4

Bad Breath, Gangrene, and God's Angels

Katherine A. Dettwyler is an adjunct professor of anthropology and nutrition

Dealing with nonhuman prnnates or the remains of the As you read, consider the following questions:
dead (see Selections 1, 2, and 3) can be emotional l. What was Dettwyler hoping to find out by exam-
enough, but when one's subjects are living people, ining the mouths and teeth of her subjects?
even a scientist conducting research can have very per-
2. Why was the condition of the teeth of her subjects
sonal responses. Your scientific objectivity is chal-
so poor compared with those of other people in
lenged and you are often presented with ethical dilem-
Mali?
mas. In the process, however, you can learn a lot about
yourself as well as your subjects. In this selection, 3. Why did the man Bakary object to Dettwyler's
Katherine Dettwyler recounts several emotionally giving her daughter chicken to eat?
charged experiences she had while conducting what 4. What are the problems encountered by Dett-
started out to be rather routine research on human den- wyler's subjects with regard to self-administered
tition. In this chapter from her book, she refers to Mi- medication?
randa, the daughter whom she had taken to Mali with 5. Why are children with Down syndrome rare in
her, and her son Peter, back home. It is relevant to her societies like the one Dettwyler was studying?
story to know that Peter has Down syndrome.

There is more than one kind offreedom . Freedom to and ton, like the fog blankets that regularly obliterate the
freedom from . In the days of anarchy, it was freedom to. hills around San Francisco Bay. Thunder growled;
Now you are being given freedom from . Don't underrate it. the smell of ozone permeated the air. Rain pounded the
-Margaret Atwood iron roof overhead, drowning out all thought, while
great rivers of water streamed off the corners of the
J stood in the doorway, gasping for air, propping my building. Gusts of wind whipped through the trees,
arms against the <loor frame on either side to hold me blowing the rain into my face. I turned and plunged
up. I sucked in great breaths of cool, clean air and back inside, back into the fray.
rested my gaze on the distant hills, trying to compose The morning had begun pleasantly enough, with
myself. Ominous black thunderclouds were massed on villagers waiting patiently under the huge mango tree
the horizon and moved rapidly toward the school- in the center of the village. But before long, the ap-
house. They rolled down the hills like wads of dark cot- proaching storm made it clear that we would have to
move inside. The only building large enough to hold
the crowd was the one-room schoolhouse, located on
the outskirts of the village. Here adults learned to read
From Dancing Skeletons: Lije and Death in West Africa by Katherine A.
and write the newly alphabetized written Bambara.
Dettwyler, (Long Grave, IL: Waveland Press, Inc., 1994). Reprinted General education for children was still a foreign
by perrnission of Waveland Press, Inc. Ali rights reserved. concept.

16
 BAD BREATH, GANGRENE, AND GOD'S ANGELS 17

Inside the schoolhouse, chaos reigned. It was 20 scrub and polish the teeth. Chemical analysis of these
degrees hotter, ten times ·as noisy, and as dark as twigs showed that they had antibiotic and anticavity
gloom. What little light there was from outside entered properties.
through the open doorway and two small windows. Apparently, the knowledge of this traditional
The entire population of the village crowded onto the mode of dental hygiene never made it to Merediela,
rows of benches, or stood three deep around the pe- and 1 faund myself face-to-face with incredible dental
riphery of the room. Babies cried until their mothers wear, multiple cavities, exposed roots, and draining
pulled them around front where they could nurse, chil- abscesses. 1 was familiar with all of these dental condi-
dren chattered, and adults seized the opportunity to tions from working with prehistoric Native American
converse with friends and neighbors. It was one big skeletal material, but 1 had never really pondered what
party, a day off from working in the fields, with a cool- they would be like in the flesh-what it meant far the
ing rain thrown in far good measure. 1 had to shout the living people who had to cope with teeth like that. Now
measurements out to Heather, to make myself heard 1 knew firsthand, and it was not a pretty sight, nor a
over the cacophony of noise. pleasant smell. "It's no wonder kissing isn't big around
The stench in the room was incredible: hundreds here," 1 quipped, trying to find sorne humor in the sit-
of unwashed, sweaty bodies mingled with the ever- uation. "From now on, I'm only looking in little kids'
present undertones of wood smoke, tobacco, and mouths. Next!"
spices. It was so dark inside the schoolroom that 1 had
to shine a flashlight inside people's mouths, and peer A middle-aged man dressed in a threadbare pair of
closely, my face right in theirs, in arder to count their Levis shoved a crying child farward. 1 knelt clown to
teeth. Being this up clase and personal made people encourage the little boy to step up onto the scales and
understandably uncomfartable. They guffawed with saw that his leg was wrapped in dirty bandages. He
embarrassment when 1 looked in their mouths, over- hesitated befare lifting his faot and whimpered as he
whelming me with the odor of rotting teeth. 1 had to put his weight onto it. "How old is this child?" 1 asked
keep retreating to the door of the schoolroom to com- Heather. She consulted his birth certificate. "Four years
pase myself and get sorne fresh air, to keep from old," she answered. By that time, he was crying loudly.
thr9wing up. Halfway through the morning 1 gagged "What's the matter with his leg?" 1 asked his father.
once again and turned to Heather in disgust. "I can't "He hurt it in a bicycle accident," he said.
stand this anymore. 1 am absolutely giving up on look- 1 rolled my eyes at Heather. "Let me guess. He was
ing far third molars in adults' mouths." riding on the back fender, without wearing long pants,
1 was interested in third molar eruption as evi- or shoes, and he got his leg tangled in the spokes."
dence that rural Malian adults had faces and jaws large Moussa translated this aside into Bambara, and the
enough to comfartably accommodate third molars man acknowledged that that was exactly what had
(wisdom teeth). My hidden agenda was to argue happened.
that current understandings of human evolution were Bicycle injuries of this kind were frequent, and
skewed, because they took modern Europeans, with they would often result in devastating wounds to chil-
their relatively small faces, as the epitome of what dren's legs and feet. In the country, children wear few
"modern humans" looked like. Arguments over inter- orno clothes, and no shoes. They straddle the backs of
pretations of the fassil record and the date of the first rickety bicycles, hanging on behind their father or
appearance of "modern humans" with "small faces" older brother. A moment's inattention, and they get
became irrelevant when the full range of modern hu- caught. Bicycle spokes can do nasty things to children's
mans was appreciated, including particularly West limbs.
Africans with their large, projecting lower faces and The father set the little boy up on the table we
fully operational sets of third molars. were using as a desk, gently unwrapping the filthy
1 knew from studies in Magnambougou that most dressings. The last few layers were crusted over and
urban adults had beautiful, healthy teeth, including had to be teased away, exposing the wound. One
all faur third molars, fully erupted and in perfect glance and 1 had to turn my head away in horror and
occlusion. The lack of refined sugar, and the use of dismay. The room suddenly seemed hotter, the air
traditional tooth-cleaning sticks in many parts of Mali, thicker than ever.
resulted in few cavities. Every morning, adults walked The festering wound encompassed the boy's ankle
around with the stub of a tooth-brushing stick pro- and part of his faot, deep enough to see bone at the bot-
truding from one comer of their mouth. Only par- tom. His entire lower leg and faot were swollen and
ticular trees provided "tooth brushes"- sticks that putrid; it was obvious that gangrene had a firm hold.
were chewed to a frazzle at one end, then used to "When did this happen?" 1 asked the father.
18 BEING A BIOLOGICALANTHROPOLOGIST

"About five days ago," he replied. makes you feel. Also, they haven't worked hard to pro-
"How did you treat the wound?" duce the food. They have their whole lives to work for
"We just covered it with this cloth." good food for themselves, when they get older. Old
"Why didn't you take him to a doctor?" people deserve the best food, because they're going to
"We thought it would get better by itself," he said, die soon."
turning to look pleadingly at the boy's mother. "Well, I applaud your respect and honor for the
"You have to take him to the hospital in Sikasso im- elderly, but health-wise, that's completely wrong. How
mediately," I explained. do you expect children to grow up to be functioning
"But we can't afford to," he balked. adults if they only get millet or rice to eat?" Of course,
"You can't afford not to," I cried in exasperation, many children don't grow up at all, on this diet. They
turning to Moussa. "He doesn't understand," I said to die from malnutrition, or from diseases such as
Moussa. "Please explain to him that the boy is certain measles that wouldn't kill a well-nourished child.
to die of gangrene poisoning if he doesn't get to a doc- Studies of the long-term consequences of childhood
tor right away. It may be too late already, but I don't malnutrition have shown that adults who have sur-
think so. He may just lose his leg." Moussa's eyes vived are functionally impaired when it comes to sus-
widened with alarm. Even he hadn't realized how seri- tained work effort. They cannot work as long as adults
ous the boy's wounds were. As the father took in what who were not malnourished as children.
Moussa was saying, his face crumpled. In Magnambougou, the prevailing idea in child nu-
While the boy's father ran to get his cache of care- trition was that children alone should decide when,
fully horded coins and bills, I dressed the wound with what, and how much they wanted to eat, but they were
antibiotic cream and a clean gauze bandage. I gave the usually offered whatever was available, including sorne
boy sorne chewable children's aspirin, as though it of the meat and vegetables in the sauce. In rural south-
would help. I had to do something constructive. The ern Mali, "good food" (which included all the high pro-
little boy cringed when I touched him, but he no longer tein/high calorie foods) was reserved for elders and
cried. Father and son were last seen leaving Merediela, other adults. Children subsisted almost entirely on the
the boy perched precariously on the back of a worn-out carbohydrate staples, flavored with a little sauce. My
donkey hastily borrowed from a neighbor, while the actions in giving Miranda my share of the chicken were
father trotted alongside, shoulders drooping, urging viewed as bizarre and misguided - I was wasting good
the donkey to greater speed. food on a mere child, and depriving myself.
Villagers' reactions to my behaviors were often
Lunch back at the animatrice's compound pro- very enlightening. This conversation was no exception,
vided another opportunity for learning about infant and I would have liked it to continue. However, it was
feeding beliefs in rural Mali, through criticism of my interrupted by the arrival of a string of children with
own child feeding practices. This time it was a chicken miscellaneous cuts and scrapes, coming for first aid. I
that had given its life for our culinary benefit. As we quickly finished eating and went to attend to them. I
ate, without even thinking, I reached into the center did what I could with soap and water, antibiotic oint-
pile of chicken meat and pulled pieces of meat off the ment and Band-Aids. One little boy sat straddling his
bone. Then I placed them over in Miranda's section of mother's hip, his arms draped across her shoulders.
the communal food bowl and encouraged her to eat. She showed me an open sore on the back of one of his
"Why are you giving her chicken?" Bakary asked. buttocks.
"I want to make sure she gets enough to eat," I re- "What happened here?" I asked his mother.
plied. "She didn't eat very much porridge for breakfast, "He had malaria, so I gave him an injection of
because she doesn't like millet." Quinimax. Now the malaria is gone, but his leg is sore,"
"But she's just a child. She doesn't need good food . she answered.
You've been working hard all morning, and she's just "But he can walk on it all right?" I asked, taking the
been lying around. Besides, if she wanted to eat, she boy's hand and leading him around to see if he could
would," he argued. still use the leg.
"It's true that I've been working hard," I admitted, "Oh yes, he can walk fine."
"but she's still growing. Growing children need much "Where did you get the needle for the shot?" I
more food, proportionately, than adults. And if I didn't pressed, as I held the boy clown and administered to
encourage her to eat, she might not eat until we get the sore.
back to Bamako." "From a neighbor," she answered.
Bakary shook his head. "In Dogo," he explained,
"people believe that good food is wasted on children. In Mali, as in many medically underdeveloped
They don't appreciate its good taste or the way it places, injections are thought to be more effective than
 BAD BREATH, GANGRENE, AND GOD'S ANGELS 19

oral medicines. In many cases, the doctor merely pre- doorways, it was light and airy and would provide
scribes the medicine to be purchased at the pharmacy; protection in the event of another thunderstorm.
it is up to the patient to find a way to have the medicine The roof pales were hung with a variety of ob.-
injected. This often means tracking down a "neighbor- jects-a bundle of cow bones above one door, a bundle
hood needle" and paying a small fee to borrow the of corncobs above the other. Numerous boys' circum-
needle. For a little extra, you can get someone to inject cision toys were wedged into the rafters. Known as
the medicine, or you can do it yourself. The needle may sistrums, these wooden toys are made from tree
be rinsed in water between uses, but it certainly isn't branches and strung with serrated clises made from
sterilized. The multiple use of needles leads, not un- calabashes. Newly circumcised boys wear special
commonly, to minar infections at the injection site. As clothing and are allowed to parade through the village
AIDS becomes more common in Mali, it will become shaking the toys. The calabash clises make a loud clack-
even more dangerous. But as unsanitary as this method ing sound, alerting everyone to the impending arrival
is, it may be better than having the injection done by of the boys, and people come out to give them small
the doctor at the clinic, as my friend from Magnam- presents in honor of their new status as circumcised
bougou, Agnes, can attest. boys. I had never seen so many in one place.
During the rainy season of 1982, Agnes took There was sorne initial confusion caused by the
her one-year-old daughter to the local maternal-child fact that people outside couldn't really see what we
health clinic because she had abad case of malaria. The were doing, and everyone tried to crowd in at once.
doctor gave the infant an injection of Quinimax, a That was straightened out by the chief, however, and
viscous oil-based chloroquine mixture, one of the measuring proceeded apace, men, women, children,
strongest means of combating malaria. Oral chloro- men, women, children. One family at a time filed into
quine tablets probably would have done the job, but in- the hut through one door, had their measurements
jections have that special cachet. taken, and departed through the other door. It was cool
Unfortunately, the doctor, a Malian trained in and pleasant inside the hut, in contrast to the hot sun
France, had little understanding of anatomy. Instead of and glare outside. Miranda sat off to one side, reading
giving the shot into the fat and muscle tissue of the but- a book, glancing up from time to time, but generally
tocks, or the front of the thigh, he administered it in the bored by the whole thing.
back of the thigh, directly into her sciatic nerve. This "Mommy, look!" she exclaimed in mid-morning.
nerve, as thick as a finger, runs the length of the leg and "Isn't that an angel?" she asked, using our family's cocie
provides communication between the brain and the leg word for a child with Down syndrome. Down syn-
muscles. Damage to the nerve by the needle had left drome children are often (though not always!) sweet,
the little girl crippled. happy, and affectionate kids, and many families of
At one year of age, she had just learned how to children with Down syndrome consider them to be
walk, but she was immediately reduced to crawling special gifts from God, and refer to them as angels. I
again, dragging her useless leg behind her. Agnes turned and followed the direction of Miranda's gaze. A
fought back, though, taking her to Kati every month for little girl had just entered the hut, part of a large family
acupuncture treatments and working with her for long with many children. She had a small round head, and
hours every day, trying to strengthen her leg. It took all the facial characteristics of a child with Down syn-
more than a year, but eventually she was able to walk drome-"Oriental" -shaped eyes with epicanthic folds,
again. As horrible as her experience was, it had worse a small flat nose, and small ears. There was no mistak-
repercussions beyond her own family. ing the diagnosis. Her name was Abi, and she was
A few months after the Qui.nimax crippling epi- about four years old, the same age as Peter.
sode, the little hoy next door to Agnes carne down with I knelt in front of the little girl. "Hi there, sweetie,"
malaria. His mother faced a choice on her little boy's be- I said in English. "Can I have a hug?" I held out my
half: malaria or paralysis. He had already survived sev- arms, and she willingly stepped forward and gave me
eral bouts of malaria. From her perspective, a trip to the a big hug.
doctor carried a more certain risk of being crippled by I looked up at her mother. "Do you know that
an inept injection. She gambled, and kept him at home. there's something 'different' about this child?" I asked,
She gambled, and lost. This time, he died of malaria. choosing my words carefully.
"Well, she doesn't talk," said her mother, hesi-
In N'tenkoni the next morning, we were given use tantly, looking at her husband for confirmation. "That's
of the men's sacred meeting hut for our measuring ses- right," he said. "She's never said a word."
sion. A round hut about twenty feet in diameter, it had "But she's been healthy?" I asked.
a huge center pole made from the trunk of a tree that "Yes," the father replied. "She's like the other kids,
held up the thatched roof. Because it had two large except she doesn't talk. She's always happy. She never
20 BEING A BIOLOGICALANTHROPOLOGIST

cries. We know she can hear, because she does what we with Moussa's help. And how, I thought to myself,
tell her to. Why are you so interested in her?" would that have helped them anyway? They just ac-
"Because I know what's the matter with her. I have cepted her as she was.
a son like this." Excitedly, I pulled a picture of Peter out We chatted for a few more minutes, and I mea-
of my bag and showed it to them. They couldn't see the sured the whole family, including Abi, who was, of
resemblance, though. The difference in skin color course, short for her age. I gave her one last hug and a
swamped the similarities in facial features. But then, balloon and sent her out the door after her siblings. I
Malians think all white people look alike. And it's not turned to Moussa and Heather and said, "Guys, I need
true that all kids with Down syndrome look the same. a break. I'll be right back."
They're "different in the same way," but they look most I walked out of the hut, past the long line of vil-
like their parents and siblings. lagers waiting patiently for their turn to be measured.
"Have you ever met any other children like this?" I They turned to stare as I passed. I went behind the an-
inquired, bursting with curiosity about how rural imatrice's compound and sat clown on a fallen log. I
Malian culture dealt with a condition as infrequent as took several deep breaths, trying to get my emotions
Down syndrome. Children with Down syndrome are under control. Finally I gave in, hugged my knees close
rare to begin with, occurring about once in every 700 to my chest, and sobbed. I cried for Abi - what a coura-
births. In a community where 30 or 40 children are geous heart she must have; just think what she might
born each year at the most, a child with Down syn- have achieved given all the modern infant stimulation
drome might be born only once in twenty years. And programs available in the West. I cried for Peter- an-
many of them would not survive long enough for any- other courageous heart; just think of what he might
one to be able to tell that they were different. Physical achieve given the chance to live in a culture that simply
defeéts along the midline of the body (heart, trachea, accepted him, rather than stereotyping and pigeonhol-
intestines) are common among kids with Down syn- ing him, constraining him because people didn't think
drome; without immediate surgery and neonatal inten- he was capable of more. I cried for myself- not very
sive care, many would not survive. Such surgery is courageous at all; my heq.rt felt as though it would
routine in American children's hospitals, but nonexis- burst with longing for Peter, my own sweet angel.
tent in rural Mali. For the child without any major There was clearly sorne truth to the old adage that
physical defects, there are still the perils of rural ignorance is bliss. Maybe pregnant women in Mali had
Malian life to survive: malaria, measles, diarrhea, diph- to worry about evil spirits lurking in the latrine at
theria, and polio. Sorne, like Peter, have poor immune night, but they didn't spend their pregnancies worry-
systems, making them even more susceptible to child- ing about chromosomal abnormalities, the moral im-
hood diseases. The odds against finding a child with plications of amniocentesis, or the heart-wrenching ex-
Down syndrome, surviving and healthy in a rural ercise of trying to evaluate handicaps, deciding which
Malian village, are overwhelming. ones made life not worth living. Women in the United
Not surprisingly, the parents knew of no other chil- States might have the freedom to choose not to give
dren like Abi. They asked if I knew of any medicine birth to children with handicaps, but women in Mali
that could cure her. "No," I explained, "this condition had freedom from worrying about it. Children in the
can't be cured. But she will learn to talk, just give her United States had the freedom to attend special pro-
time. Talk to her a lot. Try to get her to repeat things grams to help them overcome their handicaps, but chil-
you say. And give her lots of love and attention. It may dren in Mali had freedom from the biggest handicap of
take her longer to learn sorne things, but keep trying. In all- other people's prejudice.
my country, sorne people say these children are special I had cried myself dry. I splashed my face with cool
gifts from God." There was no way I could explain cells water from the bucket inside the kitchen and returned
and chromosomes and nondisjunction to them, even to the task at hand.