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Intro
At the end of the 18th century, James Watt, a Scottish scientist who had already made waves by revolutionizing the steam engine, was desperate to find a chemical cure to the disease known as phthisis. Despite his efforts, he was unsuccessful, and both of his children died of the disease. Later, author John Green’s great-uncle Stokes Goodrich was diagnosed with the same illness, then known as tuberculosis (or TB). His father was a well-respected physician, and though he cared for him as best as he could, Stokes died at 29 years old. Humans for many centuries could not beat tuberculosis; even now, it stands as one of the deadliest viruses in the world. Everything is Tuberculosis explores the historical, cultural, and social impact of tuberculosis, humanity’s potential to cure it, and the injustices that are interwoven with the disease.
Green and his wife Sarah travel to Sierra Leone in 2019 to learn about their neonatal and maternal healthcare systems but, while there, they end up visiting Lakka Government Hospital. There, Green meets Henry, a young Sierra Leonean boy who is joyful and energetic, excited to show Green around the hospital, and who shares a name with Green’s young son. A nurse reveals that, despite Green’s assumption that Henry is a child of a patient or staff member, Henry is suffering from TB. Henry tells Green about his treatment and the poor conditions of the hospital, which is underfunded due to Sierra Leone’s poverty. Unlike other patients, Henry has the company of his mother Isatu, who visits him every day. The hospital staff assures Green that they will fight for Henry’s life. Following his visit to Lakka Hospital, Green becomes fascinated by tuberculosis and how it influenced many cultural and historical phenomena, from the creation of the cowboy hat to the beginning of World War I.
Although many believe Sierra Leone to be a poor country, that is only true because of the damage British colonialism and imperialism has had on the country’s economy and infrastructure. This affects Sierra Leoneans to this day, including Isatu. Isatu grew up poor but had an abundantly happy childhood thanks to the strength of her community. Unfortunately, a civil war broke out when Isatu was only 23, and, after meeting Henry’s father, her life became one fueled only by her need to survive. She went on to have Henry and a daughter named Favor.
It took multiple trips to the doctors for Henry to be diagnosed with TB, but once he was, he began taking the standard drug regimen for treating the disease. His father was unhappy with the treatment’s lack of progress, however, and took Henry to a faith healer instead. This pause in treatment likely caused Henry’s TB to become drug-resistant. After Henry’s health worsened, Isatu returned Henry to the standard drug regimen. At this time, Favor died of a cyst blocking her airway. Isatu, despite her efforts, could not afford the procedure that might have saved her daughter’s life. Henry’s condition continued to worsen. Though advanced tests and treatments that could have helped Henry were common in the wealthy world, he had no access to them in Sierra Leone. He was finally moved to Lakka hospital, a place where TB patients are often sent to die.
Just as conceptions of death have changed over the centuries, Green explains, so have conceptions of TB. Once, it was understood to be caused by demonic possession and later by moral failings. Eventually, because TB was killing well-respected people as well as marginalized people, it was romanticized and seen to heighten a person’s creative prowess. Such romanticization also led to the romanticized consumptive body, one that was overly thin and waiflike. Such beauty standards persist today.
In 1882, German scientist Robert Koch reshaped understanding of TB entirely when he discovered that it was caused by the bacteria Mycobacterium tuberculosis. Now that TB was known to be caused by bacteria, it was seen as a disease of the poor and non-white populations. Those with TB were no longer tortured artists, but rather subhuman creatures who should be avoided at all costs. Koch was pressured to further his discovery of M. tuberculosis when French scientist Louis Pasteur developed a vaccine for anthrax. Koch hastily created tuberculin, a vaccine that he touted as a cure but was in fact ineffective.
Thanks to Koch’s discovery, tuberculosis was finally understood to be contagious through coughing, spitting, and infected animals. While there was still a sense of morality attached to the disease, preventative measures now helped lessen infections, at least in wealthy countries. Finally, in 1921, the BCG vaccine was developed, and though it couldn’t cure the disease, it could prevent severe illness, especially in young children. Then, in the 1940s and 50s, drugs were developed that could help those with TB, some of which are still used today. From then on, medical developments were relatively common, but most of them were only accessible to wealthy, primarily white countries. In these low- and middle-income countries, TB rates are still incredibly high, and though humanity has every capability to treat it, these countries remain abandoned by wealthy society. Pharmaceutical companies also cause the inaccessibility of treatments for tuberculosis, as they artificially raise prices to increase their profit.
After months of Henry’s condition worsening, Dr. Girum Tefera, a new doctor at Lakka, set his mind to cure Henry’s tuberculosis. This was incredibly difficult, given Sierra Leone’s lack of funding and resources, but Dr. Girum wanted to set a precedent: people in Sierra Leone could be cured of tuberculosis if they receive personalized and advanced treatment. Once Henry received such personalized treatments, his tuberculosis was, in fact, cured, and he was able to return home with Isatu. Green and Henry keep in touch today. While much needs to be done to properly treat TB in poor countries, Green argues, it is completely within society’s grasp if we stand together and respect each other’s humanity.
