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.