For more about this work, read the recipes Chef Jody Adams created for University Hospital or join her for a live video chat to benefit Partners In Health.

Sunlight gleamed off the stainless steel table as Louinique Occean kneaded a smooth, round ball of dough. On the other side of the table, Jody Adams, James Beard Award-winning chef, prepared a colorful spread of nutritious dishes.

This scene isn’t uncommon in Cambridge, Mass., where Occean is the head baker at Adams’s renowned restaurant, Rialto. But today they’re in Haiti, working in the kitchen at University Hospital in Mirebalais, operated by Partners In Health in collaboration with the Haitian Ministry of Health. Occean, who is Haitian-American, and Adams, a PIH trustee, have come at the request of the medical team to help the kitchen staff make healthier meals for patients, using locally sourced ingredients.

What I’ve learned from Partners In Health is that if we want a sustainable change, we can’t just impose something. We have to see what’s appealing to people.

In Haiti, lack of access to nourishing food is at the root of many health problems. About 22 percent of young Haitian children show signs of chronic malnutrition. Doctors and nurses often see poor nutrition exacerbating the effects of other health problems, including tuberculosis, HIV, and diabetes. Malnutrition puts women at greater risk of dying in pregnancy and childbirth.

The University Hospital staff aims to raise the quality of the hospital food as part of a comprehensive approach to good health just as they are raising the standard of Haiti’s public medical care. But changes to eating habits don’t come easily, especially when many nutritious foods are unfamiliar, unavailable, or too expensive.

And, Adams said, “What I’ve learned from Partners In Health is that if we want a sustainable change, we can’t just impose something. We have to see what’s appealing to people.”

Cooking for the poor

Adams is energetic and elegant, with short auburn hair that stands out against a white chef’s hat. She’s known for her use of New England ingredients in regional Italian food at Rialto, where she’s been chef and owner since 1994.

Adams got involved with PIH after meeting co-founders Paul Farmer and Ophelia Dahl as guests at her restaurant. “I had read Mountains Beyond Mountains and drank the Kool-Aid,” she joked. “The notion that you use the expertise of the people on the ground, through the model of community health workers and accompaniment, really resonated with me.”

I work in this restaurant where we feed people who have never, ever worried about their next meal. So in my world, it’s really important to have balance.

So, when Bravo’s "Top Chef Masters" invited her to appear on the show, she decided to highlight PIH as the charity to receive her winnings. The show aired in spring 2010, just after the earthquake in Haiti, when PIH faced unprecedented need.

In one episode, she netted $5,000 for PIH with a fig-and-walnut tart with pomegranate syrup and zabaglione, but not long after, an undercooked goat leg sent her packing. After that episode aired, she connected with a Haitian family —in Boston for post-earthquake medical care through the support of PIH—to show she could cook a goat properly, Haitian style. The Boston Globe covered the celebratory dinner as redemption for Adams.

In 2011, PIH invited Adams to join its Board of Trustees. She accepted, with the caveat that she wanted to do more than fundraise. She hoped her talents in food and hospitality could help patients. “I work in this restaurant where we feed people who have never, ever worried about their next meal. They don’t want for anything,” Adams said. “So in my world, it’s really important to have balance.”

Looking for ways to connect her professional experience with the goals of PIH, Adams invited Claudia Pierre Flerismond, the head of hospitality at University Hospital, to tour Boston-area hospital and restaurant kitchens.

Born in Mirebalais, Flerismond, 40, spent much of her childhood trailing her mother, who taught school for Zanmi Lasante, PIH’s sister organization, in Cange. “I grew up with Zanmi Lasante,” Flerismond said. Flerismond got her start in hospitality in Cange, pitching in as an ever-growing stream of visitors came to learn about and work at the small hospital there. Today, as the head of hospitality at the 300-bed University Hospital, she supervises more than 130 kitchen, laundry, and housekeeping staff.

The tour of kitchens in Boston inspired both Flerismond and Adams. It was during this visit and subsequent conversations that Adams zeroed in on the idea of improving food for patients at University Hospital. The need and the opportunity were great—the hospital had a huge demand for food and a shining new kitchen.

“Bread seemed to be an important part of the puzzle, and Occean could bring his expertise to appeal to Haitians,” Adams said. “What better way to do it?”

Louinique Occean, the Haitian-American head baker at Rialto in Cambridge, Mass., prepares a bulgur-flour dough in the kitchen of University Hospital in Mirebalais, Haiti. Photo: Stephanie Garry/Partners In Health

In search of the key ingredient

Occean and Adams flew to Port-au-Prince in March 2014 for a weeklong visit to the hospital. “Jody, I’m home,” Occean said soon after the plane touched down. The first order of business on this homecoming: find and purchase whole-wheat flour.

It’s not a common ingredient in Haiti, especially in poor, rural areas. After searching luxury grocery stores, a French bakery, and a hospitality supplier, they ended up at a food wholesaler near the airport.

“We’re in search of whole wheat, which seems to be impossible to find,” Adams said to the manager.

A quick tour of the warehouse revealed why. Much of what the company distributes is imported processed or frozen food, in cans, jars, or boxes—cheap and easy to store—and goes to supermarkets and hotels, not the rural poor.

The manager said he’d like to source and distribute fresh Haitian products, like coffee, rice, peanuts, and mangoes, but storage and a reliable supply are big barriers. In the 1980s and 1990s, the U.S. government coerced Haiti into lowering tariffs on imported food, flooding the country with subsidized American commodities such as rice, which were cheaper than home-grown products. It demolished much of the little agriculture Haiti had.

After hours of searching—coming across an abundance of soup-in-a-cup, condiments, and even foreign ice cream—Adams and Occean realized that whole-wheat flour wasn’t an option. But Occean had another idea, one rooted in Haitian cuisine and easy to acquire: cracked bulgur wheat, which is cooked as rice substitute in Haiti and commonly called blé.

The baking professor

By 7 a.m. the next day, Occean, sporting a baseball cap over his dreadlocks, was busy in University Hospital’s kitchen, surrounded by the dozen or so staff members preparing lunch for more than 150 inpatients and nearly 700 hospital staff.

Occean had taken the bulgur to a local business that grinds corn, and brought it back looking much more like flour. He mixed several doughs with different proportions of the bulgur flour to see which he liked most. His ideal dough would be airy and fine, mimicking the white bread many Haitians enjoy.

Occean is intimately familiar with Haitian food. Born in Haiti, at age 18 he moved with his family from Haiti to Boston, settling in Dorchester. At 25, Occean was working at Rialto as a dishwasher when Adams noticed him eyeing the bread and sent him to train at Clear Flour Bakery in Brookline so he could learn and refine the baker's craft. Now he's Rialto’s head baker, starting each day at 3 a.m., long before dinner guests enjoy his creations.

Over the years, his personal diet has changed. He’s shifted away from Maggi, sodium-rich bouillon cubes that are a favorite among many Haitians, including his own mother, and eats loads of vegetables. 

Adams tapped Occean’s connection with Haitian food and personal experience in the quest to bring more nutritious food to patients at University Hospital. He is proud to play the role of a professor in his home country. “When Jody asked me to help, it was the first time something like that happened in my life, to have an opportunity to go to my country to help out,” Occean said. “I hoped to do that one day before I died. But I didn’t know if it would happen.”

Chef Jody Adams and Rialto head baker Louinique Occean examine the bulgur-flour bread Occean made for patients at University Hospital in Mirebalais, Haiti. Photo: Stephanie Garry/Partners In Health

Little by little

Flerismond had taken steps to improve the food for patients, and welcomed Occean’s and Adams’s help. She had managed to eliminate fried foods and Maggi from the menu but on other occasions when she experimented with new vegetable dishes, they didn’t go over so well. Some patients sent them back.

Flerismond described these challenges to Adams and asked for help in devising dishes that incorporate slight changes to typical Haitian food. Piti piti wazo fe nich li. "Little by little," the Haitian proverb goes, "the bird builds its nest."

Adams is accustomed to overcoming similar challenges. At her own restaurant, she tries to let delicious dishes lead and food ideology follow. In Haiti, she sees great potential to develop the agricultural industry and increase access to nutritious food without sacrificing people’s health or the environment, which is what she believes has happened as the U.S. food system has become more industrialized.

Her morning meal, a typical Haitian breakfast of ground corn with fish and vegetables called mais moulin, was reimagined as a baked casserole.

“Nobody is going to make a choice to eat an unhealthy food if they know what the impact is,” Adams said. “The doctors, the nurses, and Claudia all know that we don’t have to shove it down people’s throats. You can eat it because it tastes good.”

Local foods, international dishes

Back in the University Hospital kitchen, Adams poked around the warehouse and walk-in fridge. Staples common in the U.S., such as milk, butter, and yogurt, are too pricey for Flerismond’s hospital budget. But Haitian soil still yields plenty of other foods: onions, green peppers, eggplant, parsley, garlic, spicy Scotch bonnet peppers, and—one of Adams’s favorites—peanuts.

Inspired, Adams came up with several peanut-based sauces, including a spinoff of romesco, a Spanish sauce with tomato, and another featuring grated coconut. She prepared roasted peppers stuffed with tomatoes and topped with a parsley pesto, as well as a chicken soup with vegetables and pasta (the chicken had met its end just moments before). Her morning meal, a typical Haitian breakfast of ground corn with fish and vegetables called mais moulin, was reimagined as a baked casserole.

The hospital’s cooks gathered around as Adams showed them how to make each dish. On the other side of the table, Occean continued to knead and massage his doughs, optimistic that the patients would like the new, healthier take on a familiar staple.

“Today, they’re going to try it,” he said. “After a few days, they’re going to like it.”

Asking for seconds

The following day, University Hospital kitchen staff went from ward to ward in the hospital, pushing carts full of Occean’s bread, topped with peanut butter and wrapped in napkins. They handed it out to patients for breakfast.

“The patients loved it,” Flerismond said. “The following day, they were asking for it.”

A new industrial mixer will ensure that the kitchen staff can bake and serve Occean’s nutritious bread every day. Flerismond has dished out Adams’s chicken soup recipe several times to patients, who loved it. And the new peanut sauces, served over rice, have been a hit.

“People come to the hospital really sick. They’re often malnourished and close to death,” Flerismond said. “After they eat the food, they don’t want to leave the hospital, because they’re taken care of here. That makes me so happy. Jody and Occean are helping me to realize a dream, to take care of sick people.”

PIH staff member Aliesha Porcena contributed to this report.

Try Adams's recipes for University Hospital.