Book Review: Dancing Skeletons, an ethnography

Dancing Skeletons: Life and Death in West Africa
Author: Katherine A. Dettwyler
Waveland Press, Long Grove, IL
Year: 1994

On average, about 17 children out of 1000 under the age of 7 dies in the world each year (El-Ghannam 2003) 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 (Dicko et al 2005) 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 (Morgan et al 2001). 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 (CDC 2004).

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 perspective depended upon her own parenthood and, perhaps, the proximity of Miranda as she conducted her research. And it was Miranda’s brush with death having contracted malaria (pp. 149-161) that punctuated the statement that Dettwyler was able to make with regard to both the tragedy and the joy that are simultaneously present in Western Africa.

The very title of the book refers to the children that Dettwyler watched dance in celebration for their village, which met the goals of a CARE project management team (pp. 141-142). The children were physical “skeletons” of malnourishment, dancing for the successes of their village in applying good health and hygiene practices, apparently oblivious to the problems they still faced with proper nutrition (pp. 143-144). This is where she drives home one of her themes by pointing out that it isn’t enough to simply address the medical and hygienic concerns of rural West Africa without actively working to resolve the problem of malnourishment among children. The latter endeavor could provide growing and developing children with the ability to avoid mortality from health problems like malaria and measles if their bodies were healthy and strong enough to fight the infections.

The tragedy and seriousness of nutrition and health in rural West Africa is made very clear in Dettwyler’s narrative and gives the reader insight into the true nature of the problems faced by the people there. Too often, statistics and headlines dominate Western knowledge of the plights of the developing world, but Dettwyler is able to objectify the problems and present them with a perspective that allows her readers to understand some of the associated cultural problems. For instance, Dettwyler offers an anecdote of a lunch she shares with a Malian coworker who criticizes her insistence that Miranda eat some chicken rather than less nutritious millet as the other Dogo children ate:

“In Dogo,” he explained, “people believe that good food is wasted on children. They don’t appreciate its good taste or the way it makes you feel. Also, they haven’t worked hard to produce the food. They have their whole lives to work for good food for themselves, when they get older. Old people deserve the best food, because they’re going to die soon.”

“Well, I applaud your respect and honor for the elderly, but health-wise, that’s completely wrong. How do you expect children to grow up to be functioning adults if they only get millet or rice to eat?” Of course, many children don’t grow up at all, on this diet. They die from malnutrition, or from diseases such as measles that wouldn’t kill a well-nourished child (pp. 94-95).

This argument largely appeared to fall on the deaf ears of her Malian hosts, but the reader is able to begin understanding a new perspective to the problem of malnutrition when this anecdote is compared with an earlier one in which Dettwyler tries to convince a Malian woman who has a child with kwashiorkor, a protein deficiency, to provide a appropriate food for her daughter to improve her health. The woman’s response is to ask for medicine in spite of Dettwyler’s insistence that food is the cure (p. 73).

Dettwyler rightly compares and contrasts Western nutritional expectations to that of developing West Africa, and notes that what is considered to be understood in Western cultures like America, that children need balanced meals, is something that we take for granted and something that needs to be taught in developing nations.

What I also found very appealing about Dancing Skeletons, was Dettwyler’s use of humor throughout the book. On several occasions, she noted that the Malians enjoyed laughter and Dettwyler’s ability to speak Bambara gave her opportunity to make jokes, sometimes at her own expense, in order to lighten the moment or just make others laugh. Each of her accounts of trips in the back of a bache, the pickup trucks that serve as public transportation, caused me to laugh aloud as she described the delight and surprise of the Malians that discovered her ability to speak the language, usually some time after they had been speaking about her (pp. 38-40). Dettwyler’s exchange of insults with a Malian colleague on their first meeting was another source of great amusement, and her observance of this cultural tradition, which included accusations of laziness and flatulent habits, gives the reader insight in her ability to seek that which is common to her and the people she came in contact with (p. 60).

Finally, I also noted that there were times in which Dettwyler described an event or situation in which I held an expectation that later in the book a connection would be made, as if part of a plot device in a novel. One such situation was the account Dettwyler gave of meeting the “noble hunter,” Bilo Bissan and the mystery that surrounded him (pp. 104-105). Her description of him as well his behavior gave me the distinct impression that the encounter would be significant at some later point. Not finding this later point, I initially felt a little let down –an expectation was unfulfilled. Perhaps it was simply that her characterization of him stirred my curiosity, but I realize that the expectation of more is probably an unfair one. Dancing Skeletons is, after all, a work of non-fiction and, as entertaining as it was and as pleasurable as it was to read, it was about real life –and death, and, therefore, did not have a plotline that could be fulfilled where all loose ends could be neatly tied at the end. As Dettwyler implies in her final paragraph of the book, Malian adults and their children continue to face life and death in a manner completely alien to me.


CDC (2004). Schistosomiasis Fact Sheet, Parasitic Disease Information. Centers for Disease Control and Prevention National Center for Infectious Diseases Division of Parasitic Diseases . Found at: [last accessed on 11/21/05].

Dettwyler, Katherine A. (1994). Dancing Skeletons: Life and Death in West Africa. Long Grove, IL: Waveland Press

Dicko, A.; Mantel, C.; Kouriba, B.; Issaka S.; Thera., M.A.; Doumbia, S.; Diallo, M.; Poudiougou, B.; Diakite, M.; Doumbo, O.K. (2005). Season, fever prevalence and pyrogenic threshold for malaria disease definition in an endemic area of Mali. Tropical Medicine & International Health, 10 ( 6), 550-556.

El-Ghannam, Ashraf Ragab. (2003). The Global Problems of Child Malnutrition and Mortality in Different World Regions. Journal of Health & Social Policy, 16 (4), 1-26

Traoré, M.; Maude, G.H.; Bradley, D.J. (1998). Schistosomiasis haematobia in Mali: prevalence rate in school-age children as index of endemicity in the community. Tropical Medicine & International Health, 3 (3).

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