While she was helping to run a vaccination campaign in July, health worker and midwife Victorine Yangakola became aware of a serious nutritional crisis in Boda and surrounding villages in the western region of Lobaye in the Central African Republic (CAR).“I was coming across children with reddish hair and swollen bellies,” Yankagola recalls. “It was clear to me that this was severe malnutrition.”

Alerted by the ministry of health, Médecins Sans Frontières (MSF) established an emergency programme in Boda in August. MSF field coordinator Luis Tello said MSF’s original intention was to stay for three months, but the agency is now looking to maintain a presence in Boda at least until May 2010. Part of the problem is that the fields are being neglected in favour of hunting for diamonds.

“You couldn’t talk about Boda without talking about diamonds,” says sub-prefect Joseph Denam Gueknekini. “Even the municipal office I am sitting in now was funded by diamond money.”But Gueknekini, a former head teacher in Boda, says over-dependence on diamonds has exacted a heavy price on local communities. “Before, when diamonds were good and there was a lot of money circulating, you would find a lot of young people abandoning school to go off to mine diamonds. As people say here: ‘The pick is lighter than the pen’. Young men think they can become millionaires through mining diamonds. It seems a much more attractive option than cultivating a manioc (cassava) field.”

Farmers across Lobaye complain of falling manioc prices, a lack of basic tools, a shortage of credit and a lack of cooperative structures. Many farmers neglected their fields in favour of the chantiers, the mining areas.

Vulnerable childrenMany of the children MSF is encountering, both in Boda and surrounding villages, are extremely vulnerable, showing clear signs of kwashiorkor, an acute form of childhood protein-energy malnutrition. “The numbers are not decreasing as well as we expected,” Tello acknowledges. “To solve the problem completely will be difficult.”

MSF’s tactics for combating child malnutrition include using a basic milk formula for new arrivals at the clinic in Boda, then moving affected children on to nutritional, therapeutic food, before giving them local food. Tello says there should be a monitoring period of six to eight weeks as the child gradually recovers. MSF offers an outreach service, driving, where possible, into outlying villages, providing medical care on the ground and ferrying malnourished children to Boda.

“Mothers should be bringing their children into clinics for vaccinations and anti-worm treatments,” Yangakola argues. “Mothers should be getting basic information on how to look after their babies. Instead, you find them giving three-month old babies manioc and water, which does nothing to help their nutritional status.” But Yangakola warns that nutritional concerns are not confined to women. “Often you see mothers coming in for pre-natal consultations who weigh as little as 35 kg. Because of local customs, many mothers give birth at home. They don’t get access to antibiotics, iron and the kind of good food you need after giving birth.”

Problem diets:
Yangakola is strongly critical of dietary habits in Lobaye, arguing that the dependence on manioc has contributed significantly to the rise of kwashiorkor in the west. “They have got everything here, oranges, papayas, groundnuts, vegetables, maize, but it is always manioc, often cooked with just water, no oil and no salt,” a health worker complains.

“I have worked in the CAR since 1975 and the illiteracy and malnutrition rates are the worst I have seen in the country,” says Italian missionary Adelino Bruneli. “The food here has very little nutritional value.” In the local market there is a brisk trade in manioc flour and coco, a green plant harvested in the nearby forest. “Coco and manioc make an easy meal,” says Christine Diango, a mother of seven. “It is not what mothers should be cooking, but meat, fish and vegetables are all very expensive here.” Much of the produce comes from Bangui, 145 km east, with transport costs forcing up prices.

While health activists like Yangakola talk about the need for a grassroots information campaign on diet and nutrition, the fight against malnutrition in Boda takes place against a background of infrastructural breakdown and sharp economic decline. Medical facilities in Lobaye are thinly spread, with an under-equipped hospital in the provincial capital Mbaiki