Means in the Modern Age

My feelings about cooking are complicated. Sometimes I feel joy when I cook, and other times it’s more like shame. After reading “Making Modern Meals: How Americans Cook Today” by UVM Associate Professor of Nutrition and Food Science Amy Trubek, PhD, I was at once relieved and alarmed that I’m hardly alone.

I was raised in an Irish-Catholic household, the youngest of seven children. Every night, my mother cooked a protein, starch, and vegetable for dinner. Meals usually consisted of chicken, venison, liver or trout, along with potatoes or rice and green beans or peas.

For some reason, my mother and I never cooked together. We would bake cakes once in a while, but cooking was never part of our relationship. She never asked me to help, and I guess I wasn’t interested enough to take the initiative and learn from her in the kitchen.

My lack of knowledge and indifference eventually turned into intimidation, which made me avoid cooking altogether in my 20s and early 30s. It wasn’t until I was married and had a child that I faced my fear. Once I became a mother, I figured it was time to buy a skillet and figure out a way to regularly cook for my family.

What Does Cooking Mean to People in the 21st Century?

Trubek, a trained cultural anthropologist and chef, teaches at UVM on the contemporary food system, food and culture, qualitative research methods, and food history.

To research “Making Modern Meals: How Americans Cook Today” (University of California Press, 2017), she visited homes and professional kitchens to interview 50 people, including parents, working professionals, bakers, and chefs about their cooking strategies, habits, and challenges.

“I found myself very moved by how much food matters to people, and that they want to do the right thing as best they can,” Trubek said in an interview last week. “Everybody wants to nurture themselves and others. It’s not that they don’t want to, it’s just that it’s difficult.”

Her book is organized innto five sections: Cooking Is a Chore, Cooking Is an Occupation, Cooking Is an Art, Cooking Is a Craft, and Cooking Is for Health.

Trubek also examines the social pressures and domestic ideals tied to cooking, especially for women. The chore of cooking has become so entangled with social obligations and moral values, and providing good food defined as “healthy” has become equated with being a good mother.

Perhaps I’m a good mother when I cook locally sourced beef chili in my slow cooker and a bad one when I serve up a box of macaroni and cheese for dinner. That’s often how it feels. It’s one of the complexities that Trubek set out to learn more about in “Making Modern Meals.”

In the Cooking Is a Chore chapter, Trubek writes, “It can be argued that ambivalence toward making everyday meals has run wide and deep in the case of American women because they are laboring with such a heavy symbolic load on their backs. Even though women can now vote, wear pants, and work outside the home, cooking as ‘the regular or daily light work of a household or farm’ remains part of a women’s role as the center of family life.”

She acknowledges that it’s hard not to feel a certain amount of pressure and emotion in the kitchen. With the rise of celebrity chefs, glossy food photos on Instagram, and Tasty Tuesday videos on YouTube, food has become increasingly glamourous while cooking remains a virtuous task. Still, it’s hard to believe that in 2017, cooking dinner continues to crackle with such a cultural and moral charge.

Unfortunately, Trubek doesn’t see that changing anytime soon. “We’re social animals, and social comparison is a way we define ourselves,” she says. “But do you need to feel in anyway burdened by it? The answer is no.”

When it comes to gender roles, she does see a potential shift on the horizon “If one of the big changes we’re seeing is that cooking is not an everyday chore, but rather an expression of self or care for the family, then the question of gender is really compressing. It will be interesting in 50 years to see whether anyone views cooking to be associated with a particular gender.”

In or Out: Where We Eat

Prior to the Industrial Revolution, almost all food preparation occurred at the household level. In 1929, Americans spent 85 percent of their total food budget on food prepared in the home, and 15 percent of food eaten outside the home. In 2012, Americans spent over 50 percent of their total food budget on foods eaten outside the home.

Cooking has clearly been transformed over the past several decades. We spend more money on food prepared outside the home, spend less time cooking, eat fewer meals at home, and have more diet-related disease issues. Trubek agrees that one culprit is the demands of modern life, such as working full-time while raising children.  We also have more options for enjoying food outside the home than our grandparents or great-grandparents did 75 or 100 years ago.

Lack of time and stage of life do make a difference in a person’s decision to cook or eat out, Trubek says. Research has also found that being of a more advanced age had a significant, positive effect on time spent preparing food, most likely because these people are retired or have less time-consuming jobs.

For me, a working parent, it’s hard enough to find time to prepare meals, let alone teach my six-year-old daughter much about cooking.  But I also don’t want my daughter to feel as lost in the kitchen as I once did. Since she was three years old, my daughter has helped my husband and I make things like blueberry pancakes, lasagna, and chicken pot pie.  How should I continue to teach her to cook when I don’t have decades of wisdom to pass down?

“I think you can make cooking with her somehow necessary and meaningful, but it doesn’t need to have a huge amount of emotional weight,” Trubek says. “When it comes to food and cooking—especially domestic cooking—emotions have become a big part of it. I think that is just part of who we are. But I think you can also just look at it matter-of-factly with your daughter as in, ‘We’re cooking, this is something we do, and this is what is happening today.’”

Ultimately, Trubek hopes that a conversation about why cooking matters will help address other issues like obesity and the rising consumption of processed food.

“The thing I find fascinating is that cooking has been a profoundly important piece of the human experience. We think about cooking a lot, but we don’t verbalize our thoughts. However, when you talk about it, you realize how complex cooking really is.” she says. “By having a cultural conversation about cooking and food, it can lead to better teaching, better communication, and better policies about food.”

Filling a Critical Gap in End-of-Life Care

By Cabot Creamery Co-operative

Death is a natural part of life. Even so, talking about death feels anything but natural.

According to the National Palliative Care Center, 20 percent of the United States’ population will be over age 65 by the year 2030—that’s more than 60 million people. Chances are, a significant portion of these seniors will be diagnosed with a terminal illness.

A recent article in the New York Times reported that, on average, patients make 29 visits to the doctor’s office in their last six months of life, even though 80 percent of patients say they hope to avoid hospitalization and intensive care at the end of life. Our healthcare system is designed to save lives—or attempt to do so—regardless of the outcome or impact on a patient’s quality of life. However, our healthcare system is only beginning to recognize the value of high quality end-of-life care.

Fortunately, there is a growing movement that helps fill the critical gap in end-of-life care. For the terminally ill, dying is a process they’re living through. End of-life doulas (also known as death doulas, soul midwives, transition coaches, and more), help the dying live better throughout the process—and ultimately die well.

For the farm families who own Cabot, life and death are a part of everyday life. From their animals to the generations of family who have run the farms, Cabot farmers have a unique perspective on dying and want to help others have better conversations around the topic, including the Death Over Dinner Project, an interactive conversation with dozens of medical and wellness leaders about end-of-life care.

Here are 3 things you might not know about end-of-life doulas:

End-of-life doulas are in demand.

The word doula, which comes from the ancient Greek word for servant, is traditionally associated with childbirth. In this context, a doula provides emotional and physical comfort and support to a mother before, during, and immediately after childbirth. End-of-life doulas serve essentially the same purpose, but at the opposite end of the life cycle. They provide care and support for the dying and their family, guiding them through unfamiliar territory and making the transition as physically, emotionally, and spiritually peaceful as possible.

End-of-life doulas don’t replace palliative and hospice care providers.

Instead, doulas work alongside providers to ensure the holistic comfort of the dying. While many end-of-life doulas come from nursing or therapeutic backgrounds, it’s not a prerequisite, as their role as a doula is not medical. While other caregivers focus on the body, end-of-life doulas focus on the soul. The role of a doula might be best described as faithful companion, or friend in death. Being physically and mentally present for the dying is their first priority. They may be part of a broader support system, or they may be the only one there to hold a hand. The process of dying is deeply personal, and as individual as each of us. Doulas adapt to meet the needs and wants at hand.

Professional end-of-life doulas receive training and certification.

Compassion comes naturally, but anticipating, understanding, and supporting the needs of the dying, and often their families, takes specialized skills, training and education. Several end- of-life care certification programs exist in the United States, including the University of Vermont’s (UVM) End of Life Doula Professional Certificate.

UVM’s certificate program comprises eight-weeks of interactive online content based on a comprehensive curriculum that includes:

  • Death Awareness
  • Commonalities in the End-of-Life Experience
  • The Grief Continuum
  • Dignity Therapy
  • Holding Space/ Honoring Sacred Space
  • Religious/ Cultural Beliefs and Practices
  • Preparing for Loss
  • Bereavement Support and Much More

Program graduates come away prepared to meet the growing demand for meaningful, compassionate end-of life care.

“Death matters. It’s a meaningful, emotionally-complex, natural part of life,” says end-of-life doula Francesca Arnoldy, who orchestrated the UVM program in association with the UVM Larner College of Medicine, UVM Continuing and Distance Education, and Cabot Creamery’s Centennial Legacy Projects. “Doulas understand the importance of the experience—for the person dying and for those being left behind. They provide a hand to hold, a listening ear, and nonjudgmental, compassionate understanding during the dying process—aiding comfort, relieving anxiety, while helping to shift our culture’s fear of death into empowerment.”

Learn more about the End of Life Doula program at UVM.

Author Michael Moss Exposes How the Food Giants Hooked Us

By Andrea Estey

Have you ever snacked on a bag of salty, crunchy chips and gotten the feeling that you just couldn’t stop? You’re not alone. That irresistible sensation is completely by design. It’s just one of the ways the processed food industry tempts us to eat more of “the food we hate to love,” as author and journalist Michael Moss illuminated at the 2017 Aiken Lecture on Nov. 1.

Drawing on his best-selling book, “Salt Sugar Fat: How the Food Giants Hooked Us,” Moss took the audience, sitting in a packed Ira Allen Chapel, on an exposé of this “unholy trinity,” the ingredients the trillion-dollar industry “relies on to make their products easy, irresistible, and cheap.”

Moss used potato chips as an example. The satisfying “mouthfeel” you get, said Moss, is exactly what the industry is after; chips can be as much as 50 percent fat. Another key part of the chip equation is their crunch: The industry has figured out that the more noise a chip makes, the more of them you’ll want to eat.

And consumers seem to be paying the price. According to the NIH, more than one in three adults, and one in six children and adolescents, are considered to have obesity in the United States. Those numbers have big implications – some estimate associated healthcare costs at more than $150 billion nationwide.

“Crawling around the food system is like reading a detective story,” said Moss, whose work as an investigative reporter with the New York Times on the dangers of contaminated meat won him a Pulitzer Prize in 2010.

What Moss has unearthed in his food systems detective work is lots of deliberate product development, and marketing, to make us consume more. Some tactics, says Moss, echo those used by big tobacco. (In fact, Philip Morris owned Kraft Foods until 2007.)

Moss points to Lunchables as a case study. In addition to the salty, fatty chow inside every package, it’s marketing that makes the product so successful with children, said Moss. “Lunchables give kids the feeling of empowerment.” Their slogan: “Lunchtime is All Yours.”

Where do we go from here? Moss said the work starts when we’re young, when our strongest food memories and associations are formed. “In talking with kids, we need to help them see information about food as empowerment.”

Since information is power, when you’re reading an ingredient list, Moss suggested paying attention to what order things are listed (the biggest item comes first, and the smallest comes last). “You have to be careful in the grocery store,” said Moss, as he walked through the ingredient list of a frozen broccoli, potato and cheddar dinner, in which broccoli was the very last ingredient.

As for the larger food industry, Moss hopes produce growers and the makers of other whole foods will have fun marketing their goods, as processed foods titans have, rather than preaching. Moss worked with an ad agency to test this fun-first approach, and developed a marketing campaign for the much-loathed vegetable, broccoli. Taking a page out of the processed food industry’s handbook, the campaign was built on a fictitious brand battle, pitting broccoli against kale, the trendy vegetable of the moment. One ad from the campaign read: “Broccoli: Now 43 percent less pretentious than kale.”

During his visit to campus, Moss also spoke with a group of 25 food systems students. He seemed to speak to them as he ended his talk with a call for exposing the truth behind the things we eat. “We have to take an investigative reporting approach to food systems.”

-Andrea Estey is a writer and digital content strategist for the University of Vermont.

 

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