JIMANI, Dominican Republic - Dressed in scrubs and a red kerchief, Angela Guerrera crouched over the 69-year-old Haitian grandmother. She plucked at the filthy bandage and revealed the damage caused more than a week earlier by the collapse of a concrete wall: The left foot was severely flattened from toes to instep.
The patient, Orana Soliman, had been airlifted today from Port au Prince to this medical outpost, where Guerrera and her 18 colleagues from Cooper University Hospital spent the day tending to Haiti's wounded and desperate refugees.
A week and a day after the earthquake ravaged Haiti, the public hospital in this border town provided a snapshot of the crisis. Soliman rested on a bare mattress spread on a dirty floor. All around her, lining the corridors, were hundreds of other patients, including amputees with vacant stares.
Guerrera, 30, was assisted by internist Sam Negin, 44 of Cherry Hill, who held the IV drip bag high throughout because the hospital had run out of poles. The two doctors from Cooper kept their focus amid the chaos. They assessed the infection and the likelihood that bones were broken.
After consulting with a senior member of the team, orthopedist David Fuller, 45 of Haddonfield, they decided that the grandmother did not need an immediate amputation. They cleaned the infected area, lightly dressed the wound and passed along their assessment to a local doctor in charge of triage.
With the medical system overwhelmed, there are no medical charts, no computerized records. After a quake victim is stabilized, a piece of paper taped to the wall notes the drugs administered and the time and date. To keep track of the patients she plans to monitor, Guerrera, of Haddonfield, sketched out a diagram to use as a reference in the coming days.
As the Cooper team moved on to the next patient, the woman's grateful son expressed his appreciation. "USA is the best country in the world, with the best doctors," said Jean-Sauveur Janvier, 29, who was evacuated along with his mother. "They have much love for the Haitian people."
He was sitting near his mother, in the hospital corridor, when two volunteers in T-shirts came in, carrying a cardboard box with tiny Bibles. They pressed one into each patient's hand.
Earlier in the day, Fuller was in the operating room, assisting orthopedic surgeons. The Cooper specialists arrived here on Tuesday, two days after departing for the island and after enduring a frustrating delay in getting to the front lines. Their advance planning immediately paid off, however. The external fixators, used to stabilize broken bones, proved critical. They resemble cages, assembled outside the wounded area and attached to the bones with screws.
"That's exactly what we needed," said Omar Malik, a Pakistani trained in the Dominican Republic who is in charge of the hospital's operating room. "We could have used them yesterday."
External fixators are more expensive than plaster casts and can cost up to $2,000 per surgery, said Malik. Fuller figured there was enough to perform 30 to 40 operations.
Most of the 19-member team began the day at a local church that served as post-op facility. The one-story stone building has a corrugated steel roof and two ceilings fans to stir the air. Until the Cooper crew arrived, just two doctors and one nurse were available for more than 50 men and women, a handful of injured children and a few babies at risk, including a five-day old.
Nicolas Erbrich, a pediatrician who lives in Philadelphia, examined the infant and worried that fresh blood in the diaper might signal an injury to the intestines that could be life threatening. He consulted with a local doctor, Yvonne Jean-Francois, who advised that the infant be transferred to a nearby private hospital.
Erbrich, 37, also noted the importance of feeding the children regularly, especially the very young ones. "For the kids whose injuries are stable, the problem is nutrition," he said. "They can't go as long without eating as adults."
The only source of electricity at the makeshift post-op is a generator. Martha Butler, a volunteer from the National Evangelical University in Santo Domingo, said there is a reliable supply of food and drinking water.
At one point, a woman who was being examined howled from the pain in her back and legs. D'Andrea Joseph, a trauma specialist who lives in Philadelphia, suspected the woman had a broken hip. Pain killers are largely unavailable, but the team from Cooper brought along morphine. They applied a dose and were then able to complete an examination.
Trauma technician Al Gonzalez, also of Cherry Hill, and emergency room doctor Joshua Torres-Cruz, 30 and from Woodlynne, had lifted the woman for the examination. They felt the hip floating free-a typical sign of a break-and a request for surgery was placed.
Joseph stood and looked over the room. Picture a basketball court crowded with people, all in pain. "I've never seen anything like this in my wildest dreams," she said.