The southwestern area of Central African Republic (CAR) continues to face a severe nutritional emergency. In September, after being alerted by local authorities, MSF medical teams opened four feeding centers in Carnot, Boda, Nola, and Gamboula. Teams also implemented a number of outpatient treatment programs. Three months later, staff have treated more than 4,000 children. Clara Delacre, MSF emergency coordinator in Boda and Nola, explains the situation on the ground.
How has the situation evolved over the last three months?
In Boda, the number of patients has been increasing progressively…so much so that 1,600 children have already been admitted to the program, half of them suffering from severe acute malnutrition and the other half from moderate malnutrition. In Nola, another 750 children have been admitted and the percentage of severely malnourished is similar to the one we have in Boda.
In our projects in Carnot, Gamboula and Pissa we are treating children who are suffering from severe acute malnutrition. In Carnot, so far we have treated 1,600 children, while 178 more were treated in Gamboula, though this has now been closed as admissions decreased. Meanwhile, a new project opened in Pissa, where 117 children were admitted within the first week. All together, we have already treated almost 4,250 children.
Throughout this time, we have conducted several evaluations across the area, and I think that right now our coverage is good and most malnourished children in the region are being treated.
Barely a month ago, the ambulatory programs in Boda suddenly increased by 400 children in two weeks. About 70 percent of these children were coming from a place called Gadtzi and its surrounding area. What was the reason for the increase, and how have you addressed the situation?
The increase was due to the message spreading far and wide by word-of-mouth that our service is here. It is resulting in our receiving mothers who have walked up to 50 kilometers (30 miles) with their children to come and see us.
We had about 200 children receive treatment in Gadzi and we were going there every two weeks, so we barely had time to see them all. In addition, we suspected that we were not reaching the entirety of the affected population, so we assessed the situation and decided to create a medical team to visit the area every week. On each visit the team stays for five days to conduct an outpatient clinic for Gadzi and two other surrounding areas.
In the past few days, we have heard that poisoning from eating bitter or under cooked cassava was the reason why people are still falling sick. What can you tell us about this?
There is a kind of cassava they call ‘bitter’ that grows very fast and whose cultivation was introduced in recent years. The problem is that it needs longer cooking time and when people are hungry or cannot spend three, four, five days cleaning it, they eat it straight away. Many times, this causes cyanide poisoning, also known as konzo, which in turn causes neurological disorders. Yet in the area where we work, we have not seen many such cases so far.
Now that the rainy season is coming to an end, is a decrease in new patients expected?
Perhaps, when the malaria incidence rate decreases, the number of patients will also decrease, as this is one of the factors contributing to the situation. Yet, on the other hand, the results of the next harvest remain to be seen that could have an impact on food availability during the dry season. Now is also the time when people start coming back from the bush to the towns, so we will also start to see patients whom we had not had access to before.
What other underlying problems need to be addressed in this region?
While some local events have contributed to this current crisis by leaving many people without a source of income and reducing their buying capacity, this is compounded by the virtually non-existent access to health care in an area where up to 65 percent of patients we see suffer from malaria. Overall, this region has been rather neglected by the international community which has focused mostly on providing aid to the north of the country. Thereby, specific projects on food security, education and access to health are more than necessary across the entire region.