Journal of Community Health, Vol. 31, No.

3, June 2006 (Ó 2006)

DOI: 10.1007/s10900-005-9011-3

BELIEFS AND PRACTICES CONCERNING TWINS,

HERMAPHRODITES, AND ALBINOS AMONG THE
BAMANA AND MANINKA OF MALI
Gavin H. Imperato, MS; Pascal James Imperato, MD, MPH & TM

ABSTRACT: The Bamana and Maninka of Mali greatly value twins, and
have elaborated a range of cultural beliefs and practices to assure their
survival. Rates of twinning among these two ethnic groups average from
15.2/1000 to 17.9/1000 births compared to 10.5/1000 births (without
assisted reproduction) in the United States and Great Britain. Twins
(flaniw) are regarded as extraordinary beings with unusual powers, and as
a gift from the supreme deity. A small altar (sinzin) is maintained in the
home of twins, and periodic sacrifices of chicken blood, kola nuts, millet
paste and millet beer regularly made to assure their protection. Albinos
(ye´fegue´w) and true and pseudo-hermaphrodites (tye´te´mousote´w) are also
considered twin beings. However, they are believed to be the result of
aberrant parental social behavior. The Bamana and Maninka believe that
all four groups (twins, albinos, hermaphrodites, and pseudo-harmaphro-
dites) are closely linked to Faro, an androgynous supernatural being who
provides equilibrium in the world. Faro is the original albino and
hermaphrodite who gave birth to the first pair of twins after self-
impregnation. Whenever a twin dies, a small wooden statue is sculpted
called a flanitoke´le´ (twin that remains). This commemorative figure is kept
close to the surviving twin, reflecting a belief in the inseparability of twins.
Eventually, the surviving twin takes responsibility for the figure. When a
surviving twin marries, another figure is often sculpted in the opposite sex
from the deceased twin, and placed with the original sculpture. Such
commemorative sculptures are not created upon the death of those who
are albinos, hermaphrodites, or pseudo-hermaphrodites. In recent years,
transformational belief patterns have evolved as increasing numbers of
Bamana and Maninka embrace Islam. Traditional beliefs are often given
Islamic myths of origin. However, even in this Islamic context, many
practices that assure twin survival are maintained.

KEY WORDS: Bamana and Maninka twins; albinos; hermaphrodites; pseudo-

hermaphrodites.

Gavin H. Imperato, MS completed his graduate studies in biology at New York University, and
recently conducted field research on twinning in Mali; Pascal James Imperato, MD, MPH & TM is
Distinguished Service Professor and Chair of the Department of Preventive Medicine and Community
Health, State University of New York, Downstate Medical Center.
Requests for reprints should be addressed to Pascal James Imperato, MD, MPH & TM,
Department of Preventive Medicine and Community HealthSUNY Downstate Medical Center, Box 43,
450 Clarkson Avenue, Brooklyn, NY 11203, USA; e-mail: pascal.imperato@downstate.edu.

198
0094-5145/06/0600-0198/0 Ó 2006 Springer Science+Business Media, Inc.
 Gavin H. Imperato and Pascal James Imperato 199

INTRODUCTION

The Bamana (Bambara) of Mali in West Africa are the largest ethnic
group in the country, numbering close to 4.5 million. As such, they occupy
a dominant cultural, political, and social position in the life of modern
Mali. Although the Bamana and the closely related Maninka (Malinke)
have been undergoing conversion to Islam for a very long time, many retain
beliefs and practices whose origins are in Bamanaya, a traditional religion
and way of life characterized by initiation societies, blood sacrifices, and
belief in a complex religion characterized by several deities and a complex
legend of creation.1
The Bamana (Bambara) and Maninka (Malinke) conceive of twins
(flaniw) in a broad context. This includes monozygotic twins (two indi-
viduals born together and derived from one egg and one sperm), dizygotic
twins (two individuals born together and derived from two separate eggs
and two separate sperm), true and pseudo-hermaphrodites (tye´te´mousote´w),
and those who are albinos (ye´fe´gue´w). The respective singular forms are
flani, tye´te´mousote´, and ye´fe´gue´. The plural of Bamana nouns is generally
rendered by the addition of w as a suffix. When the noun is modified, the w
is added only to the modifier. There are regional variations of the word for
albino including ye´fe´gue´, yafe´ge´, ye´pe´ge´, ye´fougue´, and ye´fuge´. The word for
albinism is ye´fe´ge´ya. Another term used for albino is foune´, which also de-
scribes praise singers who in Bamana and Maninka society are part of the
nyamankalaw who are artisans, bards, and blacksmiths. It is noteworthy that
the term foune´ is also used by the Maninka and Khassonke for twins. Thus, a
female twin is called foune´mouso and a male twin foune´tye´. This is significant
since it demonstrates that a single term is used to describe both twins and
albinos because both are considered true twins.2 The term gomble´ or gombole´,
which literally means ‘‘red monkey,’’ is used to describe those albinos who
have a less severe form of the disease manifested by tan or bronze colored
skin and light brown hair.
Triplets (sabani) and quadruplets (nanini) are extremely rare
among the Bamana and Maninka, and are unknown to most. In many
areas, they are considered as twins. While monozygotic (identical) twins are
recognized as being different from dizygotic (fraternal) ones because of
their seemingly identical physical appearance and because they are always
of the same sex, they are not viewed differently from their dizygotic
counterparts in terms of cultural beliefs and practices. In part, this derives
from the often confounding characteristics present in monozygotic twins
such as inverse laterality and discordance in a number of traits. The former,
200 JOURNAL OF COMMUNITY HEALTH

sometimes referred to as mirror-image twinning, occurs in 10–15% of

healthy monozygotic twins. In these mirror-image twins, a number of fea-
tures are on the opposite sides such as cowlicks, hair whorls, side on which a
first tooth erupts, the position of nevi, and handedness. Discordance refers
to the expression of a minor trait in only one of a twin pair, and occurs in
most, if not all, monozygotic twins.3 In addition, about 10% of monozygotic
twins are affected by congenital abnormalities and genetic disorders, often
obvious at birth. This is 2–3-fold the rate seen in singleton (one baby)
pregnancies where the rate of congenital abnormalities is 2–3%.4 From a
certain perspective, monozygotic twins are clones, and as such have poor
epigenetic control during development leading to somatic mutations. As a
result, congenital abnormalities are common in these types of twins5
(Table 1).
The presence of malformations, disruptions, or deformations due
to discordant mutation in one monozygotic twin can alter appearance, and
in a rural Bamana or Maninka setting render a conclusion about identical
twinning impossible. Malformations such as cloacal anomalies, neural-tube
defects, and congenital cardiac defects contribute to neonatal mortality in
these twins. Disruptions such as limb reduction defects and hemifacial
microsomia (smallness of one half of the face) greatly alter appearance as
do deformations such as club feet, dislocated hips, and cranial synostosis
(premature closure of the sutures of the skull).
Dizygotic twins are also susceptible to the above-mentioned defor-
mities, which result from two babies growing in a space meant for one.
However, they are less susceptible to the above-discussed malformations
and disruptions. As a consequence, perinatal mortality rates are higher in a
rural African setting among monozygotic twins compared to their dizygotic
counterparts. However, both types of twins are vulnerable to a higher risk of
premature birth than is the case with a singleton (one baby) pregnancy. It
has been estimated that only a third of twin pregnancies come to term. In a
rural Malian setting, this results in a higher infant mortality among one or
both of a twin pair, based on prematurity alone. Mortality among mono-
zygotic twins is increased above that in dizygotic twins or singletons because
10% of these infants have some type of congenital anomaly.6
Many twin pregnancies are lost or else become singleton preg-
nancies. It is estimated that only one in eight fetuses beginning as a twin
goes on to be born as a twin.7 These early intrauterine losses are not
generally observed in the absence of advanced radiological imaging. Such
intrauterine loss is very much higher among monozygotic twins, and is
usually due to congenital anomalies. The remaining monozygotic twin,
 Gavin H. Imperato and Pascal James Imperato 201

TABLE 1

Definitions of Medical Terms

CLONES A single individual organism that is genetically identical
to another individual.
TWINS Children developed within the uterus at the same time
from the same impregnation.
DIZYGOTIC TWINS Two individuals born together derived from two separate
eggs fertilized by two separate sperm (essentially, sib-
lings who share a womb).
MONOZYGOTIC Two individuals born together derived from one egg and
TWINS (Identical) one sperm.
KARYOTYPE A method of organizing the chromosomes of a cell in
relation to number, size, and type, e.g., 46, xx (female);
46, xy (male).
GENOTYPE The genetic makeup of an organism.
PHENOTYPE The physical and physiological traits of an organism.
HERMAPHRODITE An individual with both ovarian and testicular tissue, but
with either a predominantly 46, xx karyotype or 46, xx/
46, xy mosaic.
*Bilateral—an ovary and testicle present on both sides.
*Complex—both internal and external organs of both
sexes.
*Lateral—a testicle on one side and an ovary on the
other.
*Transverse—outward organs of one sex and the internal
organs of another.
*Unilateral—an ovary and testis (or ovotestis) on one
side, and either an ovary or a testis on the other.
PSEUDO- An individual who possesses what appear to be the
HERMAPHRODITE external genitalia of one sex and the internal gonads of
the other.
*Female—large clitoris resembling the penis and
hypertrophied labia majora resembling the
scrotum. Karyotype is 46, xx.
*Male—small penis and a scrotum without testes thus
resembling the vulva. Karotype is 46, xy.
Sources: References 6, 20–25.
202 JOURNAL OF COMMUNITY HEALTH

now a singleton, is still vulnerable to developing the congenital anoma-

lies that affected the other fetus. Neonatalogists are well aware that a
singleton born with certain anomalies may have started as a monozygotic
twin.

TWINNING RATES AMONG THE BAMANA AND MANINKA AND

OTHER POPULATION GROUPS

In 1968, there were 761 twin births reported among 34,780 live
births in 52 maternity centers in Mali, representing about one quarter of all
live births in Mali. Thus, the rate of twin births was 21.8/1000 births. Data
for maternity centers serving Bamana and Maninka populations showed a
rate of 17.9/1000 births.8(128-131) These Ministry of Health and Social Af-
fairs data did not differentiate between dizygotic and monozygotic twins.
However, it can be assumed that the majority of these twins were dizygotic
because the rate of monozygotic twin births is fairly constant across dif-
ferent populations at 3.5/1000 births. In 1990, Dolo, Diall and Diabate
reported a twinning rate of 15.2/1000 births at the Hôpital National du
Point-G in MaliÕs capital, Bamako, whose patients are primarily Bamana.9
This 15.2/1000 rate is not significantly different than the 17.9/1000 rate
reported in 1968.
While monozygotic twinning rates are constant at 3.5/1000 births
across most population groups, those for dizygotic twins vary greatly. Be-
cause dizygotic twins contribute two-thirds of all twin births, they account
for these population rate differences. While routine DNA testing can often
differentiate monozygotic from dizygotic twins in developed countries,
such is not possible at present in much of Africa. Thus, one can only
compare overall twinning rates between African populations and those in
the United States and Europe.
The spontaneous (without assisted reproduction) prevalence of
twin births in the United States and Great Britain is about 10.5/1000 births,
of which two-thirds are dizygotic.10 Historically, twin birth rates rose in the
United States and Europe with advancing maternal age until the age of
39 years. Since the 1990s, older age at childbearing and the use of assisted
reproduction have greatly contributed to the overall dramatic rise in mul-
tiple gestations. By 1997, twin birth rates in the United States had risen for
white women to 28.8/1000, for Hispanic women to 19.5/1000, and for
African-American women to 30.0/1000. The overall rate was 26.1/1000
compared to the historical rate of 10.5/1000.11
 Gavin H. Imperato and Pascal James Imperato 203

Historically, African-American women in the United States had a

twinning rate of 14.0/1000, well above the national average of 10.5.
However, with assisted reproduction and later age at childbearing, that rate
has risen to 30.0/1000. The historical rate reflected in part the higher
spontaneous rates of twinning long observed among the various African
populations, and especially the Yoruba of Nigeria11 (Table 2).
A number of medical researchers have documented high rates of
twinning among the Yoruba, Ibo, Hausa, and Fulani of Nigeria. Foremost
among them is Percy Nylander, who was a lecturer in the Department of
Obstetrics and Gynecology at the University of Ibadan. He found rates as
high as 45.9/1000 among the Yoruba. He determined that the high rate of
twinning in western Nigeria was due to an increased proportion of dizygotic
twins.12
While the causes of monozygotic twinning have not yet been fully
elucidated, it has now been shown that spontaneous dizygotic twinning is
associated with an increased serum concentration of follicle-stimulating
hormone (FSH) in the mother. These levels are much higher in Yoruba
women than in women in Great Britain matched for age and vary with
geography, season, ethnic origin, and increasing parity (number of
children). They are also higher in tall, heavy, and older women.12 It has
also been documented that spontaneous dizygotic twinning runs in
families and that in such instances the higher levels of FSH are inherited
either as an autosomal dominant or autosomal recessive trait. It has also
been demonstrated that 7–15% of the population carries a gene that is
dominantly inherited and which predisposes to dizygotic twinning
(Table 3).13

TABLE 2

Comparative Rates of Spontaneous Twin Births in Different Population

Groups
Population Group Rate/1000 Births
Yoruba (Nigeria) 45.9
Bamana and Maninka (Mali), 1968 17.9
Bamana and Maninka (Mali), 1990 15.2
U.S. and Great Britain in general 10.5
African-American Women 14.0
The rates presented are for spontaneous (without assisted reproduction) twin births.
Data Sources: References 8–12.
204 JOURNAL OF COMMUNITY HEALTH

TABLE 3

Three Facets of Sexual Differentiation

 Gonadal for the production of gamates (genetically mediated)
 Genital for the conveyance of gamates to a point of fertilization (hormonally
mediated)
 Behavioral for the urge to behave sexually (multi-factor mediated)
Sexual identity established by 3 years
Sexuality established in adolescence
Source: Federman DD. Three facets of sexual differentiation. N Engl J Med 2004; 350:323–4.

A BROAD CONCEPT OF TWINNING

The Bamana and Maninka are well aware that twins are often born
prematurely, and that when born at term are often smaller than singleton
infants. This recognition of higher rates of prematurity and low birth
weights and their association with higher infant mortality no doubt con-
tributed to the elaboration of beliefs and practices favoring twin survival.
For among the Bamana and Maninka, twins are accorded a privileged status
that provides them and their parents with greater than usual access to a
variety of resources. Such access is not extended to hermaphrodites,
pseudo-hermaphrodites, and albinos, who are also considered twin beings.
For unlike twins, who are regarded as extraordinary beings with unusual
powers and as a gift from the supreme deity (Pemba, Bemba, NÕgala), indi-
viduals affected by these three pathologies are thought to be the result of
aberrant social conduct. Unlike twins, they are sometimes feared because of
their powers, and viewed with ambivalence because they are the result of
behavioral departures from societal norms.
The basis for considering four distinct groups of individuals as twins
is Bamanaya, a corpus of essential spiritual and cosmological beliefs and a
mode of living that define someone as Bamana or Maninka. To embrace
Bamanaya is to believe in the centrality in oneÕs life of nyama (vital life force,
energy, or power) and boliw (ritual objects which are regularly given blood
sacrifices). Boliw (singular boli) are great reservoirs of nyama whose powers
are increased and renewed through regular sacrifices. However, it is in the
legend of creation and in its principal deity, Faro, that the duality of human
nature (good and bad, male and female, strong and weak) and the concept
of twinning are both elaborated and codified for the spiritual belief system
that is at the heart of Bamanaya.
 Gavin H. Imperato and Pascal James Imperato 205

TWINS, HERMAPHRODITES, AND ALBINOS AND THE LEGEND OF

CREATION

There are two major variants of the Bamana legend of creation, and
subtle regional differences within them. The legend in the southern region
is depersonalized compared to its analogue in the north.14(80-83) While the
southern legend revolves around non-human forces, that in the north is
centered on supernatural personalities embodying known human virtues
and vices.15,16(1–55),17(116–120),18(1–6) It is within the context of this northern
Bamana creation narrative that societal values, attitudes, and practices
concerning twins, hermaphrodites, pseudo-hermaphrodites and albinos
are given metaphysical importance and historical legitimacy.
Zahan summarized this northern creation legend beginning with
belief in a supreme being known as NÕgala, Bemba, or Pemba. Closely asso-
ciated with him and with the act of creation are several supernatural
beings.18(1–6) Prominent among them are Mouso Koroni Koundye´ or Nyale´,
Faro, and Ndomadyiri. From a certain perspective, these beings are also
manifestations of God. During the first phase of creation, known as dali folo
(first putting in order, first creation), the earth was naked, and God
manifested himself as a grain (kise) known as Pemba. A balanza tree (Acacia
albida) grew from this seed. But when it became fully grown, it withered and
fell to the ground. Eventually, all that remained was a long beam of wood,
known as Pembe´le´. This wooden beam secreted mildew that accumulated
beneath it. Pembe´le´ mixed this mildew with his own saliva to create a new
being, a female, known as Mouso Koroni Koundye´ (little old woman with a
white head) (Figure 1).
Mouso Koroni then engaged in the creative process, engendering
vegetables, animals, and human beings. The latter were then immortal. Her
creativity was characterized by disorder, confusion, and haste. This is ex-
cused by some Bamana on the grounds that she wanted to populate the
earth with beings as rapidly as possible. Finally, Mouso Koroni planted the
Pembe´le´ in the ground, and he became a tree once again. Men worshipped
Pemba, now a balanza tree, the tree that eventually introduced them to
death. In time, men transferred their worship to Faro, another supernatural
being and manifestation of God, who is the master of water.
Some Bamana believe that Mouso Koroni disappeared at this point,
after spending a wretched life on earth authoring disorder. Others, how-
ever, believe that she continues to live, the personification of air, wind, and
fire. She is also the ‘‘mother of magic,’’ the first sorcerer, and as such is
called by another name, Nyale´.
206 JOURNAL OF COMMUNITY HEALTH

FIGURE 1

Statue depicting Faro with a reptilian/piscatorial body, female breasts,

and the head of an uncircumcised boy reflecting androgyny, Cercle of
San, 16 inches, Imperato Collection (Photograph by Robert E. Mates).

Mouso Koroni was originally created with a soul that had two parts, a
ni and a dya, like those of all human beings. But at the time of her creation,
while God gave her the ni, he entrusted its double, the dya, to Faro. Thus,
Mouso Koroni was incomplete from the moment of her creation. Nonethe-
less, she authored the first phase of creation, characterized by prodigious
growth and fertility. As Zahan18(5) notes, as Nyale´, she gives strength to
newborns and hastens the ripening of grain. She is the source of all human
ideas which have been or will be given to man, and represents energy,
activity, and desire. But she is also the source of all malice, misunder-
standing, treachery, deviancy, and sorcery. She is an extravagant being,
 Gavin H. Imperato and Pascal James Imperato 207

unruly, uncontrolled, and excessive. She causes all creation to proliferate,

but in an uncontrolled manner. The hasty nature of Mouso KoroniÕs creative
efforts resulted in defective beings. She is the author of numerous anom-
alies, both physical and psychological.
In entrusting Mouso KoroniÕs dya to Faro, God in effect set limits on
the amount of disorder in the world. He also deprived the primordial
female being of coherence and made her defective. It could be cogently
argued that the ancient Bamana conceived of this component of the myth
to rationalize womanÕs imposed inferior position in their society and the
necessity for male dominance (Table 4).
The second phase of creation, called dali flana (second putting in
order, second creation), was dominated by Faro and Ndomadyiri. The former
represents equilibrium, and the latter stability. Faro is believed to be
androgynous and to live in water. In some drawings and sculptures, he is
represented in female form with long black hair, breasts, a white face and
head, a fish tail and flippers covering each auditory meatus.16(41-42) In other
sculptures, he has a white human head and trunk, female breasts, and
either a piscatorial or reptilian body. His tail and breasts are made of
copper. The former has the shape of a fin.16(42)
Faro is the original albino, having stolen his white face from Teliko, a
lesser deity associated with whirlwinds and dust devils. As detailed by Di-
eterlen,16(41) Faro was originally comprised of sound, a voice in the waters of

TABLE 4

Characteristics of Faro, the Principal Bamana and Maninka Deity

 One of the trinity of deities responsible for creation. Is the dominant deity.
 Provides equilibrium in the world, and is associated with water.
 Physical characteristics:
Albino
Black eyes
Feminine face
Upper body covered with skin; lower part covered with copper
Long, smooth black hair
Right hand is male; left hand is female
Webbed tail
Hermaphrodite
No external ear; external auditory meatus covered by a fin
Gave birth to two female twins who are the ancestors of the Bozo people
Considered a duality in one physical being
Sources: References 1, 14, 16, 18.
208 JOURNAL OF COMMUNITY HEALTH

the sea. Te´liko, a lesser deity, who was a winged albino and who is associated
with whirlwinds, dust devils, and the air, attempted to fly across the world in
order to dominate it. Warned about this by the dogfish (oulou-dye´gue´), Faro
decided to take Te´likoÕs body as his own and at the same time vanquish his
challenger. Te´liko gnawed at his own flesh in order to nourish himself to a
point where only his bone marrow remained. Eventually, his body was
transformed into red copper, and he fell into the sea. The dogfish, who was
lying in wait for him, sang in order to draw him closer. Te´liko, sensing a trap,
flew back up into the sky until he reached its limits. Losing strength, his dya
(double) fell into the sea where his body was seized by Faro, except for the
external male genitalia which Faro gave to the dogfish. Thus it was that Faro
acquired an albino head and trunk and a copper tail. Te´liko meanwhile
reconstituted himself as an albino but remains a lesser deity, traveling
across the earth on whirlwinds. He is perceived as a relatively innocuous
deity living in the air. Because he is the original albino, the Bamana and
Maninka believe that human albinos originally had wings and were capable
of flying, attributes that were lost through contact with the impure
earth.16(88) FaroÕs right hand is male, and the left female. He has no
apparent external genitalia, but impregnated himself and gave birth to
female twins when water first flowed on the earth.16(42) Thus, he is the
author of twinning and also the original hermaphrodite (Table 5).
Although FaroÕs role is to perfect the world, organize it, put it in
equilibrium, and give it eternal life, he is closely associated with twinning,
albinism, and hermaphroditism. He was born from GodÕs vaporous breath,
from a bubble of saliva while God was pronouncing the words of crea-
tion.15,17(118) Faro is GodÕs visible countenance and his word. However,

TABLE 5

Some Characteristics of Bamana and Maninka Twins (Flaniw)

 Considered as offspring of Faro.
 Do not inherit the ni and dya of a recently deceased relative.
Ni and dya given by Faro.
 Dya perpetually rests in water, guarded by Faro.
 Viewed as special beneficial beings.
 Sinzin (support) altar created for them consisting of a double calabash in the
form of an hourglass.
 Considered one being expressed in physical duality.
 Accorded exceptional status.
Sources: References 16, 18, 28, 29, 30.
 Gavin H. Imperato and Pascal James Imperato 209

during this second phase of creation, this word was unintelligible to hu-
mans, consisting of a language in which all the words were connected. It
was Ndomadyiri, the divine blacksmith, the third supernatural person after
Mouso Koroni and Faro, who made this primordial word into useful lan-
guage. He is, as Zahan says, what is left, the earth, after the evaporation of
water (Faro) due to the action of the wind (Nyale´). This provokes the notion
of fixity, of remaining in place after the withdrawal of his previous associ-
ations. So the Bamana and Maninka see him symbolized in trees, fixed and
powerful living beings, the source of the first life, Mouso Koroni. As a tree,
Ndomadyiri is the master of herbs and remedies, and a healer, a charac-
teristic of all blacksmiths. Thus, Ndomadyiri is the eponymous ancestor of all
blacksmiths, and the author of all healing. Faro and Ndomadyiri complement
one another. Faro represents water and rain, needed for life, while Ndom-
adyiri is the earth and fire, and has stability and provides man with a
home.18(5-6)
The third phase of creation is that of the present. As Zahan18(5)
observes, it is the stage when human beings and things confront one an-
other. The formation of human societies results in confusion and disorder
due to men asserting themselves and expressing their wills and emotions.
However, Ndomadyiri, as a blacksmith, is omnipresent, stabilizing society
through his supervision of its religious rites.
Mouso Koroni, who had retreated during the second phase of crea-
tion, appeared again during the third as Nyale´. While the second phase was
characterized by order, balance and harmony, the third has great potential
for the disorder and confusion characteristic of the first phase because of
her presence. Again, a male-dominated society which relegates women to
an inferior political and social position produces powerful religious and
metaphysical reasons for so doing.
Known in this last ongoing phase as Nyale´, Mouso Koroni represents
activity, energy, mystery, desire, secrecy and, as Zahan18 so well explains, a
desire for all that man wants to achieve. She is unbounded enthusiasm, and
extravagance, but also a source of fertility and creation. If left to the
influences of Nyale´ alone, man would indulge in all manner of excesses,
and society would break down. That is why Ndomadyiri is present, to control
and set limits.
Zahan cogently reasons that the Bamana creation story contains
both positive and negative elements.18(6) Nyale´ cannot totally disappear
because she is the source of all activity, animation, rivalry, and very
importantly, courage. The world cannot progress without her. But left
alone, her influence would result in a complete breakdown of creation.
210 JOURNAL OF COMMUNITY HEALTH

Thus, Ndomadyiri is needed as a counterweight of stability. In a sense, Nyale´

and Ndomadyiri are diametrically opposed principles. It is Faro who provides
a balance between the two.

PERCEPTIONS OF HERMAPHRODITES AND ALBINOS

In the pre-industrial rural Bamana and Maninka world, people are

not able to distinguish between true hermaphrodites and pseudo-her-
maphrodites. In true hermaphrodites, both ovarian and testicular tissues
are present in a variety of patterns. The karyotype may be female (46, xx) or
a mosaic (46, xx/46, xy). However, about 80% of true hermaphrodites are
46, xx (female). True hermaphrodites often have an ovotestis and ambig-
uous external genitalia. In industrialized societies, the sex of rearing is
often dictated by the phenotype, which is usually female.19–23
True hermaphroditism is a relatively rare disorder in most parts of
the world except sub-Sahara Africa, where it is not uncommon.23 In a study
of 96 cases described in Africa, 96.9% showed a female (46, xx) karyotype.
The 46, xy karyotype (male) is extremely rare, but not unknown.21 Al-
though the sex of rearing is dictated by the karyotype, in practice this
means that most are raised as females.23,24 The causes of true hermaph-
roditism are not fully understood.
Pseudo-hermaphroditism is by comparison a more common disor-
der. In male pseudo-hermaphrodites, the karyotype is 46, xy (male), the
gonads are testes, but the external genitalia are incompletely virilized,
ambiguous, or female. There are several gene mutations responsible for the
various types of male pseudo-hermaphroditism. These affect a number of
protein and enzyme systems which result in inter-sex anomalies.23
In female pseudo-hermaphroditism, the karyotype is 46, xx
(female), the gonads are ovaries, but the external genitalia are virilized.
Most cases of female pseudo-hermaphroditism result not from genetic
mutations, as is the case with the male counterpart disorder, but from
exposure of the female fetus to the virilizing effects of androgens in utero.
The commonest causes of this endocrine dysfunction are congenital
adrenal hyperplasia, placental aromatase deficiency, masculinizing mater-
nal tumors, and the administration of androgenic drugs to women during
pregnancy.25
There are several other genetic mutations that result in inter-sex
anomalies.23 However, like the two forms of pseudo-hermaphroditism, the
Bamana and Maninka would classify all of them as hermaphrodites. For the
 Gavin H. Imperato and Pascal James Imperato 211

TABLE 6

Characteristics of Bamana and Maninka Hermaphrodites (Tye´te´mousote´w)

 Accorded exceptional status.
 Considered a duality in one physical being.
 Originally, man was androgynous, and thus isolated.
These beings were unable to hear, see, taste and smell, and
produced no odor. They only possessed a sense of orientation toward their
own maturity.
 Uncircumcised and unexcised children are considered androgynous.
 No physical distinction possible between true hermaphrodites
and pseudo-hermaphrodites.
 Considered their own twin.
 Like twins, do not inherit the ni and dya of a recently deceased relative.
 Ni and dya given by Faro.
 Tere and wazo not united.
Sources: Reference 16, authors’ field research.

purposes of this discussion, they are all grouped under the rubric of her-
maphroditism (Table 6).
The genetic basis of albinism is complex. Currently, 12 different
genes have been identified that result in different types of albinism when
mutated. The best understood of these diseases and the most common is
oculocutaneous albinism type 1 (OCA1) due to a total lack of the enzyme
tyrosinase. This enzyme is essential for melanocytes in the skin to form
melanin. In individuals with this disease, the skin and hair are white, and
the irides of the eyes a blue-gray or pink, depending on light source. They
also have defective vision, significant light sensitivity, sunburn easily, and
are prone to skin cancers. In those with tyrosinase-positive albinism, the
enzyme is not totally lacking. Although their hair may turn yellow over time,
and their ocular irides turn a light brown, their skin is never darker than a
cream or pink color. However, in a third form of the disease, tyrosinase
variable albinism, the infant has white hair, pink skin, and gray eyes at
birth, but later develops light tanning of the skin and yellow or light brown
hair over time.26
The Bamana and Maninka refer to those with OCA1 and tyrosinase-
positive albinism as ye´fe´gue´w. These are albinos whose skin never tans but
which may burn on exposure to the sun.16(88) However, they use the term
gomble´, derived from gon (monkey) and ble´ (red), to signify ‘‘a red man’’ for
those with tyrosinase-variable albinism. They are not aware of the genetic
212 JOURNAL OF COMMUNITY HEALTH

and biochemical causes of these different forms of albinism. However, they

are very familiar with their phenotypic or outward expressions.
Sometimes the term gomble´ is used to describe those with OCA1
albinism because they can develop severe sunburns and turn red in color.
However, strictly speaking, the term is reserved by most for those with the
milder form of the disease.
Complicating the mosaic of albinism are several syndromes associ-
ated with systemic pathology. These forms of albinism are not associated
with defects in melanin production, as is the case with oculocutaneous
albinism, but with genetic defects in the packaging of melanin and other
cellular proteins.27 Known as syndromic albinism, these genetic diseases
also affect other organ systems, sometimes severely. However, those with
these rare autosomal recessive disorders would be considered as ye´fe´gue´ by
the Bamana and Maninka because of their skin color.

FARO: THE UNIFYING SUPERNATURAL BEING FOR TWINS,

HERMAPHRODITES, AND ALBINOS

In general, twins are referred to as flaniw (singular flani) which

means ‘‘two little ones.’’ A male twin is often referred to as flanityema and a
female one as flanimousoma. Twins are considered a gift from Faro, who gave
birth to the first twin pair who were female. As a result, they do not inherit
their spiritual elements, the ni (soul) and the dya (double), according to
Bamana reincarnation beliefs. Those beliefs hold that at death, oneÕs true ni
goes to rest on the family altar while the dya enters water where it is pro-
tected by Faro.16(58) The first newborn following the death of a family
member inherits their dya, but as a ni and their ni as a dya. These twin
elements, which all humans possess, are either male or female. In the case of
boys, the ni is male and the dya female; the opposite is true for girls. Thus, a
humanÕs spiritual elements reflect both twinning and androgyny (Table 7).
In the case of twins, hermaphrodites, and albinos, these spiritual
elements are not inherited from the most recently deceased family member,
but rather directly from Faro, who is the source of an infinite reserve of
them.16(58,88) In addition, the dya of these individuals does not enter their
bodies, but rather remains under FaroÕs protection in water.16(85) As a result,
the dya is constantly protected from evil nyama and other malevolent forces.
Twins are always considered a special blessing from the creator God
under the protection of Faro. As such, their parents are referred to as
kunandi (privileged ones). Following their birth, their mother places a
white cotton band (dyala) around her forehead to demonstrate that their
 Gavin H. Imperato and Pascal James Imperato 213

TABLE 7

Bamana and Maninka Human Spiritual Characteristics

ni – soul At death, the ni is guarded on the family altar; the dya
rests in water.
dya – double The next newborn in a family inherits them, assuring
perpetual reincarnation.
tere – character, At death, the tere is released as nyama, a vital life force.
conscience (Pemba)
wazo – negative The wazo is released in the blood associated with cir-
force (Mousso Koroni) cumcision or excision. Normally, the tere and wazo
are united in each person so as to balance the latter.
Data Source: References 16, 17, 34, authorsÕ field research.

dyaw are guarded by Faro.16(85-86),28,29 There are a number of rituals sur-

rounding the birth and naming of twins which have been previously de-
scribed in detail.16(86),18,28,29 However, it is important to emphasize that
twins represent manÕs original androgynous nature for the Bamana and
Maninka, and hence their close association with Faro, the androgynous
deity31 (Figure 2).
The traditional Bamana give the names Séni and Siné to two male
twins, and Bintou and Wasa to two female twins.16(86) Islamized Bamana
give two male twins the names Lassana (Alassan) and Fouséni, and two
female twins the names Adama and Haoua. When it is a matter of a male
and female twin, Lassana and Stafine are given.28 There are some variations
in these names. Sama and Kafeune may be used for female twins, and Seni
and Gno for male ones. A child born to a woman after a twin birth is called
Sadio.29
The father of twins maintains a small altar called sinzin (support).
These are comprised of either wooden cups or calabashes or woven
straw.29,30(97-98) The former are often joined to a wooden handle or else at
their apices to form an hourglass shape.18(14),32 The internal composition
of these small altars has been previously described. Some contain pieces of
umbilical cord wrapped around two small sticks with forked ends made
from a branch of the sunsun tree (Diospyros mespiliformis).29 Chicken blood,
kola nuts, millet paste, and millet beer are used as sacrificial materials on a
yearly basis at the beginning and end of the rainy season, the first cutting of
hair, circumcision, excision, and marriage.18
Special bowls called flani daw (twin bowls) are made for twins, often
carved from the wood of the sunsun tree (Diospyros mespiliformis), the balanza
214 JOURNAL OF COMMUNITY HEALTH

FIGURE 2

Young woman holding a female twin, and a flanitoke´le´ representing a

deceased female twin, Cercle of Bamako (Photograph by Pascal James
Imperato).
 Gavin H. Imperato and Pascal James Imperato 215

tree (Acadia albida), or other trees. These flani daw usually consist of two
bowls attached side to side, and are often used by a female twin for washing
following childbirth, and by both male and female twins to protect them-
selves and others. Sometimes a three-lobed bowl is sculpted from the same
woods described above. These consist of a central wooden handle with two
bowls on either side and one at the distal end18(7–8).
In previous communications, significant details were provided
about a number of practices and beliefs related to twins.28,29 However, we
would like to emphasize here a few relevant to twins who reach adulthood.
Sometimes, two male twins married the same woman, representing a rare
example of polyandry.16(87),29 In most instances, two male twins married
different women, but at the same time. Similarly, two female twins married
different men at the same time.29 Male twins were permitted to have sexual
relations with one anotherÕs wives.32 Thus, the children of male twins are
never referred to as the children of a specific twin, but as the children of
the twins. The husbands of female twins were permitted to have sexual
relations with both women. Travélé reported that sometimes marriages did
not take place on the same day.32 In such instances, both female twins
entered the first husbandÕs house on the marriage night, and he had sexual
relations with both, starting with the oldest (the second born). When twins
were of mixed sexes, the brother had sexual relations with his sister before
she was taken to her husbandÕs house.32
Twins are believed to possess magical powers such as the ability to
walk on water because their dya resides there with Faro. Twins are also
believed capable of transforming themselves into scorpions, an arthropod
that symbolizes twins with its eight limbs, like those of twins. Twins often
served as intermediaries in settling disputes, and often marched at the head
of armies in time of war because of their special protective powers.
From the time of their birth, twins are the recipients of regular gifts
of food and clothing. When they are older, they often solicit gifts on Friday,
the Moslem day of observance. This practice ensures access to additional
food and resources for these children who are at greater risk for various
morbidities and mortality.
Hermaphrodites and pseudo-hermaphrodites are both known as ty-
e´te´mousote´w which literally means ‘‘not male and not female.’’ This term can
also be used for both male and female homosexuals. However, the term mouso
flana, meaning ‘‘the second female,’’ is sometimes used to describe a male
homosexual. Censorious Moslem Bamana often use the Wolof word gorjigen,
meaning ‘‘male female,’’ for a male homosexual. In so doing, they are
216 JOURNAL OF COMMUNITY HEALTH

attempting to demonstrate that male homosexuality is alien to the Bamana

world, and that it was imported from the Wolof people in Senegal.33
Hermaphrodites and pseudo-hermaphrodites are considered both
male and female, and as their own twin. As such, they do not inherit the ni
and dya of a recently deceased relative. Rather, their ni is given by Faro, and
their dya guarded by him in water. They are considered a duality in one
being, and androgynous like Faro and the first humans ever created.16(87)
Unlike twins, who are respected as unusual beings, hermaphrodites
and pseudo-hermaphrodites are viewed as the other, and very much on the
periphery of Bamana society. This marginalized social position relates not
only to their physical characteristics, which preclude their being fully
integrated into adult Bamana society through either circumcision or exci-
sion, but also to their spiritual essence. In this regard, they are analogous to
uncircumcised children and hyenas (surukuw), who are also considered to
be androgynous.17(115) However, this androgyny is not merely physical as
reflected in the unusual appearance of the external genitalia of hyenas and
the prepuce of a boy and the clitoris of girl. All these beings are also closely
associated with a dominant wazo, a spiritual element that is a powerful
negative force encompassing ignorance and separation from higher intel-
lectual planes.34(191)
In addition to a ni and a dya, the Bamana believe that each living
being possesses a tere, which is a positive force comprised of conscience and
character, and which reflects Pemba the creator God. At death, the tere is
released as nyama, a powerful force. Each being also possesses a wazo (also
called wanzo), a negative force which originated with Mouso Koroni. The tere
and wazo are joined in most humans, where the former places controls on
the latter. In albinos, hermaphrodites, and pseudo-hermaphrodites, the
two are not joined together. Thus, the wazo, which is manifested by igno-
rance and a range of undesirable character traits, exerts greater influence
in these individuals. It is through circumcision that the wazo is released,
because it resides in both the clitoris and prepuce where it impedes fer-
tility.16(64) Once released in the blood of circumcision, the wazo enters the
multi-horned masks of the NÕTomo initiation society comprised of children.
Thus, it is through circumcision that children lose both their wazo
and androgyny, and are put on the road to becoming responsible adults in
Bamana society. Hermaphrodites and pseudo-hermaphrodites retain both
their androgyny and wazo because they are not generally circumcised or
excised. As a consequence, their inability to marry and procreate is caused
not merely by their physical androgyny, but because they retain their wazo,
which prevents fertility.
 Gavin H. Imperato and Pascal James Imperato 217

Hermaphrodites and pseudo-hermaphrodites derive no social

advantage from being considered twins and androgynous like Faro. More
importantly, their gonadal dysgenesis closely associates them with Mouso
KoroniÕs chaotic, disordered, and defective creative processes. The Bamana
see them as reflections of her and the world of creation as it was before dali
flana (second putting in order, second creation), the second phase of
creation dominated by the equilibrium of Faro and the stability of Ndoma-
dyiri. Similarly, their frequently permanent uncircumcised/unexcised state
condemns them to retain their wazo, which is an essential source of igno-
rance and sterility, and which confers on them a permanent state of in-
fancy. As a result, they can never be given access to the ever-increasing
levels of spiritual knowledge required for responsible adulthood. Thus,
they are placed in a permanent pariah position in Bamana society. Most live
out their lives within the extended families into which they are born.
The Bamana and Maninka believe that albinos are the result of
sexual intercourse occurring in mid-day when the sun is at its zenith and the
sky almost bright white in color. This mid-day sky is called the sky of FaroÕs
anger.16(88) Sexual intercourse at this time of day is a prohibition among
those who adhere to Bamanaya, and results in the conception of an albino.
This single individual, with white skin that reflects FaroÕs own and the color
of the sky under which they were conceived, is considered a twin being. At
the time of such a sexual infraction, Faro unifies twins in the womanÕs uterus
and removes the color of the skin. As an avatar of twins, albinos do not
inherit either the ni or the dya of a deceased relative. Rather, they are
considered beings created by Faro, and receive these spiritual elements di-
rectly from him, as is the case with twins and hermaphrodites. Because
albinos are born from an act of transgression, their ni and dya are not linked
together as is the case in other human beings. This results in powerful and
uncontrolled wazo. Consequently, a circumciser/exciser must make special
sacrifices to their family altars prior to performing the procedure that re-
leases an albinoÕs wazo in order to protect themselves. For wazo is released in
the blood that flows at both circumcision and excision (Table 8).
Because of their powerful and unrestrained wazo and their nyama,
uncircumcised albino children were and still are sought out as sacrificial
victims to Faro. Their nyama is so powerful that no incantations need be
pronounced during the sacrifice.16(88) Even after circumcision/excision,
when devoid of wazo, albinos are considered excellent sacrificial victims to
Faro because of their powerful nyama. As a consequence, parents keep
albino children under close surveillance. In the past, even adult albinos
were seized and sacrificed. However, it was and is easier to kidnap an albino
218 JOURNAL OF COMMUNITY HEALTH

TABLE 8

Characteristics of Bamana and Maninka Albinos (Ye´fe´gue´w)

 Conceived in daylight (koblenkaba).
 Represent twins merged in utero as a consequence of conception in daylight.
 Like twins, do not inherit the ni and dya of a recently deceased relative.
 Tere and wazo not united.
 Accorded exceptional status.
 Considered a duality in one physical being.
 Body parts viewed as possessing great powers:
* Head—assures a large family and prosperity
* Hair—brings riches
* Bone marrow—brings gold or copper
* Excrement—produces a good harvest
* Sitting on interred bones—wishes granted
Sources: Reference 16, authorsÕ field research.

child compared to an adult. Both ye´fe´gue´w and gomble´ albinos are considered
as equally valuable as human sacrifices.35
Even the various body parts of an albino are viewed as endowed with
special powers, thus adding to their risk of being used for sacrifices. The
head assures a large family and prosperity; the hair brings riches; the bone
marrow brings gold or copper; the excrement produces a good harvest; and
sitting on the interred bones of an albino assures that wishes are granted.
The Bamana consider albinos so powerful that even after death they will
attempt to disinter them.
Albinos are viewed as possessing an essence almost identical to that
of Faro. However, because they are the result of a serious sexual infraction,
they are nonetheless considered defective. This sexual infraction consisting
of daytime sexual intercourse might not strike non-Bamana and Maninka as
a serious matter in and of itself. However, this interdiction has little to do
with sexual relations between wives and husbands, which usually occur at
night, but more to do with extramarital sex. This proscription was especially
elaborated to prevent women from having extramarital affairs during the
day with lovers while their husbands are away in the fields farming. For such
affairs are difficult for women to have at night when men are at home. Thus,
the birth of an albino often raises suspicions on a husbandÕs part that his
wife had sexual intercourse during the day with a lover, unless he did
himself.35 Today, many Moslem Bamana believe that albinism results when a
child is conceived by a woman who had sexual intercourse while menstru-
ating.35
 Gavin H. Imperato and Pascal James Imperato 219

COMMEMORATIVE TWIN SCULPTURES

Albinos and hermaphrodites are not commemorated after death

with sculptures as is the case with twins. Whenever a twin dies, and this is
especially common in the perinatal period, a small wooden figure is
sculpted called flanitoke´le´w (twin that remains or the same double). These
sculptures were first documented in the scholarly literature by Joseph
Henry in 191030(98) who also illustrated one in situ. Four decades later,
Dieterlen briefly discussed flanitoke´le´w, saying the following:16(87)

If one of them dies at a young age, the blacksmith makes a small wooden doll
called flanitoke´le´, which receives the name of the deceased, and which the
mother places on the mat next to the living child. The latter carries this doll
with him at the moment of his circumcision, and keeps it with him during all
his retreat to bring it back to the paternal home where it must never leave.
When he marries, he plants the doll in the earth with another wood that sym-
bolizes the wife of the deceased (Figure 3).

As previously reported, a flanitoke´le´ is often sculpted in the sex of

the twin who has died and is given the same name.28,29 This statue serves as
the physical support for the nyama of the deceased twin. It is generally kept
close to the surviving twin by the mother, who also carries it under her
clothing whenever she goes out with the latter. The practice of keeping the
statue close to the surviving twin reflects belief in the inseparability of twins.
The surviving twin carries the sculpture with them during excision or cir-
cumcision, and following this takes responsibility for it. There are regional
variations in these practices as illustrated by DieterlenÕs finding that the
statue always remains in the custody of the paternal household.16(87)
Flanitoke´le´w are still sculpted if a twin dies after circumcision or
excision, but not after marriage. If both twins should die prior to marriage,
statues are sculpted and are cared for by the mother. In some villages, a male
who receives the statue from his mother at the time of his circumcision
returns it to his father at the time of his marriage. This mother-to-child-to-
father transfer is explained in part by the fact that after marriage male
offspring continue to live in their fatherÕs household compound (goua).
Where this practice is observed, a surviving female twin takes the statue with
her when she marries and keeps it in the goua of her husbandÕs family.
Whenever a surviving twin marries, another statue is often sculpted
in the opposite sex from the deceased twin and placed alongside of it. This
spousal statue is called flanitoke´le´tyema if male and flanitoke´le´mousoma if fe-
male, respectively meaning ‘‘husband of the flanitoke´le´’’ and ‘‘wife of the
flanitoke´le´’’ (Figure 4).
220 JOURNAL OF COMMUNITY HEALTH

FIGURE 3

Bamana flanitoke´le´ statue, Cercle of Segou, 15 inches, Imperato Collection

(Photograph by Robert E. Mates).

Differentiating flanitoke´le´ from spousal figures is difficult to impos-

sible unless one is familiar with the history of the sculptures. Confounding
matters is the fact that while flanitoke´le´w are often sculpted in the sex of the
deceased twin, they are equally as often sculpted with prominent female
breasts to reflect the intimate association of twins with androgyny. In some
villages, a spousal figure in human form is not sculpted. Rather a simple
wooden rod several inches long is made to represent the spouse of the
flanitoke´le´. In the southwestern Bamana country, such wooden rods are
sculpted in place of actual figures to represent both deceased twins and
their spouses.
Flanitoke´le´w vary considerably in height from 2 to 18 inches on
average. The larger ones are often dressed and decorated with jewelry and
are sometimes presented with gifts equivalent to those given to the sur-
 Gavin H. Imperato and Pascal James Imperato 221

FIGURE 4

Bamana flanitoke´le´ statue, Village of Tokoroba, Cercle of Banamba, 18

inches, Imperato Collection (Photograph by Robert E. Mates).

viving twin. As mentioned previously, twins are usually given gifts of food
and other items by members of the community. Henry recorded that five
cowrie shells were usually given to the statue whenever a gift was presented
to the surviving twin.30(98) At that time, cowrie shells were used as currency
in the colonial French Sudan (Mali).
There are regional variations in the size and styles of flanitoke´le´w.
Some of the smallest figures, measuring two inches in height or so, are
222 JOURNAL OF COMMUNITY HEALTH

found among the Maninka in the Cercle of Kita. Unlike the larger statues,
these are usually pinned to the inside of a motherÕs clothing and later to
the inside of a surviving twinÕs clothing. In the northwestern Bamana area
known as Bélédougou, flanitoke´le´w are often as tall as eighteen inches.
Similarly tall statues are frequently found in the west-central Bamana area
in the traditional regions of Djitoumou and Banimounitie, respectively
corresponding to the Cercle of Bamako and the northern portions of the
Cercles of Bougouni and Dioila (Figure 5).
Flanitoke´le´w in the Bambouk region of the Maninka country, which
corresponds to the Cercle of Kenieba in western Mali, average some ten

FIGURE 5

Maninka flanitoke´le´ statue with dyala headband, Cercle of Kita, 14 inches,

Imperato Collection (Photograph by Robert E. Mates).
 Gavin H. Imperato and Pascal James Imperato 223

inches in height. This contrasts with the very small figures sculpted in the
eastern Maninka country in the Cercle of Kita. Flanitoke´le´w in the eastern
Bamana area in the Cercles of Segou, San, Macina, and Niono average
fourteen to sixteen inches. Contrary to their usual practice with wooden
sculpture, blacksmiths in the eastern Bamana country often do not char
the surfaces of twin figures. This may relate to the fact that unlike most
other forms of sculpture, twin figures are closely handled on an almost
daily basis.
Twin figures are frequently sculpted in abstract forms. However,
Maninka flanitoke´le´w often tend to be realistic in their architectonics.
Incorporated into these figures are the coiffures once traditionally worn by
Bamana men and women, as well as the traditional bamada hat worn by men
which is a powerful anti-sorcery symbol.
Despite the inexorable adoption of Islam by the Bamana and
Maninka, practices related to twins and rooted in Bamanaya still persist in
many rural villages. Similarly, attitudes toward albinos and hermaphrodites
remain unchanged in many areas. However, modernization and Islamiza-
tion have for some time now formed the basis for continuous transition and
change in Bamana and Maninka society. This has resulted in the gradual
disappearance or decline of the sinzin rituals in a number of areas, and
theological syncretism in which Faro has become a benevolent Islamic water
genie who resides at the bottom of the Niger River and in the ponds, lakes,
and wells. For many Moslem Bamana and Maninka, blessings once sought
from Faro through sinzin sacrifices are now provided through the rituals of
Islam.

ACKNOWLEDGMENTS

Special thanks are extended to the late Djigui Diakité, the late
Makan Fané, the late Bafing Kané, and the late Moussa Kanté for their
assistance with field investigations conducted in the 1960s and 1970s.
Much appreciation is also extended to Modibo NÕFaly Keita, Kolékélé
Mariko, and Amadou Sanogo for their valuable help in those years, and
with more recent field investigations conducted from the 1980s through
2006. We also wish to acknowledge the assistance of Boubacar Doumbia
in interpreting several Bamanan-kan expressions, and that of Austin C.
Imperato with various aspects of our research.
224 JOURNAL OF COMMUNITY HEALTH

REFERENCES
1 Imperato PJ. Legends, Sorcerers, and Enchanted Lizards. Door Locks of the Bamana of Mali. New York and
London: Africana Publishing Company, 2001. pp. 6–22.
2 Personal Communication, Modibo NÕFaly Keita, Kita, Mali, July 24, 2005.
3 Hall JG. Twinning. Lancet 2003; 362:735–43.
4 Myrianthopoulos NC. Congenital malformations in twins. Epidemiologic survey. Birth Defects Orig
Art Ser 1975; 11:1–39.
5 Hay S, Wehrung DA. Congenital malformations in twins. Am J Hum Genet 1970; 22:662–78.
6 Hall JG. Twins and twinning. Am J Med Genet 1996; 61:202–4.
7 Boklage CE. Survival probability of human conceptions from fertilizations to term. Int J Fertil 1990;
35:75–94.
8 Keita D. Service de Sante´. Bamako: Ministère de la Sante Publique et des Affaires Sociales, 1968. pp.
128–31.
9 Dolo A, Diall NG, Diabate FS. Apropos of 507 pregnancies and twin deliveries in the District of
Bamako. Dakar Med 1990; 35(1), 25–31.
10 Kiely JL, Kiely B. Epidemiological trends in multiple births in the United States, 1971–1978. Twin
Res 2001; 4:131–3.
11 Martin JA, Park MM. Trends in twin and triplet births: 1980–1997. Nat Vital Stat Rep 1999; 47(24),
70–85.
12 Nylander PPS. Twinning in Nigeria. Acta Genet Med Gemellol (Roma) 1970; 19:457–64.
13 Lewis CM, Healy SC, Martin NG. Genetic contribution to dizygotic twinning. Am J Genet 1996;
61:237–46.
14 Paques V. Les Bambara. Paris: Presses Universitaires de France, 1954.
15 Ganay S. Aspects de mythologie et de symbolique Bambara. J Psych Normale Path 1949; 2:181–201.
16 Dieterlen G. La Religion Bambara. Paris: Presses Universitaires de France.
17 Zahan D. La Dialectique du Verbe Chez les Bambara. Paris: Mouton & Co, 1963.
18 Zahan D. The Bambara. London: J. Brill, 1974.
19 Kristic ZD, Smoljanic Z, Vukanic D, Janjic G. True hermaphrodism: 10 yearsÕ experience. Pediatr
Surg Int 2000; 16:580–3.
20 Wiersma R. Management of the African child with true hermaphroditism. J Pediatr Surg 2001;
36:397–9.
21 Krob G, Brown A, Kuhnle U. True hermaphroditism: Geographical distribution, clinical findings,
chromosomes and gonadal histology. Eur J Pediatr 1994; 153:2–10.
22 Wiersma R. True hermaphroditism in Southern Africa: The clinical picture. Pediatr Surg Int 2004;
20:363–8.
23 MacLaughlin DT, Donahoe PK. Sex determination and differentiation. N Engl J Med 2004;
350:367–78.
24 Behrman RE, Klugman RM, Nelson WE, Vaughn VC. Nelson Textbook of Pediatrics. Philadelphia: W.B.
Saunders Company, 1993.
25 Mink HW, Belaisch J, Smadja A. Female pseudo-hermaphroditism. Presse Med 1993; 22:1735–40.
26 Oetting WS, Fryer JP, Shriram S, King RA. Oculocutaneous albinism type 1: The last 100 years.
Pigment Cell Res 2003; 16:307–11.
27 Scheinfeld NS. Syndromic albinism: A review of genetics and phenotypes. Derm Online J 2003; 9(5),
5–15.
28 Imperato PJ. Twins among the Bambara and Malinke of Mali. J Trop Med Hyg 1971; 74(4), 154–9.
29 Imperato PJ. Bamana and Maninka twin figures. African Arts 1975; 8(4), 52–6083.
30 Henry J. LÕAme dÕun peuple Africain. Les Bambara. Leur vie psychique, ethique, sociale, religieuse. Munster:
Aschendorffschen Buchhandlung, 1910.
31 Zahan D. Note sur lá gémelléité et les jumeaux en Afrique noire. Bull Fac Lettre´s Strasbourg 1963;
351–353.
32 Travélé M. Usages relatifs au jumeaux en pays Bambara. Outre Mer 1931; 3:99–102.
33 Koné K. When male becomes female and female becomes male in Mande. Mande Stud 2002;
4:21–29.
34 Zahan D. Socie´te´s dÕInitiation Bambara. Le NÕDomo. Le Kore´. Paris: Mouton & Co, 1960.
35 Personal Communications, Amadou Sanogo, Segou Mali, July 29 and August 22, 2005.