“Dancing Skeletons; Life and Death in West Africa”

While attending the University of Washington I have taken many prerequisite nursing classes. In each one so far, the topic of malnutrition has been brought up. The ethnography that I chose was no different. I read “Dancing Skeletons; Life and Death in West Africa” but Katherine A. Dettwyler.  Dettwyler has her doctorate in biocultural anthropology and works for Texas A&M University. She made her first venture to the country of Mali in West Africa during her quest for her PhD. She obtained it and then made the return trip to Mali to research on malnourished children in the country and how it affected their later development. The book presented an emphasis on Dettwyler’s research on infant feeding and child health in Mali which depicted a good view of Malian nutritional health. She explored a variety of topics such as ethnocentrism, culture shock, population control, breastfeeding, child care, the meaning of disability and child death in different cultures, female circumcision, women’s role in patrilineal societies, the dangers of fieldwork, and the realities involved in researching emotionally draining topics. In general, I found the topics displayed in this ethnography to be very interesting. I have taken many classes that deal with the anatomy of humans. In those classes we also discussed how inadequate nutrient uptake can cause malnutrition and be very harmful. This ethnography made many connections for me and made some of my previous studies more of a reality. That being said, I did not like the way the ethnography was written. Dettwyler was very scatterbrained throughout the entire book. The author would be trying to make a point and then hit a tangent. This ruined the impact of some of her statements. It was difficult to follow and pinpoint what she was trying to say. I think a big factor in why this happened is that she tried to tackle so many topics in one small book. She commented on malnutrition mainly but she also segued to female circumcision among other random topics. I found it to be interesting but very hard to follow. That being said, I did find some of her main points. Some of the topics that I think I found to be most important and that I also agreed with the author on include the importance of education in regards to helping those in need, seeing how perspective affects the role of the anthropologist, and also seeing if your method of helping is actually efficient or interfering.

Summary

                As I said before, the ethnography was written in a very scattered fashion making it hard to sum up what is was solely about. However, the premise is that Dr.  Katherine A. Dettwyler made her original voyage to the country of Mali during her time in grad school. During that time she did a lot of fieldwork and collected a lot of data. Much of the data was measurements on children. About ten years after she left Mali the first time, Dettwyler returned with her 6 year old daughter, Miranda, to try and finish her original projects by reexamining her original subjects and seeing how they developed in a malnourished society. When visiting the children, Dettwyler found that many had died from malaria, few had survived, and some previously healthy children had fallen ill to malnutrition. Interesting enough, those who had died from malaria most likely died because their immune systems were failing because of a lack of nutrients. Dettwyler continued to survey her subjects and expanded her research by collecting stool samples of the natives. Upon analysis, Dettwyler could see the amount of children living with parasites and use it to get a better understanding of how the bodies of Malians function. I will talk about this later, but it was very interesting to see from this research how many Malians had parasites but it did not even faze them. Many of them actually embraced some of the ailments caused by the parasites.

The second part of the ethnography focused on Dettwyler’s research of children living in the Bush. She visited many villages like Dogo and measured all of the children while at the same time advocated for nutritional health. It was very interesting to see how the Malian’s had made up their own etiology on how to deal with malnutrition. I like to think that her time spent with the people was beneficial and she has a lasting impact on their nutritional health. The ethnography ends with Dettwyler coming to an abrupt conclusion. She sees an organization, CARE, celebrating the success of helping a village become “clean.” At first Dettwyler is excited like everyone else, however she realizes halfway through the celebration that while the village may be sanitary, the children are still sickly thin. All of the work to make the village cleaner was pointless if the people were going to die anyways of malnutrition. She ends on that point which emphasizes the importance of nutritional health and the fact that there are many ways to help people, but overall a holistic approach is the best way to be effective and actually help people.

Education

Throughout the entire ethnography, Dettwyler emphasized the importance of educating the people of Mali. In the west we often think that the reason so many children in third world countries are dying of malnutrition is because there is not enough food. While there is often times a shortage, much of the time the children just are not offered real food. Mali follows a patriarchal lifestyle that gives more value to men and adults in general. They believe that because very small children do not do as much labor as adults, they do not need quality food or much food in general.

“But she’s just a child. She doesn’t need good food. You’ve been working hard all morning, and she’s just been lying around” (Dettwyler, 94).

This etiology seems completely normal to them. Because they follow this method of thinking, many children do not get more than breast milk for a year or more, while a child actually needs more nutrients after six months. Also, once a child finally does get “real food,” it often times it is not much more than Millet, a grain with little nutritional value. It is faux pas to give a child meat because they think it is a waste of quality food. Children then develop disorders such as Marasmus or Kwashiorkor (diseases caused by a lack of nutrients). The people of Mali think it is a sickness that needs medicine. The truth is that their child just needs either more food or food with more nutrients. Dettwyler’s research mainly consisted of taking measurements of the children and adults. Along the way though, she tried to make known to the people the importance of nutrition. While she respected their way of life, she knew that she could help the children. Many other programs in the same region were working nearby. They tended to work on sanitation issues. While this did improve the quality of the Malian’s life, it did not do them any good without proper nutrition education. The Malians needed to be taught that children actually do need food to develop properly. They may be doing less physically demanding labor, but their bodies are developing and need many nutrients. A good portion of the ethnography stressed the importance of teaching the Malian’s about the importance of nutrition.

Perspective

                As I was mentioning about education, while Dettwyler saw changes that needed to take place in Mali, she also was courteous of the Malian’s perspectives and etiologies. During her research, Dettwyler along with measuring and educating children, also took fecal samples of children to see how different pathogens effected human development. In her various findings, she encountered many pathogens present in the children. It was interesting though that some of the pathogens had become so common that the Malians did not even find them strange. One story in the book correlated exactly from one of our class readings. Children got Schistosomiasis, a parasite, when they were children. As they got older, the pathogen count increased in their urine turning it a red color during puberty. In the United States, red urine would be a sign that something is seriously wrong. The Malian’s though saw this as a male menstruation. So women got their menstruation around thirteen and that is when men got theirs as well. It was a “becoming a man” type of process. Dettwyler knew from her western medicine that what was truly happening was that the boys were infected with the parasite. She began her process of educating the people on what the issue was, but they did not want to hear it. The Malian’s were proud of their male menstruation. Dettwyler figured that she could buy them all drugs and push the issue further, but in the end she decided there was no point. She could try to show them a new perspective, but that did not mean that they had to listen. Along with that, what place did she really have in telling these people how to live? This was not an issue to the people. They knew that they had bloody urine but it was not an issue to them. We talked in class about how people perceive things different regionally. The Malians physically saw a change in their urine and they embraced it. As a matter of fact they made what we in the US would call a tragedy into a sign of respect.

Worthwhile Interference

Towards the end of the book, Dettwyler tells about a health resource program, CARE, going in to celebrate the success in cleaning up Segou, a town in Mali. While there, Dettwyler was thrilled to see all of the improvements done in Segou in regards to sanitation. However, during the celebration many of the children were dancing with much energy and as a physical anthropologist she noticed how emaciated the children looked. Dettwyler stormed out of the ceremony because she basically had an epiphany. While the town was cleaned up it did not even matter because the people and children were still sick from malnutrition. They spent all the time and resources to work on cleaning and developing safer skills but it had all been pointless because nutrition education had not been emphasized. Dettwyler wanted to emphasize the importance of taking a holistic approach when trying to improve the lives of other people. She did not think that CARE did a bad job by interfering with the town’s practices, but she did think that her cause was more important. I agree to a certain point. She pointed out that there is no point in having good sanitation if the residents are not getting enough food to survive. She also argued that by focusing on the nutritional needs, immune systems would be boosted which in turn would help the people have a better chance at counteracting diseases like Malaria. I do think that both of her points are good but I think sanitation is also a very good cause to spend resources. She is right that nutritional education should be addressed but maybe they both could move at a slower pace and they could work together. This should improve the health of the community without compromising either side.

While I will admit that the author drove me crazy throughout the entire book, I did like the content. She was weak in that she often let her opinions get the best of her and lead her on tangents that detracted from the actual point she was trying to make. I found the topics and information provided to be very interesting and a major strong point. I am in a nutrition class right now and it was a lot of fun to make connections between that and my book. I also saw lots of overlap between lecture and the book which was interesting. Dettwyler stayed in Mali for six months and in that time I feel that she made an improvement on the people. She did not go out and petition the government to make changes; she just merely talked to the people. Based on the case studies it did help people to become more aware of how their life choices affected their wellness.  In general I feel like this ethnography practically could be used to show Americans what West Africa is actually like. Many Americans already have an idea of Africa and the struggles people there face. This book would set them straight and let them be aware of what is really happening in our world. I will definitely argue that malnutrition is definitely a global health problem. It transcends national boundaries. It may seem like this issue is only a problem for those in Mali, but we are all connected. If there are people dying anywhere it affects us. And this issue is a health issue for sure.

“Did you look at them? I mean really look at them? Their little arms and legs were like sticks! I wanted to rush out and tell them all to sit down, to conserve their energy, to save it for growth or fighting off disease. How can they dance? When they’re so malnourished? (Dettwyler, 144).

Clearly the author is upset about the health of the children and rightly so. They are medically ill. And children are not just malnourished in Mali either. This happens all around the world making it a legitimate global health problem. This ethnography was written in the 90s meaning over fifteen years have passed since Dettwyler had these experiences. My heart goes out to all of the children who have suffered with malnutrition. Not only are they dying of starvation but their lack of nutrients contributed to their malarial deaths because their immune systems were shot. As I have said multiple times, while I enjoyed most of the content, Dettwyler was very annoying to me, but I truly hope that her research in Mali made an impact and saved even at least one life.

Stacie Larsen

Dettwyler, Katherine A.. Dancing skeletons: life and death in West Africa. Prospect Heights, Ill.: Waveland Press, 1994. Print.