Peter Hedberg first heard about the magnitude 7 earthquake that rocked Haiti in the afternoon of Jan. 12 from the comfort of his home in Durant, Okla. Days later, after paying his way to the Dominican Republic and hitching a ride on an army Blackhawk helicopter into Port-au-Prince, the general surgeon was operating in tents and swatting flies away from legs and arms that had been splintered under caved concrete. He went to Haiti because he was inspired to help during the disaster relief's critical hours. He went because he remembered why he became a surgeon. He went, like so many other healthcare professionals, because the true spirit of giving moved him.

Primitive at best
In Port-au-Prince, Dr. Hedberg saw what he imagined a war zone would look like. Badly injured Haitians lay in crowded triage areas. Compound fractures went untreated for days, exposing bone and tissue to the open air.

He spent hour upon hour in muggy, 85-degree heat operating in makeshift tents made with plastic sheet roofs and surgical drape sides. He performed countless amputations and debridements, and tried to ease the suffering of patients with gangrene, sepsis, compartment syndrome and severe burns.

The conditions were primitive at best. In the early hours of the relief effort, Dr. Hedberg operated without cautery, with no power and with a gigli saw used to divide bones as his primary instrument. He jury-rigged traction devices using broken cinder blocks attached to ropes hung over the sides of patients' beds.

Nelson Aquino, a nurse anesthetist at Children's Hospital Boston, e-mailed from Haiti on a cell phone while waiting for a night shift to begin. "The days are long right now," he wrote. "We head in (to a hospital in Port-au-Prince) around 8 a.m. or as early as we can get a ride. In the afternoon, we leave to rest, preparing for a night shift that lasts from 6 p.m. to 6 a.m. We operate all night and tend to patients in makeshift post-op recovery tents. When all is said and done, we work 16-hour days."

During occasional breaks, Mr. Aquino tries to steal naps on a mat in the shade of a tree, but air force planes constantly fly low overhead, making rest difficult. When he's done working, he heads back to a compound set up in a university atrium, resting in a sleeping bag rolled out on concrete.

Trying to repair compound fractures that have gone days without treatment is tough to take. "To see patients lose a limb and not be able to care for themselves or get any basic long-term care is difficult to see," writes Mr. Aquino. "Haiti will be a country of amputees."

Humbling experience
Lyall Ashberg, MD, a pediatric orthopedic surgeon from Melbourne, Fla., arrived in Port-au-Prince 5 days after what locals now call l'evenment, or "the event."

He went straight to the Centre de Diagnostique et de Traitement Int?????? ©gr?????? © (CDTI), a small private hospital originally built for elective surgery and well-to-do patients who can pay cash. The CDTI was poorly equipped for trauma surgery and had hundreds of patients waiting to see a doctor. "There were throngs of people lying in tents with infected open fractures of every variety," says Dr. Ashberg.

For a week Dr. Ashberg performed amputations, repaired fractures, set screws and implanted rods. The hospital had a shortage of orthopedic instruments and those it did have were often ancient and rudimentary. There were no saws or drills. "I brought my Black & Decker drill with me from my garage," says Dr. Ashberg. He wrapped it with gauze each time he had to set a screw or drill for a pin.

Indeed, most of the supplies used by surgeons were those that they brought from home. It took several days for the donated medical supplies from abroad to arrive. There's still a shortage of drugs, tourniquets, sterilizing equipment, sterile drapes, gloves, instruments and dressings, says Dr. Ashberg.

Surgeons in Haiti were constantly improvising. "You have to rely on your diagnostics skill and creativity," says Dr. Ashberg. He now knows that he can set a femoral nail without fluoroscopy and perform many procedures without general anesthesia, using just a bit of narcotics and regional anesthesia.

The hospital where Dr. Ashberg operated was severely shorthanded. Hundreds of patients waited during slow room turnovers. With limited staff, the surgeons and anesthesia providers mopped, changed OR beds and cleaned their own instruments. The hospital's small reprocessing department with a single sterilizer was completely overwhelmed. Rather than waiting hours for instruments to be sterilized, surgeons soaked cleaned instruments in disinfectant to speed things along.

Waves of patients kept coming. "We never saw anybody twice," says Dr. Ashberg. "There was no post-op area. People just went out in the street." Once outside, patients walked away or laid down on mats or cardboard to recover.

Dr. Ashberg says that now that he's home he has a hard time talking about his time in Haiti, as though he had lived through a war. "It was a very humbling experience," he says. "It makes you feel very lucky."

Hope for Haiti
In the coming months, the country will need more orthopedic surgeons, anesthesia providers, nurses and, as time goes on, rehabilitation specialists.

"I feel like I haven't done enough because of the enormity of the task," says Dr. Hedberg. He's already plotting his return trip. "The Haitian people are going to need specialized care for months to come."

The scenes of total destruction are incredible. The pain, anguish and, yes gratitude, in the tears and smiles of the Haitian people inspired all who went. "These people are so stricken with grief, pain and acceptance of what has happened," writes Mr. Aquino. "You're working high on adrenaline, but the emotions run, too.

"I know we're making a difference one day at a time," he continues. "You can see it. The biggest feeling I have is hope. Hope that the people and country of Haiti will be strong and lively again. When I see these people, I'm in awe and admiration of their courage and strength to move forward after devastation."