Alerted by the Ministry of Health, Médecins Sans Frontières 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 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.
Many of the children MSF is encountering, both in Boda and surrounding villages, are extremely vulnerable, showing clear signs of kwashiorkor. "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 35kg. 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."
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, 145km 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 the main focal point of a faltering health service. The road network is poor, with many regions inaccessible during the rainy season. Tello of MSF argues that a punitive cost-recovery programme, with patients charged much more than they can afford for treatment and basic medication, creates a dangerous dependence on traditional healers.
Losing their sparkle
As elsewhere in the CAR, diamond mining in Lobaye, which began in the 1930s, is exclusively artisanal, with all production coming from alluvial products of sand, gravel and clay. But diamond revenues have been badly hit by the international drop in prices, sparked in part by the global financial crisis.
The industry involves a complicated network of regulated and informal actors, including the diggers, the site owners and the buying houses, or "bureaux d'achat". The government closed most of these in 2008 as part of a heavily publicized campaign to clean up the sector, eliminating illegal practices and establishing better regulatory controls. One of CAR's main diamond buyers, ADR, continues to operate in Boda, but other houses have closed. Much of the buying is done by local collectors, some of whom double up as site owners, or "chefs de chantier", supervising the work of dozens of diggers, who are obliged to turn their stones over for sale to the owner rather than sell elsewhere.
At Banagbélé, a diamond site 14km from Boda, off the main road to Mbaiki, the men dig and sieve. There is a scratch village here, with huts for workers. Most have come from Boda or nearby villages and many will see their families just once a week. Augustin Teng, 39, says he can earn between 50,000 and 100,000 francs (US$100 and $200) in a good month, but others are on daily rates of only 1,000 or 1,500 francs ($1 or $2).
Teng says he supplements his income from the chantier by keeping up his fields of manioc, maize and groundnuts and says other miners should follow suit, particularly given the drop in diamond prices. "That is what we have here in Centrafrique: diamonds and the land," says Teng. "But you won't get much from either at the moment."