There is always humming from somewhere.  It is usually low and musical as patients try to distract themselves from phantom limb pain that is not at all phantom.

There is a friendly Haitian pastor who walks daily into the medical ward. He raises his hands and prays loudly in Creole for roughly four minutes. I only understand the Amen! at the end. He always shakes my hand before he leaves the room.  Many people here think the quake is divine intervention for lives lived wrong.

There are roosters and dogs at five in the morning.  There is a generator running outside.
They wake us up.  It can be annoying. There is the beeping of one of our only portable oxygen monitors as a baby’s saturation starts to dwindle.   We have lost three babies in three days from dehydration, cerebral malaria, and bowel obstruction.  None of these is strictly earthquake related.

There is the rapid, open mouth pant of asthmatic children, of anxious and anemic mothers, of old men in heart failure. 

There is the click-clank of walkers as so many amputees start to ambulate.  They break into a grimace- smile- laugh as so many get up for the first time since the earthquake.
French Creole music blares from the headphones of the 15 year old amputee as I come to round on her in the late afternoon.

There is the general absence of any sound of any violence.

It is thirteen days after the earthquake.  I coordinate a twelve member team at St. Marc’s hospital, a government facility on the west coast of Haiti. Partners in Health has worked here for two years before the quake, supporting the site with materials and salary. An orthopedic surgeon, a plastic surgeon, an anesthesiologist, an emergency room physician and five nurses are with me from the Brigham hospital in Boston.

Those first few days lacked nuance. Limbs needed to be hacked off, open fractures operated on, and patients prioritized into who will die now and who won’t die until a little later.

Now we reshuffle and reprioritize the massive case load of wound debridement, skin grafts and fractures and weigh them against new things which come through the door all the while.   After seeing a third child this week die of pneumonia, or dehydration or cerebral malaria, we clearly understand that this country existed in a state of emergency long before the earthquake: an emergency without enough witness. The earthquake exacerbated an existing bleed.  The country is now hemorrhaging.

Over the last few days, challenges mount.  We balance between tending to a flood of patients directly created by the earthquake and trying to treat the ongoing everyday traumas, heart failures, diabetic comas, malaria and severe dehydration of a destitute population.  Each day, the challenge becomes to run one hospital, not two parallel American and Haitian hospitals.  The goal is one Haitian hospital with lasting effects that benefits the Haitian population long after we leave.
How the hell are the Haitian people so tough?  How do they absorb the brutal shaking of the earth into their bones, and still endure?  The last few days reveal what they have always had to deal with- that death comes from dumb treatable diseases.

They have always known their lives were not entirely or even mostly in their hands.  The earthquake was more proof.  It was brutal and all at once.

In the fog of all that is chaotic and difficult, I witness an awe inspiring collaboration among so many people which imbues in me a certain deep faith in humanity.

Necrotizing fasciitis liquefies the muscles of one of our sickest patients. He sinks into sepsis, barely arouse-able but his pulse is still strong.  We quickly run out of options in this hospital.  Through a friend of a friend we contact the Canadian embassy.  The Canadians immediately send a helicopter.  It lands on a nearby soccer field.

There is the barely audible guttural grunt of acceptance from a family member.  The family agrees for us to transport the patient to Canada or to the USNS Comfort for a higher level of care. The families never are able to accompany the patient for reasons that I have no control over.  This is the height of vulnerability, of powerlessness. For the hope of healing, Haitians routinely give up their own into the hands of an unknown skilled somebody foreign to a somewhere else outside Haiti.

The chopper lands and we make our way to the secure field.  As we load our patient onto the helicopter, Haitians hang off the fence in all directions to catch a glimpse; hundreds of them.  

We get air lifted and make our way 40 minutes in the chopper to the USNS comfort, the military ship which has something like 8 operating rooms and capabilities of a full fledged fancy US hospital.  An entire massive ship by the US military dedicated to Haitian patient care.  Not a military, not an occupation, not men with guns who parade around foreign land like they own it.  The ship contains a solid trauma bay with some of the best American doctors.   As we leave our patient and rise into the air, off that ship, in the helicopter I think that maybe the United States can rewrite our sordid history on this island.  Maybe the USNS Comfort and all these dedicated Americans I have met over the last two weeks represent that shift.

I am on the ground.

I am not sure what the 10,000 foot plan looks like.