The fish pie and mash, left, and macaroni and cheese are not particularly appetising. Photo / Supplied
A fortnight in hospital left Catherine Milford convinced the hospital food has to change.
In February, my world changed. One minute I was happily riding the large 700kg chestnut mare I've ridden for years, the next, I was on the ground - and the horse fell on my leg.
It was a freak accident, but I was comparatively lucky and rather than anything worse, I broke my femur in seven places.
I was whisked off to hospital and after two days of traction, I underwent a six-hour operation, was given several blood transfusions and was put back together with enough metal plates, pins and screws to build a small cabinet.
So began a two-week stay in Auckland's North Shore Hospital.
Despite most staff's heroic efforts, hospital's not a place you want to be. It's unfamiliar, you're in pain or feeling terrible (usually both), you have none of your creature comforts and you're utterly reliant on strangers.
It's a weirdly insular world, where everything takes on an unnaturally deep significance and your days are measured out by doctors, visits - and food.
I'm a great believer of the dictum that we are the sum of what we eat. Which, at North Shore Hospital, made me and my fellow patients a pile of - well, mush.
"The quality of hospital food is terrible," says health and fitness expert Lee-Anne Wann, who had her daughter Lexi (Alexandria) via caesarian section in hospital three months ago.
"I couldn't eat what was provided - I took my own bag full of food so I'd be strong enough for my baby."
Wann provides all her maternity clients with food bags to take for their stay. "People in hospital feel poorly, so making food they want to eat is half the battle," she says. "We eat with our eyes first - even when we're well, no one wants a plate of awful-looking food."
A prominent advocate for healthy, unprocessed food and nutritionist for the Vodafone Warriors, Wann believes hospital patients can be provided with good nutrition that can complement the pharmaceutical medicine provided by doctors - but many of the foods on offer simply don't belong.
"Why is green jelly there? Where's the nutrition?" she says. "There's little fibre in many of the dishes and no nutritional value in the macaroni cheese provided that I can see.
The addition of garlic and turmeric, a sprinkling of parsley and served with peas for fibre, and a cup of ginger tea would make this dish helpful for reducing inflammation and improving wellness.
"The breakfast of rice bubbles, orange juice and yoghurt wouldn't be my choice. Orange juice is much too high in sugar - sparkling water with a slice of fresh lemon would be much better - and porridge with cinnamon instead would be both healthier and cheaper than rice bubbles.
And why is herbal tea not an option? Chamomile to aid sleep, ginger for nausea: herbal teas are an inexpensive tool simply not available in hospital."
Hospital food has never had a good rap, and it's undoubtedly difficult to provide patients with all requirements.
"Food is a medicine, and hundreds of specifications are needed to create the meals required across our hospitals," says Steve Fisher, General Manager of Communications and Human Resources at NZ Health Partnerships, an umbrella organisation that works with six DHBs across New Zealand - Auckland, Counties Manukau, Waitemata, Nelson Marlborough, Hauora Tairawhiti and Southland.
"This is a very detailed process that takes between 12-18 months to develop with clinical dietitians."
My hospital stay showed clearly that these detailed specifications aren't being met.
I'm a great believer of the dictum that we are the sum of what we eat. Which made me and my fellow patients a pile of - well, mush.
The Nutritional Standards for Meals and Menus for Adult Inpatients states: "The menu will offer food choices that are appealing, and which patients will eat and enjoy" and "The menu must be planned so that it provides variety of colour, texture, taste, cooking methods and appearance at each meal".
Boxes weren't ticked for me or anyone else I spoke to.
An October 2014 Nutritional Analysis report by Heather Spence PhD and Mike Drake BSc measuring the nutrition content across seven New Zealand DHBs found in some patient types, nutrient levels were exceeded "by several hundred percent".
However, there are "notable differences" between DHBs. Key goals not met were levels of protein and fibre; and "menus for adults, older persons and teenagers were lowest at meeting nutrient goals in most DHBs". Iron and zinc levels were low on most menus.
Food and support services company Compass Group New Zealand provides food for a range of companies across New Zealand from over 300 sites.
They provide meals for nine of New Zealand's 20 district health boards (the rest are provided by Spotless), including Auckland, North Shore and Middlemore hospitals.
They were also the providers for Canterbury DHB under a 15-year contract.
After a patient in Dunedin Hospital was advised by his doctor to bring in his own food and protests outside the hospital in April 2016, with accusations the food was "slops", Southland terminated its contract with Compass and food production was brought back in-house.
Justine Banfield, Corporate Communications Manager at Compass Group, says the company caters for 48 specialist diets, including gluten free, vegan and infant. It serves about 940 meals a day in Dunedin alone.
"Some patients also require texturally modified diets, like pureed food, which was the case with the Dunedin patient who complained," he says.
"We take a rigorous and consistent approach to our food service, but some patients will always choose other options, like to bring in their own fast food, which we wouldn't recommend."
But if the food was better quality, fewer patients would get meals from outside the hospital.
Wann says visual representation is important. "A smoothie would be better than nasty-looking glops of puree."
"Good nutrition doesn't need to be expensive either - one drop from a $19 bottle of lemon essential oil in a glass of water would give 125 patients a much healthier drink than sugar-laden orange juice.
"And chia or flax seeds added to smoothies and porridge would do a lot for fibre content."
We cater for 48 specialist diets and we serve about 940 meals per day.
DHBs, Compass and NZ Health Partnership refused requests to provide financial information on the price per meal, but obviously costs are a consideration - not least, the amount of waste from the number of meals that get thrown away every day.
The battery of tablets I was given included plenty of laxatives - something I wouldn't have needed to take if I'd had enough fibre in my meals.
My recovery is going well now I'm home, which is largely due to good diet. Lots of water and fruit, loads of greens and a lot of calcium and as much fish as I can get, and I hope one day I'll be fully fixed - in part, because I'm eating the right foods.
I will always be grateful to the staff at the hospital who did a tremendous job looking after me and putting me back together.
But despite the paperwork and the regulations, there is no doubt: in order to contribute to patients' recovery, hospital food has a long way to go.
• Catherine Milford is a food blogger and writer at eatscooksreads.co.nz
This is almost devoid of protein, is low in fat and has a high glycaemic load: it hits the bloodstream quickly, then leaves you with crashing energy levels. When blood sugars drop, your body releases stress hormones, which can ramp up inflammation - the last thing someone recovering in hospital needs.
The carbs in the yoghurt and rice bubbles don't make it to the lower gastrointestinal tract to be digested. Over time, these foods starve our good gut bacteria and promotes bacterial overgrowth in our upper GI tract, causing problems like bloating, gas and cramping.
The yoghurt is full of sugar. Rice bubbles are low in sugar, but also in everything else - basically a "nothing" food. Breakfast should be high in protein, incorporating natural fats to keep blood-sugar levels stable. Greens are a good source of folate and have more prebiotic fibre to help feed our gut bacteria. Fruit provides us with fibre - that's missing here.
INSTEAD: Natural yoghurt, low-sugar muesli or porridge with full-fat milk, two hard-boiled eggs.
OR: Scrambled eggs in butter with steamed dark greens (for antioxidants and anti-inflammatory properties) and a banana.
Bolognese sauce is a great source of protein and micronutrients like iron and zinc, which are important for healing. However, in this meal no vegetables are visible.
Seasonal vegetables aren't expensive and protein like mince that's naturally higher in fat is better absorbed and is a good source of Vitamins C, A and K.
Parsley, if the budget can stretch to it, is a brilliant addition. Pasta has no nutrients whatsoever, so doesn't have a valid place on a hospital plate.
INSTEAD: A lot more seasonal greens, cabbage and cruciferous vegetables like brussels sprouts, and some orange foods - roast pumpkin or steamed carrots - on the side. Celery, grated carrot or leeks could be added, too.
Swap out the pasta for potato - it's cheaper, higher in fibre and has more nutrients.
Overall: These meals do nothing to promote meal satisfaction. A roast pork meal with potatoes, vegetables and gravy looked good, but it was the only one that did. In my opinion, better choices of food would help the healing process a great deal.
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