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Individual Interview

Sydney Karp
NSD 555: Dr. Sudha Raj
Fall 2013





















Purpose: The purpose of this assessment was to identify someone of another cultural descent
and gain insight into the clients dietary behaviors, with regard to his/her background and
ethnicity. As a future dietetics professional, it is imperative that I am culturally competent, have
a thorough understanding of various dimensions of cultural knowledge, as well as be aware and
open to individuals of all cultures. Nutrition professionals encounter challenges as they struggle
to communicate with clients of different cultures, those who have distinctive beliefs and values.
It is important for a dietician or nutrition educator to be aware of the individuals food habits and
dietary practices, which may be different with respect to certain cultural behaviors, traditions,
and values.

Method: The method used to collect information in this assessment was via an informal,
individualized interview. I made a date and went to the clients apartment where we discussed all
of her habits, practices, and likes/dislikes. First, food habits and dietary preferences were
collected. The clients core foods, secondary foods, and peripheral foods were recorded. Eating
times were assessed, as well as foods that the client prefers and dislikes. A 24-hour recall of the
clients dietary intake was done using the multi-pass method approach. The client was asked to
recall everything consumed over a 24-hour time period, from the time and context of where it
was eaten, to ingredients, quantities, and preparation methods. Following this, a Food Frequency
Questionnaire was generated to evaluate the frequency of consumption of various foods, whether
they be of cultural origin or Americanized foods. Using Supertracker, the 24-hour diet recall was
inputted and analyzed for nutrient content and adequacy.

In addition, the GREET model of cultural competency was used because the client was non-
native. This model helps to comprehend the context of the patient and how the patient
understands illness, healthcare systems, and diet management. The GREET model looks at the
generation of the client as well as reasons for immigration, acculturation of their extended family,
ethnic behavior and time living in the United States.

Results: Shanz Mehdi is a 20 year old, Junior Economics major at SU. She is 120 pounds and 5
feet 7 inches with a BMI of 18.8, which makes her a healthy weight for her age. Shanz moved
to the United States for her education at Syracuse University in 2011 and currently has a 6-year
Visa. She is originally from Karachi, Pakistan, which is in the Sindh Region. While she was born
there, Shanz spent 2 years in Oman and 3 years in Kenya before moving back at age 5 till
enrollment in college. Shanz is of Muslim ethnicity, however she and her family are very much
liberal in their practices. She is the eldest of 3 children, where her younger brother is 18 years old
and her sister is 6 years old.

Shanz has many specific food habits and preferences. She does not typically eat breakfast, and
is not a snacker, which means that her total intake comes from two meals spread widely
throughout the day. The core foods in Shanzs diet are chicken, rice, roti, coffee, garlic, and
chili powder. She prefers that every dish eaten is spicy, and if not, she adds chili powder to it.
The secondary foods in the clients diet are curry, shrimp, avocado, tea, Nimco chili chips,
Starbucks green tea lemonade and berry hibiscus, as well as specific spices (masalas) from home
such as Shan Keema, Bihari Kabab, and Nihari. These foods are incorporated into Shanzs diet
a few times each week. On occasion, Shanz enjoys cookies, cake, steak, pasta, sushi, and Thai
food, as well as traditional Paki foods such as Paratha (fried roti), Biryani (Pakistani rice with
chicken and potatoes), and Daal (lentils). These are the peripheral foods in the diet and many are
only enjoyed when Shanz returns home to Pakistan on holiday.

Discussion: Although Miss Mehdi has only lived in the United States for 2 years, she seems to
have been well acculturated to the mainstream American lifestyle. She had mentioned that she
did not find it difficult to adopt eating habits of the Western diet, for she lives in a big city at
home where she is used to eating American foods, and has also taken trips to Chicago multiple
times. Additionally, while living at home, Shanz and her siblings often ate Americanized food
such as pasta, burgers, fried chicken, French fries, and sandwiches for lunch. However, dinner
was always Paki food because that is when her father was home and that was his preference of
meal. When the family would go out for a meal, it would usually be Thai, Italian, Portuguese,
French, or Japanese cuisine. Her habits here in the US seem to be very similar, as she usually
eats a sandwich or American fare of food for lunch and then makes Paki food for dinner. The
lack of a breakfast meal in Shanzs diet does not raise any suspicious questions because it is
typical of the Paki culture. According to Kitter, Sucher, and Nelms text Food and Culture,
breakfast is not always consumed by the Pakistan culture and traditionally people only eat two
meals a day. Lunch and dinner are large meals and if affordable, include a meat, poultry, or fish
dish, and sambals: side dishes such as curries, cholay, raytas and other fresh vegetable or fruit
salad-like mixtures, chutneys, and pickles selected for a balance of flavors and textures (p.434).

The GREET model was used for cultural competency in order to assess Shanz.
She is not an immigrant, but here on a temporary Visa. She is the first generation of her family to
live in the US for an extended period of time. She came here specifically for education and plans
on becoming a citizen and working here after college. Shanz does not have any extended family
living in the US, however she has family in London where the culture is much more similar to
the US. Shanz mentions that since living in the US, she has neglected many of the customs and
food habits that she has back at home. This showed evidence that Shanz has assimilated into the
cultural fabric of the mainstream culture here in the US. Yet, she has kept an identity that
values her own culture back at home and tries to implement that here at school as much as
possible. She has found a balance between the two cultures and does not report to feel any
dissonance or resistance. Shanz feels that having a kitchen on campus allows her to cook at
least one meal a day that is reflective of her habits back home, which keeps her tied to her roots
and helps ease nostalgia and homesickness from her culture.

My client compares to members of her ethnic population in the US because of her appearance
and slight accent, however Shanz seems to be much less culture bound. It seems that while her
parents encourage her to use more traditional Asian practices, Shanz often prefers to do things
more similar to people in America. While India has a high-context culture with low-context
elements, Shanz appears to be much more low-context than what is expected by her culture. She
states that in Pakistan, she feels more pressured to be formal and proper because of her family
name. She comes from an extremely liberal family with strict values that are more moral than
religious. This is because both of her grandfathers had a high name in society and thus there is
pressure to carry on the family legacy. Shanz regards her family as being very family oriented,
similar to other South Asian families and shares values such as social interdependence and
hierarchy. Living in South Asia and then coming to the US, Shanz said that she feels a much
lesser need of female seclusion. At home, she dresses a lot more traditionally with clothing that
is less revealing than what she likes to wear here at school.

When questioned if she practiced Ayurveda medicine or specific customs of Pakistan culture,
such as attending a Mosque, Shanz replied no and did not seem to be very familiar with the
practices. She claims to be Muslim but does not often practice the religion.

There are many positive and negative aspects of Shanzs current diet, which seems to be fairly
balanced. She rarely eats processed foods and gets most of her nutrients from fresh, whole foods.
She seldom eats granola bars or packaged, ready-to-eat meals. However, her diet lacks in
calories, calcium, potassium, iron, zinc, vitamin A, vitamin D, vitamin B-12, and vitamin E.
While Shanzs consumption of grains is classified as being under status for recommendations,
the total amount of carbohydrates in her diet are not very off from recommendations. Only half
of Shanzs grains are whole, and the rest are refined. Most of these refined grains are coming
from the white rice that she consumes daily. She did not eat any fruits or dairy, which accounts
for her lack of Calcium and Vitamin D. The lack of fruit in her diet may account for her reduced
sufficiency of vitamins. Shanz said that she used to drink milk everyday, but now seldom does,
only about once every three weeks. Shanzs diet was excessive in fat and sodium. 33% of her
fat intake came from avocado and 31% of her sodium intake was attributed to the processed
turkey deli meat in her sandwich. Shanzs lack of iron can be due to many things. Although the
24-hour recall only assessed a variable portion of her eating habits, it did give a glimpse into
what Shanzs usual intake is like. While Asia has the highest prevalence of anemia in the world
with about half of all anemic women living in the Indian subcontinent, it cannot be assumed that
this is the reason for Shanz (Siddiqui). A positive aspect of Shanzs diet is that she does not
use any added sugar and does not have a tendency for sweets.

As evidenced in the article, Dietary Habits of Asian Indians in Relation to Length of Residence
in the United States, most Asian Indians who come to America tend to incorporate many
American foods into their diet, however they continue to eat many traditional meals with less
frequency. This can be attributed to the lengthy time of preparation that is needed for many of
the cultural dishes, such as slow cooked Haleem stew with beef and lentils. This reflects the
dietary habits of Shanz because she tends to eat American dishes during the day and when she
goes out for dinner, but cooks traditional meals with her Indian roommate at her apartment when
time allows. Although not everything that Shanz cooks is traditional Paki food, most of her
mixed dishes are based on staple legumes, grains, and spices of her culture. Since coming to the
US, Shanz has almost completely eliminated the presence of dairy in her diet, which may differ
with other people of her ethnicity in the US.

Like stated previously, Shanz is not much of a snacker. When she occasionally craves
something, she snacks on Nimco chili chips from Karachi, which are fried and prepared with
soybean oil. Similar to other Asian Indians residing in the US, Indian snacks, that is, deep-fried
sweets and other concentrated sources of sugar, fat, salt, dried fruits, and nuts, were mostly
reserved for special occasions such as weekend socials, family gatherings, festivals, and religious
ceremonies (Raj, Ganganna, Bowering).

When questioned about her Health and Religious beliefs, Shanz commented that she is a very
liberal Muslim and does not attend a Mosque for prayer. Additionally, she does not pray to Allah
in any frequent manner. Shanz does abstain from pork and tries to buy Halal foods when she is
home in Pakistan, but doesnt worry about doing that since coming to the US. Shanz defines
health as being well and not sick. She only uses the term illness for serious conditions such as
cancer and heart disease. Miss Mehdi prefers taking conventional medicine brought from
Pakistan because she feels that the medication here in the US is not strong enough. When dealing
with headaches and pain, Shanz prefers to take Panadol, which is a medicine from Pakistan that
is similar to Tylenol. She buys all of her medicine at home, for they are not available here in the
US and are made in the UK. Although her mom supplied her with Johar Joshanda Herbal tea and
recipes for homemade remedies such as Desi Remedy, Shanz finds conventional medicine to
be more convenient and would rather take a pill than take the time to make tea. If faced with a
health challenge, my clients prospective behavior would to seek help via the SU Health Center
and obtain conventional medicine such as a prescription for an antibiotic.

I would go about counseling Shanz by telling her that it is necessary to include some elements
of dairy into her diet in order to help with the lack of Calcium and Vitamin D. Additionally, I
would recommend that she obtains more sources of iron, because that is a prime concern in
women from South Asia. Since Shanz is not a vegetarian, she can obtain iron from both heme
and non-heme foods such as beef or beans. Shanz mentioned that she loves steak, so I would
encourage her to try and cook some type of beef more often. I would encourage Shanz to
increase her consumption of whole grains, and possibly find a rice mix that is either brown or
multigrain.

A great element of Shanzs diet is that she prepares most of her meals herself. This is important
because, not only is she buying her food and choosing the ingredients, but also she can alter her
recipes and know exactly what she is going to be eating. However, Shanz is not bound to eating
at home and when given the opportunity, can easily eat at any restaurant she goes to. Shanz is
very flexible with her diet, but tends to fall into habit at school, similar to many students
considering a structured schedule. Because of her limited time, Shanz needs to think about her
meals beforehand and make sure that she can fit cooking into her busy day. Also, Shanz
mentioned that she eats dinner with her roommate almost every night, which is important in the
context of her diet. She looks at eating in a positive manner, does not seem to have many
restrictions or limitations, and is not over concerned about her behaviors.















Appendix:

Demographic information
Shanz Mehdi
20 y.o, Female, Junior Economics major at SU, 120 lbs. and 57, no activity
2.5 years (since Freshman year)
Country of residence: Karachi, Pakistan (Sindh Region)
o Born there, spent 2 years in Oman and 3 years in Kenya
o Moved back to Pakistan at age 5 till 18
Muslim
o Liberal
Oldest of 3 kids (younger brother is 18 yo and sister is 6 yo)

Food habits and dietary preferences
Doesnt eat granola bars, ready to cook meal types
Doesnt use sugar or sugar syrup
Usually eats lunch around 1:30/2 and doesnt eat dinner before 9
Usually eats at home in apartment with roommate for dinner, and alone for lunch because
of different schedules during the week
Doesnt prefer fruit or sweets
Since living in an apartment, has conformed to eating mostly fresh food and cooking
every night
Not a snacker
o Phases of certain snacks that she cant resist
Always has Nimco chili chips from Karachi
Prepared with soybean oil
Dont eat breakfast
Everything has to be spicy
o If she is at a restaurant and something is not spicy, asks for chili flakes or chili oil
Needs to have some type of meat in every meal
o Mostly chicken
o Loves steak, shrimp, and seafood
Doesnt eat fish that smells or tastes fishy
o Doesnt eat pork or any pig products---religious reasons
MuslimIn Islam you are not allowed to eat pig because it is known to be
a dirty animal and non-hygienic
According to Islam, shouldnt eat meat in Non Muslim countries because
the animal is supposed to be slaughtered in a certain way that is only done
in Muslim countries Haram NOT ALLOWED TO EAT
Haram vs. Halal
o Halal= can eat, meat bought from Islam store in in country
o Haram= cant eat
Core Foods
o Chicken
o Rice (mostly white)
o Coffee
o Roti (bread, made of wheat)
o Tomatoes and onions are base of everything
o Red chili powder
o Garlic
Secondary Food
o Curry
o Spices from home:
Shan Keema Masala (from home): for minced meat, ground turkey
Bihari Kabab Masala: cubes of chicken, marinate with this and yogurt,
brown onions and garlic, oil
Nihari Masala
o Shrimp
o Avocado
o Tea
o Starbucksgreen tea lemonade, berry hibiscus
o Nimco chili chips from Karachi
Peripheral Foods
o Parathafried roti
o BiryaniPakistani rice with chicken and potatoes (uses Biryani Masala spice
mix)
o Cookiesmilk chocolate chip
o Cheesecake
o Chocolate cake
o Steak
o Pasta
o Sushi---salmon and avocado, spicy mayo or something
o Daallentils
o Thai foodred chicken curry, kung pao noodles, beef chili and basil
If sick
o Desi Remedy: Homemade
Boil water, slice of ginger with skin, cinnamon stick, cardamom, 1 tbsp., 1
tsp. pepper and drink
Basically clears throat and head
Herbal so you can drink as much of it
o Packaged: Johar Joshanda
Centuries old herbal tea for flu, cough, cold, catarrh, irritation of throat,
and fever
Made by Qarshi Industries (PVT) Ltd in Hattar-Pakistan
Halal

What Health and Illness Means to Client; Views on Conventional Medicine versus
Traditional Health Care Methods
Health: being well, not sick
Illness: cancer, heart disease, tumors (pressing and serious)
o Doesnt refer to having a fever or ill
Patient prefers taking conventional medicine brought from back home because pt. feels
that US medication is not strong enough
o Patients medicine is bought in Pakistan and made in UK
o Doesnt prefer to buy medicine in the US
Takes Panadol (Tylenol)
Patient that conventional medicine is faster, more convenient
o Would rather take a pill than make tea
o Traditional is more time consuming and results are not immediate


FFQ (Food Frequency Questionnaire)

Foods
and
Amounts
Average Use
Never 1-3x
per
month
Once a
week
2-4 x
per
week
5-6 x
per
week
Once a
day
2-3 x
per day
4-5 x
per day
6+ x
per day
Pizza X
Sushi X
French
Fries
X
Ice
Cream
X
Daal X
Paratha X
Roti X
Tea X
Chicken X
Biryani X
Tomatoes X
Milk X
Red meat X
Curry X
Rice
Chili
pepper
X
Broccoli X
Avocado X
Naan X
Mangoes X
Kebabs X
Coffee X
Milk X


24-Hour Recall
Tuesday September 17, 2013
Breakfast: prefers to skip breakfast, even in home country, and waits for lunch
Coffee (always, a must)
o Hazelnut creamer
o No sugar
In apartment

Water in between meals

Lunch: Came home from class, ate a turkey sandwich
Dutch country wheat bread, 2 slices, toasted
Mayo1/2 tbsp.
2 drops Ketchup
2 drops mustard
3 slices honey roasted turkey Hillshire farms deli select
2 leaves of lettuce from a head (iceberg)
1 entire avocado
Jalapenos
Water

Dinner: Chicken
3 pieces of chicken tenders
o Seasoned with oregano, chili powder, cumin seeds, coriander powder, garlic salt,
and Italian seasoning mix
o Little bit of canola oil to cook
o Marinated and grilled
Sesame ginger simmer sauce by Safeway select on top
cup jasmine rice with fried rice mix (sauce), garlic
Steamed broccoli with butter

**Not usually a snacker**

Dietary Analysis

Nutrients of concern:

Under:
Total Calories
Calories coming from carbohydrates
Calcium
Potassium
Iron
Zinc
Vitamin A
Vitamin B12
Vitamin D
Vitamin E
Choline

Over:
Fat44% of calories but should be 20-35%
o Most comes from avocado, mayo, and sesame sauce, and mayo
Sodiumshould be having less than 2300 mg but has 2769 mg
o Most comes from deli meat, broccoli cooked with salt and butter, and fried rice
mix



Works Cited

Ezenkwele UA, Roodsari GS. Cultural Competencies in Emergency Medicine: Caring for
Muslim-American Patients from the Middle East. J Emerg Med. 2013;45(2):168-174.
Mehdi, Shanze. "Individual Cultural Interview." Personal interview. 18 Sept. 2013.
Raj S, Ganganna P, Bowering J. Dietary Habits of Asian Indians in Relation to Length of
Residence in the United States. J Am Diet Assoc. 1999;99(9):1106-1108.
Siddiqui MS, Siddiqui MK. Public Health Significance of Iron Deficiency Anaemia. Pakistan
Armed Forces Medical Journal. September 2008(3)

Daal Chicken Behari Botti
Salad with Chicken
Grilled Chicken with Sesame and
Ginger Sauce and Garlic Rice