The white Land Rover bounces over the rutted streets of Port-au-Prince and skirts a two-story-high pile of steaming garbage policed by spotted pigs the size of oil barrels. It passes the ruined façade of Our Lady of the Assumption Cathedral, unrepaired since a powerful earthquake rocked Haiti on January 12, 2010. Then it careens by the once-grand National Palace, now collapsed onto itself like a melted wedding cake. As the Land Rover rattles by a tent city that's home to 50,000 Haitians, passenger Aaron Pugmire shouts over the sound of the car's squeaking axles: "Now we're headed to one of the biggest disgraces to the medical profession in the Western Hemisphere."
At a dingy green-and-white concrete complex, moist, softball-sized pools of blood lead like steppingstones up to the entrance of Haiti's State University Hospital, where thousands of stinking corpses clogged the courtyard after the quake. A middle-age man is on his knees, wailing: "My heart. My heart!" One hand clutches his chest, while the other grips the metal grate that separates him from an unmoved receptionist. A public facility with more than 400 beds, the General — as it is known — is Haiti's largest hospital. But it's neither free nor easy to enter.
"Bonsoir," says Pugmire, an emergency medical worker, shaking the hands of the security guards at the gate and briskly sidestepping the man. "I'm here to find a patient." He nimbly steps around the blood and pushes past a terrifying pastiche of scores of men and women — some naked, bloody, and foul smelling — who lie beneath flickering lights. Many are curled up on the shit-smeared linoleum floor.
Pugmire passes a man who holds his head in his hands as blood trickles down his arm and puddles in a plastic seat. He then crosses a courtyard where unused heart monitors are parked like broken-down cars. Instead of nurses, family members tend to the sick and injured. Through an open door, he spots a boy writhing on an examination table; doctors are nowhere to be seen.
Pugmire, a curly haired Richard Branson look-alike, is here to find 87-year-old Eunide Baptiste. He dropped her off five days ago for an operation on a badly broken hip. Now, she sits in a room with 50 other glassy-eyed patients, awaiting a physician. An ancient bleach bottle dangling from a string around her ankle serves as traction for her injury.
"They have done nothing for me here," Baptiste says softly in Kreyol, as Pugmire approaches. The young EMT holds her x-ray up toward a broken window. "This is ridiculous," he fumes. "You drop them off here, and they rot."
Indeed, rotting is the rule in health facilities on this island nation two hours by plane from Miami. Death is at home in Haiti. A life expectancy of barely 60 years places it dead last in the Western Hemisphere. Haitians survive on an average income of $400 per year. Nearly 60 percent live in poverty, and 70 percent are unemployed.
For decades, General Hospital — nicknamed "the morgue" — has symbolized the ruined state left in the wake of the Duvalier dictatorships that ran the country from 1957 to 1986. Without clean water or health clinics, Haitians are 12 times more likely than Americans to die of communicable diseases. Women are 50 times more likely to perish while giving birth. Last year, the country of 10 million reported 50,000 cases of malaria: 30 times as many as in the neighboring Dominican Republic.
"Health is what underpins an economy," says Robert Maguire, an expert on Haiti at Trinity University in Washington, D.C. "You can't expect a country to develop if its people are sick. Sick people can't farm. Sick people can't sell goods."
Last January's seven-magnitude earthquake compounded the crisis. The tremor damaged 60 percent of the country's health facilities and destroyed four hospitals in the capital. Since last October, more than 5,400 Haitians — most living in tent cities established since the earthquake — have died from cholera.
Now things could change. Billions of dollars in foreign aid offer a rare chance at reinventing health care. And one tiny hospital may serve as a model. Tucked down a narrow street off the road to the airport, Bernard Mevs is the only trauma and critical care center in Haiti. Gunshot and car crash victims are sent from around the city to its tall, orange gates. Inside, ventilators keep patients breathing during surgery, amputees receive prosthetics, and patients learn to walk again.
The hospital is a partnership between Project Medishare — a nonprofit founded by University of Miami doctors — and Bernard Mevs's Haitian surgeons. Since the earthquake, Medishare has flown thousands of volunteers like Pugmire, the EMT, to the hospital to help treat 100,000 patients and train Haitian nurses and doctors.
But the challenge is enormous. After finding Baptiste, Pugmire tracks down a doctor at General and explains how to treat the patient. But the next day, doctors release Baptiste, and she drags herself to Bernard Mevs seeking treatment. She is in worse shape than when she left.
Sixteen months before Baptiste arrived at Bernard Mevs, Wilfrid Macena washed the dirt and welding dust off his hands and looked to the sky. It was almost 5 p.m., and the compact, athletic 25-year-old with a wispy mustache could see the early January sunset above his courtyard workshop in Carrefour, on the capital's poor, westernmost tip. Wilfrid's pretty young wife, Simone, and 3-month-old son, Wilflamson, waited for him at home only a few blocks away. The welder shouldered his tools and headed for the gate.
Just as he walked outside, the earth began to pitch and roll. A strange, inhuman shriek rose from the ground like a thousand breaking bones. Wilfrid dropped his tools and tried to run, but the buckling soil tripped him. He put his hands out to brace himself, one on an old coconut tree and another on the heavy brick wall surrounding the workshop.
As he tried to sprint to an open area, an electrical cable caught him around the neck like a noose. When he tore it away from his throat, the live wire melted through his shirt and into the skin on his right shoulder. He sank to the trembling earth in pain, then tried to run again but fell. He staggered once more to his feet, but the earthquake floored him for a fourth and final time.
The wall crashed like thunder all around Wilfrid. Pain tore through his body. When the dust cleared, Wilfrid could see the blood seep into the packed dirt beneath his right leg. And when he brushed aside the brick fragments, he spotted the white of his tibia poking through his dark skin. He pulled off his T-shirt, wrapped it around his shredded shin, and screamed for help.
Seconds later, Wilfrid's boss, a businessman known only as Dady, arrived and carried him to the street. He boosted the younger man onto the back of a pickup truck and drove toward a hospital downtown. But the earthquake had left Boulevard Jean-Jacques Dessalines a nightmarish landscape of crumbled buildings, honking cars, and dazed victims. A drive that normally took 20 minutes lasted four hours. Finally, the pickup inched down a steep hill in central Port-au-Prince and around a corner, but the path was completely blocked by concrete slabs.
"Leave me in the street," Wilfrid pleaded. Instead, his boss hailed a passing motorbike and climbed on. Promising to tell Wilfrid's family that the young man was alive and to return with help, Dady disappeared into the darkness.
The pickup didn't move. From behind him, Wilfrid heard cries of "Jesus, Jesus, Jesus" ring out over the ink-black city. Men pushed wheelbarrows full of the injured. Fires burned in the distance. Nearby, a young girl's corpse lay in the rubble. The bed of the truck grew sticky with Wilfrid's blood. I'm going to die here, he thought.
As he awaited help, Wilfrid recalled his parents' small sugarcane farm near the port city of Miragoane. He had played soccer in the fields with his 14 brothers and sisters and flown ornate kites fashioned from banana leaves.
And he thought of Simone, a beautiful, light-skinned girl in a white dress whom he met at church. Though she lived far away in Port-au-Prince, he brashly pronounced that day: "I love you. You and I are going to be together." Wilfrid was only 16 years old, Simone a year his senior.
Wilfrid kept his promise and followed her to Port-au-Prince, where he won over her father by reciting Bible verses. In 2003, they married in a large gospel-filled ceremony. Six years later, Simone gave birth to a boy: Wilflamson. By then, Wilfrid had bought his own generator and welding tools. He had thought, 2010 is going to be a good year. Then the quake annihilated his homeland.
As dawn broke, Wilfrid woke up in the truck bed feeling stronger. He asked a passerby to go to his sister Luciana's house for help. A few hours later, she appeared and broke into tears at the sight of her little brother's crumpled and bloody body. But she scrounged up some rice that tided Wilfrid over till noon, when Dady returned. "Bad news," he said. There were no hospital beds available. Dady drove Wilfrid home.
For three days, in a home without a roof, Wilfrid cleaned the compound fracture with hydrogen peroxide and changed the dressing. But the leg grew stiff and swollen. His boss took him to Adventist Hospital in Diquini, a few miles away, but no doctor showed up for four days. Finally, a cousin drove him three hours away to Bon Samaritan Hospital in Jimaní, Dominican Republic. There doctors set the bone, but the flesh was already gangrenous.
An American doctor said he had a choice: lose the leg above the knee or die from infection.
"Cut away," he responded.
Two months later, when Wilfrid arrived on crutches at the Port-au-Prince airport, he was taken to a bustling hospital unimaginable before the earthquake. Dozens of scrubbed American volunteers raced among three circus-sized tents filled with patients. Many — like Wilfrid — had been injured in the earthquake but never seen by a doctor.
The hospital was run by Project Medishare. Barth Green, a neurosurgeon at Jackson Memorial Hospital, had founded the nonprofit in 1994. He was a loquacious man in his 60s with slicked-back silver hair. At first, Green and others had run small clinics in the remote central plateau. After the earthquake, the doctor borrowed a friend's private jet, recruited other physicians, and, he says, "set a course for the Dominican Republic legally. Then we just turned right and landed [in Haiti]. The airport was barren. Part of the runway was buckled. The terminal had collapsed. So we went to the UN, which had an installation on the edge of the airport. All their guys were killed, but they had a couple of meeting tents that weren't destroyed and in them were hundreds of dying and dead Haitians. We walked in, and there was one doctor, and she had nothing except for her purse. She burst into tears when she saw us. So we just took over."
Soon there were 150 volunteer nurses, doctors, and EMTs who rotated every three days in and out of Medishare's giant tents. Three hundreds cots were overflowing with patients. But when the rainy season began, floods wreaked havoc on the field hospital. A patient on a ventilator died when a nighttime fire forced occupants into a nearby field.
On June 6, five months after the earthquake, Medishare moved into Bernard Mevs, a small, private hospital near the airport. Although it meant downsizing to 50 beds, Bernard Mevs provided security, steady electricity, and sturdy walls for an emergency room, intensive care units, and a laboratory.
Now there are ventilators, a CT scanner, and world-class doctors. The hospital saves dozens of lives a month, yet unpaved roads and contaminated water still conspire against Haiti's poor. By the time they arrive at Bernard Mevs, it's often too late.
One Wednesday afternoon when New Times visited the hospital, a tall, slender 15-year-old girl walked up to the metal gates. Natanael Louissant wore a brilliant sky-blue skirt and a white, striped blouse, as if headed to the small church in outlying Siloe where she sang in the choir. But her face was smudged with dirt and marked by exhaustion. And she could barely stand without the help of her father, Fanes, a deeply religious electrician with dark skin and simple clothes.
Fanes explained that his daughter had come home from school on Friday with a fever. A local doctor had diagnosed her with malaria and given her pills, but her breathing had grown worse.
Ginger Hart, a young nurse who had worked in China and India before volunteering in Port-au-Prince, checked Natanael's blood oxygen saturation with an oximeter. The young girl looked healthy, but the machine gave a reading of 58 — barely half the normal level.
"Piece of shit," Hart said to herself and flung it to the side. "It's always crapping out." But Natanael's temperature was a cool 96.1 degrees Fahrenheit, and her lungs gave off a pneumonic wheeze. So Hart walked her back to the emergency room and tried another oximeter. This time, it gave an even worse reading of 52. Natanael's lungs were failing, she realized. Hart would have to stick a tube down the girl's trachea and pump her lungs by hand.
But before Hart could intubate, Natanael coughed. A bead of blood hung from her wide lower lip. Then she coughed again — spots of crimson stained her blouse. It happened a third time. Suddenly there was blood dripping from her ears and nose.
Hart pulled Natanael upright, but it was too late. Blood poured from her mouth and onto her lap. The nurse ran to look for a doctor. When she returned seconds later, Natanael's pulse had disappeared. She fell back onto the ER bed. And when Hart shoved a tube down her throat and squeezed a bag to make her breathe, blood spurted up like a fountain.
Doctors and nurses grabbed their gloves and tools.
"I need suction!" yelled Dr. Stuart Horak.
Then the electricity went out. A minute passed in the dark. When the lights came back on, Natanael was dead.
"What the fuck just happened?" Hart asked. Pneumonic anthrax, someone suggested. Hemorrhagic dengue fever, said another. They collected blood and tissue samples to send to the Centers for Disease Control's lab in Port-au-Prince.
Pugmire and Hart wiped down Natanael's body with disinfectant and covered her with a white sheet. Then Pugmire and Horak carried her small body on a stretcher through the ER's back door and across a courtyard to the hospital's hidden morgue: a dirty, broken tent underneath a sagging mango tree.
In the waiting area, Fanes Louissant collapsed on the ground when Horak told him that his daughter, alive only minutes before, was now dead. He huddled against a low wall and rocked uncontrollably, occasionally wailing with grief. As friends tried to console him, he tied pink and yellow cloths around his arm as a prayer for strength from God. Out of sight, Pugmire mopped the bright-yellow stretcher where Natanael had lain, alive, just minutes before.
"Just another day in Haiti," Hart said.
Despite the high technology, death is no stranger at Bernard Mevs — even if it visits less often than elsewhere in Haiti. No one knows this better than Marlon and Jerry Bitar, the twin Haitian surgeons who run the hospital. They were residents at General Hospital in the '90s.
"Out of every 100 people coming to General Hospital for critical care or trauma, we lost 77," Marlon Bitar says. "At Bernard Mevs, only 22 percent of those patients die."
"Before, being in the operating room was like conducting an autopsy," adds his brother. "We knew that the patient would be dead afterward. Because after the operation, we were finished. We couldn't do anything else for them."
"Now, when a patient comes to us for critical care, we have an entire department to keep them alive," Marlon answers. "A normal Haitian hospital doesn't have that. They can't do the followup, and the patient dies."
"It's very sad, because if you look on the map, Haiti is next to Florida," Jerry says, ticking off the five leading causes of preventable death in Haiti: heart attack, stroke, severe trauma, severe burns, and maternal emergencies. "We are two hours from Miami, but here they all end up dead."
Three days after Natanael Louissant's death, Pugmire heads to the family's home in a Land Rover. The 22-year-old EMT from Southampton, England, passes the armed guards in crisp navy uniforms and exits through the orange gates onto a narrow street sclerotic with vendors. The Land Rover lumbers through traffic and past tap taps until the pavement deteriorates into deeply rutted dirt. The car slows to a crawl passing over a milky gray stream where children play. "And you wonder where cholera comes from," he says.
Pugmire and a driver work their way slowly up one of the hills surrounding Port-au-Prince, the city's wide bay cradling Île de la Gonâve in the distance. The journey is at most five miles, but it takes more than an hour. Finally they park opposite a flattened building, the remains of the local hospital. Pugmire wants to find out what happened to Natanael — and to discover if there is a public health risk.
Pugmire walks down a steep slope and enters a shady alley between closely set cinder-block houses. Natanael's parents and younger brother are gone: They couldn't afford the $1,000 necessary for a funeral in Port-au-Prince, so they headed to the countryside to bury their daughter. "God is my fortress" is written in chalk on a metal door. Plastic yellow flowers hang like a chandelier near Natanael's bed.
"She was a reserved child and a beautiful singer," says Quenia Belizaire, the pastor's wife and a friend of the Louissants'. She sits in the Louissants' closet-size living room wearing a hat that reads "Alachua County Fire Rescue." Pugmire asks about Natanael's symptoms, as if he could still save her. But like so much in Haiti, it's a game of "what ifs": What if there had been a local hospital still standing after the earthquake? What if it hadn't taken her all day to reach Bernard Mevs? What if the College Academique d'Haiti where Natanael attended fourth grade had cleaner water or air conditioning?
"She wanted to be a nurse," says Belizaire, as Pugmire gets up to leave. "Now her life is in God's hands."
The rain dies just after 9 p.m. on Tuesday, May 17, as Amazan Jean-Uber drops off the last bundle of cheap Chinese clothing in central Port-au-Prince and heads back toward his home in Carrefour. As usual, his three friends recline in the back, leaving the stocky 34-year-old to navigate his noisy Isuzu truck along the empty, wet streets. But as he enters a large roundabout, Jean-Uber slows. Something is not right. A heap of tires and metal is piled in the middle of the road, blocking his path.
Suddenly a dozen men emerge from the shadows of a nearby tent city, machine guns drawn.
"Freeze!" one yells. But Jean-Uber has been robbed before, and with three children, he can't afford to lose another 1,500 gourdes: roughly $50, or a week of his pay as a delivery driver. He slams on the brakes and shifts the truck into reverse. The bandits are all around him. They open fire but miss. Jean-Uber switches back into drive and guns the engine toward the roadblock.
Just as the truck plows through the debris and away from the ambush, a single bullet pierces the cab door and ricochets into his side.
His legs go numb. Jean-Uber feels the warmth leak out of his body, but he keeps driving. Finally, the truck shudders to a halt on the side of the road, inches from a family's blue tent.
A passenger, Achile Ronald, leaps from the truck bed. A powerfully built man with a shaved head and mustache, Ronald pulls Jean-Uber from the front and lays him in the vehicle's rear. He slides into the bloody front seat and parks the still-idling truck, then calls his cousin, Jean-Uber's wife, for help. Soon, the wounded man is loaded into a police car and delivered to Bernard Mevs.
The cruiser arrives around midnight. Pugmire meets it at the gate and helps pull an unconscious Jean-Uber from the back seat. Blood splashes onto the street. Medishare doctors slice into his chest and then his side, looking for the bullet. Finally, they take him to a double-wide trailer parked in the hospital lot. A motorized platform lifts him and his doctors inside the only public CT scanner in Haiti. Within minutes, the machine renders an image of Jean-Uber's chest: The bullet has lodged in the exact middle of his spine.
"He's a para," or paraplegic, Pugmire says. Jean-Uber will probably never walk again.
His story ends better than Natanael Louissant's. Like many of his countrymen, he is locked in limbo, waiting for a miracle.
"My kids are so young," he says, shortly after waking up in the intensive care unit. "If I can't drive, how can I take care of my kids?"
A tube runs up his nose. Another exits his groin and empties into a clear plastic bag. After a few moments, an unfamiliar short, muscular man appears next to bed number four. "My name is Wilfrid Macena," the stranger says. "I work here, but I am an amputee."
As machines hiss and beep around them, Wilfrid tells Jean-Uber about his horrific injury and his recovery. "This is your life," he says. "You are not dead. You are alive. God willing, you will walk again one day."
A nurse comes to clean Jean-Uber. Wilfrid steps away from the truck driver's bed, then he leans in again. "I will be back," he says.
As Wilfrid leaves the ICU, Jean-Uber sits up on his elbow and watches him go, one foot after the other.
Thok. Thok. Thok. The hollow plastic thud echoes over the small courtyard of Bernard Mevs on a quiet Sunday morning. Patients in wheelchairs and visiting family members look up to locate the unnatural sound: perhaps the first time it's ever been heard in Haiti.
Thok! Thok! Thok! Something flies by in a blur of white T-shirt, dark skin, and metal joints.
"Into the pits!" yells a fierce-looking white man in a military cap and Ray-Bans. He waves his arms like a NASCAR crewman. "Into the pits!"
The blur comes to a stop and into focus: Wilfrid Macena, once a cripple, has been sprinting — fast. Sweat pours from his closely shaved head and down his face. His powerful thighs peek from beneath black shorts. But where his leg once was there is a futuristic carbon-graphite running apparatus shaped like an upside-down question mark and worth $50,000. Wilfrid is likely the first person in Haiti to wear one.
Adam Finnieston, the Ray-Ban-wearing Miami orthotist, examines Wilfrid's new leg. With a wrench, he adjusts the metal knee joint. Then he asks Wilfrid to try again. The young Haitian sprints into the distance, his plastic foot again scraping the pavement. Finnieston still isn't satisfied.
"He's swinging his leg side-to-side too much," Finnieston scowls. A thunk like that of a mortar being fired sounds when Wilfrid pops the artificial limb off his thigh and hands it to Finnieston, who adjusts it again.
Wilfrid has come a mighty distance since arriving at Project Medishare's field hospital nearly 14 months prior. Finnieston gave him his first artificial leg: a much cruder prosthetic that initially hurt his still-healing stump. Within half an hour, however, Wilfrid began nudging a soccer ball with his prosthetic and smiling. Doctors were stunned.
"It's just not normal," remembers physical therapist Jason Miller, a powerfully built but gentle-voiced Texan. "When most Haitians learn that they are going to lose their leg, they say that their life is over. But Wilfrid didn't even want to cover his [prosthetic] leg."
After watching Wilfrid boldly walk around the hospital on his new prosthetic, Miller had an idea. He asked him to speak with a 9-year-old boy named Magory whose leg had been badly crushed in the earthquake. For four days doctors had tried to convince the boy to let them amputate, but he refused.
Wilfrid pulled his jeans over his new leg and walked to Magory's bed. "Do you want to live?" He asked Magory. "Because if you do, you must give up your leg."
"But you have both your legs!"
Wilfrid slowly walked away across the hard earth of the field hospital, and then he doubled back.
"Do you see me walk?" he asked, lifting his pants to reveal the metal underneath. "You said I have both legs, but I don't. Yet I can still walk, and so will you."
The boy decided then and there that he wanted an amputation. Project Medishare hired Wilfrid later that day.
After Medishare moved into Bernard Mevs, a small prosthetics lab was built on top of the pastel orange and green hospital. Here, Wilfrid sits after testing out his new sprinting leg, surrounded by the phantom limbs of Haiti's amputee children. He cuts sheets of dense, hard plastic into precise squares, then drills holes in them to create artificial knee joints.
Wilfrid is now a prosthetic technician. "I lost a leg, and I got another one for free," he says with a smile. "That doesn't happen often in Haiti." Indeed, on this island there are no wheelchair ramps, elevators, or disability benefits. "In Haiti, the handicapped consider themselves unimportant," he says. "I show them that they are still alive."
Wilfrid has become the small hospital's ever-smiling talisman. When President Michel Martelly and hip-hop star Wyclef Jean visited the hospital this past May, Wilfrid met them draped in a Haitian flag and proudly sporting his high-tech sprinting leg. He even started an all-amputee soccer team called the Zaryen, or tarantulas, named for the metal crutches they use during games.
But this is Haiti, where even success stories are endlessly complicated. Eighteen months after the earthquake, Wilfrid, Simone, and Wilflamson still live in an igloo-sized tent under almond and avocado trees. Green AstroTurf lines the floor and a ceramic elephant sits atop a tiny, ancient television. A single light bulb flickers whenever a neighbor turns on his welding torch.
"I can run. I can play soccer. I can drive. I can do anything," Wilfrid says, climbing into his sky-blue Honda Civic. Simone is pregnant with their second child, and Wilfrid hopes to run in the Paralympic Games in London next year. "I wouldn't trade my life for what it was before the earthquake," he adds, firing up the engine and donning dark sunglasses. "It's better now."
Just as the earthquake wounded Wilfrid, it also crippled his country. And like Wilfrid, Haiti could ultimately emerge stronger than before the catastrophe.
Although the quake destroyed infrastructure, including hospitals, it reminded the world of the Caribbean nation's plight. Foreign countries quickly pledged $11 billion in aid. The French government promised $50 million to renovate General Hospital.
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But only a fraction of the aid has actually been delivered to Haiti. Corruption and incompetence have slowed the tide. "It's not only a matter of money," insists Gabriel Thimothé, general director of Haiti's Health Ministry. "We need to train more people to provide good quality of care. And we need to reorganize the health-care system." After the earthquake, foreign NGOs, or nongovernmental organizations, overran Haiti, he says, but the country cannot remain reliant on international aid. He suggests taxes on cigarettes and luxury goods to improve health care. "We need to have some funds of our own," he argues.
The Bitar brothers and Dr. Barth Green believe Bernard Mevs can be a template for Haiti's much-needed national health-care overhaul. They have asked President Martelly to institute a $10 tax on visitors to Haiti to fund a $149 million upgrade to the health-care system, and they have plans to build a training facility in the hospital. Another NGO, Partners in Health, has broken ground on a large teaching hospital 20 miles outside of Port-au-Prince.
"Bernard Mevs needs to be replicated," President Martelly said during his recent visit to the hospital. "Health care has been a problem in Haiti for a very long time. I am proud to see such a big project in Haiti, and I will help them replicate it."
But internal wrangling has slowed the plan, and nearly two months after Martelly's inauguration, there is still no prime minister — let alone a minister of health — to approve Medishare's plan for a teaching facility. "For months, everyone was really waiting to see who the next president was," says Dr. Gillian Hotz, international director of Medishare. "Now Micky Martelly has his own people, his own ideas, his own discussions of what health care is going to look like. The country has been at a standstill."