In the bowels of an east Toronto hospital lined with aquamarine tile and vintage Garland ovens, a star chef has begun a year-long experiment to revolutionize the most mocked and inedible of institutional foods.
Joshna Maharaj built her reputation whipping up healthy feasts at disparate venues, from a food bank to a high-end cooking school. The challenge of restoring palatability to in-patient food is her most daunting yet - and whether she succeeds is likely to influence the future of hospital food across the country.
The presence of the Toronto-based chef at Scarborough Hospital is proof that people in power have begun to recognize the link between health and good food, and believe it should be heeded in a place that caters to the ailing. Paradoxically, hospital patients are fed some of the nation's cheapest food - each meal costs less than three dollars per person. Much of it goes into the trash: About 40 per cent of what kitchens dish out is rejected. Administrators everywhere are struggling with this and low patient satisfaction; many admit they would never feed their families the low-budget food their kitchens serve to patients.
"Hospital food is a joke. There's not enough fresh vegetables, no salads," said Anne Marie Males, vice-president of patient experience at Scarborough. "We are increasingly out of line with the way people eat at home. Strangely, in the health-care industry, we've kind of forgotten about the connection between food and health."
The most tantalizing prospect involves adding fresh or local foods and returning to scratch cooking. Most Canadian hospitals have long since given up the basics, such as distilling soup stock from simmered bones, in favour of convenient powdered mixes. Some have gutted kitchens altogether, lured by the 30-per-cent labour cost savings that comes with installing what the industry terms "kitchen-less" systems. These consist mainly of "re-thermalization" units used to reheat food that is prepared offsite in massive kitchens. They formulate nutritionally correct meals with scientific precision.
These systems, which gained popularity in the 1980s, are "the only way of operating an efficient food service operation within the funding envelope of the Canadian Public Health Care system," according to material published by Burlodge, a large meal delivery equipment vendor.
Ms. Maharaj's mission is to prove that scratch cooking is a feasible panacea in this publicly funded, cash-strapped system. She'll try to do it by shifting the hospital's procurement - when it's cheaper - to produce certified by the sustainability inspection group Local Food Plus. She imagines a pot of curry on the fire to appeal to multicultural tastes; recipes will be sent up to patients on friendly prescription-type cards so they can replicate them at home.
She has her work cut out for her: Hospital kitchens have long been seen as little more than a cost-centre ripe for cutbacks. That she has taken on the challenge is already a small victory for the food movement, which has long eyed the health and education systems as avenues for democratization.
"Food needs a champion. It needs someone to fight for it," she said. "What you eat directly impacts your health and recuperation."
The reams of studies documenting this led the hospital to hire Ms. Maharaj after winning a $191,000 grant from the provincial government and the Greenbelt Fund. That the government backed the proposal is a sign of Canada's flirtation with an American trend: 40 U.S. hospitals run by the firm Kaiser Permanente have transformed themselves into community food hubs by hosting farmers' markets to ease access to healthy fare. Propelling the effort is the belief that nutritious food is a public-health tool, one that can address many of the issues that cause illness - obesity, heart disease, diabetes - and drive up healthcare costs.
"I come to work every day thinking about how do we keep people healthy in the first place," said Preston Maring, the Oakland, Calif., obstetrician who launched the first hospital-based market. "Providing easy access to good, healthy food is just common sense. A sharp chef's knife, two cutting boards and a salad spinner are the best public-health tools you can have."
Some hospitals across Canada have begun hosting regular markets, including two in Winnipeg, at least one in Nova Scotia and the Hospital for Sick Children in Toronto. But few have attempted a full-scale re-embrace of local foods and conventional cooking for the in-patient menu.
There are many factors holding them back: the reigning perception that fresh produce costs more than frozen outsourced food, lack of full kitchens, and staff without bona fide cooking skills. There is also the thorny issue of what drives patient satisfaction, which some corporate studies suggest has more to do with food temperature, having options to choose from and face-time with attendants than meal contents.
"I don't think there's a tradeoff in terms of home-cooked versus re-thermalization," said Susan McKay, vice-president of food services for Alberta Health. "Sometimes home cooking evokes certain things, but it doesn't necessarily mean it's always good."
Leslie Carson, manager of food and nutrition at St. Joseph's Health Centre in Guelph, a 330-bed facility with acute and long-term care patients, would disagree, having recently shifted her facility back to scratch cooking.
"People underestimate how conventional cooking really gives your employees a sense of creation.… there is no joy in unpacking frozen lasagna from a box. But there is joy in making something from scratch," she said.
That is propelling Ms. Maharaj and a team eager to "get back to cooking."
"It's not that we haven't wanted to. We haven't had the opportunity," said Debbie Lennox, a cook employed by the hospital since the '80s, when two bakers, a butcher and a dozen more staff produced food so good it won a glowing review in a local newspaper.
Many are rooting for the hospital's success.
"I think they're going to prove it's a viable thing to do and it will lead to far greater outcomes than just serving food from local farmers," said Paul Sawtell, owner of the Toronto-based distributor 100km Foods Inc. "The red herrings … about local food being more expensive are slowly being proven incorrect."