On average, about 17 children out of 1000 under the age of 7 dies in the world each year because of malnutrition, homicide, wars, drowning, car accidents, what have you -a sobering statistic for any loving parent. In West Africa, however, that number becomes 172 children out of 1000! For a parent, this figure isn't just sobering, it's staggering to consider and it's the highest child mortality rate in the world.
In the West African nation of Mali alone, the risks to children include not only the same risks as the rest of the world: accidents, cancers, homicides, etc., but also malaria, schistosomiasis, HIV/AIDS, malnutrition, and other infections diseases and conditions unique to the tropical and largely rural regions of the world.
Malaria occurs most among the youngest children and is responsible for over 33% of all fever sympotoms during the rainy season in Bamako, Mali. Also in Bamako, in 1998, nearly half of all children were infected with schstosomiasis (Clerq et al) and in rural Mali, the rate was as over half of the children between 7-14 years of age in some areas (Traore et al 1998). Schistosomiasis is a tropical parasite, abundant in Africa, and transmitted to humans after being hosted in larval form by freshwater snails. The parasite leaves the snail and enters a human host wading in the water by burrowing into the skin of feet and legs. Schistosomes affect about 200 million people worldwide and the eggs produced by the worms that grow in the blood vessels of the host are passed to the bladder and intestines and can cause blood in urine and stool.
In her book, Dancing Skeletons: Life and Death in West Africa (1994), Katherine A. Dettwyler is faced with each of these health problems and more as she narrates her experiences in observing their cause and effect. Most of these experiences are from the perspective of an outside observer; some are of one who has an empathic interest in the people she considers friends; but at least one brings home a parent's worst fear: the fear of losing a child.
As an ethnography, Dancing Skeletons was not what I expected. Dettwyler's literary style was refreshing in light of other ethnographies I've had the pleasure or even misfortune to read. Her use of both humor and tragedy had the effect of motivating me to finish the book or certainly move on to the next page in order to discover what happened next. Occasionally, however, the expectation wasn't fulfilled.
Especially engaging was Dettwyler's use of dialog beginning on the very first page and continuing throughout the work. This had the effect of personalizing Dettwyler's experiences and providing the reader with brief bubbles of real-time activity that placed the reader in Mali as a non-participant observer. Dettwyler's narratives between dialogs gave necessary information for the reader to understand the contexts of the dialog sections and to get the data she was trying to pass on, but the dialogs themselves brought Dettwyler's personal experiences to life with emotions of joy, amusement, tragedy, and frustration.
Dettwyler's very first dialog section involved her evaluation of a severely malnourished child and it set the stage for what appeared to be a major theme of the book: that understanding cultural paradigms in Africa is essential when attempting to address its problems. This malnourished child and the mother's inability to properly care for him posed the question: why is there a disparity in the diets and care of children versus adults. As a parent I found it easy to empathize with Dettwyler's perspective in many of her contacts and interactions with children and her concerns for her own child, who accompanied her to Mali.
That Dettwyler chose to bring her daughter, Miranda, to Africa with her struck me initially as somewhat negligent, given the conditions Dettwyler described and the inherent risks that both would face with potential health problems alone. However, it was soon apparent that much of Dettwyler's