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Cultural OverviewThe following overviews of different cultures allow you to gain an understanding of thediverse range of foods and fluids one culture may prefer compared to another culture. Itallows you to see any overlap of foods in the cultures that may be available forselection on a hospital menu and those that may not be accessible or readily available.Some of the cultures you may be working with include:Aboriginal and Torres Strait Islander dietThe Aboriginal and Torres Strait Islander diet has changed from a hunter-gatherlifestyle to a more westernised diet that is typically a high kilojoule, low nutritionallifestyle. Traditionally, Aboriginal and Torres Strait Islander peoples enjoyed a healthydiet of high in carbohydrates, protein, and nutrients, and low in fat and sugars. Withwhite settlement came flour, sugar and processed meat (NHMRC, 2000).Characteristics of Hunter-Gatherer and Western LifestylesHunter gatherer lifestylePhysical activity levelHighWestern lifestyleLowPrinciple characteristics of dietEnergy densityLowHighEnergy intakeUsually adequateExcessiveNutrient oderateHighSimple CarbohydrateUsually lowHighDietary fibreHighLowFatLowhighSodium: potassium ratioLowHighNutrient composition of diet(NHMRC, 2000)Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for CertificateIV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,HLTHA020, HLTAHA021- 196 -

When providing nutrition support for indigenous Australians, involve localAboriginal and Torres Strait Islander Cultural Liaison Officers, local indigenouscommunities or health organisations wherever possible. They can provide specificinformation about cultural and spiritual needs and methods of catering for the dietaryneeds of these people.Mediterranean DietThe Greek and Italian communities are well-established in Australia. There is a largeamount of integration with mainstream communities, with second and third generationmigrants growing up and sending their children to Australian schools (ASeTTS, 2007)Italian (Gallegos & Perry, 1995)Common foods patients prefer may vary slightly depending on the region in Italy thepatient is from, and the degree of influence from living in Australia for many years.Preferences may include: Pork, veal, chicken, fish, cold meats e.g. salami, prosciutto, mortadella etc., arepopular served with olives, cheeses, pickled vegetables. Vegetables – many people grow their own– E.g. radicchio (bitter lettuce), lettuce, spinach, artichokes, peas, capsicum,tomato, broccoli, broad beans, eggplant, and zucchini.– Pulses - eaten in soups and served with pasta e.g. Lima beans, broad beans,chickpeas and lentils. Bread – usually present at every meal Sweets – served on special occasions.– May be rich liqueur soaked cakes or fritter type pastries.– May contain cream or ricotta cheese. Fruit – the usual ending to a meal. Beverages– Strong black coffee or coffee with milk.– Tea (in Australia). Herbal teas are used for ailments and insomnia.Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for CertificateIV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,HLTHA020, HLTAHA021- 197 -

Greek (Gallegos & Perry, 1995)Environment and regions determine the type of diet. Common foods often preferredmay vary slightly depending on the region the patient may be from and include: Meats including lamb, chicken, fish, and pork. Beef is used less often. Meatmay be baked, braised boiled, fried, or grilled. Salty seasonings such as anchovies, caviar, cheese, sardines, and salt are verypopular. Vegetables– Many vegetables (e.g. tomato, capsicum, zucchini, and eggplant) are stuffed witha meat and rice filling as a main course.– Leafy greens e.g. chicory and endive with lemon juice and olive oil dressing andsalads. Fruit – dried fruit and nuts are popular Bread is popular Sauces– Traditionally tomato, olive oil, garlic, herbs (oregano and parsley) or egg andlemon.– Herbs and flavourings – parsley, oregano, garlic, celery, mint and bay leaves. Sweets– Often covered in honey syrup. E.g. Greek walnut cake, semolina cake, Halva,filo-pastry with custard, baklava, Greek shortbread. Beverages– Coffee (Greek or instant) and cocoa.Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for CertificateIV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,HLTHA020, HLTAHA021- 198 -

Polish Meat– Meat, pork in particular.– Baked or fried meats usually come with gravy (red meat), sour cream sauce(white meat); boiled meat is cooked with black peppercorns, salt and bay leaves.– Cold meats such as ham, polish salami and jellied meat like pigs trotters.– Chicken, duck, and game are enjoyed in traditional recipes.– Fish, baked or fried in butter, tinned herrings are popular. Vegetables– Boiled in salted water, sautéed in butter, sprinkled with breadcrumbs, and usuallycooked with sugar, salt, vinegar and cream.– Popular vegetables include cabbage, beets, onions, mushrooms, tomatoes,carrot, spinach, beans, cauliflower, turnips, peas, parsnips, potatoes, capsicum,celery, cucumber, and eschalots.– Salad with lettuce, tomato, onion, cucumber, and radish eaten with sour cream;may accompany main meal. Sweets– Puddings, Kisiel (opaque jelly containing flour), poppy seed cake, jelly, fruit, icecream.– Yeast cakes and torts are served at festivals.(Gallegos & Perry, 1995)Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for CertificateIV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,HLTHA020, HLTAHA021- 199 -

Bosnia-Herzegovina, Republic of Croatia, Republic of SerbiaEach of these groups is unique in their culture (Gallegos & Perry, 1995).The following is aimed as a guide to possible eating habits and is not a clear definition.General characteristics of the diet: Crusty white bread is common and usually eaten at most meals. Pickled or preserved foods are common. Vegetables are usually dressed with a sauce or fried with onion and garlic and mayhave other sauces with them. Commonly eaten vegetables include potato, silver beet, cabbage, capsicum, beans,peas, sauerkraut, tomatoes, squash, eggplant, pumpkin, cauliflower, and corn. Soups, stews, and goulashes are favoured. Moussakas, pastries, and rice dishes are all commonly eaten. Cornmeal dishes similar to polenta and pasta are also enjoyed. Turkish coffee and sweet desserts and cakes such as baklava are frequently eaten. Condiments and herbs such as fresh tomato sauce, olive oil, paprika, dill, parsley,rosemary, basil and bay leaves are common.Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for CertificateIV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,HLTHA020, HLTAHA021- 200 -

Asian examplesChineseThere are a number of regions in China that all have different ways of preparing food. Rice is the almost always the basis of a meal. Foods are commonly steamed, boiled or stir fried. Meat and chicken are cut up finely. Beef, pork, and chicken are used in traditional cooking. Fish – whole, steamed with fresh ginger, shallots, dry sherry. Fresh green prawns are preferred to the cooked variety. Stir-fry seafood combinations usually contain scallops, squid, prawns with gingeralong with shallots and Chinese broccoli. Sauces add flavour, e.g. light or dark soy sauce, soybean paste, black bean sauce,prawn paste, oyster sauce, peanut or sesame oil and salty bean curd are often usedin cooking. Soups based on stock with meat and vegetables. Noodles and dumplings are addedfor substance. Wheat flours (noodles, dumplings) are available in northern China while rice is moreavailable in southern China. Vegetables – many varieties are enjoyed for example; Chinese cabbage, Chinesespinach, Chinese broccoli, English spinach, eggplant, snake beans, French beans,celery, carrot, capsicum, marrows, pumpkins, tomatoes, shallots, chives, onion,bamboo shoots, lotus, water chestnuts, sweet potatoes, yams, soybean, mung beansprouts, garlic, ginger, chilli, and shallots. Beverages– Chinese tea or plain water.– Soups are sometimes drunk as refreshers during the meal.– May enjoy fruit juice in Australia. Soft drinks rare at home. Sweets – fruit and sweet snacks, sweet bean soup, sesame seed balls, eggrolls.Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for CertificateIV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,HLTHA020, HLTAHA021- 201 -

VietnameseRice forms the basis to the diet and is often eaten at each meal although noodles aresometimes used as an alternative. Meats– Pork and poultry such as chicken or duck.– Fish and shellfish are popular. Shellfish and fish bones are a source of calcium inthe diet. Prawn shells and fish bones are used to make stock. Vegetables– E.g. Spring onions, celery, capsicum, mushrooms, cauliflower, cabbage, onion,Chinese cabbage, Chinese mustard greens, bean sprouts, snow peas. Legumesare frequently used.– Salads are usually sprinkled with fresh herbs like parsley or peppermint leaves.– Popular salads include: cabbage, lettuce, watercress, or bean sprouts. Breads – crusty French bread sticks are preferred. Sauces – soy sauce and fish sauce is used for most dishes for flavour. Sweets– Rice cakes and sticky rice dishes are part of festive occasions.– Fresh fruit especially the tropical varieties such as mango, banana, and watermelon. Beverages – Chinese tea or coffee with condensed milk.Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for CertificateIV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,HLTHA020, HLTAHA021- 202 -

African examplesIMPORTANT: Be aware that some of this information will not be tribe specific,for example, Sudan consists of one geographical country but is populated by more than200 different language groups. Ethnicities can have very different cultures andpractices which will not all be described here (ASeTTS, 2007).The following is a list of foods that are either not common in an Australian context orare used in different ways in Africa. It is not an exhaustive list. Some people from thispart of the world are Muslim and may require access to Halal foods. Bread and cereals– Maize flour can sometimes be called mealie meal and is used to make porridge.– Millet flour.– Flour is used to make the staple porridge eaten alone or as an accompaniment.Sorghum flour is another variety used to make porridge.– Teff is a grain used in Ethiopia to make injera. It is grown in Australia as animalfeed but is currently unavailable for human consumption. Quinoa may be anadequate substitute.– Injera is the Ethiopian/Eritrean name given to flat, fermented bread.– Asida is one of the South Sudanese names for the porridge. Pulses– Black-eyed beans are used extensively both in cooking and as a snack.– All other pulses.– Seeds and nuts.– Tahini is used as a spread and as an addition to stews and vegetable dishes. Fruit– Plantain is like a large green banana. It is quite starchy and is always cooked.– Tamarind Available from Asian food markets in fresh, puree or dried form.– Used to flavour porridge, as a drink or to eat. Dairy– Camel’s milk may be consumed by those coming from Ethiopia, Eritrea, Somaliaand parts of Kenya.– There is no commercial dairy in Australia.Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for CertificateIV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,HLTHA020, HLTAHA021- 203 -

Vegetables– Sweet potatoes are eaten extensively as are the leaves.– Amaranth also called Chinese spinach.– Cassava is a starchy woody shrub used as flour or grated in savoury or sweetdishes.– Okra.– Molokhia is a small green leaf which is used to thicken stews. Meat– Dried fish is used in many dishes and is often used to flavour stews.– Goat meat is eaten by a number of different African groups. It can be found insome selected butcher’s shops. Italian butchers sell goat as capreto.– Camel meat may be consumed by those coming from Ethiopia, Eritrea, Somaliaand some parts of Kenya. Camel meat may be locally available but this will needto be checked depending on the location of your health service. Fats and Oils– Red Palm Oil is used especially in West Africa and gives food a distinctive taste.It is not readily available but there are some local importers emerging.(ASeTTS, 2007)Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for CertificateIV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,HLTHA020, HLTAHA021- 204 -

Middle Eastern examplesThe following foods are either not common in an Australian context or are used indifferent ways in the Middle East. It is not an exhaustive list. Many people from this partof the world are Muslim and may require access to Halal foods.Name in EnglishName in ArabicAvailabilityBreadKhoboz wa SamoonBreadSamoonLebanese BreadKhoboz LubnaniTurkish BreadSamoon turkyRice and FlourRooz wa TaheenFruitFakihaApricot and DriedapricotMishmish wamishmash mojefefDatesTemorPruneInjasSultanasKishmishFig and dried FigTeen wa teen mojefefVegetableKhothrewatWhite AlbanYoghurtLebenPlain yoghurt is used extensivelyLabnehLeben MokethefSpreadable yoghurt, is available in somesupermarketsMilkHaleebMany different varieties of milk are used includingcow, sheep, goat and camelMany different varieties of bread are used. Someare leavened breads and others are flat breads. InAfghanistan there is a variety which is called naanwhich is similar to what is called Turkish bread inAustralia.Dried fruit is a common feature in the Middle East. Itis usually eaten as a snackAvailable fresh from Asian food markets. Alsoavailable frozen or canned. Okra is cooked quicklyto retain its crispness or for longer to draw on itsmucilaginous properties.Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for CertificateIV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,HLTHA020, HLTAHA021- 205 -

PulsesBokoolBlack-eyed BeansLobya Yabsa (Beatha)Broad Beans (dried)Bagilla YabsaBroad BeansBagilla khethraCannellini BeansFasolya Yabsa(Beatha)Chick PeasHommosHaricot BeansLobya khethraLentilsAdassMung BeansMashYellow split peasHommos MajrooshSeeds And NutsAl jGoatLehem MaezLambLehem IgelAll pulses are used extensively as side dishes,additions to main dishes or as snacks.Paste made from sesame seeds used as a spreador a flavouringOften sold as capreto at Italian or specialitybutchers(ASeTTS, 2007)Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for CertificateIV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,HLTHA020, HLTAHA021- 206 -

IndianFood in India varies from region to region and is strongly influenced by religion andcustom. The wide variety of food that is eaten and the regional variation presented inIndia is too complex to specify, therefore general differences between northern andsouthern India are identified (Gallegos & Perry, 1995).ItemNorthern IndiaSouthern IndiaStapleWheat – eaten as chapattisRiceCurryUsually dry so can be eaten withchapattisUsually wet so that the rice cansoak up juicesSaladRaira made from yoghurt to whichfruit and seasonings are addedSambal a mixture of a relish and asaladFruit and vegetablesA wide variety are eaten throughout IndiaMeatMutton, Chicken, pork. No BeefMainly vegetarianFishRiver FishOcean FishDairyRicotta cheese, yoghurtYoghurt at every mealGheeOilNo coconutCoconutTeaCoffeeLassi (yoghurt drink)ButtermilkFatDrinksIn addition most meals are served with an array of different dishes includingpappadums, pickles, relishes, and raitas. Curries are eaten regularly.Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for CertificateIV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,HLTHA020, HLTAHA021- 207 -

Activity 21 – Meeting Cultural and Religious Dietary Needs1. List three places where you could source information on the cuisine of variouscultural and religious groups that are found in Australian society.2. Describe how you could access interpreter services for a client in your health carefacility?3. What other services could help you assist culturally diverse clients?Activity continues on the next page.Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for CertificateIV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,HLTHA020, HLTAHA021- 208 -

Activity 21 – Meeting Cultural and Religious Dietary Needs continuedSelect a religious group which follows dietary restrictions or protocols and answer thequestions below. If possible select a group that you have seen represented in thepatients at your hospital.4. What is the religious group that you have selected? Why?5. What foods or fluids are restricted or forbidden?6. Complete the following sentences.a) According to the Islamic faith, Muslims should: Use meat Avoid all products Avoid drinks and food containing .b) food is food that conforms to Jewish dietary laws.c) Most Hindus do not eat or items containingproducts.Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for CertificateIV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,HLTHA020, HLTAHA021- 209 -

4.2 Diet and ReligionThere are a number of religious groups within Australian society who may followparticular dietary restrictions. These include, but are not limited to: Some Christian denominations e.g. Seven Day Adventists Jewish Muslim HinduThere is often: Food laws and traditions that are observed. Variability in the level of restriction within religious groups. Changes to food and eating behaviour as a result of feast and fasting occasions(these may occur many times over the year).ChristianityPract

Plan and modify meals and menus to meet specific cultural and religious needs of client group in line with organisational guidelines Follow processes defined by dietitian to evaluate meals and menus to ensure they meet cultural and religious needs of the clients . 4.1 Profi