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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-aged 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 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 Creole 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 South Florida. 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 to reinvent 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' 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.
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.