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No Place Left to Bury the Dead: Denial, Despair and Hope in the African AIDS Pandemic
A cautionary evaluation of the AIDS epidemic in Africa seeks to raise awareness about the human side of the disease, placing an emphasis on the sufferings of women who are coping with its impact on their families and daily lives while offering hope about new treatments and prevention methods.
- GenresAfricaNonfiction
352 pages, Hardcover
First published November 20, 2007
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March 31, 2020
No Place Left to Bury the Dead by Nicole Itano
This book about the HIV/AIDS outbreak in Africa was published in 2006. Obviously quite a lot has happened in the intervening years so this was not an up to date account. Still it was an interesting account of the early history of the outbreak and spread of HIV/AIDS. Ms. Itano visited three countries: Lesotho, South Africa and Botswana. She explored the story of HIV/AIDS in those countries through the experiences of three families. Throughout the book she weaved the narratives of the lives of these families together with the account of how each country dealt with the crisis differently.
In each of the cases Ms. Itano wrote about one got a sense of drama, struggle, poverty and misery. Just getting food on a daily basis was a struggle for people in the story who were not afflicted with HIV/AIDS. But she did not leave it to the reader to imagine the struggles for people who were afflicted: she wrote about that in detail too. Concerning a family of children orphaned by AIDS she explained, “While they waited for their grants to be processed, the Mathenjwas’ economic situation was precarious. Their only food came from Gogo [their grandmother, a pensioner]. Mfundo was fed lunch at school, but his two older siblings usual went without until the evening meal. The never had luxuries like sugar or tea or candles.” (p 163) Luxuries? The things we take for granted.
The people who died of this disease did not undergo “untold suffering” – she told all of that too. She described how care givers, unaware of the risks, engaged in treatments which put themselves at risk; she documented cases where the care givers got HIV/AIDS because of some of the traditional healing measures which had them in direct contact with the patient’s blood. To put it in perspective, in 2003 about 350,000 (in a nation of a little less than 2 million at the time) people in Lesotho were HIV positive and they were receiving practically no treatment. (p 77) So if one were to take the story of the one person in Lesotho she described in the death throes of AIDS, and multiply that by 350,000 it gives one an idea of how bad things were. With only one hospital treating AIDS patients in 2003, it was bound to get worse there.
In each of the three cases we learn about the detriments of some of the health care systems and the benefits of others. Of the three countries Botswana was the most advanced in its approach to treating HIV/AIDS. It benefited from having established control over its own mineral resources and was able to provide food baskets and social services to people who tested positive for HIV/AIDS. (p 231 et seq)
Ms. Itano did not write from a detached, impersonal standpoint. I appreciated that because she retained her humanity and acknowledged her struggles with her emotions when working with the families and the victims. She also acknowledged her privilege and did her best to help where she could. When she had an ethical dilemma she wrote about it and about how she dealt with it. I did find that she could be judgmental at times, particularly when dealing with alcoholism. It is very difficult for an alcoholic to overcome their addiction in the best of circumstances with all kinds of help. If a person in a rural village in Africa is an alcoholic how will they even recognize that much less seek recovery? In this regard I thought Ms. Itano could have been a bit more understanding of the reality.
This book had many opportunities for insights into the way the global community has conducted business in the 21st century – a form of neocolonialism. The International Monetary Fund (IMF) makes its appearance early in this story:
“Under the guidance of financial organizations like the International Monetary Fund and as a part of a broader “structural adjustment program” intended to stabilize the country’s economy and reduce poverty, Lesotho was encouraged to reduce spending by recouping more of the costs of basic services, such as health care and education through fees.
The philosophy behind structural readjustment was that the economies of poor countries were at high risk of collapse and that in order to ensure long-term stability they needed to open their markets, reduce expenditures, and eliminate price controls and subsidies. Countries were required to make these changes in order to acquire loans from international lending agencies. Critics of the programs say they hurt the poor by raising barriers to basic services like health care and education by wrenching open underdeveloped economies from outside before they were properly prepared to compete. In Lesotho, the immediate impact of these policies on the health system was stark. In 1988, the cost of a trip to a government health clinic or hospital doubled, and though the fees seem inconsequential to an outsider….the effect was to drive many people away from the formal health system. A study by the World Bank found that in some areas, use of public health facilities fell 50 percent after the price increases.” (p 29-30)
This lengthy quote is provides a very good picture of the crisis of our times. We are engaged in a long-term wealth transfer from the poor to the rich. The IMF and the World Bank are not concerned with helping the poor – they are concerned with “opening markets”. The idea of a trickle down effect from open markets has been debunked for a long time now. Interestingly the organization always seems to make having poor people paying for health and education a priority while having no problem with, for example, Lesotho’s “bloated” military (p 104). The attack by the IMF is two-fold, weaken the poor by making basic needs like health and education more difficult to obtain and transfer money out to multi-national corporations by “opening markets.” An educated population is harder to control so by keeping people ignorant and sick the IMF has them right where they want them: taking loans from multi-national banks who underwrite the IMF. As further evidence of how international aid works in our world today she later explained that in South Africa, “Grants from the American government often required recipients to get three different quotes before buying new equipment such as computers, while European Union programs often limited organizations to buying locally or European produced goods. If the best and cheapest computers happened to be from China – or for that matter, if the only available computers happened to come from there – too bad.”
Ms. Itano also uncovers for the reader the consequences of colonialism which still impact South African society today:
“After its annexation by the British, the Ingwavuma area was set aside as part of a “native reserve” where whites were forbidden from owning land…. The British policy, however, was less enlightened than it first appeared….the amount of land set aside for them was not large enough to sustain the entire population, and the creation of the “native reserve” in Zululand marked the beginning of an overpopulation problem that continues to this day. Africans were also heavily taxed by the British government, through the imposition of hut taxes, custom duties and fees to register marriages and divorces... These taxes, which fell more heavily on Africans than on whites, subsidized the development of nearby white areas. They paid the salaries of white government officials, funded the building of roads and hospitals in white areas, and subsidized white schools.” (p 132-3)
Without question there is still a deep chasm between black living standards and white living standards in South Africa. This division can be clearly traced back to the colonial policies. Imagine the audacity it takes to steal someone’s land, force them into “native reserves” and then charge them a fee for the favor. Enhance that audacity by the rapaciousness required to take the money from the poor in those areas by charging them fees and taxes and then use it to develop roads, hospitals and schools, not for the poor (and rightful owners of the land) but for the white well-to-do colonizers. While this was a small aside in Ms. Itano’s book it makes as clear a case for reparations for colonialism as can be made in such a short space. These problems were then compounded with the explosion of HIV/AIDS: between 1990 and 1998 the prevalence of infected women rose from 0.8 % to 23%. (p 145)
I hope you get the opportunity to read this book because the stories are compelling human drama that bring us to terms with reality. Moreover, it exposes the strength of human spirit in the face of extreme adversity. Still, the fight against the system is real. As the South African Minister of Health, Mr. Tshabalala-Misimang said, “The resolution of this court case only confirms our view that international markets, which play an increasingly important role in all our lives, have no inbuilt conscience. But governments and ordinary people acting collectively have a precious responsibility to make the huge companies that dominate markets accountable for how they respond to the most critical issues of our times.” (p 206)
Related reading:
“Deadly Monopolies: The Shocking Corporate Takeover of Life Itself – and the Consequences for Your Health and Our Medical Future.” By Harriet A. Washington (exposing the pharmaceutical industry)
“Beyond Banksters” by Joyce Nelson (exposing international banking, IMF and World Bank)
This book about the HIV/AIDS outbreak in Africa was published in 2006. Obviously quite a lot has happened in the intervening years so this was not an up to date account. Still it was an interesting account of the early history of the outbreak and spread of HIV/AIDS. Ms. Itano visited three countries: Lesotho, South Africa and Botswana. She explored the story of HIV/AIDS in those countries through the experiences of three families. Throughout the book she weaved the narratives of the lives of these families together with the account of how each country dealt with the crisis differently.
In each of the cases Ms. Itano wrote about one got a sense of drama, struggle, poverty and misery. Just getting food on a daily basis was a struggle for people in the story who were not afflicted with HIV/AIDS. But she did not leave it to the reader to imagine the struggles for people who were afflicted: she wrote about that in detail too. Concerning a family of children orphaned by AIDS she explained, “While they waited for their grants to be processed, the Mathenjwas’ economic situation was precarious. Their only food came from Gogo [their grandmother, a pensioner]. Mfundo was fed lunch at school, but his two older siblings usual went without until the evening meal. The never had luxuries like sugar or tea or candles.” (p 163) Luxuries? The things we take for granted.
The people who died of this disease did not undergo “untold suffering” – she told all of that too. She described how care givers, unaware of the risks, engaged in treatments which put themselves at risk; she documented cases where the care givers got HIV/AIDS because of some of the traditional healing measures which had them in direct contact with the patient’s blood. To put it in perspective, in 2003 about 350,000 (in a nation of a little less than 2 million at the time) people in Lesotho were HIV positive and they were receiving practically no treatment. (p 77) So if one were to take the story of the one person in Lesotho she described in the death throes of AIDS, and multiply that by 350,000 it gives one an idea of how bad things were. With only one hospital treating AIDS patients in 2003, it was bound to get worse there.
In each of the three cases we learn about the detriments of some of the health care systems and the benefits of others. Of the three countries Botswana was the most advanced in its approach to treating HIV/AIDS. It benefited from having established control over its own mineral resources and was able to provide food baskets and social services to people who tested positive for HIV/AIDS. (p 231 et seq)
Ms. Itano did not write from a detached, impersonal standpoint. I appreciated that because she retained her humanity and acknowledged her struggles with her emotions when working with the families and the victims. She also acknowledged her privilege and did her best to help where she could. When she had an ethical dilemma she wrote about it and about how she dealt with it. I did find that she could be judgmental at times, particularly when dealing with alcoholism. It is very difficult for an alcoholic to overcome their addiction in the best of circumstances with all kinds of help. If a person in a rural village in Africa is an alcoholic how will they even recognize that much less seek recovery? In this regard I thought Ms. Itano could have been a bit more understanding of the reality.
This book had many opportunities for insights into the way the global community has conducted business in the 21st century – a form of neocolonialism. The International Monetary Fund (IMF) makes its appearance early in this story:
“Under the guidance of financial organizations like the International Monetary Fund and as a part of a broader “structural adjustment program” intended to stabilize the country’s economy and reduce poverty, Lesotho was encouraged to reduce spending by recouping more of the costs of basic services, such as health care and education through fees.
The philosophy behind structural readjustment was that the economies of poor countries were at high risk of collapse and that in order to ensure long-term stability they needed to open their markets, reduce expenditures, and eliminate price controls and subsidies. Countries were required to make these changes in order to acquire loans from international lending agencies. Critics of the programs say they hurt the poor by raising barriers to basic services like health care and education by wrenching open underdeveloped economies from outside before they were properly prepared to compete. In Lesotho, the immediate impact of these policies on the health system was stark. In 1988, the cost of a trip to a government health clinic or hospital doubled, and though the fees seem inconsequential to an outsider….the effect was to drive many people away from the formal health system. A study by the World Bank found that in some areas, use of public health facilities fell 50 percent after the price increases.” (p 29-30)
This lengthy quote is provides a very good picture of the crisis of our times. We are engaged in a long-term wealth transfer from the poor to the rich. The IMF and the World Bank are not concerned with helping the poor – they are concerned with “opening markets”. The idea of a trickle down effect from open markets has been debunked for a long time now. Interestingly the organization always seems to make having poor people paying for health and education a priority while having no problem with, for example, Lesotho’s “bloated” military (p 104). The attack by the IMF is two-fold, weaken the poor by making basic needs like health and education more difficult to obtain and transfer money out to multi-national corporations by “opening markets.” An educated population is harder to control so by keeping people ignorant and sick the IMF has them right where they want them: taking loans from multi-national banks who underwrite the IMF. As further evidence of how international aid works in our world today she later explained that in South Africa, “Grants from the American government often required recipients to get three different quotes before buying new equipment such as computers, while European Union programs often limited organizations to buying locally or European produced goods. If the best and cheapest computers happened to be from China – or for that matter, if the only available computers happened to come from there – too bad.”
Ms. Itano also uncovers for the reader the consequences of colonialism which still impact South African society today:
“After its annexation by the British, the Ingwavuma area was set aside as part of a “native reserve” where whites were forbidden from owning land…. The British policy, however, was less enlightened than it first appeared….the amount of land set aside for them was not large enough to sustain the entire population, and the creation of the “native reserve” in Zululand marked the beginning of an overpopulation problem that continues to this day. Africans were also heavily taxed by the British government, through the imposition of hut taxes, custom duties and fees to register marriages and divorces... These taxes, which fell more heavily on Africans than on whites, subsidized the development of nearby white areas. They paid the salaries of white government officials, funded the building of roads and hospitals in white areas, and subsidized white schools.” (p 132-3)
Without question there is still a deep chasm between black living standards and white living standards in South Africa. This division can be clearly traced back to the colonial policies. Imagine the audacity it takes to steal someone’s land, force them into “native reserves” and then charge them a fee for the favor. Enhance that audacity by the rapaciousness required to take the money from the poor in those areas by charging them fees and taxes and then use it to develop roads, hospitals and schools, not for the poor (and rightful owners of the land) but for the white well-to-do colonizers. While this was a small aside in Ms. Itano’s book it makes as clear a case for reparations for colonialism as can be made in such a short space. These problems were then compounded with the explosion of HIV/AIDS: between 1990 and 1998 the prevalence of infected women rose from 0.8 % to 23%. (p 145)
I hope you get the opportunity to read this book because the stories are compelling human drama that bring us to terms with reality. Moreover, it exposes the strength of human spirit in the face of extreme adversity. Still, the fight against the system is real. As the South African Minister of Health, Mr. Tshabalala-Misimang said, “The resolution of this court case only confirms our view that international markets, which play an increasingly important role in all our lives, have no inbuilt conscience. But governments and ordinary people acting collectively have a precious responsibility to make the huge companies that dominate markets accountable for how they respond to the most critical issues of our times.” (p 206)
Related reading:
“Deadly Monopolies: The Shocking Corporate Takeover of Life Itself – and the Consequences for Your Health and Our Medical Future.” By Harriet A. Washington (exposing the pharmaceutical industry)
“Beyond Banksters” by Joyce Nelson (exposing international banking, IMF and World Bank)
August 24, 2022
(3.5) A story of three case studies of families living with HIV/AIDS in Africa. This book took me a year to finish however, I actually thought it was quite compelling, striking a good balance between facts and story. I also appreciated that the author described her struggle with trying to stay objective while feeling guilty about not helping her interlocutors.
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November 16, 2025I like how this book struck a balance between facts and story. I was glad to read about the success of antiretroviral treatment and how Botswana has a social safety net that helps their people. It’s nice to read real stories about real people.
This entire review has been hidden because of spoilers.
August 4, 2014
This book is amazing. It's very well written & I almost couldn't put the book down but since life takes over, I had to. The stories that the author tells are real & her experiences in dealing with being in the south of Africa was very moving. The struggles that the HIV+ & AIDS patients have to go through is unreal. It's really amazing how their government was basically ignoring the epidemic that was happening in Lesotho. The people didn't have access to the care they needed, but what was worse is that nobody was talking about it & they didn't even want to get tested to find out they had this disease. The people she follows throughout her time here is really inspiring & the relationship she has w/ them is more family-like. It is really sad that it took so long for the entire region of south Africa to get the assistance hey needed to curb HIV/AIDS. The taboo of nobody wanting to get tested took decades before it became acceptable in the various countries, cities & towns. Being able to finally have the resources to build clinics for people also took a very long time to actually come into fruition. Although organizations & people were donating to the cause they were not really "allowed" to build anything which f course makes you wonder how that even happened & where the funds ended up going. The scores of people they would have to bury & the amount of funerals she would go to on a weekly basis actually changed thankfully to be less & less as time went on. This book is just encapsulating & although not a fun topic, it's real & shows how this all came about.
June 10, 2024
I often enjoy the journalistic style of writing when learning about an issue. A journalist author penetrates into a situation and documents it with their keen eye for detail and excellent writing ability. That's the idea at least although it wasn't perfectly executed in this book, No Place Left to Bury the Dead. While on the whole the book wasn't bad, I've come to have high expectations for the writing in journalistic books, especially from those who have been researching the topic for years. The writing in No Place Left just isn't that great and while the background information on the initial spread and discovery of HIV/AIDS was good, the author tended to repeat herself quite often and did a poor job of concluding each of the case studies about AIDS' effects on communities in Lesotho, South Africa and Botswana. In addition, the author chose to include references to herself conducting cultural research in the book, which is fine, but the way she described herself was unappealing. If you want to learn more about HIV/AIDS in Southern Africa, this is one book where you will certainly find some information, but I'm not gonna force you to read it.
April 30, 2014
The book has a nice balance of information on the history and progression of HIV/AIDS through various countries within Africa and the personal stories of 3 families dealing with loss and struggle due to the disease. Itano gives you a well rounded picture of how the disease has touched the lives of people living within a range of economic statuses; you are left with a powerful knowledge that no one is above its reach. I really appreciated that personal aspect of the book. There is just no way to get a full grasp of a tragedy and plight such as this one by learning the history and statistics alone. Understanding the culture, how they deal with illness and family, and how outside influence has helped/harmed the situation is another side of the same coin that is easy to treat as negligible, yet it is so vital.
She also did a wonderful job of shining a light on how much good actually happens when too much 'help' is sent... when it is trendy to throw money at a problem without full understanding of what resources are actually needed and where, and what happens when the trend dies out and people are forgotten.
She also did a wonderful job of shining a light on how much good actually happens when too much 'help' is sent... when it is trendy to throw money at a problem without full understanding of what resources are actually needed and where, and what happens when the trend dies out and people are forgotten.
August 12, 2011
This is a great, great great!!! book ... very moving but it is quite sad ...
Obviously the issue of HIV/AIDS in Africa can seem overwhelming and hopeless but this book gives the spotlight to individuals and families that are doing their best to make it.
Would love to know how the people in the book are doing ... but there are so many others who do not have access to the drugs they need and they are in fact dying without anyone to remember/tell their story.
Read this book ...
Obviously the issue of HIV/AIDS in Africa can seem overwhelming and hopeless but this book gives the spotlight to individuals and families that are doing their best to make it.
Would love to know how the people in the book are doing ... but there are so many others who do not have access to the drugs they need and they are in fact dying without anyone to remember/tell their story.
Read this book ...
October 2, 2008
Although I am somewhat familiar with the AIDS crisis in Africa, the magnitude of the disaster still stuns me, even after much reading about it. This book was actually able to offer some hope, as they are now having some success in Africa with antiretroviral treatment. A very good look at what was done, what wasn't done and what needs to be done, through the framework of 3 AIDS patients and their families.
November 18, 2012
Itano provides a very well researched account of the political structures and systems in southern Africa in the late 1990s and early 2000s while intricately tying them to the personal stories of those affected by the policies. These stories were so well told, in fact, that I found myself crying and laughing in certain situations. I especially loved Adeline.
February 1, 2009
This is a revealing tale of the epidemic as seen from an on-the-ground view in Africa. The stories were surprising, especially when discussed in the greater historical context of the international reaction.
September 26, 2012
Finished No Place to Bury the Dead: Denial, Despair and Hope in the African AIDS Pandemic last weekend. For a depressing topic, I actually really enjoyed the book and how it follows different people’s approaches to helping themselves and others through difficult times caused by HIV/AIDS.
February 4, 2008
Fantastic. Anyone interested in AIDS in Africa should read it. Great mix of not only indiviual stories that make AIDS more "real" but also great history and general info.
June 10, 2018
Awesome book, would really recommend to anyone who wanted to learn more about the aids epidemic from a more personal point of view.
November 17, 2017
This book gives a human face to the scourge of AIDS.It presents the different players in this human tragedy with all their social and cultural reactions to a new and frightening enemy that curls the population in its prime.The pragmatic approach to the danger by the government of Botswana is remarkable and the denial of the South African government is simply puzzling.
Displaying 1 - 14 of 14 reviews