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02 June 2025 | Story Leonie Bolleurs | Photo Supplied
Dr Lucia Meko
Dr Lucia Meko believes that face-to-face engagement helps students become more empathetic, culturally aware health professionals.

In South Africa, the streets often tell stories of contrasts where wealth and poverty, tradition and modernity, and diverse cultures meet at the same intersection. It is a place where neighbours may speak different languages, worship in different ways, and sit down to very different meals. These everyday differences do not just influence how people live – they shape what ends up on their plates.

According to Dr Lucia Meko, Senior Lecturer and Head of the Department of Nutrition and Dietetics at the University of the Free State (UFS), dietitians play an important role in such a diverse landscape. “Their mission is to empower individuals and communities to make informed, healthy food choices that support long-term well-being. According to the Health Professions Council of South Africa (HPCSA), dietitians are trained to provide personalised nutrition counselling aimed at preventing and managing diet-related diseases,” she says.

“This means that whether someone is dealing with diabetes, high blood pressure, or simply trying to improve their eating habits, a dietitian can offer guidance tailored to their unique needs and circumstances.”

However, Dr Meko believes that while theory is important, many students only truly understand the reality of their future clients when they experience it first-hand. At the UFS, students do not have to wait until the end of their degrees to gain this insight. Community service learning begins in their very first year.

This approach immerses students in the communities they will eventually serve, offering a practical education that goes beyond textbooks. By working directly with communities, students gain a deeper appreciation of the challenges individuals face in making healthy food choices,” she says.

“These experiences help shape well-rounded professionals who are not only knowledgeable but also empathetic and culturally aware,” adds Dr Meko.

Unlike traditional volunteering, this is structured learning with clear outcomes. Students apply classroom theory to real-world issues while simultaneously giving back. Through this process, students develop critical thinking, cultural competence, and the ability to communicate health information in ways that are relevant and respectful,” she explains.

 

What really happens on the ground

To understand what this looks like in practice, Dr Meko points to a research study conducted by the department. It examines the experiences of fourth-year students during a Community Nutrition Module internship. This internship is one of eight work-integrated learning (WIL) components in the module.

In this particular placement, students work in Ward 51 in Mangaung, visiting homes and engaging directly with residents. During each visit, they profile the community member’s demographics, measure nutritional status (using weight and height), and assess dietary patterns. Afterward, they offer tailored dietary counselling.

Beyond individual visits, students also explore the broader food environment: visiting supermarkets, vegetable gardens, early childhood centres, and street vendors all form part of their learning.

Importantly, this programme is not one-sided. Feedback from both students and community members is gathered to improve the experience and assess its impact.

So far, early findings are promising. Students not only learned; they were transformed. Interestingly, students mostly showed appreciation for their own privileges in comparison to the disadvantaged communities they visited,” says Dr Meko. One student reflected: “It humbled me and made me very grateful for all that I have, because I think we really lose sight of that sometimes.”

After a township tour, another student admitted: This was very insightful, as we often have stereotypes about the way people live and what people eat, simply because of where they live.”

In a cooking activity, students were challenged to apply dietary guidelines in real kitchens. The outcome? A deeper understanding of the barriers faced by many. “Dietetic guidelines we have given to some patients were really put into perspective, as cooking with less salt is not as easy as we think,” says Dr Meko, quoting student feedback.

Some even used what they learned in other placements. One student took a simple grocery list she developed during her internship to the hospital setting: “It is the most practical way to influence someone to shop differently.”

Others were inspired to continue working in food access. “I was impressed with the size of the vegetable gardens and was also inspired to be part of projects like these in the future,” shared another student.

Perhaps one of the most powerful observations came from a student who said: “I feel empowered but also sad to see that this is how most of the country is living and that we can make a difference, no matter how small.”

 

A lasting impact for both student and community

For Dr Meko, this is exactly what service learning should achieve. “While lectures and textbooks can teach the theory behind intercultural competence, it’s the face-to-face interactions – listening to people’s stories, understanding their struggles, and working alongside them – that truly bring those lessons to life.”

She adds that this kind of learning also builds stronger, more respectful relationships between the university and the communities it serves. “It fosters partnerships built on mutual respect, shared goals, and the exchange of knowledge and resources – locally and beyond.”

Community service learning is not just a tick-box exercise. In the UFS Department of Nutrition and Dietetics, it is a meaningful bridge between knowledge and empathy, between theory and reality, and – most importantly – between future dietitians and the people whose lives they hope to improve.

News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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