Down on the Urban Farm

Last fall, in a kitchen at Yale’s West Campus, a group of internal medicine residents took on a cooking challenge, Iron Chef style. They were divided into teams, given a few simple pantry ingredients, such as beans and grains, and 15 minutes to harvest tomatoes, cilantro, mustard greens, and more, from the West Campus Urban Farm. Then they competed to cook the healthiest—and most scrumptious—meal with one pan on a single burner. This was not just for fun; this was an elective class in teaching patients the benefits of creative, affordable home cooking.

“They made great things that were healthy and inexpensive,” said the elective’s co-creator, Sanjeet Baidwan, M.D., HS ’16, a clinical instructor at the School of Medicine. During her year as chief resident for advocacy and community health at Yale, she met with patients to understand what they needed from their primary care physicians. “Time and time again, people would say that they want their doctors to help them live healthy lifestyles, which is important, because lifestyle choices, including exercise and diet, have such an impact on the chronic diseases that so many physicians spend so much time treating.”

Baidwan realized that for physicians to address patients’ growing questions on how to achieve healthier lifestyles, they needed to learn how to cook healthy food themselves. “We were able to show them,” she said, “so they could say to their patients, ‘you can do this, because I have done it.’ ”

To make the course more hands-on, Baidwan reached out to Justin Freiberg, who directs the Yale Landscape Lab, which provides access to the 136-acre West Campus for student and faculty projects spanning the health sciences, energy, entrepreneurship, and land use. The Lab includes the quarter-acre raised bed urban farm that yielded its first harvest in 2013. The farm researches new and improved methods for urban agriculture techniques, and also has experimental beekeeping and mushroom growing programs. Produce from the farm is used in the Lab’s educational and research programs across Yale, as well as in the West Campus cafeteria. Freiberg, who has worked in farm-based education for more than 10 years, has designed educational programs at the Stone Barns Center for Food and Agriculture and Added Value in New York.

“It may seem like connecting medicine and agriculture is bridging two distinct unconnected disciplines,” said Freiberg, “but there is much more in common between the two than it seems.” Freiberg likens the farm environment to the human body. “There are so many parallels between the cultivation of a healthy agricultural ecosystem and that of a healthy human that the doctors quickly realize that they can take models that they have learned in their medical education, and apply them here.”

While the course addresses healthy eating for patients from any walk of life, the residents pay special attention to cooking on a budget and thinking about cultural norms. They focus on items that are not only readily available and known to their patients, but inexpensive: the ingredients that the physicians used in their cooking competition cost less than a dollar per person per meal. Working at the farm in any season, even in winter, Freiberg says, also requires the doctors to get creative with what is available, similar to what patients might face if they live in food deserts, where access to fresh food is limited. “We’ve had groups pull the snow off of raised beds, harvest the little bit of cilantro or mustard greens that have survived, and still create a meal both culturally relevant and delicious,” Freiberg says.

In her medical practice, Baidwan has seen this new approach work. One of her diabetic patients moved from insulin to oral hypoglycemic, cooked for herself, and lost more than 20 pounds. “There were those people, when they got it, they got it, and they wanted to spread the gospel,” Baidwan said. “They made this connection and really felt empowered to be in control of their own health.” According to the Centers for Disease Control and Prevention, she added, 66 percent of American adults are obese or overweight, leading to an undue burden on the health care system that medical education is not addressing.

The course began as a one-day required workshop at West Campus for all 100 primary care and medicine/pediatrics residents during the 2015-16 academic year. This past year, it became a two-week elective for 10 residents who studied in the Lab’s barn, harvested produce at the farm, cooked it in the kitchen, and took field trips to educational farms, including New Haven Land Trust community gardens and Stone Barns Center.

Committed to expanding this approach to health education that integrates hand-on farm experience, Baidwan and Freiberg created Yale Cultivate Health, which includes the classes the two conduct that merge health and sustainable food. Currently, Yale Cultivate Health includes their School of Medicine course, similar workshops at the School of Nursing (YSN), and a second elective at YSN focusing on educating midwives on the role of plants in the health of their patients. Baidwan and Freiberg are working to expand Yale Cultivate Health programming, and have hopes that their course at the School of Medicine will expand to become a required education component.

Physicians themselves, Freiberg said, can benefit from a new-found emphasis on healthy eating. “The more we talk to doctors, the more they anxiously look around the room and say, I, too, haven’t been eating very well,” he said. “For so long, their profession has been one of very high intensity and long periods of work. They become martyrs for their own cause.”

A little friendly competition to cook the best meal also helps get the message across. “These are doctors at Yale,” he laughs. “They are used to competition. Of course, in the end, everyone ties, but we don’t tell them that.”