Resident Spotlight: Dr. Annie Lalande

Hey, Residents!

Happy August, everyone! This month’s Resident Spotlight is with Dr. Annie Lalande, a PGY-4 in General Surgery. Dr. Lalande’s interests lie in sustainability and food systems, including within hospitals for patients. We were happy to chat with her about her journey and plans for the future, including a Masters in Resources, Environment and Sustainability at UBC with focus on food systems in healthcare to decrease the environmental impact of inpatient nutrition.

Happy reading!

You are a General Surgery resident, interested in sustainability and food systems. What drew you to these topics specifically?

It’s not a typical path, I know! Growing up practicing a lot of outdoor sports, I think I gained an early appreciation for nature and rapidly started feeling concerned about waste, pollution and climate change. Until recently, my involvement was more at an individual level; initially forcing my family into composting (don’t worry they enjoy it now!) and more recently working towards a less wasteful lifestyle.

However, at the hospital, I have found myself conflicted and often at odds with my personal beliefs about environmental sustainability, witnessing a discrepancy between liberally using limited and finite resources, while working in an institution that exists to treat many diseases that result from or are worsened by climate change. Thankfully, there was someone here I could turn to, who like me was very concerned with these topics: Dr. Andrea MacNeill. She is a surgical oncologist at Vancouver General Hospital spearheading the movement to make our surgical department, our hospital and our health authority more sustainable, paving the way for healthcare across Canada. Ever since we started working together, she has been a mentor and never-ending source of inspiration.

The specific topic of food came to me after a particularly frustrating week of rounding, where I realized that none of my patients were eating after their operations because they all disliked the food they were being served. I couldn’t bring myself to understand how this had become an acceptable standard in our hospitals, resulting in malnutrition for our patients and damage to our planet, and decided we should really work on fixing this.

Can you tell us a bit more about how these topics come into play in healthcare?

They are inextricably related! The recently published EAT-Lancet commission has brought forth food as a major contributor to climate change and environmental degradation, through unsustainable global dietary habits and agricultural practices, as well as food waste. Food is an aspect that we can all relate to, for the simple reason that everyone must eat. Yet, as we know, in hospitals, food is often unpalatable, and seen as an area for cost-containment. This results in malnutrition for our inpatients, and large amounts of wasted resources; on average in Canada, approximately 50% of the food served to patients is thrown away. More studies are emerging within our literature linking poor in-hospital nutrition to increased length of stay and complications, incurring larger costs to our hospitals. Still, this remains an under-appreciated issue within the medical community, and the striking paucity of physician leadership in food improvement programs leads to perpetuation of the status quo.

Healthcare has recently been highlighted as a significant contributor to greenhouse gas emissions (4% of Canadian greenhouse gas emissions!). We believe that improving food systems within our hospitals will be an important step towards mitigating our environmental impact and promoting healthy habits in our patient population.

In September, you will be starting a Masters in Resources, Environment and Sustainability at UBC, focusing on food systems in healthcare to decrease the environmental impact of inpatient nutrition. What does an undertaking like that entail?

We first want to assess the current situation at Vancouver General Hospital, focusing on surgical inpatients and evaluating how much and why food is thrown out. We will then create a trial menu, in line with current planetary health guidelines, and compare its impact on patient satisfaction, nutrition, perioperative outcomes, length of stay and environmental impact. We have a dynamic team involved, which includes Chef Ned Bell (prior executive chef for Ocean Wise and founder of Chefs for Oceans), a registered dietician and current medical student and experts from UBC in environmental behavioral psychology, large-scale food systems and environmental law.

It will be quite an undertaking, but the time is ripe for a change (… sorry for the pun!). COVID-19 has exposed a lot of critical flaws in our current food systems across the world, and is expected to cause twice as many people (260 million) to suffer from hunger this year. It is however giving us an opportunity to rebuild our food systems to become nourishing, healthy, accessible and environmentally respectful. We are excited to take part in this transformation in the healthcare system!

What are your future plans, once you have obtained your Masters?

I will still have two years of residency left to complete after this, which will be fun to return to. I’ve been passionate about trauma surgery for a long time and I am currently planning to pursue a fellowship in that field. I am still not sure where exactly I will want to work, but I know I will want the pursuit of sustainability in healthcare to become a significant part of my practice. At the moment, I hope I will stay in BC for at least a while longer – after all, it is a wonderful area both for sustainability and outdoor activities!

Changing habits is not an easy feat. What would you suggest as first steps to start addressing your personal environmental impact?

 I think the first step is awareness. We must accept that we are facing a terrifying crisis, but that we can all have a positive impact through the choices we make every day; that realization is incredibly empowering! Start small, be kind to yourself and recognize that no one is perfect. Begin by picking something that seems achievable: whether it be bringing your reusable shopping bags to the grocery store, preferentially choosing produce that are package-free, bring your own utensils or coffee cup at work (people who know me know I usually keep a Spork in my pocket…), or choosing to use your bike instead of your car to travel short distances once in a while. It’s also something we can be aware of in the hospital: avoid ordering unnecessary tests and be mindful of using only what you need during procedures. It’s also important to realize that we all have our environmental “flaws” and that we don’t get it right all the time; it is not a crime and does not take away from all the efforts you are making in the right direction. Ask questions, start a dialogue with your friends and don’t forget that small gradual changes go a long way!