PORT-AU-PRINCE, Haiti—Inside a small stucco pavilion built as a urology clinic -- one of the few buildings in the hospital complex deemed structurally sound -- patient after patient was wheeled into the makeshift operating room on an old bed Saturday. Workers doused the walls with disinfectant as a couple of nurses prepped the wounded and gave them a bit of anesthesia. Then out came the saws.
The work was amputations.
Oda Mukkuaka, a Haitian surgeon who has worked at Port-au-Prince's General Hospital for four years, helped guide the saw across the shin of a 40-year-old woman who had lost her foot after she was hit by falling debris.
Using a headlamp like those worn by miners because there was no electricity, surgical scrubs tied around his waist in the heat, Mukkuaka doused blood and cleared away tissue. Once the cutting was done, he swiftly pushed metal wire into the skin, sewing shut a pocket-like fold to form what will now form the end of her stump.
Somewhat remarkably, given the nature of the work and the magnitude of the disaster before him, Mukkuaka, 35, seemed to take the grueling two-hour surgery in stride.
"We are used to working in a harsh environment because we are in Haiti," he said, citing shortages of supplies and the population's precarious existence. "The difference this time is the volume."
Haitian doctors seemed largely missing in action in the first hours and days after the quake. Clinics and hospitals, if not destroyed, were mostly shuttered.
A small group of physicians continued working at General Hospital, but it was a triage that made "MASH" look like a boutique clinic in Beverly Hills.
Georges Lamarre, a tall, gaunt general practitioner, was at home when the quake roared through Port-au-Prince. Within two hours, he made his way back to the hospital and started tending to the walking wounded who staggered to the hospital, a collection of two-story green and white buildings on a scrawny lawn. First thing: He delivered the baby of a woman pulled from a collapsed building.
By midnight, five doctors were working at General Hospital; by dawn, about 20. Many doctors had died, were missing or were absorbed in saving their families.
"We had a lot of patients that first night, but the next day it was uncontrollable," said Lamarre, 35. Most of the patients bled to death, he said. There were no antibiotics or blood supplies. "Up to this moment, there are patients out there we haven't even touched."
They included Yolanda Gehry, who brought her baby, Ashleigh, to the hospital Tuesday night. Four days later, a doctor came by and taped up the baby's head but had not yet treated her shattered hand. Ashleigh sat in her mother's lap, sobbing disconsolately, a bloodied bandage swaddling her left hand like a woeful mitten.
"The Haitian doctors didn't have anything to help us, so we had to wait for the foreigners," the mother said. "I am not angry. I am waiting."
On the trash-strewn hospital grounds, the injured lay on thin mattresses; some had rickety beds with plastic sheets held overhead on sticks to shade against the sun's brutal heat. Flies swarmed. Most have been there since Tuesday. Buildings are too damaged to put them inside, where many are too fearful to go anyway.
Jule Lutheran said he thought that his goddaughter's arm might have been saved if she had been seen earlier. The 26-year-old woman, Jean Orelis, lay sprawled on a cot, her arm crudely wrapped. "We depend on God and the doctors, so we can't be angry."
Inside the room where the surgeries were taking place, a few tables over from where Mukkuaka operated, doctors cut the leg off a 7-year-old boy named Ulysses. As he awoke, he began to moan, then cry, "Oh God! Mes amis!" Then his cries evolved into a singsong as a doctor carried him away.
For all their efforts, several of the Haitian doctors seemed dazed and shellshocked. The operations did not begin in earnest until foreign medical teams, including the Los Angeles-based International Medical Corps, arrived Saturday with supplies.
In the operating room, tables and corners were stacked high with gauze, syringes, surgical gloves, rolls and rolls of tape, IV starter kits, scissors, scalpels and other supplies. One nurse said they were already running out of sutures.
"We always need basic materials to work with," said Lamarre, the general practitioner. "In normal times, sometimes we don't have oxygen or medicines."
Even with the help, Lamarre remained doubtful that all the people outside the doors could be treated.
Lamarre was on his way to a surgery that would cut off both a woman's legs at the thigh. There were so many amputations, he said, because of the nature of crush wounds and trauma.
What is this woman's future?
The doctor raised his eyebrows.
"In Haiti?" he asked.
"These people are finished."