Ripple Effects

By PF Anderson

Ripple Effects, from Fanbase Press, is one of my absolutely favorite graphic novels. I can’t stop talking about it to pretty much everyone around me. Given the slightest opportunity, I bring it up. One of the first things I say is, “This is like a master class in how to do health literacy. I expect this to become a model that others follow.” More on that shortly. Meanwhile, if you don’t have time to read the rest of this review and are teetering on the fence about whether or not to buy it, skip the review and just buy a copy (this is especially true for libraries)!

The book is so much more than simply health literacy (and health literacy is anything but simple). For starters, everything about it is top notch, from the storytelling and art to the paper itself. This is a very professionally produced book — amazing team, focused storytelling, high quality production values, fantastic art with a lot of nuances, excellent paper with crisp printing. It’s a pleasure to hold and touch. It’s no wonder it’s garnered so many award nominations! Winner of the 2024 Dwayne McDuffie Award for Diversity in Comics and the 2022 Foreword INDIES Book of the Year Awards (Graphic Novel/Comic), it was also nominated for or honored by the Eisner Award, Harvey Award, ALA’s Best Graphic Novels, and more.

Graphic medicine, by and large, has grown out of grassroots initiatives, alternative comics, and independent publishing efforts. It’s not something that you typically find coming from a large, mainstream comics press. This is a good thing, because it means we get to have stories beyond what’s popular. Graphic medicine is full of gritty memoirs and real world lived experiences. Graphic medicine are fictional stories here, but they’re less common, and in those fictional or mainstream stories, the graphic medicine aspect can end up a side note to the central story. Often the stories are told, from cover to cover, primarily by one person who does it all— the story, art, lettering, coloring, all of it, and published in a wide range of small press options from tiny zines on cheap paper to large, luscious coffee table books in full color.

In Ripple Effects, this is a superhero story that stays gritty, and reads like real experiences, while being a team effort. I suspect the exceptional team is a part of the reason it all holds together so well. Jordan Hart (creator, writer, colorist); Bruno Chiroleu (artist); Oceano Ransford (letterer); Shane Kadlecik (color flatter); Justin C. Harder (cover artist); Perry Littrell (consultant) — this is a team of professionals with a lot of background in working with comics publishers. Jordan’s first comic was Terminarch (2016); Bruno is the editor for Terminus Libros, an Argentinian comics publisher; Oceano is involved with the Nightmare Theater series; Justin’s faculty at Otis College of Art and Design, and has worked with Marvel and Disney. It shows. That Ripple Effects has a full team of specialists is quite a luxury. But they don’t let themselves get trapped into doing things the same way as a large mainstream press. That’s part of why Perry Litttrell is listed as part of the team, consulting on the real world life of a person with diabetes. It’s clear that this is a work of love, both for the creative team as well as for the press, and a story with stories within all of which are told from the heart.

The story itself has roots in the classic superhero genre, reminiscent of the Golden Age comics printed on frail paper and purchased at the corner drug store, except the superhero isn’t an over-muscled white dude in a cape living in a mansion but a young multiracial inner-city man named George, with diabetes, and still living with his parents. Curiously, the diabetes appeared full-blown at the same time as his superpowers, and they interact badly. (You’ll have to read it yourself to find out more about how that works.) Each chapter reads like a single comic book issue, with its own gorgeous cover, roughly 32 pages long. Each introduces a new aspect of the main character, diving into his lived experience struggling to balance his superpowers and invisible disability with his obligations to his family and the community. Each chapter is loaded with action scenes and tough decisions, ending with a gasp that makes you want to flip the page.

So, what happens when you flip the page? Remember the old Stan Lee Marvel comics? Gamma rays, radioactivity, mutations … Stan Lee fit science into the stories, and then had small sidebars to give a bit of scientific background information and citations, so that the reader would get curious and want to learn more. Ripple Effects goes further, and this is what makes it such a brilliant master class in health literacy. What happens when you flip the page is that each issue of the story ends with a short essay. Each essay connects to something that happened in the story immediately preceding, connecting something that happened with or to George (a.k.a. his superhero name, “Ripple”) to the lived experiences of the essay’s author. Starting with the brilliant foreword by Matthew Noe, each of the essays talks about another kind of invisible illness: Complex regional pain syndrome (CRPS); diabetes; myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS); paranoid schizophrenia; multiple sclerosis (MS). The essays, each written by a different author (including such comics notables as Dr. Theresa Rojas, Jazmine Joyner, Mike Ahn, and Amanda Lawson) connect the intersections of life with an invisible disability, while still revealing the inner struggles and joys of life with a disability. In the final, closing essay, Jordan Hart, the author, talks about his own invisible disability, thrombophilia (excessive blood clotting), and how it inspired and informed the story. Absolute magic.

The volume closes with more of the traditional perks of comics — bonus content! This includes early drawings and sketches, character designs, alternate covers, and my favorite, the advertisements. The ads are actually health infographics. The book uses every affordance of the medium available to it. Highly, highly recommended.

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PF Anderson is the Emerging Technologies Informationist for the Health Sciences at the University of Michigan, where they also serve as Graphic Medicine liaison and Disability Research liaison, collaborating closely with the Center for Disability Health and Wellness Research.