Getting to Know


Ms. Jennifer Baral, Critical Care Dietician
My role as a dietician has evolved over the past few years, especially in the Pediatric Intensive Care Unit (PICU).  In the past, dieticians have not always been involved in the daily patient monitoring rounds in PICU. Before, it was common practice for dieticians to write their suggestions in the nutrition progress notes without the physicians looking at it. Physicians therefore became the clinical staff member managing the feeding of patients without dietician consultations.

Dramatic changes have since occurred. I am now openly invited to participate in the daily multi-disciplinary PICU rounds. I am actively involved in overseeing pediatric patients’ nutritional status on a daily basis. My role in a critical care setting is uniquely challenging as I am faced with children who are intubated, sedated and fluid restricted with complex nutritional statuses. Optimizing caloric intake of critically ill children is often difficult due to the challenges of multi-factorial feeding intolerance.

As a critical care dietician, participation in daily morning rounds is essential to be able to communicate with the team about the nutritional care plan and management for the patients and working in collaboration with the inter-disciplinary ICU team to promote optimal nutrition is crucial for this.  One of my roles is to review each patient in the PICU, identify those at risk of malnutrition and then plan patient-specific nutritional interventions.

Critical care dieticians manage both enteral and parenteral nutrition.  I assess nutritional requirements of individual patients to ensure adequate nutrition without overfeeding or underfeeding. I also deal with formula selection, initiation, advancement, and target rate of feeds. As well as monitoring tolerance and complications of feeds. For patients who have impaired gut function, parenteral nutrition is the optimal choice of feeding.  I determine calorie intake from total parenteral nutrition (TPN) in comparison to the child’s caloric need. I also give recommendations about mineral and trace elements requirement in TPN according to patient lab results and condition and monitor fluid and electrolyte statuses of patients, as well as managing glucose control.

In addition to implementing recommendations and managing nutritional care of complex PICU patients, I participate in policy and protocol development and undertake my own research. To date, we have formulated the feeding protocol enteral feeding guidelines for PICU which will be implemented soon. I participate in developing, implementing and revising nutrition protocols to ensure all patients receive timely, appropriate and cost-effective nutritional support, including guidelines for initiating feeds out-of-hours. Furthermore, I serve as preceptors for dietetic internship programs and often have the opportunity to teach optimal nutrition practice to every level of the healthcare team, including medical students, interns, residents, and nurses. I have just delivered an education session for allied health regarding feeding syndrome and I will be looking forward to delivering more education sessions for residents as well as nurses and other allied health.


Ms. Bella Santiago, Office Administrator, Department of Pediatrics
As an Office Administrator, a typical day is mostly spent in front of the computer, between eight to nine hours a day. First thing I do is check to see the day’s schedule and ensure logistics are sorted for the Chairman. I sort through corporate correspondence and communications from the medical administration offices, and various departments. Based on the urgency and priorities, I confer with the Chairman and follow through the appropriate action and response. Our office is a particularly hectic one, where the phone is constantly ringing off the hook and emails flooding my inbox, all making difference inquires, follow-up on previous matters, and requests. It might seem chaotic but I try my best to accommodate as many people as I am able to during the day. On a daily basis, with the department, I communicate with the Chairman’s office, 16 different pediatric subspecialty services, and various corporate and medical departments through HMC. Throughout the day, our office receives several physicians and visitors. I listen to everyone who comes to me for all sorts of work-related requests, queries, some of whom look to me for my opinion and suggestion on resolving matters raised within the department and ensure a timely solution in a professional manner. 

My role, specifically, is to oversee overall administration and office management with specific focus and direct responsibility reporting to the Chairman and the Departmental Executive Committee, constituted of Heads of Sections. I arrange meeting and appointments for the Chairman and Heads of Sections, as required. I also facilitate meeting requests from departments and institutions. Part of my day is spent writing correspondence and responses on the Chairman’s behalf and action items as needed. I’m involved in the process and timely follow-up of all recruitments for medical, technical, clinical, professional, and administrative staff. Also related to it, I process medical staff locums and provide logistical support for visiting consultants, as required. If that weren’t enough for one day, I ensure appropriate documents are processed and submitted for staff promotions. In line with this facet, my role extends from handling physician compliance and credentialing, to re-credentialing and obtaining clinical privileges, to conducting initial assessments and coordinating all staff registrations for compliance with mandatory courses. Moreover, I maintain staff personnel files following SQE and office documents. As well, I prepare the annual budget and purchase requests in coordination with Heads of Sections from various subspecialties according to specific requirements and work diligently to ensure its timely processing. I manage and coordinate duties and responsibilities of other secretarial, clerks and office aide staffs within the department. Though people are the primary focus, a nice working environment is conducive to working well. To that end, I look after all staff offices, office space requirements, on-call rooms, doctors’ loungers, conference room in regards to furniture needs, maintenance, or any other raised concerned.

As you can tell, everyday is a hugely busy day where the ‘to-do list’ gets longer no matter how hard we work to shorten it. So remember, if it’s hard to get in touch with me, it’s nothing personal!