Looking back on a distinguished career

The Report: August 2010 vol.31 num.4

AS DIETITIAN SANDRA HOMENUK heads into retirement, shes pleased to see that the profession shes leaving looks very, very different than the one she entered 40 years ago.

-I started working in the fall of 1970," says Homenuk, who retired from her position as Dietetics Practice Leader at BC Womens and Childrens Hospital on July 29th. -It was a time when there were kitchen maids, not kitchen aids."

Gender politics have definitely improved over the past 40 years, Homenuk says, but the biggest transformations in her field have been in its breadth ... there is now a wide array of subspecialties ... and in the dieticians relationship with other health care professionals.

-The change that means the most to me has been the inclusion of dietitians in the inter-professional team. Its much more interesting than 40 years ago, because we are part of creating the overall care plan," she says.

The other really significant development dates back to 1971 when dietitians were included in the newly formed Health Sciences Association.

-When I started, there was no union for allied health professionals. There was RNABC, which was the nurses bargaining association, and HEU, but the dietitians, pharmacists, lab technologists, occupational therapists, social workers, etc. were not part of any kind of organized labour," she explains.

In many cases, these health science professions were formally exempt from union membership through a regulation known as negative certification, but this was not universally valid. So in some cases these professions could be recruited by other unions.

This did not work for employers, because the health sciences professions often supervised HEU members. Also, it didnt work for the health science professionals, who didnt necessarily find their interests could be upheld in other unions.

The formation of HSA ensured that health science professionals maintained their professional identities, says Homenuk. -Otherwise, we would have gotten lost. Our draw for trainees would have been affected. Because it came down to the question, ‘Do I want to be a professional or do I want to be a regular rank and file worker?\ says Homenuk.

She has watched with interest over the years as HSA has grown. -Now there are so many different disciplines within HSA, but to start with there were less than a dozen."

As well, she has seen her workplace grow. -Childrens Hospital was a tiny place when I finished my internship. There was one dietitian in the Dietetics Department, as well as several who were part of other programs. Now I have a staff that includes over 40 dietitians ... over 25 fulltime equivalents. That translates into our ability to care for the kids better."

Another change she has seen in the past 20 years is an increasing shift to outpatient care.

-The majority of our patients are outpatients. This means more kids get to stay at home. Twenty years ago, wed have kids who come into the hospital with chronic constipation or celiac disease, and theyd stay three weeks. Now they dont stay at all."

Similarly, diabetes education is now done in an outpatient setting, which is much more effective, she says. -When people are in hospital, that is not a good teaching moment. People tend to be stressed, which is not good for learning."

Dietetics is an increasingly varied field, says Homenuk. While paediatrics and womens health are already specialties, within them there are an increasing number of sub-specialities.

-We have staff in cystic fibrosis, eating disorders, acute brain injury and rehab, neuromotor, inborn errors of metabolism, diabetes, endocrine, the Oak Tree HIV program, oncology, renal or kidney, critical care, cardiology, solid organ transplants, nutritional outpatient counselling, neonatal intensive care, a ketogenic diet position, diabetes and pregnancy, anti- and post-partum, womens reproductive mental health, Shapedown (a healthy weight program), a paediatric weight management program, gastroenterology, and prenatal nutritional counselling."

As dietetics evolves apace with other medical fields, new programs emerge. -We recently established a Complex Feeding and Nutrition Program that helps kids who eat by tube or IV as they graduate from the ward to going home. And there is a new Mental Health Metabolic Clinic to treat kids on second-generation ant ips ychot i c s , which can cause extreme weight gain."

Working with children often gives dietitians the rare opportunity to follow their patients over years of development.

-Children grow. If they have a chronic condition they need a dietitian to manage their condition through all the stages of their development. So we can follow them from when they are diagnosed, through ambulatory and outpatient care, right through till they transfer to adult care, sometime between 16 and 19 years old.

-A lot of my dietitians are thrilled about that