As a newly minted medical doctor, Nimali Fernando’s baptism by fire came in a Houston community pediatric clinic where she would see as many as 60 new-born babies a day. Long hours and a bone-crushing caseload that never gave her more than 15 minutes to spend with a patient took their toll. But it was the high prevalence of overweight and obese children that fanned the flames of her growing frustration with the way pediatric medicine was practiced in this country, a frustration that would soon sow the seeds for a new vision of medicine.
It would take nine more years in a traditional pediatrics practice before those seeds would sprout. During that time Dr. Fernando paid her dues by performing the requisite number of immunizations and treating more ear aches than any doctor should have to in a lifetime. She also continued to see her share of the 30 percent of children nationally who are overweight and obese. But it was the other 70 percent that began to seize her attention. The majority of these children, while not showing weight problems, had symptoms that were clearly linked to poor eating behaviors, including parents who simply didn’t know how to cook.
Dr. Fernando realized she was chained to a treatment treadmill that would never get her any closer to the root causes of her patients’ illnesses; that no matter how many hours she’d put in or prescriptions she’d write, nothing would change. It was then that she checked on those seeds that were now becoming vigorous plants, and decided the time was right to shed her white coat and the trappings of a conventional doctor’s office. And like a butterfly free of its cocoon, Dr. Fernando stretched her wings and morphed into Doctor Yum, food and health crusader par excellence!
Opened in 2012, Yum Pediatrics and its non-profit arm, The Doctor Yum Project (the brands that Dr. Fernando chose, trademark pending; www.doctoryum.com) is located in an unassuming central Virginia office park. Curiously, its neighbors include a Burger King, Giant Supermarket, and the county office of the Virginia Farm Bureau. But step inside and no matter how sick you feel, the cheery food- and garden-themed interior will brighten your spirits. There’s comfy, children-sized furniture, plastic fruit and veggie toys, a wide-screen TV on the wall with appropriate cooking shows running on a continuous loop, all set against a soft, pastel color scheme of pea green, carrot orange, and blueberry blue. And if you’re still not sure what Dr. Yum’s message is, the poster-size Michael Pollan quote on the wall – “Eat Food, Not Too Much, Mostly Plants” – should clue you in.
The office was not open to patients on the Saturday morning Dr. Fernando showed me around, which was part of the reason she was wearing running shorts and a dirty pink t-shirt emblazoned with the word “Compost.” She apologized for her admittedly grimy appearance, telling me that she, her husband, and two young boys had just completed a two-and-half mile community mud run. Showing me around the examination rooms – “Pea Room,” “Carrot Room” – it was easy to see how children (to say nothing of anxious parents) would feel comfortable amidst the uncluttered environment that exuded warmth rather than sterility, beautiful graphics of fruits and vegetables rather than wall charts of body parts, and traditional Sri Lankan tapestries representing Dr. Fernando’s heritage. All manner of traditional pediatric medicine, including pediatric gynecology are practiced in this space, but the “treatment modality” that receives the most attention is eating.
That is why the largest room in the office – and the center of her practice – is the Dr. Yum teaching kitchen where the road to wellness begins for many. It is in this spacious, well-outfitted modern kitchen where Dr. Fernando and her associates teach cooking, eating, and tasting. If you have children, you know that it is the tasting that matters, which is why she has assembled an esteemed panel of “experts” – 24 taste testers whose ages range from 1 to 13. Using recipes for healthy food, e.g. the crunchy apple sandwich – two apple slices, unsweetened whole grain cereal, and sunflower butter – Dr. Fernando shares her creations with her young experts who report their reaction on Dr. Yum’s five-level rating scale: Super Yuck, Yuck, OK, Yum, or Super Yum, each one with its own happy/unhappy face emoticon.
Cooking classes are taught with children under 6 years old and their parents together, but with children 7 to 12, no parents are present. Dr. Fernando has found that mom or dad’s participation creates a weird dynamic that tends to reduce the child’s ability to learn. To teach how one can prepare and enjoy a healthy breakfast, she hosts a pajama party cooking class for kids who, of course, show up in their PJs. She has also developed her own food curriculum which is being piloted with a number of area teachers and about 200 children. As one teacher put it, “We can’t believe how the Dr. Yum curriculum has changed the way our kids eat!”
There’s also a garden, and not the usual Wal-Mart pot with a couple of scraggly cherry tomatoes struggling for life. The 900-square feet, fenced-in growing space attached to the end of the Yum Pediatric building will be going into full production this year. Robust tomatoes, however, were already growing from a dozen 5-gallon tubs, a peach tree was displaying its first marble-size fruit, and old rain boots had been repurposed as marigold pots.
Taking in this scene where the combined footprint of Dr. Yum’s kitchen, teaching space, and garden exceed that of the square footage devoted to treatment and administration, I couldn’t help but devise a ratio – call it the Winne Wellness Index – that might have implications for how we address health care in this country. This is best expressed as the combined space of gardens, kitchens, and food education (feel free to substitute dollars, hours, or healthy breakfast pajama parties) divided by the combined space of treatment and administration (dollars, hospital beds, or rip-off health insurance companies are also suitable metrics).
I can imagine that this relationship could be expressed mathematically as:
G + K + E = (When the ratio is 1 or greater, the country’s overall health is high)
T + A
Because we in the U.S. spend more on health care than any other nation, and generally are sicker than any of the 17 most developed nations, we have to ask ourselves how we’ve got it so wrong. A big part of the problem is that our health policies and agriculture policies are as distant from one another as Mars is from Venus. Based on these obvious disparities, one can imagine that if the Winne Wellness Index was applied to the U.S., the ratio would be something like .0000016, or only slightly higher than the life-span of a ripe cantaloupe. With a few thousand more Dr. Yums practicing pediatrics, supported by communities and schools that share Dr. Nimali Fernando’s theory of health, that ratio might one day begin to soar skyward. That would be Yummy!