From Romania to the UK: a journey from Eastern to Western dietetics

Oana tells us about the challenges faced in Romania as it transitioned from being a communist country to joining the EU and how this has affected dietetics and her own career journey.

Oana Oancea, RD

Specialist Dietitian - eating disorders and mental health

I followed a three-year bachelor's degree program in Nutrition and Dietetics at a reputable university in Romania. This program provided a solid foundation in nutrition science, biochemistry, physiology and clinical dietetics. However, I lacked the practical experience and exposure to a diverse range of cases that would have better prepared me for professional practice.

Reflecting on my journey from being an internationally trained dietitian to practising professionally in the UK, on the differences in education pathways, the scope of practice and the nature of the dietetic profession in Romania, it was not an easy process for me to transition into the role of an HCPC Registered Dietitian. But I knew from before beginning my studies that I would immigrate as soon as I graduated.

My very first job in England was in mental health and very soon I started to work with patients with eating disorders - an area of healthcare I never thought I would end up specialising in.

The Romanian backdrop

The understanding of eating disorders in Romania was limited, and there was a prevailing belief that they were not recognised as real illnesses. In fact, so much so, they were often regarded as a myth!. This perception was influenced by the historical context of food scarcity during the communist era. The lack of recognition and understanding of eating disorders created barriers for individuals seeking help and deterred dietitians from specialising in this area.

To understand the challenges I faced transitioning into the role of a Registered Dietitian in the UK, it is important to examine the historical context in Romania. Romania was a communist country until 1989, when the Communist regime fell, bringing significant changes to the nation. The relationship between food and communism in Romania was not a positive one, as scarcity and rationing were prevalent. This historical context shaped the beliefs and understanding of nutrition and health in the country.

Under the rule of Nicolae Ceaușescu, Romania experienced a highly centralised command economy, which aimed to erase inequalities by directing resources towards industrialisation and national development. This approach resulted in severe food shortages and rationing, as resources were redirected to other sectors or exports.

The scarcity of essential food items, such as meat, dairy products, vegetables and even basic bakery items was a notorious aspect of everyday life in communist Romania. Necessities were not easily accessible or affordable for most citizens, resulting in long queues, black markets, and a constant struggle to obtain adequate nutrition. Rationing cards became a common feature, distributing limited supplies to citizens regardless of their preferences or nutritional needs. The communist regime heavily relied on propaganda to maintain control and shape public opinion. In the context of food, this propaganda often depicted scarcity as a consequence of external enemies or imperialist exploitation.

Additionally, the scarcity of food and poor nutritional practices during this period contributed to a rise in health issues such as malnutrition, anaemia and vitamin deficiencies with pellagra being widespread.

In 1984, a new and lower food standard was adopted. Romanians were entitled to 39 kilograms of meat, 78 litres of milk and 166 kilograms of vegetables annually. Oil and sugar were given once a month, the ration being one kilogram. They were entitled to half a loaf of bread per day and the chicken of a size of a pigeon was a dream most of the time.

The lack of education and access to proper nutrition further perpetuated these problems. The communist regime's control over information also hindered the dissemination of accurate knowledge regarding nutrition and health.

Post-communist countries faced challenges in adapting their healthcare systems to new political and economic realities. Limited funding and inadequate infrastructure have hindered the development and implementation of comprehensive mental health services, including eating disorder treatment programs.

Mental health issues, including eating disorders, have historically been stigmatised in post-communist countries. This stigma arises from a lack of awareness, cultural taboos and an underestimation of the severity of these disorders. Consequently, it was near impossible to get help for eating disorders as these were mostly perceived as caprice or a sign of weakness or personal failure.

The communist era led to a lack of nutritional education, as concepts related to health and nutrition were often overshadowed by the struggle for access to basic food. Although initially intending to reduce inequalities, the emphasis on resource management resulted in widespread malnutrition and health-related issues. Consequently, the population's understanding of the relationship between food and health was limited and often focused on immediate survival rather than long-term well-being.

Eating disorders: the challenges for Eastern dietitians

Treating eating disorders in post-communist countries remains a challenging task, given the historical context, limited resources, and cultural factors. Romania's integration into the European Union and market-oriented reforms have led to improvements in food availability, variety, and quality. Nevertheless, dietitians still face numerous challenges in treating eating disorders in post-communist countries. These challenges include limited specialised training, inadequate access to treatment facilities, cultural barriers and a lack of interdisciplinary collaboration. These aspects can hinder their ability to provide effective and evidence-based nutrition therapy to individuals with eating disorders. Moreover, open discussions about mental health may still be perceived as taboo, hindering the treatment-seeking process.

For me, it was very challenging not only on a professional level but personal personally too, to accept and understand these illnesses. At my university, barely half a page was allocated to eating disorders and it was a non-mandatory lecture for the students. You could feel the real effort and struggle of the author to present eating disorders as legitimate illnesses.

I left Romania and am now in a country where the government announced in 2023 that they plan to invest at least £2.3 billion of additional funding a year by March 2024 to expand and transform mental NHS health services. That means an extra two million people will be able to get mental health support. It’s a different world, but along the way, cultural barriers and challenges have been significant hurdles and are faced by many dietitians from post-communist countries when adapting to the Western healthcare system. These barriers can be categorised into language proficiency, professional norms and healthcare beliefs. But the challenges are not insurmountable. Through language proficiency, professional development and cultural sensitivity, dietitians can bridge the gap and provide quality care in Western healthcare systems. Collaboration, support and an open-minded approach from various stakeholders will play a vital role in overcoming these challenges.

As healthcare continues to evolve, the future holds promising opportunities for dietitians from post-communist countries to make significant contributions to the field in an increasingly globalised society.

Oana Oancea, RD

Oana works with Day Centre patients and outpatients. She also holds discussions around healthy eating and mental health at the Carers Support Centre in Dumfries. In the past, she led the CAMHS Addiction and Eating Disorders Unit in Priory Hospital, Chelmsford.