David Feldman, Ken Mrcozek, and Mary Ann Hopkins perform a left femur external fixation on a 15 year old boy, while Dianna Voiculesco provides anesthesia support.

The courtyard that houses our Tent City remains illuminated well after the sun has gone down. For that we are thankful, but it comes at the cost of both the constant baritone hum of a closet size generator that spews mocking fumes into what should be fresh island air.
The lights of the courtyard also draw the attention of an army of flying insects that join forces with the mosquitoes to reclaim what they feel is their rightful terrain. Some are brown with spots, others have hard shells with ridges, still others have menacing pincers; all have an annoying way of aiming for the nostrils.
Just as a moment of respite is achieved by waving the insects away and moving upwind of the generator, the realization comes that while FONDATION ARISTIDE is conveniently located a short drive away from the airport, it is also unfortunately located directly beneath the final approach path of planes that will touch down within 20 seconds.
As such, the planes appear as close as the view from an outdoor airport parking lot. Without the meager benefit of sound isolation that brick walls might provide, our Tent City is continuously bombarded by the deafening roar of large cargo planes adamantly screaming their way into the airport every 5-10 minutes.
With that soundtrack, teams of physicians move about the courtyard; the newly arrived seeking information from hour-long veterans.
I met a group of orthopedic surgeons and an anesthesiologist who had just returned from the field.
-Which hospital were you in?
"General hospital"
-What sorts of injuries are you seeing?
"10 day old pelvic fractures, 5 day old lacerations...none of the patients want to stay inside the hospital...we get in do what we can and get them out. They're all outside."
-Has your team been able to operate effectively?
"Well, I think right now it's tough getting operating room time. You have to wait for a while. You know? I mean, I'm an older surgeon and I'm use to being in the OR all day and delegating other minor stuff. Today, I was the one going on rounds and having to do those minor stuff like checking casts, changing bandages, you know?"
-Too many surgeons?
"There's still a lot of traumas coming in, but unlike a week ago, there's also a lot more surgeons around"
-What kind of doctors don't they have?
"Well, they're gonna need docs to take care of all the medical stuff. Patients are coming in with renal failure, some are postop, and that's where I don't think we have enough doctors to take care of that stuff"
-What about the children?
"Yeah, there's a bunch of sick kids...we need pediatricians too"
-So what do you think should happen?
"Well we need a better coordination of who's coming and what skills they are bringing with them. I'm not sure we know all of that in the hospital."
-Did your team have everything it needed to function?
"Yeah, we were lucky because we attached to a another group with nurses...I think they're from Boston. Anyway, our group is just surgeons so we needed to get a good mic. If you show up with just surgeons you can't do anything. You need nurses, anesthesiologists, all that. You need a prepared team to do it right. Mt Sinai is here and they have complete teams."
-Anything else that you learned? "We brought a lot of stuff with us but it wasn't until we got here that we realized what we forgot and what we really need...MARKERS AND PAPER!!!!"
-Yeah, the simple stuff.
"Yeah"

Location:Port-au-Prince,Haiti

After leaving the airport, we turned left down a narrow street to greet a mostly darkened Port-Au-Prince. Near the airport there appeared to be a few cafes where small groups of "twenty-somethings" congregated. Curious eyes stared at our crowded car as we passed by, while others did not seem to notice. It is possible to imagine that in the pre-earthquake days this was one of the destination Friday night spots. Today however, the small cafes seemed to be a refuge for those seeking desperately to hang on to something that was familiar.
Speaking creole our driver calmly indicated areas of interest, and Dr. Patricia Poitevien and I translated for the group. When asked about what he thought of the condition of the country, he shook his head, shifted his grip on the wheel, and almost in a whisper he offered this assessment "back to zero".

Location:Port-au-Prince,Haiti

Thw sun was setting as we approached Port-Au-Prince and the sun was just beginning to set. Gazing at the red and orange hues pairing the sky above Haiti, it was easy to doubt the destruction below.
As the plane made it's descent into the capital our attention was drawn to a large fire west of the airport. Even thousands of feet in the air, large flames could be seen giving birth to billowing smoke (picture) that testified to the mysery on the ground.

Location:Port-au-Prince,Haiti