The villagers listen politely to the nutrition worker, but they can't contain their skepticism when she tells them to give vegetables to their children. "A lot of us don't have anything to give," one villager objects.
He is telling the truth. Drought has ravaged the Sahel region of West Africa, where 23 million people in eight countries are facing food shortages this year. It's the second-worst humanitarian emergency in the world – behind only Somalia, where up to 100,000 children have already died – and it's quickly growing worse.
Yet the nutrition worker has a point. Some villagers do have vegetables, but prefer to sell them in the market, as tradition dictates. Just outside the village meeting, where stray goats wander in the dust, a bicycle is loaded with cabbage for transport to the nearest market.
"You grow nice vegetables, yet you don't give them to your families," the nutritionist chides the villagers. "It's a little strange, isn't it?"
Her visit to Zarkoum, a village on the edge of the Sahel in Burkina Faso, is an early step in a renewed campaign of health education here. In this land of chronic drought, where rainfall has declined by nearly 50 per cent since 1954, relief agencies are searching for long-term solutions instead of stop-gap aid. Education will be a big part of any solution.
Learning the lessons of Somalia, the aid workers are trying to intervene early, before hunger turns into catastrophe. But this is the third severe drought in the Sahel in less than a decade. Innovative new ideas will be needed – and are already being introduced.
About a million malnourished children across the Sahel are expected to need emergency aid this year. The crisis has been worsened by wars in neighbouring states, with 70,000 refugees fleeing from Mali and 200,000 migrant workers losing their jobs in Libya. The lean season – when the last harvest has been fully consumed – is approaching fast, likely beginning next month.
Yet in the proud culture of this harsh semi-arid region, men would rather sell vegetables than admit their inability to feed their children. "Malnutrition is a disease of shame," says Abila Dabaye, a doctor at a hospital in the town of Kaya in Burkina Faso. "People don't want to admit that their children are malnourished."
At the age of 16 months, Assama Bamogo has already been treated for malnutrition twice. Doctors sent her home with instructions to her family to feed her properly, but drought destroyed their harvest, food prices doubled, and soon Assama's stomach was again swollen from malnutrition.
"It was the lack of rain," says her grandmother, Aissato Bamogo. "When I saw her malnourished again, I took her back to the hospital with a broken heart."
In another room of Kaya hospital, nurses are rushing to help a newly arrived child, 18-month-old Teni Tindano, who weighs less than six kilograms. She is on the verge of death. The staff quickly attach her to an intravenous drip and a nasal feeding tube and give her therapeutic milk from UNICEF to keep her alive.
Her father, Arzouma, has been forced to take odd jobs as a brick-maker for about $1 a day because his crops failed in the drought. His wife is scavenging for tiny bits of gold in the informal gold pits near Kaya.
"We eat only one meal a day," Arzouma says. "Sometimes we go to the bush to collect wild leaves to eat."
Across Burkina Faso, thousands of desperate people are on the move, searching for anything to replace their failed crops. Many women and children, some as young as 6, have migrated to the gold fields, where they dig for gold in the mid-day heat, usually for less than $1 a day. Often they scrounge for days without finding anything.
Emergency aid is on its way to the Sahel, including $41-million from the Canadian government. But the people of the Sahel need more than just food.
They need long-term programs to boost their agricultural productivity, to adapt to the warming climate and declining rainfall, to improve their literacy and to strengthen their employability in the towns and cities. And they need to understand the basics of nutrition and health – and to get rid of the superstitions that have hindered them for decades.
Veteran aid workers say that they have been tackling these myths for 30 years. But in a society with one of the world's highest rates of illiteracy, the myths persist: the notion that infants should be given water instead of breast milk; that children should not be given eggs because it will turn them into thieves; that pregnant women should not eat chickens because it could cause sickness; that infants should be "purged" with hot herbal water; that vegetables should be sold in the market, not consumed at home.
In the past, health workers would simply lecture the people of the Sahel, ordering the young mothers to stop these practices. The lectures were ignored. The health workers forgot that the true authorities at home are the fathers, grandmothers and mothers-in-law, who believe in tradition.
Mothers, some as young as 15 and often illiterate, are afraid to disobey their parents, even if it contradicts the message from the health workers.
"Most people don't even think of eating chickens or eggs, because they think it's meant for rich people," says Amadou Kansaye, a worker at ACDI/VOCA, a U.S.-based aid group, and deputy project chief for the new "Victory Against Malnutrition" campaign in Burkina Faso.
The campaign, led by groups such as Save the Children and ACDI/VOCA, emphasizes the art of negotiation and persuasion in educating villagers in small groups, with witnesses testifying about the health benefits in their own families, and with progressive grandmothers put forward as role models.
"One reason for the failures in the past was that we didn't take time to explain the benefits," Mr. Kansaye says. "You can't just tell people, you have to persuade them. It's labour-intensive and it takes time, but it has to be done."
In the village meeting in Zarkoum, nutrition worker Suzanne Lalsaga begins the campaign by asking whether infants below the age of six months should been given water. The answer is no, because the water can transmit disease and suppress the baby's appetite for breast milk. But the villagers admit that it still happens. In fact, only 4 per cent of mothers in the region give exclusively breast milk to their children in their first six months of life.
"They think there's not enough water in breast milk," says Rasmata Nakoulma, a health worker in a nearby village. "We tell them not to give water, but it's very difficult to change their behaviour."
Back at Kaya hospital, the staff are struggling with broken equipment, shortages of medicine, and an influx of malnourished children. "Often there are too many cases for me," Dr. Dabaye says.
"They call me and tell me a child is about to die, and I run there – but then I'm called to another emergency. Sometimes the children die. If they have enough food, they can recover – but we know there's not enough food in their homes."
A CRISIS FOR CHILDREN
Nearly half a billion children around the world are at risk of physical and mental underdevelopment over the next 15 years because of a lack of food
The Sahel emergency is part of a larger global crisis. Nearly half a billion children around the world are at risk of physical and mental underdevelopment over the next 15 years because of a lack of food, according to a new study.
Malnutrition still causes the deaths of 2.6 million children every year, even though the mortality rate has decreased in recent years, according to Save the Children.
The aid agency conducted a survey of five of the hardest-hit countries – India, Nigeria, Bangladesh, Peru and Pakistan – and found that one-sixth of children had abandoned school to help their struggling families by working for food.
It also found that five African countries – including Congo, Burundi and Ivory Coast – are suffering higher rates of hunger today than they did 20 years ago. About 60 million African children are already stunted by malnutrition, it said.
- Geoffrey York