PORT-AU-PRINCE — Seriously injured people continue to provide deep challenges to the city’s barely functioning hospitals, nearly two weeks after a massive earthquake overwhelmed medical staff.

We try to do the best we can,” said Enid

Paret, a nurse at the University Hospital, the city’s largest. “There are many things we do now that we wouldn’t do under normal circumstances.”

Then again, these are not normal times in Haiti where the country’s health system is facing serious strains despite daily influx of nurses and other medical professionals parachuted in to help deal with the more than 600,000 people who have been severely injured in the aftermath of the 7.0 earthquake that struck this city and the southern provincial areas on January 12.

The earthquake rattled the foundation of the Adventist Hospital in the city’s Diquini neighborhood, forcing patients and staff into the courtyard and lawn where they remained throughout the weekend.

Nurses like Paret are in the forefront of the race to try to stave off an already astronomical body count. They rush patients to makeshift hospitals, they do triage and assist on providing care.

“We’re not trained to handle such volume of cases so fast,” Paret said. “But we have help coming from all over the world to help us deal with this tragedy.”

A skeleton crew of doctors and nurses, accustomed to a 70-bed hospital with modern operating suites, rushed among 400 patients who made their beds on concrete walkways, gravel roads and bare patches of lawn outside the Adventist hospital.

Receptionists and nurses triaged patients and filled out forms at a table beneath a tarp. A technician read X-rays on a folding table under a tree.

Nick Stevens, a nurse from Nebraska said he has run short of IV fluids, painkillers, antibiotics, numbing agents, sutures, gloves, gauze, masks, iodine and antiseptics. The generator is operating, but more diesel fuel is needed.

The hospital has water, but not enough. On a recent day last week, a water expert from Global Medic of Canada began setting up a water purification system to increase the supply of safe water.

“People are dying of infection and dehydration,” he said. “The patients are having to sleep outside. They don’t eat enough. And there’s nothing from the government, no help at all.”

Stevens, whose specialty is obstetrics and gynecology, set up an operating room in a tent of blue tarps in the hospital’s cement driveway. A few feet away, Jean Marvins Benjamin, an eight-day-old triplet born two months early, lay in an incubator oxygen tube in his nose as he has difficulty breathing.

In the makeshift operating tent, Yvrose Jeanty, an emergency room nurse who lost her father and two children from the quake, helped amputate the lower leg of a 38-year-old man who had been crushed by a falling building.

“In Canada or the U.S., this leg would be saved. In the U.S. they would put pin and plates and fixate the fracture,” said Jeanty, who was trained in Miami before moving back to Haiti five years ago. “But here, they don’t have the resources.”

“There are tens of thousands of people with orthopedic injuries who need treatment urgently. We have open fractures of every type. Many of them will lose their lives, limbs, live a life of disability,” she said. “We need orthopedic trauma surgeons who can come with their own instruments.”

A few yards away, Pierre Junior Le Riche, 25, lay in the concrete breezeway of the hospital with an IV hooked to his arm. He was on the second floor of a five-story building that collapsed and spent two days trapped beneath the rubble.

The weight of the cement crushed his lower body. Gangrene crept slowly up his left leg, and his toes were already black. Doctors said they would have to amputate to his knee, if not higher.

A the University hospital the same situation is repeated.

According to officials, staff there has performed more than 800 surgeries, 200 amputations under the tent of the hospital, whose facility was destroyed.

“During the first two weeks, we received some traumatic cases; feet, legs, head and broken arms from debris falling on people’s chest or head,” said Alix Lasegue, the hospital’s executive director, adding that about 80 percent of the cases are traumatic with 20 percent being acute.

According to Lasegue, the surgery unit is unusable, the waiting area has collapsed, the pediatric department is useless, like many of the other hospitals, the city’s largest is operating under tents where complex surgery are performed under primitive conditions.

“Right now, you have the acute devastation – people dead, dying,” said Lasegue. “There’s no running water, there’s no sanitation, there’s no food, there’s no electricity.”

Doctors Without Borders runs three health-care facilities in Port-au-Prince; all of them were knocked out of commission by the earthquake. The group is treating patients in temporary outdoor facilities, but “the best we can offer … is first-aid care and stabilization,” the group’s project manager for Haiti, who is based in Toronto, said on a press call today. Many patients have crushed limbs and other severe injuries that “cannot be dealt with” in the temporary facilities, he said.

In response the U.S. is expediting the delivery of medical supplies, providing critical health services, and conducting assessments to help determine health priorities. The U. S. government also is helping to plan for Haiti’s long-term public health needs and harmonizing health inputs with other donors and groups led by the government of Haiti and coordinated by the Pan American Health Organization.

The U.S. government has more than 270 medical personnel in Port-au-Prince, including doctors, nurses, paramedics, emergency medical technicians, and others. These members work for the U.S. Agency for International Development (USAID) and the Department of Health and Human Services (HHS) including the Centers for Disease Control (CDC), the United States Public Health Service Commissioned Corps and the National Disaster Medical System.

With long waits for treatment, thousands living in close quarters at makeshift camps and severely disrupted water supplies, there is an immediate threat of tetanus and gangrene to those who are injured as well as a risk from measles, meningitis and other infections.

There is considerable variation in the official statistics surrounding the magnitude seven earthquake, but as many as 200,000 are thought to have been killed, 1.5 left homeless and three million affected overall.

Former US President Bill Clinton, the UN Special Envoy to Haiti, arrived and toured a hospital where supplies were short. “It’s astonishing what the Haitians have been able to accomplish, performing surgeries at night … with no anesthesia, using vodka to sterilize equipment,” he said.

Jon Andrus of the Pan American Health Organization, the Americas arm of the World Health Organization said that many survivors are suffering from multiple fractures and internal injuries.

In Haiti, where ailments like tuberculosis and malaria are rampant, children are malnourished and hygiene is already a challenge, the quake has added potentially lethal infections, broken bones, internal injuries and many other health complications.

“By any stretch of the imagination it is going to be incredibly difficult,” he said. “The population in Haiti was already vulnerable and faced enormous health threats.”

Health care experts are unable to say exactly how many amputations they have performed of hands, arms and legs but tens of thousands of patients have been through their hospital doors.

While most injuries occurred when buildings collapsed, officials say they are also is seeing patients with gashes and other injuries caused by amateur rescuers who frantically dug survivors from rubble with whatever tools they could find.

“We have dozens and dozens of patients waiting for surgery, including dozens of amputations, and people are still coming in,” said Lasegue head of the University hospital.

At the Renaissance Hospital, which Cuban doctors founded for eye care in 2006 and have now converted into a trauma unit, 45 amputations have been performed in three days, according to Dr Olga Maria Delgado.

Among their patients was Ticia Vital, a young woman who for two days refused to have her left leg amputated for fear it would disadvantage her in the post-quake country.

“What will I do? How will I manage to survive on my own with just one leg?” she said.

As her leg became increasingly gangrenous, her cousin Chantal Felix – with whom she works selling second-hand shoes in the Bel Air slum – persuaded her to have the operation.

“She had to accept it after the doctors told her the gangrene was spreading and that she would die,” Chantal said.

Unfortunately, Ticia’s worries about the future could now be redundant.

“She’s not been responding well to all the antibiotics we’re giving her,” said Raquel Garcia, a nurse at the hospital. “I think she has a 90 per cent chance of dying.”

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