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.