At a hospital in the Haitian town of Milot, about 70 miles north of the devastation in Port-au-Prince, a team of doctors waits.
Patients numbering in the dozens have trickled into the Hopital Sacre Coeur since last week's magnitude 7.0 earthquake. The hospital, with its 73 beds, is the largest private medical facility in northeastern Haiti.
After the quake, hospital officials naturally anticipated they would be receiving patients. This past weekend, a seven-member surgical team that had arrived from the United States was joined by six more orthopedic surgeons. The hospital commandeered two schools and turned them into makeshift hospitals. And even on Monday, they continued to enhance their capacity with a mobile clinic and other unusual measures.
But according to those staffing the hospital, as late as this past weekend their resources had been drastically underutilized.
"My staff and I were getting the hospital ready, but nothing came," said Dr. Daniel Burzon, a surgeon from Ocean Medical Center and Jersey Shore University Medical Center in New Jersey. Burzon has been coming to Haiti for 11 years through CRUDEM, the Massachusetts-based charitable organization that runs Hopital Sacre Coeur.
Burzon, who has since returned to the United States, said that on Friday the hospital had been informed that it would be receiving dozens of patients in need of immediate care. But those patients never came.
"We were expecting 30," he said. "We got four."
In some ways, Sacre Coeur's situation may reflect the logistical difficulties of triage and treatment in the midst of one of the worst natural disasters to strike anywhere on the globe in recent memory.
Tom Arnold, chief executive of Concern Worldwide, an international relief and development agency that has been working in Haiti since 1994, said that while his organization and others are working together to coordinate the distribution of water, food and shelter to those affected, many wounded are not able to get the medical attention they need.
Medical Services Decimated in Port-au-Prince
"There is a real problem in that some of the main hospitals have been destroyed," said Arnold, who is currently in Haiti. "Obviously a lot of doctors, nurses and other medical personnel have been lost. There is a need to get that sector up and going; basic medicine needs to be brought into play."
And bringing Sacre Coeur into the life-saving game may be tougher than it sounds. While Milot may be relatively close to Port-au-Prince, the journey by car is known to take seven hours -- and that was before the earthquake rendered many roads impassable.
So at the hospital in Milot, the doctors wait.
"Our surgeons have begun to speculate on the numbers of people languishing in Port-au-Prince that have perished since the last and only flight came to Milot," Tim Traynor, a CRUDEM volunteer at Sacre Coeur, wrote in an email back to the organization on Saturday.
"When we hear a chopper in the distance, we all run to the landing field like shipwrecked sailors hoping that it will land and bring us someone to save," he wrote. "We pray, we wait, we do everything in preparation over and over again, and no one seems to be listening.
"Around the edges of our hearts, we even wonder if anyone cares."
Saving Lives, Despite a Disaster
Despite being farther from the epicenter of last week's quake than Port-au-Prince, Sacre Coeur was not unaffected.
When the earthquake hit, Burzon was in the middle of an operation. He was removing part of a patient's prostate gland in order to allow the patient to urinate -- a typical procedure for the urologists that come to northern Haiti for three weeks a year to offer their services at the hospital.
Burzon said that as the building shook -- and the windows actually appeared to bend -- the surgical team looked at each other. He said no one spoke, but he imagined that everyone was wondering the same thing -- "Do we just run? Or do we speed up and try to finish, as the poorly built hospitals here all sometimes fall apart without earthquakes?"
Surgery a Challenge in Haiti Hospitals
The surgeons decided to finish the operation in what turned out to be a harrowing day in the operating theater.
"During the operation, the aftershocks came one after another," Burzon said. "We didn't know if these were actually going to be worse -- or were they the real one -- but we knew had no choice but to complete the operation, and it was in God's hands."
They continued to do some surgery, but shortages of key supplies -- gas for the generators, and medicine needed to resuscitate patients -- posed a constant threat to their ability to operate.
A few wounded in the quake did arrive. All four of the first patients who arrived on Friday required amputations. One patient had a tourniquet left on his upper arm for four days straight. The wound was covered in plastic. Massive gangrene had developed. New Jersey surgeon Dr. Stephen Fletcher had to remove the patient's entire arm, up to and including the shoulder. The operation saved the patient's life -- but not his arm.
Ironically, this patient could turn out to be one of the lucky ones. As the first week following the quake comes to a close, time is now short for those with similar injuries.
"You can have gangrene so long that it'll kill you," Burzon said.
After Quake, Delays May Be Deadly for Many
As the week began, more victims started to trickle in. On Sunday, the doctors at Sacre Coeur received 20 more patients. Helicopters brought in 11 patients on Monday, and 6 more arrived by road. The surgeons at the hospital performed 16 procedures total that day, operating until 11:30 p.m. Today, the doctors expect a busload of patients to arrive from Cap Haitian, one hour away.
But Burzon said this is not enough. He described logistical barriers to patient transport on the part of the U.S. Coast Guard, which has been using its helicopters to ferry patients into the more remote hospitals.
"They said they couldn't pick people up and transport them because they hadn't received an order to do so," he noted. "We've got these things prepared. Meanwhile, people are dying in the hospitals in Port-au-Prince or in the streets. They don't need to be."