The medical effort in Haiti is drawing together thousands of relief workers, medical volunteers, and military personnel. The logistical operation has been immense as all of these parts connect to create a network of care for the thousands of injured people.
In the middle of downtown Port au Prince, not far from the ruins of the Presidential Palace and several ministries, the University hospital is standing, but empty. Empty on the inside at least. Nobody -– from patients to doctors -– wants to be indoors.
"All of the buildings here have been deemed unsafe," says Rachel Allen, a registered nurse here.
"At first we didn't know that. So in some buildings we were putting patients back in there to get them settled and there’d be at tremor or an aftershock," she says.
The patients would flee, no matter what machine or IV bag they were attached to.
"We'd come back in the morning and everyone would be in the roads, in the middle of the roads, not under tents, under the sun, becoming dehydrated. We were losing tons of patients," Allen says.
Now, rows of tents line the streets of the compound as if the hospital disgorged its contents onto the road. There are the pre-op tents, the post-op tents, the ICU tent.
It's been more than two weeks since the earthquake, and the injuries are starting to change. There are fewer traumatic amputations, but infections are still a big problem, though they too will taper off as patients are either treated -- or die. That does not mean the numbers of sick people are easing just yet - here or anywhere in Haiti.
"It's a never ending flow here," says Anil Menon, a volunteer with International Medical Corps, one of the groups working out of this hospital.
"I don't know if you see that wooded area over there, in the middle, they will just come in there every morning and there will be a whole new set of patients almost lost in that area that we have to go through and make sure we haven't missed any big injuries. Sometimes we'll find things like completely open legs with festering infection just sitting there on a bench in the park," Menon says.
The hospital can't treat everything -- some surgeries require more sterile environments, or more equipment.
"That guy right there had a traumatic amputation of his leg, it got infected, that spread systemically so we had sepsis, on the verge of death.
This patient is beyond what this hospital can do for him, so he is being packed into the back of an army truck, and driven to a field nestled between a tent city and a slum.
Captain and trauma surgeon Richard Sharpe is loading patients from the truck into helicopters to transport them to the U.S. Naval ship Comfort or other ships with advanced medical facilities.
"Around 50 patients over the next several hours. They're going to be going to the comfort, the bataan, and perhaps the Nassau also off the coast," Sharpe says.
This makeshift air field serves as an open sewer for the slums around it - and it smells like it. In the early days of this operation, landing zones such as this were also dumping grounds for patients. Some very difficult decisions had to be made - and are still being made.
"Sometimes we come across a patient that we could potentially save maybe maybe not, but they would take such a large amount of assets we can't devote all those assets to that one patient because there's 10 or 12 other patients we could save using the same assets, that's the tough part of triage. It's not easy, it's tough," he says.
The patients who make it to one of the hospital ships may have a rough time ahead, too. Doctors on the ships are making the same kind of difficult decisions.