Did you ever wake up with a nagging cough and wonder “Is this the day I get tuberculosis?” Not bloody likely if you live in England or Germany or Denmark or any other place with an advanced healthcare system (even the U.S., despite its flaws).
If you live in Africa’s Sierra Leone, it might be another story.
That’s the one author John Green tells in his new book, “Everything is Tuberculosis: The History and Persistence of Our Deadliest Infection.” You may know Green from his coming-of-age novels “The Fault is in Our Stars” and “Turtles All the Way Down.” These books for young readers have been made into movie versions you can see in the streaming world.
TB has not been one of Green’s main themes – until now. It grew out of a visit to West Africa with a health organization. There he discovered that poor countries struggle with the affordability and availability of TB medications. Just one of the reasons that 1.25 million people still die annually from the world’s most infectious disease.
Historically, TB patients were described as victims of consumption or labeled “consumptives.” It may sound like a less scary term than Mycobacterium tuberculosis, phthisis, pulmonalis, or the great white plague. But consumption is a quick description of what TB does to the body: it consumes it. When it advances unchecked, it dissolves your lungs, renders you breathless, and then you die.
Readers of classic literature recall poets with consumption such as John Keats and Elizabeth Barrett Browning. Keats is sentimentalized because he wrote his gorgeous poems while being consumed by ravenous but slow-growing TB bacilli. Its slow pace makes it a particular tough disease to treat. It also, alas, gives writers lots of time to chronicle it.
This was captured in Jane Campion’s film “Bright Star” about the infirm Keats and the true love he found during his dying days. This sentimentalization, according to Green, painted male Romantic-era poets as heroic sufferers and stricken white women as pale and beautiful as marble statues. American poet John Ciardi may have said it best in “A Trenta-Sei of the Pleasure We Take in the Early Death of Keats” from his collection "Echoes: Poems Left Behind:"
The species-truth of the matter is we are glad (of what?)/to have a death to munch on. Truth to tell (which truth is what?)/we are also glad to pretend it makes us sad./When it comes to dying, Keats did it so well (how well?)/we thrill to the performance…
The romance of TB faded as it kept killing people in new and ingenious ways, and that many of those victims were not poets but the guy next door and millions in poor countries. Its discovery by Dr. Robert Koch in 1882 as a microscopic bacillus, a highly contagious one, suddenly made TB a dirty word.
Green meets Henry Reider is a poor black youngster in Sierra Leone with Multiple Drug-Resistant Tuberculosis (MDR-TB). He has several strikes against him, as he’s poor and he’s black and he lives in an African country without the medical resources required for long-term treatment. When Green first meets him, the boy is so small and thin that he looks like he’s eight and not thirteen.
Green points out that lack of health care spending is rampant in Africa. If Sierra Leone spent the same percentage of its budget on TB treatment as we do in the U.S., that would be 48 U.S. dollars per patient per year. That is less than what one round of TB prescriptions would cost. These medications are expensive and need to be taken for months if not years. Green writes that the country has its own medical schools, hospitals and doctors. But the drugmakers in the West reap big profits and their attorneys work hard to extend patents. Millions with no insurance are SOL.
Read the second part of my review of "Everything is Tuberculosis" next week.
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