Author John Green.
John Green is an American author and YouTuber who's perhaps best known for writing the young adult novel, 'The Fault In Our Stars'. Green is also an activist for better health care, especially for victims of tuberculosis.
In 2019, John Green and his wife Sarah - who work with 'Partners in Health' - were in Sierra Leone to learn about healthcare facilities.
At Lakka Government Hospital, which treats tuberculosis (TB) patients, John met an unusually small 17-year-old boy named Henry Reider - a congenial fellow who showed John around the facility. Green writes, "Everyone seemed to know Henry, and everyone stopped their work to say hello and rub his head or squeeze his hand....I believed him to be the son of a staff member."
Lakka Government Hospital near Freetown, Sierra Leone.
Henry Reider (17-years-old).
When Green asked the hospital's Dr. Micheal about Henry, he learned the boy was a TB patient, and he was so small because he'd grown up malnourished, and TB further emaciated his body. Dr. Micheal said Henry was being treated, but the antibiotics weren't working well enough.
Later, Green asked Henry about his treatment, and the boy said he swallowed pills every day and got injections that burned like fire under his skin. Henry also mentioned side effects, which for TB sufferers includes ravenous hunger that's almost unassuageable - a big problem when there's not enough to eat.
Henry's mother Isatu, who was struggling financially, visited Henry regularly and brought extra food when she could, but many TB patients aren't that lucky. Green notes, "Most of the patients at Lakka had no visitors. Many had been abandoned by their families: a tuberculosis case in the family was a tremendous mark of shame".
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Many tuberculosis patients in Africa are abandoned by their families.
Meeting Henry lit a fire under Green, and the author became a warrior for adequate universal healthcare for TB patients. In this book, Green relates Henry's story, intertwined with the saga of tuberculosis through the ages.
TB is a contagious disease caused by a bacterium called Mycobacterium tuberculosis, which can be spread in the water droplets of a cough or sneeze.
Mycobacterium tuberculosis.
Tuberculosis is contagious, and is spread by coughs and sneezes.
The Mycobacterium tuberculosis germ has an unusually fatty, thick cell wall that makes it a formidable enemy to the immune system. In active cases, the body - especially the lungs - are slowly overwhelmed by infection, eventually leading to death.
Mycobacterium tuberculosis organisms can destroy the lungs
Tuberculosis is one of the worst scourges of humankind. In the last two centuries, TB caused over a billion human deaths, and is estimated to have killed around 14% of people who've ever lived. In 2023, TB killed 1,250,000 people, which is shameful for a curable illness.
Deaths from tuberculosis per 100,000 people
Green discusses the history of tuberculosis, which was once called consumption. Consumption was thought to be an illness of intelligent/creative (mostly White) people, with patients including Stephen Crane, Frédéric Chopin, Thomas Wolfe, Henry VIII of England, Paul Laurence Dunbar, Eleanor Roosevelt, Lin Huiyin, Simón Bolívar, Franz Kafka, Louis XIII of France, John Keats, Sultan Mahmud II, and all three Brontë sisters. During the heyday of TB, many people went to sanitoriums for 'rest cures.'
Tuberculosis sanatorium in Switzerland
Patients in a tuberculosis sanitorium
The 'White Plague' notion led to the racialization of TB. "As late as 1880, White American physicians insisted that consumption did not occur among Black Americans, who, it was claimed, lacked the intellectual superiority and calm temperament to be affected by the White Plague." Of course, this resulted in lack of treatment for Black TB victims.
This changed in 1882, when Mycobacterium tuberculosis was identified as the cause of TB, and the organism was found in Black sufferers. Now doctors claimed that African-Americans were disproportionately dying of TB because of factors related to race, like smaller chest capacity and increased rate of respiration. This is nonsense, and Green notes that Black Americans were more susceptible to TB because of poverty, crowded housing, bad sanitation, bad working conditions, long hours, poor food, and malnutrition.
In the early 20th century, Black families often had poor living conditions
Healthcare discrimination is also seen in many immigrant communities, and the bias extends to Indigenous people and to third world countries around the globe. Green observes, "This bias against marginalized people and the healthcare workers directly serving them has proven to be one of the great facilitators of tuberculosis over the last century".
Researchers sought an effective TB treatment for decades, and the antibiotic streptomycin proved useful in the 1940s. By the mid-1950s, scientists developed the more effective RIPE cocktail, a combination of four antibiotics - Rifampin, Isoniazid, Pyrazinamide, and Ethambutol. The antibiotic pills must be taken every day for up to 9 months, and more advanced treatments may be supplemented by injections.
Green writes, "By the late 1950s, the illness was broadly curable....but even as TB became curable, the cure often did not reach the places that needed it most." Rates of TB dropped dramatically in rich countries, "But in dozens of countries, treatment either wasn't available or reached patients only sporadically. From India to Bolivia to Cambodia to Ethiopia to the 'Global South' in general, low and middle income nations continued to have TB death rates higher than those seen in the U.S. before the antibiotic era". Green sums it up as: the disease is where the cure is not, and the cure is where the disease is not.
To exacerbate the situation, many patients don't take their medicine every day, or stop before the regimen is complete. Sufferers may then develop antibiotic-resistant tuberculosis, which is much worse.....and which requires more powerful, expensive, and unpleasant medication. This happened to Henry Reider, in part because Henry's father interrupted the treatment when Henry was young, in the belief that the boy could be cured by a traditional faith healer.
Tuberculosis medicine can be daunting
Green devotes a good portion of the book to the issue of treatments available (or not) for TB. Part of the problem in poor countries is the high cost of the antibiotics, and the unwillingness of pharmaceutical companies to reduce their profit margins. Global health organizations are working hard to distribute the medications around the world, and there's been significant (but not enough) progress.
Henry's tale, peppered through the narrative, provides a sympathetic and relatable picture of one boy's struggle to survive. Henry often felt his death was imminent, and he found himself crying and too sad to leave his room. Henry worried about his mother Isatu, who loved him so deeply and would miss him so much. Henry wanted to finish school, have friends, write poems, and have a happy life.
Since this isn't a mystery novel, I won't keep you in suspense. Henry got better, and though he still has challenges, Henry earned admittance to the University of Sierra Leone, lives with his mother in Freetown, and is a YouTuber and TB activist.
Henry Reider
Addendum: With the advent of the Trump administration in 2025, the U.S. contribution to health care organizations has been slashed. "President Donald Trump's administration has moved to fire nearly all USAID staff, as billionaire Elon Musk’s Department of Government Efficiency has slashed funding and dismissed contractors across the federal bureaucracy in what it calls an attack on wasteful spending."
Because of this, there are fears about an increase in TB globally, and an influx of patients with antibiotic-resistant TB coming to the United States. Hopefully, there will be a reversal in this policy, and aid will be restored.
Rating: 4 stars
