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Boston Medical Center Puts Down Roots For Patient Health

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The BMC rooftop farm
Stacy Buchanan

At street level, Boston Medical Center (BMC) is an imposing hospital campus, with towering brick and concrete buildings densely packed together at the edge of the South End. But an unexpected sight greets visitors to a blocky power plant building across from the emergency department: three stories above Albany Street, tomatoes, cucumbers, zucchini, and a cornucopia of organically grown produce thrive in the summer heat. The 7,000-square-foot roof has been transformed into a container farm, constructed of 2,300 milk crates filled with a special growing mix and outfitted with an irrigation system that delivers water right to the roots of the plants.

Now in its second season, BMC is the first hospital farm (and one of a handful of rooftop farms) in the Boston area. In 2017, it produced about 5,300 pounds of produce; this year, Farm Manager Lindsay Allen hopes to match or exceed that amount. Allen, who has extensive experience working with traditional, in-ground farms in a variety of climates, knew that she’d have to be extra efficient with this compact rooftop space. To maximize yields, she maps out plans for the season, focusing on two types of crops: those with a quick turnaround that can be harvested and replanted multiple times, such as salad greens or radishes; and crops that produce for an extended period, like kale, cucumbers, or tomatoes.

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Farm Manager Lindsay Allen maintains tomato plants.
Stacy Buchanan

In August, the farm is in full production mode. Milk crates overflow with sprawling tomato vines, kale plants, and delicate rows of newly-sprouted lettuce mix, which will be ready to harvest as salad greens in just a few weeks. Several times a week, farm staff harvest dozens of pounds of produce, which is washed and bundled, then wheeled across a skyway that spans Albany Street. Compared to the 1,500 miles that food is estimated to travel—on average—to reach our plates, this produce moves just a few hundred feet into the main hospital building, where Allen delivers it to the hospital’s main kitchen, its teaching kitchen, or its therapeutic food pantry.

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Basil and tomato plants on the Boston Medical Center rooftop farm
Stacy Buchanan

Allen’s first stop is usually the hospital kitchen, where her bins of salad mix and green peppers join the thousands of pounds of food that the kitchen processes each week. Under the supervision of Executive Chef Jason Mclean, farm produce is featured in the cafeteria and incorporated into patient meals. Dave Maffeo, Senior Director of Support Services, recalls a mid-season learning experience in 2017, when the farm’s bumper crop of basil was harvested. “There must have been about a hundred pounds of basil,” Maffeo estimates. “I called [the Chef], and said ‘change the menu - we’re doing pesto for the next week.'" Allen, Mclean and Maffeo have used lessons like these to refine their plans so that the kitchen can smoothly accommodate the fluctuations in yield that naturally occur on a small farm.


THE FOOD PANTRY

Next, Allen heads to BMC’s therapeutic food pantry. The first hospital food pantry in the country, the program started in 2001, when doctors noted that many patients reported struggling with food insecurity. A core team at BMC realized the hospital was in a unique position to help. They could identify people in need of food assistance, provide that food in a convenient location, and tailor food packages to individual medical needs. Further, framing the pantry as part of a person’s medical care helped reduce the stigma that some patients felt around receiving food assistance. Founded with a goal of serving 500 patients per week, the program has grown over 18 years to serve an average 7,000 people a month. The pantry recently passed an important milestone of serving over one million patients.

BMC providers can “prescribe” the pantry to patients and their families when food insecurity is identified as a health risk, and can also note medical concerns that require dietary changes, such as diabetes or hypertension. Twice a month, patients visit the pantry to pick up enough food for 3-4 days for themselves and their household. Latchman Hiralall, the pantry’s Manager, has been with BMC since before it opened and was one of the core team that developed the initial concept. A dietetic technician, Hiralall trains volunteers to help patients select balanced, healthy food that works with their lifestyles and medical concerns. “The personal touch is what makes a difference,” Hiralall says, noting that most food pantries aren’t able to work with people directly to provide food that they like and will use, while also considering their health needs.

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Therapeutic Food Pantry Manager Latchman Hiralall.
Stacy Buchanan

The food pantry currently serves about one million pounds of food per year. The majority of it comes from the Greater Boston Food Bank, with regular supplements from philanthropic sources. Beginning last year, farm produce has been added into the pantry’s mix. Hiralall notes that one of the most frequent requests he hears from pantry visitors is for more fresh fruits and vegetables. Patients have been delighted with the addition of fresh, organic vegetables grown on the hospital’s own farm, delivered at the peak of ripeness and nutritional value. “They’re so excited to get those vegetables,” says Hiralall. “You can see the difference.”

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A bin of kale and Swiss chard, bundled and ready for distribution through the food pantry.
Stacy Buchanan

THE TEACHING KITCHEN

In addition to reducing food insecurity, BMC has a mission to educate patients on the hows and whys of following a healthy diet. The next stop for the farm’s produce expands on that goal. BMC’s teaching kitchen was also founded in 2001. Starting out in a couple of converted patient rooms, the kitchen now occupies a sparkling glass-walled space where Culinary Nutrition Manager Tracey Burg hosts free public classes. These range from diagnosis-specific classes for people with diabetes, cancer, and other common conditions, to basics like culinary skills 101 or making healthy family dinners on a budget. The teaching kitchen gets the bulk of the food it uses through the pantry. This close partnership enables Burg to design classes and share recipes that show pantry visitors how to prepare the food they’re taking home. Burg frames the outreach in the kitchen and pantry as “culinary medicine” that not only provides food, but also arms people with knowledge on how to shop for, and prepare, healthy, medically-appropriate food that works with their budget and lifestyle.

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Culinary Nutrition Manager Tracy Burg and BU Intern Kirsten Tramposch prepare for a class in the teaching kitchen. On display and on the menu: selected produce from the farm.
Stacy Buchanan

The establishment of the hospital farm to support the pantry and teaching kitchen completes what Burg refers to as “the trifecta” for food assistance and nutrition education at BMC. Farm offerings help Burg demonstrate how to shop and cook seasonally, which is often cheaper, and how to create healthy meals incorporating plenty of vegetables. Burg especially enjoys access to the farm for children’s programming. She leads summer camp classes to the roof to help harvest vegetables which they’ll make into nutritious, simple, affordable meals. Burg recounts a recent class where the young students, initially skeptical, came back for seconds of kale Caesar salad after visiting the farm and harvesting their own kale. “The farm is a source of pride for all of us…[the food] looks great!”

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Culinary Nutrition Manager Tracey Burg shows us tomatoes from the farm that she will use in that day’s classes.
Stacy Buchanan

THE ECOSYSTEM

Interconnections play out repeatedly on the farm, at varying scales. Discarded plant matter is composted either in traditional bins, or an 8-unit worm composting system, in order to provide nutrients for future crops. Although there are some limitations in a small urban space—at the end of the season, some excess plant material will have to be removed from the farm to a larger composting facility —Allen wants to create “as closed a loop as possible, I want us to take care of our own waste, and as much as possible to create an ecosystem on a roof.” To further this goal, the farm also hosts two beehives, managed by beekeeper Myles C. Green. The bees produce honey (the farm has harvested 96 pounds so far), and also provide pollination benefits to the farm, and to plants and gardens in the neighborhood. Allen, who considers bees “the unsung heroes of the food system,” counts education and awareness as yet another benefit the bees provide to visitors and volunteers.

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The farm’s two beehives were painted by pediatric patients. An observation window in one hive provides visitors with a window into the world of “the unsung heroes of the food system.”
Stacy Buchanan

The farm also creates connections between people and organizations. As food leaves the farm to its destination—a hospital plate, a home-cooked meal, a class in the teaching kitchen, or a weekly farmers market for employees—the BMC community is also drawn back to the farm. A typical day might see a visit from a group of middle-schoolers surprised to find carrots growing on a roof, and delighted to help pull them from the soil to use in a salad they’ll make for lunch. Tracey Burg might stop by to pick up zucchini and fresh herbs for a class aimed at supporting people in recovery from addiction. Volunteers from a refugee group—many of them experienced farmers and gardeners—might arrive to help Allen pull spent crops and start new transplants of Swiss chard that will eventually make its way to the food pantry, where Latchman Hiralall will oversee their distribution to families in need.

This simple, but fundamental, concept that the farm would be integrated into BMC’s community and mission was baked in from the start. Dave Maffeo recalls that the idea of a farm at the hospital was sparked in a conversation with Robert Biggio, Senior VP of Facilities and Support Services, where he made what seemed like an offhand comment: “wouldn’t it be great if we could grow our own food for the pantry?”

That conversation happened in spring of 2016. That summer, Maffeo toured local rooftop farms, and eventually brought John Stoddard, founder of Higher Ground Farm, on as a consultant for the farm’s construction and ongoing operations. The hospital dedicated its annual Food For Thought fundraising dinner to raise money for the farm that November (the farm’s operating costs are entirely covered by fundraising). In April 2017, just one year after that first conversation, the container growing system was installed by Recover Green Roofs and the first transplants went into the soil. Maffeo credits the speed of the project to BMC’s leadership and their support of the vision. “They recognized that it’s the right thing for us to do, the right thing for our patients, and the right thing for our sustainability work.”

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Strategically placed flowers attract pollinators to the farm, increasing the diversity and resilience of this “rooftop ecosystem.”
Stacy Buchanan

Connections are also beginning to reach outside the boundaries of BMC. The innovative model of a hospital supporting patient wellness through food access, education, and now food production is attracting interest from other institutions. Since the farm opened, Maffeo, Allen and Stoddard have been in contact with hospitals in locations as far-flung as Washington State, Alaska, Puerto Rico, and Mexico, all eager to learn more about how they could replicate this model in their own communities. Latchman Hiralall fields regular inquiries from hospitals that want to learn more about running a food pantry as part of a preventative wellness program.

Lindsay Allen hopes that Higher Ground Farms has the opportunity to work with more hospitals on starting farms of their own. Citing one last, less tangible benefit, she describes a physical therapist who volunteered to help transplant the very first tomato plants last year, and whose office windows overlook the farm. The therapist uses her view of the farm as motivation for patients doing walking exercises across her office. “It just brings people joy,” says Allen.

Hilary Emmons works part-time on the Boston Medical Center Farm.

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