Learning Across Continents

Limbikira Wasambo and Felistace Mtande at Cal Poly after giving a
presentation on the budding dietetic program in Malawi.

A dietetic internship exchange — funded by a partnership between Dignity Health and the College of Agriculture, Food and Environmental Sciences — introduced four students, two from Cal Poly and two from Malawi, Africa, to dietetics from differing perspectives.

Felistace Mtande and Limbikira Wasambo from the Lilongwe University of Agriculture and Natural Resources and University of Malawi, College of Medicine, spent three weeks at Cal Poly in late January and early February immersed in the Dietetic Intern-ship Program. The two interns experienced clinical nutrition and food service rotations at French Hospital in San Luis Obispo and Marian Regional Medical Center in Santa Maria, both operated by Dignity Health, and participated in community nutrition at the Food Bank Coalition of San Luis Obispo County. Mtande and Wasambo are among the first from their country to study dietetics; they recently completed a postgraduate degree program in clinical nutrition and are now registered dietitians in Malawi.

Last May, Cal Poly students Joyce Huang and Kelsey Krieger, both enrolled in Cal Poly’s Dietetic Internship Program, traveled to Malawi to intern under the supervision of Cal Poly nutrition Professor Peggy Papathakis, who spent 10 months there as a Fulbright Scholar doing research and helping to build the curriculum for a new nutrition undergraduate degree program.

Under Papathakis’ guidance Cal Poly nutrition students have been volunteering in Malawi in maternal and child nutrition clinics for more than a decade. This is the first time, however, that students from Malawi have been able to study at Cal Poly. “The time is right for developing a dietetics program to help the citizens of the Malawi learn to make better food choices, from preventing under-nutrition and food insecurity to prevention and treatment of non-communicable diseases like obesity, diabetes and hypertension — all of which are on the rise,” Papathakis said. “The government recognizes this and has pledged to create job opportunities for the dietetics graduates within the public hospital system.”

The benefit for students on both sides of the intern exchange is invaluable, Papathakis said. “This is important for Mtande and Wasambo since they are the first generation of dietitians and can bring lessons learned at Cal Poly home to Malawi to help develop the roles of dietitians in hospitals and health care,” she said. “Equally as important, Cal Poly interns learned about how medicine and dietetics are practiced in a different setting and of diseases prevalent in other parts of the world. They also gained a cultural understanding of the areas of health care that are the same or different from their own.”

The partnership with Dignity Health enabled the immersive experience. “French Hospital Medical Center is proud to partner with Cal Poly for this extraordinary exchange program, allowing international students the  opportunity to experience an array of departments within our medical facility,” said French Hospital Medical Center President and CEO Alan Iftiniuk. “We are always eager to offer hands-on education and training for anyone pursuing a career within the medical field, and we are grateful to have had the chance to share our best practices with Felistace and Li during their time here.”

Dietetics in Malawi

Dietetics, the science of how food and nutrition affects human health, has long been an integral part of public health in the United States. Yet in other parts of the world, it has not been a central focus. There are only six countries in Africa that have dietetic nutritionists, including Malawi, which introduced the profession just recently. Mtande and Wasambo are among less than a dozen students who have committed to pursuing the newly introduced profession. To date, there is only one practicing dieti-tian in Malawi, but five more have just become registered and plan to be practicing very soon.

Our understanding of how to meet the needs of a diverse global society was forever broadened through this experience.

— Felistace Mtande

Mtande, 33, earned a degree in clinical medicine from the Malawi College of Health Sciences, a bachelor’s degree in nutrition and food science from Lilongwe University of Agriculture and Natural Resources, and a post graduate degree in clinical dietetics from the College of Medicine, Malawi. Her journey to Cal Poly, her first time in the United States, is the final step before she enters the dietetic field at home. “Honestly we had enough theory but not enough exposure to the things we learned in class,” she said. “We had about five weeks of dietetics experience in Cape Town, South Africa, but I still had a feeling that there was more to learn, observe and feel. So when the opportunity arose, I had to grab it, and I don’t regret anything that happened to let me come here.”

Kati Fosselius, who heads Cal Poly’s Dietetic Internship Program, said, “Part of our internship’s mission is to ensure that interns make a meaningful impact on each of the varied communities served during their rotations and graduate poised to become leaders in the dietetics field, equipped to meet the diverse needs of society.”

“When Cal Poly interns completed rotations in Malawi, they learned so much about how to serve communities without the benefit of the resources they’d become accustomed to here in the U.S. Felistace and Li shared what they gained during their rotations in California, including new management and educational styles, as well as strategies for increasing revenue for clinical facilities back home. Our understanding of how to meet the needs of a diverse global society was forever broadened through this experience,” she said.

Mtande said the dietetic field is rare in Malawi because nutrition was not considered an important component of patient care until recently. “In my country, nutrition was only integrated as part of agriculture, not the health care system. But now we realize that for positive and better patient outcomes, we should take issues of nutrition seriously. And here we are now, proud Malawi dietitians,” she said.

The three weeks that she spent  at Cal Poly interning at local  hospitals through Dignity Health and working alongside dietetic professionals and other dietetic interns will help guide her as she embarks as one of the first in the profession at home. “During our time here, we have seen better ways of patient care, from diet  prescription to the nutritional support of the patient,” she said. And while she will take many of the skills learned during her time with the Cal Poly Dietetic Internship Program home, some challenges will take longer to overcome  because resources and the  expertise of service providers vary dramatically between hospitals in California and Malawi. Yet the goal is the same. “In a clinical setting we all have one common goal: to provide quality health care services to our patients,” she said. “After all I have learned and seen, I feel like it’s time to take action and be available to those who  will benefit from my services,” Mtande said. “Above all, I will never stop learning.”


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