Smart Bites September 2022 Issue

Smart Bites

GPCME CONFERENCE

Dietitians creating opportunities at GPCME

DNZ AWARD WINNERS

Meet our ANA scholarship winner, Bernice Kelly Award winner and 2022 Young Achiever Award winner

DNZ CONFERENCE

Highlights from the 2022 DNZ Conference

Click where you see this link to learn more.

Smart Bites is the quarterly magazine of Dietitians New Zealand. We exist to build a strong and sustainable profession that empowers New Zealanders to make informed food and nutrition choices and inspire change that enhances the health and wellbeing of Aotearoa, New Zealand.

Smart Bites has taken the baton of informing and updating our members from "News and Views", which for 56 years was the voice of the New Zealand Dietetic Association and then Dietitians New Zealand. Ka mua, ka muri.

Discover us online: www.dietitians.org.nz IG dietitiansnz

Contact us:

General Manager: Kath Eastwood admin@dietitians.org.nz

Editorial team: Julie Carter, Anna Greenan, Lizz Whittred, Deepti Shivandhana editorsmartbites@gmail.com

Kia ora koutou,

My name is Deepti and I'm a NZ registered dietitian currently working at Starship Community as a Paediatric Dietitian. I have recently joined the Smart Bites Editorial Team and am looking forward to meeting new dietitians and reconnecting with past colleagues.

My journey into dietetics is one echoed by so many others - I like health and I love food However, after working in this field, I've realised it is so much more than that, which is wonderfully highlighted in this issue. Thank you to all our contributors.

Upon graduating, I moved to Nelson and worked in primary care and did a bit of private work for three years alongside some brilliant and intelligent wāhine. Special mention to Tonia Talbot, Naomi Johnson and Julie North who took me under their wing and helped shape me into the dietitian (and person) I am today

My one piece of advice for new graduates is to move out of your comfort zone and apply for jobs in different parts of the country - you will not regret it.

Deepti Shivandhana

In this edition of Smart Bites, we showcase several highlights from the 2022 Dietitians NZ conference in Ōtautahi Christchurch and shine the spotlight on award recipients.

A personal highlight that resonated with me was acknowledging the tremendous amount of work Dietitians do that extends far beyond nutrition. This commitment and dedication to our work and to our community is truly extraordinary and makes me feel very proud to be a dietitian.

Enjoy reading this edition, Deepti

It’s all in the letter C: Conference reflections

As the 2022 Dietitians NZ Hybrid Conference comes to an end, I can sit back and reflect on the last couple of days. Isn’t it interesting the first place my brain goes is to all the things that didn’t go well! Dietitians (and I am no exception!) are a critical bunch…perhaps I had an unconscious premonition because the only book I took with me to Christchurch was on self compassion a timely reminder to take the small wins and not be quite so hard on ourselves! So, as I reflected on the event, I was reminded to focus on the positives and there were certainly lots of these.

Our theme, Te Kākano The Seed, was about the generation of new ideas, innovation, and the growth of Dietitians & Te Kahui Manukura o Kai Ora. It was about how we as dietitians nurture the seed inside whānau and those we work with so they can flourish. When I reflect on this theme and the two days, there were three aspects that really stood out.

Connection

How great was it to connect kanohi ki te kanohi for the first time in three years! It was wonderful to have our annual conference in the South Island for the first time in over a decade and I would like to thank all those who attended, especially those who travelled from far and wide, as well as those who connected in virtually. These connections and relationships are the foundations that provide the platform to enable the people we work with flourish. Everything is about relationships!

Kath Eastwood

Collaboration

It never ceases to amaze me the great work that is being done around the country by dietitians! Events like conference provide a great platform to share, learn from each other and collaborate in the process making good ideas great! We know that sometimes we can go faster alone, but the truth is, we go much further together. We want to cultivate a culture of collaboration and communication so that we can deliver greater collective impact and value to the communities we serve. When the health and disability system reform was announced I was hopeful that with only one commissioning agency, there would be a lot less silos and far greater integration and collaboration. I was reminded at conference though that collaboration doesn’t just happen simply changing a structure doesn’t change behaviour and collaboration is a behaviour it takes relationships!

Courage

The changes that are coming across the health sector are a chance for dietitians to identify opportunities and have the courage to step into the vacant spaces. Just because it hasn’t been done before, doesn’t mean it can’t be done, and if someone has to do it, why can’t it be us. I appreciate that sometimes doing something different can seem a little overwhelming. It’s important to remember though that we don’t go from having a seed to a great big plant overnight! It often takes time for people to catch on to new ideas and innovation and even though we live in a society of ‘we want it now’, those seeds/ ideas can grow into something significant with the right support so let’s invest in the long game and our relationships.

Kath Eastwood GM, Dietitians NZ

DNZ conference

David Letele at DNZ conference

News from the Registrar’s Desk

I’m writing this following a wellbeing holiday break in Australia my first trip out of the country for three years reconnecting with family and friends. Many of you will have experienced similar stays or deferred travels due to COVID 19. While away, the mask mandates and the health and disability vaccine mandates were both revoked. If you haven’t caught up with the official COVID 19 changes, here are some useful links:

1 COVID 19 Public Health Response (Masks) Order 2022 https://www.legislation.govt.nz/regulation/public/2022/0255/latest/whole.html

2. COVID 19 Public Health Response (Covid 19 Vaccine Certificate) Order Revocation Order 2022 https://www.legislation.govt.nz/regulation/public/2021/0094/latest/LMS487853.html

3. It is recommended that healthcare workers follow the infection prevention and control. Recommendations for health and disability care workers available at: https://www.health.govt.nz/covid 19 novel coronavirus/covid 19 information specific audiences/covid-19-personal-protective-equipment-central-supply/infection-preventionand-control-recommendations-health-and-disability-care-workers

Changes to the Dietitians Board/Te Mana Mātanga Māta Kai

Hon Auptio William Sio, the Associate Minister of Health, recently appointed two lay members to the Board. We welcome Irene Durham and Julia Hunter. Their bios can be found here: https://www.dietitiansboard.org.nz/the board/board members/

We also farewell Catherine Humphrey (Dietitian), Louise Mainvil (Dietitian), Jennifer Pelvin (lay member), Hiki Pihema (Dietitian), and Jordan Waititi (lay member). The Board appreciates the services and expertise contributed by the former Board members.

Dietitians are invited to contact the Registrar, Acting Chair Soana Muimuiheata, or Te Manātu Hauora if interested in applying to become a Board member. We are also interested in hearing from Dietitians who may be interested in support roles such as examinations work, tikānga and/or clinical advice, audit or prescribing roles, and professional competence reviews. All this work happens behind the scenes and is critical to the Board’s functions and delivery.

Prescribing

The Board is pleased to advise all 11 Dietitians who undertook the joint universities’ prescribers’ course have passed.

Thank you to those dietitians who completed the prescribing survey. Results are being analysed and will be reported on.

The Moodle quiz for 22/23 (compulsory for Dietitians with a Prescribing Endorsement) is undergoing user testing. It will be released shortly and we will alert you to the Go Live Date in the Board’s Panui. Thank you to the prescribing sub committee for their hard work on both Moodle and the survey.

Workforce

Analysis of Board registration data for the 2021/22 year by Te Whatu Ora indicates an increasing gap in supply of Registered Dietitians, especially in diabetes management, based on demand projections to 2035. The Board will report on this topic in its annual report and continues to raise the issue of service demand and training of Dietitians with key players. The loss of Otago University from the training pool equates to on average a loss of 16 qualified Dietitians per annum. The Board is grateful for the efforts of Auckland and Massey Universities for their commitment and stepping up to fill some of the training capacity demand created.

Kia Ora,

After two long years, we have finally been able to hold the Dietitian NZ National Conference in the beautiful Ōtautahi Christchurch, with both in person and virtual attendance available. It was so nice to be able to finally catch up in person with everyone at the beautiful Christchurch Town Hall. We had some wonderful and inspirational speakers and it was really valuable to be together again to share ideas, network and meet with representatives from the trade displays. We encourage all dietitians to attend our next conference in person as you really can’t beat the face to face experience.

The theme of conference was Te Kākano

The seed. This encompasses the growth Dietitians New Zealand is going through in developing its partnership with Te Kahui Manukura o Kai Ora, but also the changes within the healthcare system with the introduction of Te Whatu Ora, Health New Zealand and Te Aka Whai Ora, Māori Health Authority. It’s an opportunity for us as individuals and as a whole to reflect on where we have come from and plant new seeds to start growing a dietetics profession that is more equitable for all New Zealanders.

As a council, we ourselves have been reflecting on the direction Dietitians NZ is going. We are continuing to work on how we formalise our relationship with Te Kahui Manukura o Kai Ora.

Tyla Goodsell Mathews

As you are aware we finalised our Statement of Intent last year and are now looking at how we action this statement of intent in both the work Dietitians NZ does both internally and externally. Alongside this we are looking at how we can support our membership on their journey working within the statement of intent.

In the coming month, we are looking forward to welcoming in new council members who will bring new knowledge, perspective and energy into council. Lastly, we would like thank Liz Beaglehole for coming back onto council and helping us out over the last six months. Thank you Liz!

Written by Tyla Goodsell Mathews and Liz Beaglehole

Liz Beaglehole

Waipapa Taumata Rau, University of Auckland, Nutrition and Dietetics Update

In 2019 the Nutrition and Dietetics team at Waipapa Taumata Rau, University of Auckland, started sending two students per year to Whakatāne to join the Rural Health Interprofessional Programme (RHIP). Students spend five weeks in Whakatāne living with other students, immersed in the local community, and learning with and from each other. Very quickly, the benefits to student learning outcomes became apparent from this placement.

Following this success, when the opportunity arose for our students to join the University of Otago Interprofessional Education (IPE) Placements based in Tairāwhiti and Greymouth in 2022, swift changes were made to year two placement timetables to incorporate them. This has resulted in up to 17 students each year being able to experience these interprofessional placement opportunities.

During the five-weeks Nutrition and Dietetic students complete work integrated learning placements in Public Health and Medical Nutrition Therapy, spending time with dietitians in local hospitals and primary health organisations, and engaging with key stakeholders within education and health settings. There are also significant opportunities for student learning in:

Interprofessional education

Hauora Māori

Rural Health

Management of long term conditions

Holistic care of patients

Communication and collaboration

Advocating for the role of Dietitians in

small communities

Hospital and community health providers

outside of Auckland

(left to right) Kristen Clarke and Clare Wallis (University of Auckland Professional Teaching Fellows) with Hiki Pihema (Deputy Programme Leader, Tairāwhiti Interprofessional Programme) pausing to rest and reflect on the walk to Cooks Cove, Tolaga Bay, Tairāwhiti

Examples of learning experiences include:

Noho Marae

Local school visits to see the connection of education and health and wellbeing Spending time on a farm learning about farm life and links with health Rongoā (Māori healing system) through flora and fauna foraging Kemu Māori (Māori games) from Sport Gisborne Wairua session

Clinical psychology through a Māori worldview

Visit with DOC to kiwi nursery to see link of environment and health Te Pare o Toi (Health for Māori) session on Te Tiriti o Waitangi Basic sign language workshop

These learning opportunities all provide Nutrition and Dietetic students with a deeper understanding of food, nutrition, and health in the context of the communities which they spend time in.

For more insight into the outcomes of these programme results of the Longitudinal Interprofessional study reviewing the long term impact on health professional students the Otago IPE programme in Tairāwhiti have been published in the BMJ: https://bmjopen.bmj.com/content/12/7/e060066. This study found students developed teamwork skills and positive attitudes to collaborative learning.

A special thank you to the Dietitians in Whakatāne, Greymouth and Tairāwhiti who support our students while on these placements we couldn’t do it without you!

Student Dietitian, Morgan Easton’s reflection on her Rural Health Interprofessional (RHIP) placement in Whakatāne:

The RHIP placement is a very unique and rewarding experience. It is a great opportunity to be based in an area you haven’t been before or considered working in. You gain a greater appreciation of rural health and the barriers to accessing healthcare, whilst being supported throughout the entire 5 weeks by the student coordinators based in Whakatāne. You live with other students from different degrees and build friendships and connections which are beneficial for your inter professional development, as you gain an understanding of their different scopes of practices and how you may work together in the future. Potlucks, BBQs and group activities are organised for you, and there is plenty of free time to surf, swim or enjoy the coastal walks! It truly felt like a once in a lifetime opportunity and I can’t recommend it enough!

Student Dietitian, Sophie Hooke’s reflection on her time on the West Coast IPE programme: I thoroughly enjoyed my time on the West Coast Being a rural environment, the smaller hospital and community allowed me to interact with a wide variety of patients, medical conditions, and demographics, expanding my clinical and public health practice. Living with other healthcare students allowed for interdisciplinary reflections and discussions which was invaluable. Outside of placement hours, the outdoor activities, such as hiking, caving, farm visits, day trips to Hokitika, were endless and heaps of fun!

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Students and staff at Cooks Cove, Tolaga Bay, Tairāwhiti

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C K L A N D U N I V E R S I

Student Dietitian Georgia Blomquist on RHIP placement photos from Noho Marae at Waikotitoki Marae, Minginui

MANUFACTURED INFANT AND TODDLER FOOD IN AUSTRALIA AND NEW ZEALAND

Some key findings in recently published articles examining the nutritional quality of infant and toddler foods and the health marketing messages on product labels.

In early September, 2021, I attended the Australasian Society of Clinical Immunology and Allergy (ASCIA) annual conference presentations, virtually. The presentation by Dr Merryn Netting, Dietitian highlighting the key findings of audits undertaken on manufactured infant and toddler foods sold in Australia was fascinating.

Merryn’s ASCIA presentation led me to look for recent NZ publications investigating the nutrition qualities of manufactured infant and toddler foods available in NZ. It is worth noting that compositional requirements for Foods for Infants are outlined in FSANZ Standard 2.9.2. These state specific requirements for iron and vitamin C fortification, restriction on sodium content and texture requirements for foods produced for infants. There are no specific requirements for toddlers; they come under the same schedule as manufactured foods for adults.

A review of 414 infant and toddler food products available in the major supermarket chains of Australia comprised mostly of mixed main dishes, fruit and vegetable first foods and snacks (1). The nutritient composition of the foods was obtained from the nutrient information panel on the product label, manufacturer or retailer websites. The products were compared with infant feeding advice. Investigators found that most foods were poor sources of iron except for fortified cereals. Around 80% of first foods were fruit based. Fruit and vegetable first foods were highest in total sugar followed by desserts and breakfasts. There were no single vegetable first foods. The actual meat content in meat based mixed dishes was 9% of total ingredients despite the name of the products suggesting they were a good source of protein and therefore iron. Nearly 50% of all products were smooth purees including nearly all fruit and vegetable first foods, ready made desserts and breakfasts. More than 70% of products for infants 4 6 months were in pouches. Of the products for infants and toddlers 8 months and older 40% were in pouches.

A recent NZ publication reporting the energy, total sugars, free sugars and added sugars, iron and vitamin B12 content of infant foods in pouches and other commercial foods available in NZ (2) utilised very different methodology when compared with the Australian investigators. Recipes and nutrient lines were developed for the 266 foods identified of which 133 (63.9%) were sold in pouches. Food sold in pouches contained more than three times as much total sugar then non-pouch foods. The dairy food group contained the most free sugars and added sugars, similar for both pouch and non pouch products All forms of food appart from the dry cereals fortified with iron, were low in iron. None of the food in pouches were fortified with iron. All food groups were low in Vitamin B12. A surprise finding of the study was that food in pouches has similar energy content to non pouch food.

In 2019 the data on infant and toddler food packaging was collected from 5 large grocery stores in Adelaide The content of 282 commercial products (215 infant foods and 67 toddler foods) were analysed for explicit and implicit features positioning them as “better for you” (3). Over one third of the packaging promoted positive nutritional qualities. ‘Natural’ statements and/or images were identified on all products and half displayed statements related to ‘organic’ ingredients. Of the fruit and vegetable based infant foods, 85% displayed a sugar statement suggesting a low sugar content despite being sweetened with fruit puree. Allergen free and developmental claims are used to position infant and toddler foods as “better for you” despite the foods being highly processed.

I hope that this brief overview of three excellent publications captures your interest enough to read the articles in full and inform your practice.

N Moumin, T Green, R Golley and M Netting. (2020). Are the nutrient and textural properties of Australian commercial infant and toddler foods consistent with infant feeding advice? British Journal of Nutrition doi:10 1017/S0007114520001695

I Katiforis, E Fleming, J Haszard, T Hape Cramond, R Taylor, AL Heath (2021) Energy, Sugars, Irons and Vitamin B12 Content of Commercial Infant Food Pouches and Other Commercial Infant Foods on the New Zealand Market Nutrients, 13, 657. doi:10.3390/nu13020657.

L Simmonds, A Brownbill, A Z M N tti (2021) H lth l t d k ti product labels of commercial infant and toddler food pa en. doi:10.1136/bmjpo 2021 001241

PAEDS SIG 2022 UPDATE

The Paediatric Special Interest Group took on new leadership towards the end of 2021, with Rhonda Akroyd and Jasmine Walton stepping down after a wonderful period of leadership. Thank you both!

The new convenors for the Paediatric SIG come from a variety of paediatric focused backgrounds, and include Dr Amy Lovell (research dietitian),

Amy Andrews (North Island, Te Whatu Ora dietitian), Kim Richardson (South Island Te Whatu Ora dietitian), and Rebecca Bruce (North Island private practice dietitian) The SIG hopes to expand the convenor group to include representation from community dietetics around the motu in 2023.

Members of the Paeds SIG completed a professional development survey at the end of 2021 to help us identify key areas of practice for Professional Development events and the preferred formats for its delivery Feedback from members included a desire to build opportunities for mentorship, discuss tricky case studies together, and upskill in several areas, including renal dietetics and gastroenterology. To kick this off, we hosted a half day workshop series at the DNZ Conference in Christchurch this month, with presentations and case studies from Stella Friedlander (Starship Child Health) and Stephanie Brown (Te Whatu Ora Waitaha Canterbury).

Stella facilitated three renal workshops this year covering several areas of paediatric renal dietetics. Sessions one and two were held over Zoom in June and July covering pre dialysis, dialysis,and transplant. At the Conference, the final topic in this series was nephrotic syndrome. These sessions were interactive and included pre-reading, practice updates, and case study discussions.It was great to see so many paediatric dietitians engaging with this practice area Stella’s committed to ensuring we provide standardised paediatric renal dietetic practice. Our other presentation was from Stephanie Brown who provided an update on Inflammatory Bowel Disease, with a focus on Crohn’s Disease, the research she is completing as part of her PhD, and a case study of a patient she has worked with to manage IBD flares with cyclical exclusive enteral nutrition.

Dr Amy Lovell

Rebecca Smart

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The SIG has had continued support from dietitians at Starship Child Health and Auckland City Hospital with regards to the prolonged difficulties with product availability across oral and enteral nutrition support options. Thank you to those that developed the substitutions for feeds and supplements algorithm earlier this year, it has been such a valuable tool. We have also had the opportunity to submit responses to several FSANZ proposals, notably “Consultation Paper 3” on specialised formula.Insights from our colleagues on areas of practice including metabolic, immunological, renal, hepatic and malabsorptive conditions in preterm infants made this a really strong submission.

In 2023, the Paeds SIG hopes to continue to grow our professional development opportunities. In the coming weeks, we will put out a proposal schedule of activities to our members to vote on topics of interest, opportunities to discuss challenging case studies, and identify members that would be happy to mentor and grow our profession.

Dietitians Creating Opportunities at GPCME

Ka pai to those dietitians who represented us at the 2022 Rotorua and Christchurch General Practice Conference and Medical Exhibitions (GPCME). Some of them share a little about their experience, and the opportunities they see for dietitians in the Primary Care sector, below.

With presentations covering a wide range of topics, including common nutrition issues, infant & childhood nutrition, irritable bowel, weight bias, heart disease, weight management, intuitive eating, community mental health, eating disorders and how dietitians can augment general practice, there was A LOT for delegates to take away.

The ability of dietitians to meet clients ‘where they are at’ using a range of personalised approaches was a recurring theme. Our evidence base, knowledge and skills across a range of medical conditions were highlighted, alongside our focus on behaviour change and practical lifestyle modifications rather than strict and unsustainable diets. Also, our value in multi-disciplinary teams, and how to access specialist nutrition support as well as reliable nutrition and lifestyle information

ManyGPsdon’tunderstandthatthelownumberofdietitiansis

Kate

Other key themes and challenges to delegates included:

Who is best to deliver lifestyle advice and do they have enough time for effective conversations? (Sarah Agar)

How can we have more compassionate conversations about weight? (Amy Lowry)

There are many reasons for gut symptoms, some excellent lifestyle options that can help and there is no one miracle cure (Helen Gibbs)

The two way relationship between mental illness and weight gain, incorporating bio psycho social determinants, and the impact of antipsychotic medications (Jo Tamaki)

Every conversation with a patient is an opportunity to plant the seed for behaviour change (Lily Henderson & Rajshri Roy)

Strategies to work with clients & whanau while waiting for specialist dietary support, highlighting red flags for people with eating disorders such as refeeding, purging, bowel, micronutrient, and mood challenges (Kate Syers)

The response to these sessions was overwhelmingly positive, stimulating questions, challenges, and new perspectives among the delegates. The main challenges seemed to be access to our services in Primary Care – and some competing messages from other popular diets.

Delegate feedback:

If only lifestyle changes could be effectively managed in 15min appointments…

Open to intuitive eating, and a different way of thinking

We’re sold on the value you can add now how and where can we access dietitians?

Great knowledge & tools…

Sarah Agar and Jo Tamaki workshop

Lily Henderson (left) and Rajshri Roy (right)

Of course, the delegates weren’t the only ones who came away with new learning and challenges. Opportunities were apparent across the spectrum of our profession as well.

The health system reforms favour an equitable, and potentially preventative approach to hauora with nutrition and lifestyle being key to health and quality of life.

We can consider how we track and create demand for our services, adding to the data and advocate for greater funding for nutrition and lifestyle interventions.

At the same time, how will we advocate for our skills and being valued at the top of our scope so that we are the ones training and supporting the non dietetic workforce (like health improvement practitioners and health coaches) to engage whanau using evidenced, tailored, and non-judgemental approaches to nutrition and behaviour change. How do we turn “Trust a dietitian to know about nutrition” into more than a slogan?

And remember, any opportunity to talk with our medical colleagues (who often have a lay understanding of nutrition) is an opportunity to create an ally. Whether we are breaking down how we work with whanau, or advocating for funding, we need to bring them on a journey to understand the unique contributions that we make.

In addition to our unique and broad nutrition knowledge, we have more time with our clients than most of our colleagues, and significant skills around behaviour change. Highlight how we think in terms of determinants other than what is in the diet for example, how an eating pattern or changes will be sustainable and work (or not) for whanau over the long term!

Our kōrero at the conferences was a challenge to the traditional Primary Care model of “GP and nurse” and an invitation to enjoy the many benefits of extending their MDT such as freeing up GP time so they can orientate their care to those most in need.

In addition, our collaboration at these forums was a great experience and a privilege to present alongside some amazing colleagues, showcasing our extraordinary dietetic skills and approach. Thank you to Dietitians New Zealand for creating this demand and space for us to participate and share.

With thanks to the following for sharing their thoughts and experiences:

Amy Lowry

Helen Gibbs

Jo Tamaki Kate Syers

Lily Henderson

Rajshri Roy Sarah Agar

ANA Scholarship:Hannah Rapata

Ko Motu pōhue tōku mauka

Ko Te ara a kiwa tōku tai

Ko Uruao, Takitimu, Tairea ōku waka

Ko Awarua tōku rohe

Ko Kai tahu tōku iwi

Ko kai atawhiua tōku hapū

Ko Te Rau Aroha tōku marae

Ko Tahupotiki tōku whare

Ko Hannah Rapata tōku ingoa

I am very honoured to be an ANA Public Health Nutrition Scholarship Recipient for 2022!

I am a recent dietetic graduate from Auckland University and currently doing a PhD. My PhD is titled “Te Kai ora a Kāi Tahu”: Conceptualising Kāi Tahu kai sovereignty and Māori nutrition data sovereignty.

As with any research, over the past year my PhD project has taken many twists and turns in topic and direction. I have chosen to focus my study in an area that will conceptualise kai sovereignty from a view specific to my iwi. A view that is grounded in Tino Rangatiratanga and informed by the painful history of land confiscation of Te Waka a Māui and the impact of this on Kāi Tahu mahika kai (traditional food practices, processes and places).

I am also exploring theorisations for the intersections of kai sovereignty and Māori nutrition data sovereignty. I will be doing this by analysing the nutrition data collected from Māori by the Crown and critiquing the relevance of this data for Māori and the representation of Māori nutritional wellbeing it propagates. This critique will inform the link between nutrition data, representation, and institutional racism.

On top of my studies, I am a Māmā to a very active 16 month old! Being a Māmā and studying fulltime is very busy and so any financial support I receive during my studies is incredibly valued.

Thank you, Dietitians New Zealand!

2022 AYoung chiever Award: Dushanka Hettige

Dushanka Hettige has shown leadership in many different aspects of her dietetic career. After graduation, Dushanka worked as a Public Health and Clinical Dietitian in Palmerston North before moving to Wellington Regional Hospital in 2019 for a Clinical Dietitian role in Intensive Care, Oncology, and Haematology. In 2021, she moved into the Clinical Coordinator role for the Wellington Dietetic team. Dushanka embraced this challenge, developing the role to provide leadership with oversight of the day to day inpatient caseload, COVID response planning, student coordination and leading effective changes in practice and processes. Dushanka also provides regular mentorship and supervision to several dietitians and is hugely passionate about dietitians working at the top of their scope. She has undertaken multiple service development projects to facilitate this including developing a Customised Parenteral Nutrition Guideline, leading dietitian competency training in this area and formulating Allied Health Assistant dietetic based competencies.

Most recently, Dushanka has worked alongside an Improvement Advisor to undertake a Quality Improvement (QI) project within Wellington ICU. This identified there was a delay in dietitian referrals for patients commencing enteral feeding, which found 50% of Māori patients were overfed compared to 33% of non Māori patients at initial dietetic assessment. Dushanka identified the adverse risk of overfeeding and therefore significant inequity within this patient group. After implementing change ideas (feeding pump stickers, staff education, and daily referral screening) there was a significant improvement in the percentage of patients referred on day 1 of feeding and consequently patients were seen on Day 2 of their ICU stay, in comparison to Day 5 previously. This has resulted in timelier dietitian reviews, reduced overfeeding, and more equitable health outcomes for Maori/Pasifika patients. Dushanka was named one of the project winners at the QI Showcase in April 2022 held by the CCDHB Centre of Clinical Excellence and has showcased this work to the wider ICU and dietetic team. Alongside this, Dushanka was the primary investigator for the NUTRIENT study and is the associate investigator for the TARGET Protein study at the Wellington ICU.

With this passion for improvement and leadership, Dushanka has taken a new role as a QI and Innovation Advisor, working alongside clinicians to guide health projects to improve system outcomes and help reduce the equity gap for Māori and Pasifika patients and whānau.

Since graduating, Dushanka has been a strong contributor to Dietitians NZ (DNZ), supporting the Wellington Branch Committee as both a general member and secretary. She is an active member of the ICU SIG and guidelines committee, was involved in the DNZ Student New Graduate Working Group (2019) and is a prescribing supervisor for the DNZ group prescribing supervision programme.

Dushanka has an amazing work ethic and holds much empathy for those around her. She is intensely proud of her Sri Lankan heritage and is an incredibly valued voice in ensuring that dietetic services at CCDHB are equitable for those of all cultural backgrounds. Dushanka’s leadership potential lies not only in her actions but her values as a colleague and team coordinator thus making her a worthy recipient of this award. She strives for open communication and maintains an approachable, easy manner which bodes extremely well for future leadership opportunities I am sure will come her way.

Dushanka Hettige

Bernice Kelly Award: Lydia Henderson

Lydia grew up in rural Leigh, north of Auckland. In 2016, she moved to Dunedin and completed two years of study in Physiotherapy at the University of Otago. During this time, she was introduced to Nutrition and Dietetics whilst on placement and realised that this was what she was most passionate about. She transferred to Massey University in 2017 and completed her BSc in Human Nutrition in 2019. She undertook the MSc in Nutrition and Dietetics from 2020 2021, graduating in May 2022.

Lydia’s passion for the Dietetics profession shone through in all aspects of her work and practice. She has a lovely nature and a strong patient centred approach. Throughout work integrated learning she demonstrated strong communication skills, the ability to discuss sensitive topics, and superb motivational interviewing skills with her patients. She is very flexible, resilient and was able to manage personal challenges alongside work commitments and her studies, whilst maintaining high standards of professionalism. Lydia’s confidence grew immensely during the two year programme, allowing her to emerge as a leader among her peers.

Lydia embraced placements within diverse communities in Northland, which provided her with an opportunity to learn more about Tikanga Māori. She showed significant growth in her understanding of the importance of beliefs, whānau support and putting the patient at the centre of care. A memorable experience for her was working with the Takawaenga service that provides support for Māori patients and whānau at Te Tai Tokerau. Lydia always strived to incorporate Te Reo, discuss traditional kai and utilise the principles of Te Whare Tapa Wha in all her consultations; this was often noticed by her supervisors. She continues to develop her understanding of Te Reo, the use of waiata, karakia and the services that can support patients and her own practice

Lydia embraced every learning opportunity and flourished into a well rounded, confident dietitian who was the first in her cohort to secure a job soon after she completed her final placement at Waitematā DHB. She is now working in the Surgical Team at Health New Zealand Te Tai Tokerau.

Lydia excelled in all coursework as well as her research: The effect of a two-week ketogenic diet versus a carbohydrate-based diet on cognitive performance, mood and subjective sleepiness during 36 hours of extended wakefulness in military personnel. She conducted her research project with enthusiasm and dedication. She actively engaged in data collection, processing, analysis, and completed her thesis within an admirable timeframe despite the restrictions that Covid posed during 2021. Her supervisors were very impressed with the quality of her work and commitment. She worked diligently and independently showing critical thinking and strong attention to detail. She was one of the first students to submit her thesis for examination and received an excellent mark.

Highlights and contribution to the dietetic profession:

Lydia went above and beyond in conducting the research trial with the NZ Defence Force, playing a key role in the delivery of the strict ketogenic protocol for participants and collecting the data She presented this research at the virtual Nutrition Society of New Zealand conference in December 2021.

Lydia was an active student member of DNZ and the Nutrition Society of NZ, attending many professional development events. She pro actively completed Toro Mai, an online Massey University course in Tikanga Māori and Te Reo Māori to support the development of her cultural safety Lydia volunteered her time to consult clients collaboratively with students from other health disciplines as part of the AUT Integrated Health Clinic.

Lydia Henderson is a very enthusiastic young dietitian who shows a lot of promise and will be an asset to the profession.

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