Author John Green is coming to the University of Kansas next week. His latest book is titled "Everything Is Tuberculosis." (Eric Thomas illustration for Kansas Reflector)
Author John Green is most famous for his book, "A Fault In Our Stars," a crushing and delicate book about two teenagers love-locked as they struggle through cancer.
He will be welcomed to the University of Kansas (where I work) on Sept. 2 to speak about his book of essays, "The Anthropocene Reviewed: Essays on a Human-Centered Planet." That book is the university's common book for this academic year.
But I am most interested in Green's unlikely connection to Kansas through his most recent volume, "Everything Is Tuberculosis." Released in March, it describes how TB persists as a rampant killer throughout much of the world, but seldom in the United States and wealthy countries.
Seeing the overlap between Green's book and Kansas is simple, if you were monitoring Kansas news at the start of this year. An outbreak of TB in the eastern corner of the state -- close to Lawrence, where Green will be speaking -- made international news.
At its peak, the outbreak included 67 Kansans, two of whom died.
Dr. Ryan Kubat, an assistant professor in infectious diseases, worked with the Kansas Department of Health and Environment, to contain the TB outbreak in Wyandotte and Johnson counties. Kubat's clinical work includes tuberculosis.
According to Kubat, only a handful of active cases remain in Kansas this week, perhaps only two.
The outbreak "was primarily community based," Kubat said. "The majority of our patients were exposed within the Kansas City, Kansas Wyandotte County community."
Most of the Kansas patients have completed treatment -- but that doesn't mean that they have not been harmed.
In "Everything Is Tuberculosis," Green describes TB's statistical weight: 1.25 million dead each year, for instance. He writes movingly about how each life contained in that number represents so much: lost dreams, a lost loved one and human suffering from a brutal disease.
The numbers from the outbreak in Kansas were much smaller, of course. But each case represents community strain and individual suffering.
"Some of these (Kansas patients) have lifelong adverse effects as a result of the TB," Kubat said before listing many of the challenges: long-term pulmonary effects, the isolation of TB treatment, the family financial stress and the stigma associated with the disease.
In writing "Everything Is Tuberculosis," Green brought his best-seller megaphone to the issue. Kubat noted that Green's advocacy has helped lower the price of TB treatments.
"In global health circles, I know his advocacy has been much appreciated in terms of bringing attention to some of these issues of drug and diagnostic pricing for TB and trying to bring those costs down, especially for these low-income countries," Kubat said.
Much of what I learned through reading Green's book makes an outbreak in Kansas surprising but not impossible. In recent decades, the disease has been rare in the United States compared with many nations: In 2022, 565 Americans died compared with an estimated 1.25 million worldwide.
""TB has not gone away," Kubat said. "It's certainly been prevalent in the United States and across the globe. It has an increased focus here in Kansas, and I think that's beneficial overall."
As TB becomes antibiotic resistant and as it is given time to evolve, the risk of a superbug TB increases. Some point to this as the prime motivation for Americans to care about bringing an end to TB globally.
In his book however, Green points out that there is current suffering -- rather than hypothetical suffering -- that can be addressed.
"I think John Green said it appropriately," Kubat said. "It's quite privileged just to be kind of worried about the superbug. There are people that are suffering and dying daily, and it's not just across the globe. It's here too. It's everywhere. And I think we should acknowledge that."
Responding to the Kansas outbreak involved work from health authorities at many levels, Kubat said. Following work at the county and state levels, the CDC was involved to assist with management.
Recent federal funding cuts worry some, who feel that essential community health resources are being shaved too thin.
Kubat imagined a scenario without the support in place for the Kansas outbreak.
"In a situation where we have a lack of resources, there's an inability to manage this aggressively up front," Kubat said. "We would see more spread of tuberculosis. We see a larger outbreak. We see more people infected. Having those resources available to be able to respond promptly to an outbreak like this is imperative in order to control the damage."
Green's book glows with compassion for people who must live in situations that put them at risk for TB. His nonfiction hero in "Everything Is Tuberculosis" is Henry, a teen from Sierra Leone who struggles with many risk factors: migration; living in tight, multi-generational housing; malnutrition; communities without reliable health care; national governments with slim budgets for community health.
To a lesser extent, people living in Wyandotte County, Kubat said, are more likely to live in communities that put them at risk for TB.
"It's kind of a culmination of several factors that I think makes this particular area have a higher propensity for TB," Kubat said.
Dr. Dana Hawkinson is the medical director for the Infection Control and Prevention Program at University of Kansas Health System. He said it's vital to understand that infectious diseases like TB will not stay in one community.
"It's not going to adhere to borders," Hawkinson said. "It's not going to adhere to economic classes. We have to understand that all of these diseases have the potential to infect everybody.
"Until it is really viewed as that in the global sense, we will continue to have deficiencies in a lot of these programs or methods to help protect everybody."