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2005: Carolyn M. Bednar, PhD, RD, LD

MEXICAN/AMERICAN EXCHANGE FOR CROSS-CULTURAL NUTRITION EDUCATION

Monterrey, Mexico is only 600 air miles from Denton, Texas, but its inhabitants are a world apart in cultural differences from their American counterparts. Still people in both countries are interested in improving health through eating nutritious foods and practicing a healthy life style. Dietetics in Mexico is a younger profession than in the United States. Standards for certification of dietetics/nutrition professionals were only recently approved in 2001 by the Mexican College of Dietitians, and there are currently only 119 dietetic/nutrition professionals in Mexico who have earned certification. Their standards are patterned after dietetic education standards developed in the United States. After finishing courses for a baccalaureate degree in nutrition, Mexican students complete one year of supervised practice working for government agencies, foodservice organizations, hospitals and health care facilities, sport centers or restaurants. The national profile of licensed nutritionists in Mexico states, "They are professionals who evaluate the nutritional status of individuals and populations. They manage nutrition, food and education programs. They are able to develop research and to join with health care teams to have impact on the nutritional situation. They use prevention promotion and health care strategies to improve the nutritional status of the population."

The United States has over 70,000 registered dietitians. The Commission on Accreditation of Dietetic Education (CADE) sets standards for dietetic education, reviews programs on a periodic basis and oversees testing and registration of dietitians. In order to become a registered dietitian, individuals must complete a four-year degree program with coursework approved by CADE and an approved supervised practice program plus a national examination. In the United States, dietitians are trained with a broad background of skills including skills in medical nutrition therapy and advanced nutritional support. They frequently work with teams of health professionals in acute care hospitals where they see only acutely ill patients.

Nutrition/dietetics students and faculty at Texas Woman’s University have been learning about cultural differences and similarities to their Mexican counterparts for the past three years. Since 2002, Texas Woman’s University and the Universidad Autonoma of Nuevo Leon, Mexico, have participated in an "Agreement of Cooperation." The Universidad Autonoma is a state university in Mexico in the state of Nuevo Leon close to the American border. The university has a total enrollment of over 100,000 and a School of Public Health and Nutrition that has about 600 undergraduate students studying nutrition. Texas Woman’s University (TWU) is a state university in Texas with an enrollment of approximately 10,000 students and a Department of Nutrition and Food Sciences that has about 165 undergraduate student majors and 150 graduate students.

The cooperative agreement between the two schools has the following objectives:

• Promote institutional exchanges by inviting faculty and staff of the partner institution to participate in a variety of teaching and/or research activities and professional development
• Receive undergraduate and graduate students of the partner institutions for periods of study and/or research.
• Organize symposia, conferences, short courses and meetings on research issues.
• Carry out joint research projects.
• Encourage student enrollment in continuing education programs.
• Exchange nutrition education materials.

During the three years the agreement has been in effect, many cooperative activities have been carried out. Several TWU faculty have visited Monterrey to speak at symposia, conferences and workshops on topics such as weight management, eating disorders and computer applications related to nutrition and foodservice management. A Mexican faculty member assisted with reviewing an educational videotape, "Food Safety for Families," produced by TWU in the Spanish language. The main benefit of the cooperative agreement, however, has been an annual exchange of students and faculty each year since 2002.

American Students Visit Mexico

In summers 2002 and 2004, groups of 10 to 11 graduate students from Texas Woman’s University plus one faculty member traveled to Monterrey, Mexico, for a three-credit graduate course entitled "Diet, Nutrition and Public Health Programs in Mexico." The steps that were taken to organize and facilitate this course were as follows:

1. Course description, objectives, course components, assignment, grading criteria and a tentative schedule of course activities were developed jointly. Textbooks and educational resource materials were also selected. The main textbook used was Public Health; What It Is and How it Works by Bernard J. Turnock, Aspen Publishers, 2001. Internet Web sites were also helpful. Faculty at the Universidad Autonoma shared responsibilities for teaching various sessions of the course, giving demonstrations and arranging field trips. For some sessions, a translator was arranged. All Mexican faculty who assisted were given a certificate signed by administrators at both universities.
2. Approval for an out-of-country course was secured from administrators at Texas Woman’s University and the Texas Higher Education Coordinating Board. An application was submitted in January, five months prior to the time of the course. In order to receive three hours of graduate credit, the course needed to cover at least a portion of three weeks.
3. Arrangements were made for transportation. Faculty from the University Autonoma agreed to pick up the American students at Laredo, Texas, in a van and drive them to Monterrey (a five hour trip). The flight from Dallas/Fort Worth Airport to Laredo cost each student about $170 round trip though a regional airline.
4. Students were recruited through flyers and announcements. Students were advised to apply for a passport and make arrangements for air flight to Laredo.
5. Housing arrangements were made. American students were given two options: stay at homes of Mexican professors or students or at a hotel in Monterrey, two students to a room.
6. Plans were made to provide meals to the American students during the nine days they were in Monterrey.

Total cost of the course and trip for the American students was less than $1,000. This included charges for course tuition and fees (approximately $615.00 in 2004 for residents of Texas) plus $170 for a round trip ticket to Laredo. The students also incurred expenses for books, souvenirs and incidental items.

Mexican Visitors to US

During summer 2003, ten Mexican faculty and graduate students traveled from Monterrey to Denton, Texas. Plans are currently underway for a similar trip during summer 2005. Since the Mexican visitors did not wish to register for an official university course at out-of-state tuition rates, a course was organized and taught informally with faculty and other speakers donating their time. Students who completed the course were given a certificate signed by administrators from both universities.

The following steps were taken to organize the course and make plans for the Mexican visitors.

1. The course was developed to cover topics of interest to the Mexican visitors (nutritional support, nutrition in critical care, metabolic response to injury). Texas Woman’s University faculty and area dietitians agreed to be guest speakers. Course plans also included a visit to the university library to explore nutrition resources available on line, a visit to a large regional food show, field trip to a local hospital and demonstrations by pharmaceutical companies. A graduate student from Mexico agreed to donate time as an official interpreter for the course. Since the visitors were not fluent in English, arrangements were made to rent headphones (cost $600) that could be used for simultaneous translation of speakers. Since the course was not an official university course, no approvals outside of the Department were needed.
2. A university van was scheduled to provide group transportation from the airport to host homes, for field trip days and for a shopping trip. Total cost of the van was about $175 since a faculty member who was an authorized university driver drove the van for most of the outings.
3. Housing arrangements were planned for the 10 Mexican visitors. Four faculty members volunteered to provide housing for two or more visitors in their homes.
4. Meals were arranged as follows:
   1. Host families provided breakfasts and drove visitors to campus
   2. Four lunches were planned and prepared by graduate students at the university, and one lunch was provided by a local hospital.
   3. Three evening dinners were provided by a local dietetics group and dietitians in their homes. One dinner was provided by nutrition faculty at a nearby private school, Texas Christian University. One dinner was purchased by the visitors at the time they were visiting a local shopping mall.

Total cost of the trip for each Mexican visitor was approximately $345.00 for the round trip air ticket between Monterrey and Dallas/Fort Worth Airport. The only additional expenses were shopping money that each visitor spent on the trip to the shopping mall.

Suggested Model for Similar Project

In summary, the steps that need to be taken in organizing a similar project are:

Such a project cannot be successful unless there is a team effort by faculty at each school and other professionals in the community. The availability of computers and use of e-mail can expedite communication for those involved in such a project. Knowledge of language is helpful, but not absolutely necessary; however, everyone involved must be sensitive to cultural differences and customs. Although faculty and others who assist with such projects may be willing to forego monetary compensation, small gifts and printed certificates can convey thoughtfulness and appreciation. This type of project, which provides graduate students the opportunity to immerse themselves in another culture, can reward and enrich their lives far beyond the few weeks of the course. A visit to another country and close contact with the people and their everyday surroundings can be a life changing experience.

From this project, it has become clear that Mexican health professionals focus on preventing heath problems through education of the public. At their university, faculty and students work in community clinics to advise people on weight management, eating disorders, diabetes, diet during pregnancy and pediatric nutrition. The Mexican faculty and students appear to have a better grasp of public health education that most American nutrition faculty and students. On the other hand, the American faculty and students are trained with a broad base of knowledge and advanced clinical nutrition skills. It is obvious that both sides have gained from interaction with the other. In the words of one student who participated in the exchange visit to Mexico, "I have been able to see that there is much work that can be done on both sides of the border to increase and improve public health. There are different focuses on either side, but we have the same goal in mind."

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