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Why Reinventing Hospital Food Isn't as Easy as It Sounds

For many years, Joshna Maharaj has set her sights on improving Canada's “institutional foods,” the typically dreary menus of hospitals, prisons, and schools. But her journey has not been without its share of challenges.

A small white countertop juts up in the middle of Toronto chef Joshna Maharaj's kitchen like a bit of punctuation, tethering action to it. Maharaj darts around it with quick movements, clattering around briefly in drawers for utensils and searching out ingredients like Ontario-grown peaches. There's still a whiff of aromatic essential oils hanging in the air. The morning sun lends a soft light from the balcony, highlighting the playful splotches of colour around the room: paintings of vegetables along the walls, throw pillows, and a bright pink rug.

Everything is very pretty.

It's an inviting place, though not necessarily what you might imagine when you think of a hard-working chef and food activist.

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Inside Joshna Maharaj's kitchen. All photos by Ruben Guayasamin.
joshna_DSC5901 Maharaj prepares a sandwich of leftover chicken curry.

For many years, Maharaj has set her sights on improving Canada's "institutional foods," the typically dreary menus of hospitals, prisons, and schools. It's hard not to be swept up in the apparent optimism of her campaign—and yet it's problematic, too. The narrative of her activism inevitably lends itself to some one-dimensional, feel-good reporting.

She wants to fix hospital food; she will bring the farm-to-table movement to government institutions; and on and on. It all looks really great—the perfect kind of story to read and go about your day feeling confident that the world is definitely getting better. But, Maharaj makes it clear as soon as I walk into her apartment, that these kinds of stories tend to gloss over the stickier elements of her plans, and her life.

It's now been more than five years since Maharaj first arrived at Toronto's Scarborough Hospital in 2011, where she worked for a year, bringing her revolutionary plans into action. Using grants from the province and non-profits devoted to sustainable agriculture such as the Greenbelt Fund, she put pre-packaged food on the chopping block. Soups were made from scratch, patients enjoyed local fruits and vegetables all grown in Ontario, and Maharaj's work was brought to national attention in Canada.

However, after her departure from the hospital, most of the changes did not last.

In the time since then, Maharaj has continued advocating for food reform. Most notably, she worked at at Toronto's Ryerson University, where she was executive chef from 2013 to 2015. Her work has not gone unnoticed. Just this year, she became a finalist for the Basque Culinary World Prize—a prestigious award given out by the Basque Culinary Centre.

Despite the accolades, her journey has not been easy.

"I for sure have had to scale back my plans. I had way too big a mandate to push for the full revolution," she says. "It's a lovely idea, but there's absolutely no way. When I actually landed in institutions, there was so much else I had to battle that I had no idea about."

Only after trudging through a labyrinth of red tape, budget cuts, and labour prices did the scope of the problem swim into view.

Labour, in particular, presented an unforeseen problem that proved delicate and complex. In a 2011 TED Talk, Maharaj said: "The poor quality of food in hospitals has nothing to do with the skill and dedication of the hospital kitchen staff, and everything to do with what they are given to work with."

As Maharaj now works around her small kitchen table, grating a carrot for a simple slaw, she admits that's not entirely true.

"Some of [the staff] had been there for, like, 25 years and had another five years until retirement, and then I waltz in and ask them to completely change the way they do their job," she says. "Many of them were like, 'Yeah, right, lady.' Some of them dug their heels in the sand and hoped soon I'd pack my knives and get out of there."

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The labour issue in institutional kitchens only becomes more contentious when compared with the work that cooks do in restaurant environments, where the hours are long, the pace is often grueling and physically demanding, and, of course, the pay is minimal.

She insists: "My heart will forever remain pro-labor and pro-people making a living wage, doing a good day's work."

But the discrepancies are hard to ignore.

"A lot of folks [in hospitals] are getting paid upwards of $19 to $20 to open vac-sealed bags of food. That may be too much money for that task, but for the job of preparing food in an institution, it's a perfectly fair wage," says Maharaj." "The trick is, when I would consider what a cook who was working outside of an institution was making, and considering their output, their output is far superior to the things that were coming out of an institutional kitchen."

Arguably no chef enters into an institutional cooking environment with the intent of being a career soup-bag-microwaver. The duties inside institutional kitchens are predicted on the very space itself, and must accommodate budget and staffing cuts.

Cook-chill kitchens, in which food is prepared and packaged off-site and then reheated at the hospital facilities, are now one of the predominant systems for preparing institutional food, though tagging on the word "kitchen" almost seems like a misnomer. Consider the most basic implements of a traditional kitchen, the very tools that bring it to life—you most likely won't find any of these things in a cook-chill environment.

Maharaj recalls in detail the first time she entered a cook-chill kitchen: a space "whose soul has been sucked out of it." The most basic necessities were nowhere to be found, only the sterility of tile and stainless-steel countertops.

The staff wore medical scrubs, not chef's whites.

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"I could not see knives, oil, or salt," she says. "That means there's not chopping happening. No one is breaking down raw ingredients. No oil means nothing is being sauteed, which means no one is starting to develop flavour. No salt means nothing is getting seasoned.

So, either the food is completely sodium free, which is not the truth, or it's already salted, which means it's premade and packaged and that's it."

A kitchen designed without cooking in mind will undoubtedly produce tiresome, queasy meals.

It's easy to imagine what institutional food looks like, all its glory summed up in a perfectly rounded scoop of homogenous mashed potatoes, and some graying slices of turkey with brown gravy—that's precisely why Maharaj brings it up when she speaks.

So, it's only fitting that the meal she is preparing today in her kitchen is riffing off those tired ideas. She branches out, builds them up, and presents a delightfully fusion course that's simple and delicious.

Maharaj has prepared the food from her childhood that once brought her ridicule as the daughter of an Indian family growing up in the suburbs of Toronto in the 1980s: a leftover chicken curry sandwich.

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"We'd be in the lunchroom and we'd crack this thing open and then the smell would take over and kids are fucking terrible. So, kids would be like, 'Wwww, what is that? That's so gross!' And I'd wish, Mom, why why couldn't this just be bologna?"

What sits before us today would more than likely make any kid beg for a bite. It has the allure of a pulled-pork sandwich from the other side of the world. A simple chicken curry (made with her family's unique masala mixture) is layered on a generic white bun with fragrant Amish butter from Ontario, mixed greens, and a carrot slaw with white onions and coriander.

The butter, she says, is always slathered on thick to form a seal between the bread and the juices of the curry, keeping the sandwich from getting soggy until lunch time.

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It's by no means a difficult dish, but one that has layers of flavour—creamy pungency from the butter, the curry's mellow spice, and a vinegar tang from the slaw—as well as a variety of textures from the bread, meat, and vegetables.

Besides upending the typical notion of a cafeteria lunch, the dish also serves as another one of the challenges that Maharaj has consistently dealt with: the unbearable whiteness of hospital cuisine. Not only does beef stroganoff and fruit cocktail feel distinctly anachronistic, so much so that it might have seemed old-fashioned 20 years ago, but it's stricken with the rigor mortis of bland, inoffensive Americana.

Maharaj enthusiastically relates the story of an old Indian man whom she met at Scarborough Hospital who, following a stroke, was attempting to eat a tuna fish sandwich that was held to his lips by his daughter. He'd never tasted that delicacy before.

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"Also, apple sauce is not food in my country," he told her. What he wanted more than anything was a plate of dal and rice.

She believes wholeheartedly in the value of foods that are flavourful, sumptuous, and, well, even foreign.

"Having culturally appropriate food is something we don't really understand," says Maharaj. "That you can have food that is big flavour that is still within the bounds of a therapeutic context. In fact, adding a bit of spice to those kind of crappy ingredients goes a long way to help it out."

It goes without saying that the demographics of North America are continuing to shift away from a white majority, although you probably wouldn't realise that from staring at a hospital food tray. Yet, that food is supposedly meant to maintain the health and vitality of society's most feeble, those closest to death. To ignore the changing cultural needs of our hospitals' sick is callous at best, and perhaps even dangerous.

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It's a slow process to get these lumbering institutions of civic and social space to start moving in a new direction, and despite the challenges they continue to offer, Maharaj's passion and resolve haven't wavered. Her confidence lies in the assertion that our institutions should be a reflection of the people, not separate from them. On a personal level are our doctors, and on a social level are our hospitals, and there should not be a disconnect in care between those two realms.

"It's still problematic that you spend your whole life with a family doctor, getting good advice about what to eat," she says. "But when you find yourself in their care, what shows up on the plate is very different [from] the story that you've been getting your whole life about what you should be eating. Why does that conflict exist?

"If we are in a scenario where our institutions are a reflection of who we are as a society, we should be more than that. We should be more aspirational."