The slums in Kampala are remarkably similar aesthetically to the ones in the opening sequence of Slumdog Millionaire. This is both surprising and reassuring. Shacks roofed with tin are crowded and crisscrossed with narrow dirt paths. Smoke from restaurants and trash fires pour out of them thick like too much cream in coffee. People are everywhere, in shops, on steps, lounging on fully visible beds. In order to look at them, I invite them to look at me in my Nike running shoes and mesh shorts. Some of them say things to each other as I run by. Some of them laugh as they do so. But all of that attention comforts me because it confirms what I both suspect and hope for, that not too many Muzungus choose to run through the slums for their after-work jog and that makes me feel authentic.
In travel, the desire for authenticity is a straightforward, universal and reasonable concept. It’s eating food off the street as opposed to the nice restaurant, not necessarily because it’s cheaper or better, but because its “authentic” (although the comfort of authenticity has a way of making something taste better — much like MSG). It’s riding bikes in China, taking Boda Bodas (motorcycle taxis) in Kampala, drinking Soju in Korea, and chain-smoking in Europe. Despite the fact that we are still only tourists and gawkers, replicating local customs and behaviors adds texture to our visits and allows us to live the pictures we take.
In Mulago, my experience with authenticity has been much more confusing, conflicting and morally challenging. But first let me tease out the definition of authenticity a little more. In medicine or any learning process, there is an impulse to see new things. This is not the same idea as seeing “authentic” things. When I was on my psychiatry rotation last year, I distinctly remember a strong desire to meet a manic patient. A friend of mine told me he met a manic patient and the person took their clothes off and berated him. My desire to see mania isn’t based on the premise that it would make my learning experience more authentic. It would simply make for a broader, exciting, and potentially more degrading learning experience. The equivalent of this in travel is my (unfulfilled) desire to see an animal kill and eat another animal. That’s not authenticity I pine for. Chasing authenticity is when I tell my guide that I would rather carry my own pack and gear instead of using a porter despite the fact that the porters are still carrying my tent and the food I’m eating for a week. It was an unnecessary contrived experience to feel more genuine.
Back to the hospital. Authenticity in the hospital isn’t sprinkled with the same light-hearted irony of travel authenticity. To me it’s practically marinated in moral guilt because the same personal satisfaction of achieving an “authentic” moment is now at the expense of human life and health. Once my travel companion Dave and I went down to the blood lab with our intern to type and cross blood ourselves for a patient with a hemoglobin of three (in the states, I have no idea how it’s done. As far as I’m concerned, it consists of clicking a button on a computer that says “type and cross.”) We mixed drops of anti-ABO antigens and drops of our patient’s anemic HIV+ blood and looked for agglutination as we stirred with a plastic stick. I was certainly captivated by the simplicity of the process and the literal presentation of basic immunology. But I also felt a little extra thrill from the authenticity of the whole scene. It felt like a real “third world” hospital moment. It was crude, dangerous and critical (at one point there was an argument with another doctor if we had given enough time to allow for agglutination — the consequence if we were wrong would have been almost certain and expedited death from a transfusion reaction. Of course, he was O+ and there was no O blood that day anyway). The fact that the hospital is unairconditioned and uncomfortably hot is probably the most distressing aspect of my day, but I kind of like it because it seems more authentic to have beading sweat run down my leg, leading me to wonder if I’m incontinent. Patients strewn on floors in what’s supposed to be the lobby because there aren’t enough beds is visually “authentic.” Watching ER docs use folded cardboard boxes as splints for fractures is “authentic” ad-libbing. Diagnosing Acute Lymphoblastic Leukemia in a 12-year-old boy — a cancer that has an 85% cure rate in the US (one of the “good cancers” to get) — but not having the necessary chemo in the hospital is an “authentic” lack of resources. Perhaps the most disturbing example of this is when I found out that our HIV+, pulmonary TB patient expired overnight most likely from coughing up so much blood in his lungs that he drowned. A small part of me felt like this knowledge further legitimized my experience. Apparently in Africa, to me, dying is “authentic.”
Ultimately the desire for authenticity stems from the expectations we bring into a situation and our desire to see, feel and obtain the experiences that match them. Before coming to Mulago, I had talked to several people who told me how rundown, inadequate and tragic the hospital would be and so naturally, I needed to experience the rundowness, inadequacies and tragedies in order to feel like I had gotten the “real” Mulago experience. But that’s why authenticity is such a vapid ideal. By identifying certain aspects of an experience as more authentic than others, your purpose becomes disingenuous and subsequently, true authenticity is impossible. Even though I’m eating meat skewers off the market grill and enjoying the thrill of playing Russian roulette with E. coli, I’m personally not authentic. In fact, I’m the exact opposite of authentic. I’m doing something I never do at home and probably wouldn’t choose to do if the option were readily available to me. I’m doing it so I can say I did it. I’m a phony. And there is nothing I can think of, off the top of my head right now, that I hate more than phonies — and that includes traveler’s diarrhea.
Maybe death, HIV, shoddy infrastructure and human sadness is what I expected from my African hospital experience, but I’ve found that I’m most struck by the moments that are least “authentic.” When my attending asked me which disease besides Kaposi’s Sarcoma — Herpes Simplex Virus 8 — causes, it’s just another example from a long morning of pimping that demonstrated how knowledgeable these doctors are. My intern did a abdominal tap for ruling out an infection in probably two minutes, a procedure that normally takes an American intern 30 minutes. And one day in the ER, we had a patient who had come in with a ghastly looking tibia and fibula (lower leg) fracture. When we found him the next day, I was surprised to see that he not only still had a right leg, but the leg was in a external-fixation frame from an orthopedic surgery and he was smiling and laughing with the patient next to him. As I spend more time in the hospital, I suspect this embarrassing desire for “authenticity” will fade quickly and hopefully be replaced with less superficial, more meaningful observations and sources of fulfillment. And in the end, authentic African or not, what matters is that while some of my experience in Mulago will be ephemeral, hopefully some of it will last.