sailboats, swimming to shore, or escaping into the night from the bowels of freighters docked on the Miami River. If lucky, they connected with family or friends and disappeared into the underground of Little Haiti. If caught, they were transported to the Krome Avenue Detention Center—barracks surrounded by chain-link fencing, barbed wire, and everglades sawgrass, invisible to Miami and the world. For the Haitians, Miami could be a blessing or a curse.

Miami in 1980 was an uncommon city—not to be confused with Miami Beach, the decadent, overbuilt sandbar across the bay. It was founded a little more than a hundred years ago, as much a frontier town as Tombstone or Dodge City. Until the Cubans arrived, it was also very much a southern town. Miami was not integrated until 1967. The downtown area was disappointing then, except to the tourists from Latin America searching for bargain electronics and jewelry. Although magically illuminated, Miami’s streets were mostly empty after dark. The life of the city pulsed in the low-rise neighborhoods that surround its center—white and affluent to the south and east, African-American to the northwest, Latin to the west, and Haitian due north.

With a population of roughly equal parts white, black, and Hispanic and significant minorities from the Bahamas, the West Indies, and many countries of Central and South America, Miami is a Creole city—a collection of spices from around the Caribbean and a taste unique unto itself. To most Americans, Miami is a peripheral item as far removed in culture, climate, and geography as it can be and still be attached to the mainland. For its immigrants and refugees, however, Miami is the American dream—the embodiment of opportunity and freedom and the shortest and surest way to flee whatever they are escaping in their own country.

When poor people in Miami get really sick, they have no alternative but to go to Jackson Memorial Hospital, which is supported by Miami Dade County and obligated to treat county residents regardless of their ability to pay. With more than 1,500 beds scattered among several buildings, and with the University of Miami School