Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection

Henry Reider is a young man who had TB and hails from Freetown, Sierra Leone. He became the subject of Green’s interest when Green visited Lakka Government Hospital. Henry functions as an anchor for Green’s discussion on the state of TB healthcare in Sierra Leone. Rather than featuring multiple case studies, the book features Henry’s story as a representation of the challenging experiences that a typical Sierra Leonean person with TB might face from day to day.

Henry was born to an unnamed father and Isatu in Freetown. He was the eldest of two children and contracted TB at an early age. The healthcare system in Sierra Leone fails to detect TB at an early stage because it relies on the flawed but cost-effective microscopy tests for diagnosis. Henry’s strain of TB evolved due to his premature removal from treatment by his father. When he returned to treatment, he was recommended for in-patient treatment at Lakka Government Hospital, the only facility in Sierra Leone that treats multiple drug-resistant TB. This frightened Henry since Lakka also has a reputation for being “the place you go to die” (51). This reputation underscores the challenges of treating TB in Sierra Leone, let alone advanced strains of resistance. When Green met Henry, Henry was also experiencing malnourishment, which caused him to look like a young boy even when he was in his late teens.

Henry’s treatment consisted of an injectable regimen of drugs. Green frames Henry’s toxic regimen against the cost barriers placed against more effective drugs like bedaquiline. Henry consequently lost hearing in one ear, a common side effect of injectables-based treatment. The cost barriers imply that people like Henry are only good enough for the treatment that puts them at risk of debilitating side effects. During his time at Lakka, Henry’s biggest wish in life was to recover and return to his education. He found support in the presence of his mother, Isatu, and the bond he forged with a fellow TB patient named Thompson. When Thompson died, however, Henry started to lose hope in his treatment.

When Dr. Girum introduced a new regimen designed to treat Henry in spite of his comorbidities, Henry made the active choice to remain at Lakka and receive the treatment. This became Henry’s way of contributing to the virtuous cycle, rather than giving into the vicious cycle of resignation, which his father demonstrated. The treatment worked well in Henry’s favor, and he eventually recovered, leaving Lakka to live with Isatu again. Henry’s story shows that putting faith in a system that actively strives to put care over control pays off, not only in the short term but in the long run as well. Following his recovery, Henry returned to school and became an activist to fight the stigma against TB patients in college.

Isatu is the mother of Henry. She not only provided essential support for Henry but also illustrates how the recent history of Sierra Leone disadvantaged her from pursuing the healthcare required to save her children’s lives.

Isatu grew up in the wake of Sierra Leone’s independence from the British Empire. This meant that the social conditions of the country were still recovering from the long-term effects of colonization, leaving her to live in impoverishment for much of her early life. These conditions were exacerbated by the breakout of civil war, which forced Isatu to move from her place of birth to Freetown for safety. During this time, Isatu gave birth to her two children, Henry and Favor. This restricted her from pursuing tertiary education, as her priority fell upon making enough income to support both of them as a single parent.

When both children were still very young, Favor died of a tumor in her larynx. This underscores the high cost of advanced medical treatment in Sierra Leone, even as Isatu struggled to pool together financial support from her family and friends. This also set a precedent for the struggle to find a cure that would treat Henry in the advanced stages of TB.

Isatu trusted in the healthcare system, which became her way of contributing to the virtuous cycle of TB elimination in Sierra Leone. She was rewarded with Henry’s recovery. Green depicts the resolution to Henry’s narrative by zeroing in on Isatu’s reaction at the end of Chapter 21: “I look at you, and you are alive. My son Henry is alive” (166).

Dr. Girum Tefera is introduced in Chapter 15 as a new physician at Lakka Government Hospital. He hails from the East African country of Ethiopia and came to Sierra Leone to help address the severity of the TB crisis across the West African region. Dr. Girum is depicted as a person who believes in the power of the healthcare system when it is properly equipped to do its job. He describes the effect of proper TB treatment as “magic,” which explicates the wonder he feels when a system works according to plan. At the same time, he expresses his frustrations when a healthcare system is limited by lack of access to tools and materials. Green underlines this when he notes that Dr. Girum expressed how useless his medical skills become when he doesn’t have the drugs or tools needed to treat a patient.

Because Green deploys his skills as a narrative storyteller to relate Henry’s experiences, Dr. Girum functions like a protagonist who complemented Henry’s journey to recovery. He supplied the medical expertise and the access to the network that procured Henry’s specialized treatment cocktail. He also stood his ground when Henry’s father attempted to remove Henry from Lakka, urging him to give them one more chance to prove that the healthcare system could work.

Dr. Girum also drove the idea of the virtuous cycle by expressing the hope that Henry could set a precedent for future TB treatment in Sierra Leone. He represents the principle of implementing a treatment regimen based on care rather than control, especially when he affirmed his motivations for pursuing Henry’s case: “Why should we move mountains to save one patient? Because he is one person. A person, you understand?” (151). In care-based treatment, the dignity of the person justifies the cost of treatment.