From South Africa to East Yorkshire: a dietitian's journey through diversity

Keren grew up in South Africa and became a dietitian working in a large government hospital. Here she explains how extreme poverty shaped dietetics in her area and how the lessons learned there led her to dietetics in very different East Yorkshire.

Keren Miller, RD

Global Clinical Lead Dietitian, Oviva

Growing up in the vibrant, diverse landscape of South Africa was like being part of a living tapestry, woven with the threads of various cultures, traditions, and foods. The rainbow nation, as it's affectionately called, boasts 11 official languages, and each corner of the country is a unique blend of heritage and history.

In the vast expanse of South Africa, with much of it rural, the infrastructure is very much third world. It's a place where the luxuries we take for granted (electricity, running water, well-stocked supermarkets) are not universally accessible. This reality shapes the daily lives, health, and priorities of the people, creating a stark contrast to the Western comforts many of us are accustomed to.

The challenges of poverty...

I embarked on my journey to become a dietitian in a large government hospital. The facility housed brilliant clinicians grappling with the most complex cases, often exacerbated by extreme poverty. Poverty in South Africa operates on a different scale, leading to conditions that challenge even the most innovative problem solvers.

In this environment, poverty wasn't just a financial struggle, it manifested in extreme malnutrition, lack of sanitation and living conditions that fuelled the spread of infections. This level of poverty leads to desperate measures, resulting in violent crime and substance misuse. It was poverty that forced people to cook over open fires in flammable homes made of cardboard.

The patients under my care painted a picture of the challenges faced by those living in poverty. Malnutrition complicated by TB and HIV, severe burns from fires in informal settlements and wounds from violent incidents – all consequences of a life shaped by poverty. Amidst these struggles, there were also mothers and newborns, emphasising the importance of breastfeeding as a vital source of clean free nutrition.

Obesity and type 2 diabetes existed. Cheap calorie-dense food was more accessible than fresh produce and, in many communities, carrying extra weight was seen as a positive attribute, symbolising fertility and health.

Transitioning to a small community service was a unique experience. We travelled in pairs for safety and were always struck by the absence of formal kitchens and refrigerators. The focus was often on preventing hunger rather than achieving optimal nutrition.

I did not see fancy home-enteral feeding pumps and almost no cases of IBS!

Private practice in South Africa presents a different clinical role, and just as I was contemplating my next career move, fate intervened, leading me to East Yorkshire in the UK as a dietitian.

Skills and lessons learned: navigating the unexpected

The diverse experiences in South Africa equipped me with a unique skill set that proved invaluable in my career in East Yorkshire. Expecting the unexpected became second nature, and the ability to adapt nutrition advice creatively was a crucial asset. (HGV drivers also don’t have access to a fridge!)

Communication skills honed in South Africa, where literacy levels varied and languages were diverse, allowed me to connect with people from all walks of life. A warm, open demeanour and a smile, it turned out, transcended cultural differences.

Understanding patients' priorities became a guiding principle. The lesson was clear: imposing our professional agenda doesn't bring about meaningful change. This insight, along with a desire to find scalable accessible solutions, set the stage for my next steps into digital health.

Photo: Shane Rounce - Unsplash

As I reflect on my journey from the rainbow nation to East Yorkshire, I carry with me the colours of resilience, innovation and a deep understanding that health, nutrition and well-being are intricately woven into the fabric of our daily lives. Our backgrounds may be different, but the principles remain universal: meet people where they are, understand their struggles and work towards solutions that are both practical and meaningful to the individual.

Keren Miller, RD

Keren is Global Clinical Lead Dietitian at Oviva. She has been a dietitian for 22 years with 16 years in Specialist Diabetes in both traditional NHS services and digitally-enabled care. Keren has a Dietetic Degree and a Masters in Nutritional Medicine.