This was my friend David Bradshaw’s choice for our August Trafalgar Street Book Club meeting. I was with David in the Lewes Waterstones when he chose it, and I bought my copy at the same time. It’s a little paperback of just 200 pages, an ideal Book Club choice. It’s probably the most recent book we’ve read so far, published last year. It took me until I’d started reading it to realise that I already knew of the author John Green. He’s the brother of Hank Green, of the YouTube channel, Vlog Brothers. I’m more a fan of Hank’s work, which I’ve enjoyed for years. Hank is very geeky, very science-oriented, but with a strong interest in social issues. Digging a little deeper into John Green’s work, I discovered that he’s actually better known as a best-selling novelist, with titles such as The Fault in Our Stars, but since they are mostly aimed at a teenage and young adult audience, they’d not crossed my radar.

As one might surmise, this is a book about Tuberculosis, its history and how it continues to be endemic in much of the poor world. Green is a board member of the health charity Partners in Health. It was in that capacity that he encountered Henry, a young Tuberculosis (TB) sufferer in Sierra Leone. He provides the human interest for the book. Green follows Henry through many trials and tribulations as his doctors struggle to find a treatment for his drug resistant strain of TB.

Sierra Leone is a country on the coast of West Africa. It was a British colony, gaining independence in the 1960s. It suffered a devastating civil war from 1991 until 2002, which only ended with the intervention of the British Army. Apparently Tony Blair, the British prime minister at the time, is considered a hero in the country! Sierra Leone has a tapestry of ethnic groups with a significant population of Creole descendants of returned slaves in the capital Freetown. Henry belongs to this group. Green is rightly critical of the poor health infrastructure in the country which suffers from lack of funding, and much of the drama of Henry’s treatment revolves around his inability to access the diagnostic tools and specialist antibiotics needed to treat his TB.

The book flips back and forth between Henry’s story and a history of TB. I especially enjoyed reading about the cultural interpretation of TB. Consumption, as it was called until the late 19th century, was romanticised in the 18th and 19th centuries as a disease of sensitive poets and beautiful women. The Mycobacterium Tuberculosis that causes tuberculosis was discovered in 1882 by Robert Koch, a German scientist, who won a Nobel prize, but then went on to disgrace himself by claiming to have found a cure that never actually worked. Bizarrely he was found out by Arthur Conan Doyle, the creator of Sherlock Holmes, who as a young doctor publicly criticised the cure.

Once the cause of TB was known, it became racialised in the US, with blacks being assumed to be genetically prone to it, when the real drivers of the disease were poverty and lack of access to healthcare. He describes how first the BCG vaccine and then antibiotics have almost wiped out TB in the west. He makes the notable point that the antibiotics arrived too late for George Orwell, one of the last famous Western fatalities from the disease. Unfortunately it hasn’t proved as easy to eradicate it in poorer countries, where antibiotic resistant strains of TB are now common. Indeed Henry suffers from a drug resistant strain, but the latest drugs and diagnostics are too expensive for many poorer governments to afford.

In what was something of a happy ending, the hero of the book, Henry, finally gets the correct cocktail of antibiotics that cures his TB and, with Green’s help, becomes a YouTube personality. Green talks about vicious circles, where poverty leads to lack of effective care, which in turn leads to worse outcomes, which leads to more poverty. He’s critical of the DOTS protocol endorsed by the WHO because it forces patients to spend money and time travelling to have their drugs administered rather than trusting them to take them at home. He says it simply deepens poverty and reinforces stigma.

On the whole this was an interesting book. I learnt a lot about the history of TB, especially its cultural interpretation through the ages. It was also a fascinating and ultimately heartwarming story about young Henry and his struggles to overcome the illness. It was obviously a campaigning book. The intention is that the reader comes away determined to see better and cheaper access to drugs in poorer countries, especially those for resistant strains of TB. However, Green comes along with a heavy load of baggage. This is especially true when he desperately tries to shoehorn a US-progressive anti-colonial, anti-racist rationale into everything he sees. It means he ignores what seem to me quite obvious points. Yes, Sierra Leone was a British colony, and the British imperialism there was fundamentally extractive. Yes the railways run from the interior to the coast for that reason. But British imperial rule ended 80 years ago. The fault for Sierra Leone’s current poverty lies squarely with the country’s elite. Being an ex-colony is no excuse for the current dysfunctional corruption and the wholesale extraction of wealth that they engage in. The reason that Henry and thousands of other children have to suffer from easily curable diseases is that the country is dirt poor, and the reason it’s dirt poor is that it’s very badly run. For Green to hark on about colonialism and racism says far more about the weird internal culture of the US left than it does about the situation in Sierra Leone, and because he can’t see through the distorting lens of his own cultural prejudices, he gives the wrong prescriptions for fixing the situation and finds the wrong villains. If his campaign succeeds, it could even have hugely negative effects. Western pharmaceutical companies may decide there’s no profit in developing new treatments for antibiotic resistant strains of TB and, rather than an expensive cure, there’ll be no cure at all. Another point which bothered me, and is probably an issue with any kind of human interest story like this, is that the narrative must mean that Green, a very wealthy guy, made friends with this poor boy, and watched him almost die without lifting a finger to help. Of course he would not have got the story then. I might have been sympathetic to hear about his journalistic qualms, and the deep moral questions that must have arisen, but he never addresses that particular elephant in that particular room.