Establishing an International Community Nutrition Partnership

2015 Wimpfheimer-Guggenheim Essay Competition Winner

By: Erin Bergquist, MPH, RD, CNSC, LD


Over the past 2 years, twenty-six Iowa State University (ISU) Dietetics Interns have had the experience of a lifetime during their 4-week optional community nutrition rotation in rural Ghana.

Planning this experience was several years in the making, and consisted of strong partnerships with key academic institutions and leaders. Dr. Grace Marquis of McGill University (former ISU faculty) was instrumental in introducing ISU to University of Ghana’s Associate Professor Dr. Anna Lartey. ISU has a strong history of global partnerships and study abroad experiences, but incorporating optional international supervised practice experiences within the Dietetics Internship (DI) was a new experience. First steps in the process included getting the green-light from ISU Food Science and Human Nutrition Department Chair and College of Human Sciences Dean and obtaining a Memorandum of Understanding with the University of Ghana (UG). Next, the DI received a grant to visit the UG Nutrition and Research Training Centre, where interns would be housed during this experience, in early 2011. A Major Change Request to include up to 200 hours of optional international supervised practice in the ISU DI was submitted to ACEND and granted in summer 2011.

After the site visit and many discussions with the UG Nutrition and Food Science Department, UG Dietetics Internship program, local dietitians, local hospital and key leaders in the Asesewa community a rough plan was set into place. Over the course of the next year, through Skype, conference calls and one face-to-face meeting in Canada, the internship experience was planned to the smallest detail.

Typical activities for each internship class include meetings with key people in the community, including the hospital physician and administrator, local chief, local queen mother, mayor, police chief, community focus groups, visits to the local market, Princess Marie-Louise Children’s Hospital, local mill and local site seeing excursions.

Intern applicants to the international community rotation complete the standard application requirements for ISU with additional written essay and phone interview that assesses their potential for success in this opportunity. Situation-based questions address leadership skills, flexibility, teamwork and critical thinking skills, along with physical, and emotional demands of international travel. Once the interns are selected, the DI works closely with ISU’s Study Abroad Center. Health requirements and site-specific trainings are completed to ensure everyone is ready for travel and familiar with the location, usual diet, culture and customs they are about to experience first-hand.

Planning the experience relies heavily on recommendations from the UG and local dietitians affiliated with the Ghana Health Service, Ghana’s government run health care system. Consideration is given to allow for transportation time and rest, but for the most part, activity filled days keep the interns engaged in their surroundings and interacting with the Ghanaian and Canadian interns. Intern complete the program’s capstone project titled, Technology in Health Promotion, which meets the following competencies: CRD 1.1, 1.2, 1.3, 1.4, 1.5, 2.1, 2.2, 2.3, 2.9, 2.10. 3.1a,b,c,d,e, 3.2, 3.3, 3.4, 4.5, 4.6, 4.8, 4.10. As part of the project, interns practice the Nutrition Care Process in two small communities in the Upper Manya Krobo district of Ghana, focusing on complementary feeding practices of breastfed infants ages 6 months to 2 years. The assessment data includes focus group discussions with community elders and leaders, research into health findings and previous studies in similar areas of the region, a questionnaire (translators assisted interpretation), and anthropometric data gathering. A nutrition diagnosis is then decided. To address the intervention, interns gather the village members in a “durbar” or health fair where they perform culturally appropriate demonstrations addressing the nutrition problem. Interns use their creativity to perform cooking demonstrations, songs incorporating nutrition messaging, or skits demonstrating recommended feeding practices. The “durbar” typically has more than 70 community members present, including key leaders such as the local chief. Interns also formally present their findings to key leaders within the community and at the University of Ghana.

Interns are evaluated using a variety of methods, including weekly evaluations, weekly reflective blogs and group projects. All in all, these experiences have been an enormous success with comments from interns, such as, “After this experience, I learned my previous assumption that the NCP was only for clinical work was completely false, and now I can apply this process to help organize my thinking in any situation,” “I have learned a lot about myself and really improved my teamwork abilities,” “I have vastly improved my skills in communicating with people of different cultures through this experience,” and “I now have the confidence to deal with any situation, I am ready to head back to the U.S. and nail my first job interview!”

Although the road to developing an international program can be long, lessons provided to dietetic interns can be timeless. Through this experience, ISU DI can conclude that international experiences provide students with a more intensive experience than can be expected through local placements in the U.S., thus stimulating the students’ creativity, building their knowledge about the steps in assessing and developing approaches to problems in health, and expanding their confidence to be able to be successful in their future career.

For more information about Iowa State University Dietetic Internship’s International Program, contact Erin Bergquist erin_b@iastate.edu.