It started with pasta. Spaghetti, to be exact: tupperwares full of spaghetti cooked in the basement of Trinity Church then delivered to the homes of patients with HIV. That spaghetti was the beginning of San Francisco nonprofit Project Open Hand, and in the three decades since they started cooking in that basement, Open Hand has not just been able to survive, but thrive, changing and expanding to meet the needs of their city, with a model that’s been successfully duplicated across the country. And with an ambitious new study with UCSF underway, they’re pioneering research to support their belief that food can act as medicine.
The organization started when Ruth Brinker, a grandmother and former food service worker, noticed a friend with AIDS struggling to cook for himself. She successfully organized a group of friends to deliver home cooked meals, but the man died after one of the members went on vacation and wasn’t able to deliver the meals. The incident spurred Brinker to create Project Open Hand in 1985, with the aim to provide free, home cooked meals for the city’s increasing numbers of HIV patients.
When the organization began, it was a casual affair, starting with just $2,000 and a group of spirited volunteers. Many HIV positive patients at the time suffered from wasting syndrome, causing them to lose about 10% of their body fat, so Open Hand’s meals centered around hearty, fattening comfort food: mac and cheese, meatloaf, lots of fried foods.
“When the epidemic first started, there was nothing we could do,” said Jim Mercer, a volunteer for over 25 years. “We didn’t know what to do. We were finding that people were hungry, people were starving, they weren’t able to cook with themselves.”
Volunteers delivered the meals, and served as a point of human interaction and contact for the isolated, terminally ill patients. It was difficult, emotionally taxing work: volunteers would often return to a client’s house the next week, and find that the client had died.
The organization expanded, and started to serve Alameda County in 1989, then moved into its current Polk Street location in 1997. A year later, the Salvation Army’s anti-gay stance allowed them to expand even more. San Francisco had just voted that all city employers were required to provide domestic partner benefits to their employees. The Salvation Army, which was previously running the city’s senior meal service, refused to provide the benefits, and was forced to give up its contract with the city. Open Hand took over the contract, and started providing lunch to seniors around the city. In 2000 they started serving clients with conditions other than HIV, including heart disease and various cancers. Other cities, including Los Angeles, New York and Atlanta, successfully duplicated the program.
Now, they serve 2,500 meals a day in San Francisco and the East Bay, and have a grocery center in downtown Oakland where clients can pick up meal ingredients. A steady supply of funding (a combination of government funding and individual and corporate donors) and volunteers (they work with 125 every day) allows them to successfully help more and more patients. Since they started serving more than just clients with HIV, they’ve developed seven specialized diets, so clients with everything from low carb needs to clients on dialysis can receive specifically tailored meals.
One of the organization’s biggest shifts over the years has been their increasing emphasis on healthy eating, a far cry from the meatloaf and mac and cheese of the early days. Now, an average meal is a lean protein with lots of veggies, an apple for dessert, local and organic when cost allows.
Their new focus on health also shows how HIV has changed over the years. An HIV diagnosis is no longer a death sentence, and Open Hand’s food reflects that: instead of rich comfort food to provide physical and emotional sustenance to dying patients, their healthy food is designed to help extend the lifespan of their HIV positive clients.
“The face of HIV, especially with gay men in San Francisco, is they’re facing aging issues. You have to realize alright, we’ve got to watch our cholesterol, carb intakes and all those other things,” says Mercer, who has HIV and credits Open Hand with keeping him healthy over the years.
“I’m asymptomatic, I have no viral loads, I don’t have any symptoms of the disease and I think a lot of that has to do with making healthier choices early in the epidemic stage. Project Open Hand was instrumental in that, in giving me a base that was centered on healthy living,” he said. “At some point I realized, “Hey, looks like I’m going to be around here for a while. Put down the pasta and pick up the kale and the broccoli.’”
That new focus on healthy eating led to Open Hand’s 2014 “Food=Medicine” pilot study with UCSF. In an effort to determine what effect a healthy diet has on people’s overall health, Open Hand took a group of their clients with HIV/AIDS or both HIV/AIDS and diabetes and provided all their meals--not just the one they typically offer--customized to their nutritional needs for six months. The study is just wrapping up, and the initial results are expected to come out later this summer.
It seems like a simple enough hypothesis--of course healthy eating is better for your health, right?-- but it’s one that’s hard to prove. Although popular culture is awash in often contradictory nutrition advice, there are fairly few studies that have empirically examined the impact of food on health because it’s so hard to determine what someone actually eats--self reported accounts of one’s diets are typically way off, leading to skewed results.
Open Hand is also trying to scale their operations to be able to support the rapidly increasing senior population: a 2012 Department of Aging and Adult Services report projected that San Francisco’s senior population is going to swell 20% over the next ten years.
They’re also focusing on meeting the needs of food insecure individuals in the Bay Area, said Simon Pitchford, co-CEO of Open Hand.
“I serve on the food security task force and we put out a report about a year ago that indicated one in four people in the Bay Area is food insecure,” Pitchford said. “In a city that’s so resource rich as San Francisco, it’s such a startling statistic. That forms a lot of the population that we currently serve, and to continue to serve that population is really critical to our mission.”
For all of Open Hand’s changes over the last thirty years--from serving only HIV patients, to patients with several other diseases, from meatloaf to kale--there’s one thing that’s stayed the same: their slogan, “meals with love.”
“Ruth used to come around in the kitchen--this is going to get me verklempt every time I think about it--she would always ask the volunteers if they were cooking and [say], ‘Now you be sure you’re putting the love in that meal,’” said Mercer. “That was always something that was very important from the start and still goes on, to make sure that not only is it nutritious, but we put love in it. That’s what we’re serving our clients.”
Sure, food is food and we all need calories to survive. But Open Hand’s enduring impact can partially be attributed to their recognition that serving food to someone is more than just a meal--it’s a personal connection, demonstrable evidence that someone cares about you.
“There’s something about food. Food is such a comfort item. Taking somebody a hot meal just speaks volumes about the care and the love that you’re bringing to that person,” said Pitchford. “Food that was cooked by somebody’s hand, it’s just [got] such a special aura around it.”
“It’s the community. Going back to why Ruth started this organization, she recognized that there were people who were dying because they were malnourished, but also that there was no contact, there was a lack of socialization, an isolation,” Pitchford added. “That’s the thing that makes this so special, that we get to interact and talk to our clients all the time.”
That personal service extends to their delivery service, which Sumiyati Monoarfa found out last summer. After suffering three heart attacks in one week, she left UCSF with Open Hand scheduled to deliver her six months of dinners. It was a godsend for Monoarfa, who lives in a Tenderloin SRO with one kitchen for almost 200 rooms, making cooking a challenge. Not only did Open Hand introduce her to new foods (polenta, dill), it provided a valuable sense of community and security.
One night, Monoarfa wasn’t in her room when her delivery person came by with her food. Instead of leaving the food for her at the front desk, he asked the receptionist to call and check on her, to make sure she was safe.
“I can’t tell you how--I get emotional when I talk about them--” she said, choking up. “--How much that meant to me that he would take time out to check on my well being. It’s that personal touch, they became like your extended family because they care about you.
It is so much more than food. Their slogan “food made with love” is absolutely correct.”