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Spiritual growth

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Lettuces and taro grow in water-tray tables at the aquaponics garden maintained by patients at the Hawaii State Hospital in Kaneohe.
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Occupational therapist Judy Dacanay and Clyde Tamaru of the University of Hawaii-Manoa College of Tropical Agriculture and Human Resources examine produce growing in the aquaponics garden at the Hawaii State Hospital.
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Recipes for using fish from the tilapia ponds at the Hawaii State Hospital include Local-Style Stuffed Tilapia Fillet with Mini Musubi.

An aquaponics program at Hawaii State Hospital is growing food not just for the body, but for the soul.

Some 15 patients at the Kaneohe mental health hospital have learned how tanks filled with tilapia support the growth of everything from various lettuces to green onions, cucumbers, watercress, tomatoes, taro, soybeans, chilies and herbs. And as they tend to their garden, the patients are learning skills that will assist them in navigating life outside the facility.

"Vocational rehabilitation is one of the best practices for patients with severe persistent mental illness," says Tiffany Kawaguchi, the hospital’s psychosocial rehabilitation specialist and rehabilitation director. Other vocational programs include auto detailing, dog grooming, gardening, woodworking, paint shop and a general store. Patients are paid below minimum wage.

In aquaponics, fish waste is filtered. Leftover bacteria convert ammonia (urine) from nitrite to nitrate, a natural fertilizer that is pumped into garden tubs. Veggies grow in the nutrient-rich water in one of two ways: planted directly in cinder-bed tubs or in net pots floating in tubs.

"This is 100 percent run by patients," Kawaguchi says.

"They see through the whole process," adds occupational therapist Judy Dacanay. "They measure the feed, feed the fish, maintain tanks and measure temperatures, nitrates and nitrites. They do the seeding and replanting, assess the quality of the vegetables, weigh them and bag them."

The farmers sell their produce weekly to hospital staff. Profits go back into the program to buy more seed, fish feed or other supplies. Other rewards stick with the patients.

"They learn to interact with other people. They learn teamwork and how to respect authority," Kawaguchi says. "It’s calming for those who get agitated. It can bring them out of their shell if they’re depressed. It’s meaningful to be able to produce something with your own hands."

Patients also get to eat what they grow, and that is something they look forward to, says Dacanay, who whips up smoothies and salads for her charges. Soon she will include the tilapia.

But before the farmers partake of the fish, volunteers and donors to their program will attend a private thank-you event tomorrow at the hospital, where the tilapia will be in the spotlight. University of Hawaii Chancellor Virginia Hinshaw will be on hand, since staff from UH’s College of Tropical Agriculture and Human Resources helped launch the program with the support of the community.

Chef Diane Nazarro, of Honolulu and Windward community colleges, has created an array of tilapia dishes to dazzle guests’ taste buds. She says that despite its less-than-stellar reputation as a "rubbish" fish, tilapia is delicious.

"I pan-seared it with some salt and pepper and fed it to a fellow chef and another co-worker, a person who knows fish. They asked me, ‘Is it opakapaka?’ When I said, ‘No, it’s tilapia,’ they were floored," she says.

"Because the quality of the fish is so high, it’s such a pleasure to work with. People really need to know about this. I hope I do this fish justice, because it’s just fabulous."

Nazarro says she used "very simple processes" in her dishes. She filleted the tilapia and steamed, pan-seared, cured and deep-fried the meat. Her menu: Tofu & Tilapia Salad in Manoa Lettuce Cups, Seared Tilapia Summer Rolls with Spicy Lime Dipping Sauce, Greek-Inspired Tilapia Souvlaki on Pita Points with Tzatziki Sauce, Cumin Crusted Tilapia Mini Quesadilla, Local-Style Stuffed Tilapia Fillet with Mini Musubi, and Mini Koi-lapia Bagel.

Nazarro’s Koi-lapia pupu doesn’t involve cooking over the stove. Instead, she cures the fish overnight with kosher salt and brown sugar. The salt preserves the fish.

It’s important to note that freshwater fish such as tilapia should never be served raw.

"This general rule of thumb stems largely from stuff caught in the streams and/or cultured in large freshwater ponds and has to do with the rat lung worm that is present in the islands," says Clyde Tamaru, CTAHR aquaculture specialist, who was instrumental in launching the hospital aquaponics program. "As you might expect, cooking, salt-curing or smoking kills these parasites."

Tamaru’s assistance went beyond simply sharing his knowledge. He not only taught patients and staff to build and maintain the aquaponics system, but he generated $75,000 in community donations to make it happen. Tamaru’s still on hand whenever something malfunctions or needs repair.

"The college’s mission over the next decade is to teach the community ways to be self-reliant with food and energy," Tamaru says. "Hawaii relies on outside sources for 85 percent of its food and 90 percent of its energy."

Unlike other science being done at the university, CTAHR’s work extends beyond the laboratory into the community for practical application. Tamaru’s already working with the Department of Hawaiian Home Lands on a similar program in Waimanalo, and Waianae is slated to be next.

The scientist likes how directly his work affects people. "There’s no use to make a publication and put it in a library," he says. "For us, the satisfaction comes when we see the community grow."

Kawaguchi says Tamaru will be holding a workshop for staff members who have become interested in starting home aquaponics systems. Her hope is that the hospital will eventually be able to send patients home with materials to start their own systems.

Kawaguchi can’t say enough about Tamaru’s support.

"Clyde’s gone above and beyond, and he’s very kind to the patients. He’s helping us break down barriers and create real communities. This is so important for them," she raves.

But Tamaru says he’s learned a lot from patients.

"We’re scientists, and sometimes we look in the microscope too much," he says. "This is the part they taught me: how much impact growing food has on the human spirit."

Taste of Tilapia

Chef Diane Nazarro of Honolulu and Windward community colleges created these recipes to showcase the tilapia raised in the Hawaii State Hospital’s aquaponics program:


1/8 cup brown sugar
1/4 cup kosher salt, plus a pinch more
2 fillets tilapia, about 1/3 pound
4 ounces cream cheese, softened (half of block)
1/2 teaspoon lemon zest
1/2 teaspoon fresh lemon juice
Pinch ground pepper
6 mini bagels, cut in halves
1 tablespoon red onion, small dice
1 tablespoon grape tomato, small dice
Pinch lemon zest
1 or 2 pieces nonpareille capers

In small bowl, combine brown sugar and kosher salt. Mix well.

Coat tilapia fillet with mixture and place on perforated plate or bowl. Place plate or bowl over pan to capture residual liquid. Cover with plastic wrap and refrigerate overnight.

Preheat oven to 350 degrees. Slice fillets thinly and set aside.

In medium bowl, assemble cream cheese mixture: Add lemon zest, lemon juice and ground pepper; mix well.

Place sliced bagels on baking pan and toast in oven for 10 minutes. Remove from oven and cool.

Coat each bagel with about 1 teaspoon of cream cheese mixture.

Divide tilapia among 12 bagels. Garnish with diced red onion, grape tomato and a pinch of lemon zest and capers.

Serve immediately. Makes 12 mini bagel halves.

Approximate nutritional information, per bagel half: 100 calories, 4.5 g fat, 2.5 g saturated fat, 20 mg cholesterol, greater than 1800 mg sodium, 10 g carbohydrate, 0 g fiber, 2 g sugar, 4 g protein


1/2 cup watercress, diced
1 cup grape tomato, cut in halves
1/4 cup green onion, diced
1/3 cup Maui or red onion, sliced
1/2 teaspoon toasted black sesame seeds
1 tablespoon vegetable oil
2 tilapia fillets, about 1/3 pound
1 cup firm tofu, diced (about 1/2 block)
4 Manoa lettuce leaves
» Soy dressing:
1/3 cup strong soy sauce (Kikkoman or Yamasa brands are best)
1/4 teaspoon sesame oil
1/4 teaspoon fresh ginger, grated
1/4 teaspoon fresh garlic, grated
1 teaspoon green onion, diced
Pinch ground pepper
1/4 cup extra virgin olive oil
1/2 teaspoon rice wine vinegar
1/4 teaspoon mirin
1/4 teaspoon red chili pepper flakes (optional)

For soy dressing: In medium bowl, mix all ingredients and refrigerate.

In medium bowl, combine all vegetables except Manoa lettuce leaves.

In small saute pan, heat and toast black sesame seeds. Set aside.

In medium-size saute pan, heat to medium and add oil. When oil is hot, place tilapia into pan, skin side down, and brown, approximately 3 minutes. Turn and cook another 3 minutes. When cooked thoroughly, place on paper towel to drain excess oil. Allow to cool and tear into bite-size pieces.

Before serving, add tofu to vegetable mixture. Then add soy dressing. Toss. Add tilapia fillet.

In shallow bowl, place Manoa lettuce leaf, add about 1 cup tofu-tilapia mixture and garnish with toasted black sesame seeds. Makes 4 lettuce cups.

Approximate nutritional information, per serving: 350 calories, 28 g fat, 4 g saturated fat, 20 mg cholesterol, greater than 1200 mg sodium, 8 g carbohydrate, 3 g fiber, 3 g sugar, 20 g protein


2 tilapia fillets, about 1/3 pound
» Stuffing:
1/4 cup fresh mushrooms, diced
1 tablespoon water chestnut, diced
1/4 cup lup cheong sausage, diced
1/4 cup green onion, diced
1 tablespoon mayonnaise
» Soy-Ginger Jus:
2 tablespoons strong soy sauce (Kikkoman or Yamasa brands are best)
1/2 teaspoon fresh ginger, grated
1 teaspoon sesame oil
» Mini musubi:
1 cup steamed rice
4 pieces yaki nori strips
» Garnish:
1 tablespoon fresh ginger, fine julienne
1 tablespoon peanut oil
4 cilantro sprigs
1 tablespoon green onion, diced
1 teaspoon toasted black sesame seeds

To make stuffing: In bowl, mix mushrooms, water chestnut, lup cheong, green onion and mayonnaise. Set aside.

Slice tilapia fillets into 4 pieces each. Cut a slit lengthwise in center of each, then fill with stuffing.

Place pieces in dish or pan and steam for about 6 minutes.

Meanwhile, assemble mini musubi by molding 1/4 cup rice by hand into triangle shape and cover with a nori strip. Set aside.

To make Jus, combine ingrediants and stir.

When fish is steamed, immediately add a splash of soy-ginger jus and add julienne of ginger.

In small saute pan, heat peanut oil until it begins to smoke. Remove from heat and splash hot oil on each fillet.

Add rest of garnish and serve with mini musubi. Serves 2.

Approximate nutritional information, per serving: 450 calories, 26 g fat, 4 g saturated fat, 40 mg cholesterol, greater than 1300 mg sodium, 35 g carbohydrate, 1 g fiber, 2 g sugar, 23 g protein


1 pita bread
8 fresh baby arugula leaves
2 tilapia fillets, skin removed, cut into cubes
» Lemon vinaigrette:
3 tablespoons fresh lemon juice (about 1/2 lemon)
2 tablespoons extra virgin olive oil
Pinch kosher salt
Pinch ground pepper
1/4 teaspoon ground cumin
1/4 teaspoon fresh garlic, minced
1 teaspoon fresh parsley, minced
1/4 teaspoon lemon zest
» Tzatziki sauce:
1/2 cup plain yogurt
1/2 Japanese cucumber, pureed or grated
1/4 teaspoon fresh lemon juice
1/2 teaspoon fresh parsley, minced
Pinch kosher salt
Pinch ground pepper
1/4 teaspoon ground cumin
1/4 teaspoon fresh oregano, minced
» Garnish:
1/4 cup grape tomato, diced
1/2 Japanese cucumber, diced
Pinch fresh parsley, minced

In medium bowl, mix all ingredients for lemon vinaigrette and set aside.

In medium bowl, mix all ingredients for Tzatziki sauce and refrigerate.

Assemble tilapia cubes on 4 6-inch skewers. Place in pan and pour lemon vinaigrette over skewers. Marinate for 5 to 7 minutes.

In saute pan, heat pita bread until pliable. Remove from pan and wrap with aluminum foil to retain heat.

Heat another pan on high until hot, then add skewers to sear fish, about 3 minutes on each side. Turn skewers, lower heat to medium and allow fish to continue cooking. Remove from pan and drain on paper towel to remove excess oil.

Cut pita into fourths, creating triangles. Place on plate and add a teaspoon of Tzatziki sauce. Add 2 pieces arugula leaves and top with tilapia skewers. Drizzle more Tzatziki sauce. Add garnish and serve immediately. Serves 2.

Approximate nutritional information, per serving: 380 calories, 23 g fat, 4.5 g saturated fat, 50 mg cholesterol, 250 mg sodium, 27 g carbohydrate, 4 g fiber, 6 g sugar, 19 g protein

Nutritional analysis by Joannie Dobbs, Ph.D., C.N.S., a nutritionist in the Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii-Manoa.


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