Imagine all of the Federal buildings in Washington collapsing in less than a minute killing 30-40% of our government workforce, crippling the tax collection system leaving the government no money to pay salaries or overhead. Our government, which seems to barely work at full capacity with gleaming buildings and a gargantuan budget, would come to a halt.

This is the state of Haiti today. Arriving again in Haiti, five weeks after we first landed in the chaos of the first days after the earthquake, the tarmac of the airport was eerily quiet, almost deserted. Some things had changed. There were more tent camps, a few more latrines, less rubble in the roads, more mouths fed, less acute medical injuries and trauma, more tents instead of open air surgical wards at the University Hospital where we were the first surgical team after the quake. But the layers of trauma were more apparent. At the University Hospital, the entire second year nursing class was crushed and died in the nursing school. Teachers and nearly all the schools were destroyed. During the five o'clock hour of the quake all the priests and seminarians met in their churches. Most of the priests, the future priests and their churches are now gone. The Universities with most of their precious intellectual capital of professors and the best and the brightest of Haiti are gone.

Please note: This blog is a reprint of an article that appeared on Huffington Post a few weeks ago.

How can we measure the resiliency of the Haitian people who are the poorest in the western hemisphere with 55% living below the extreme poverty line of $1 a day? On a good day in Haiti, nearly half the population doesn't know when or where the next meal will come; in good times, 47% don't have any access to the most basic health care; 45% of the population doesn't have clean water and 80% are without basic sanitation. People fear going to the nation's main hospital, which we have worked to bring to life over the last week, because at its best, it provided inadequate care in facilities with marginal electricity and water, and received no funding. When we arrived there, we found no basic medical supplies to restock the meager supplies we could fit into our bags and our small plane.

How can we measure the resiliency and capacity to endure of these people who have endured for 200 years? Perhaps it is in the strength of the 85-year-old woman found yesterday in the rubble 10 days after the quake still breathing, with a pulse and blood pressure and who after some intravenous fluids, started producing urine again. Or the little boy who a day after being found in the rubble after a week was running around our medical camp hugging the nurses and doctors who brought him back from near death? Or the 13-year-old who ran to the top of the 3-story building as it collapsed under her, riding it down to the ground suffering "only" a massive laceration to her thigh that her mother attempted to stitch without anesthesia with a needle and thread. There is barely a whimper from the hospital campus where we reduced fractures with only a little pain medication and where gaping, infected and necrotic wounds are re-bandaged daily without sedation. There is only the occasional wailing from a broken heart.

Please note: This blog is a reprint of an article that appeared on Huffington Post a few weeks ago.

It is nine days after the quake, and last night three gaunt Haitian medical students, their school destroyed, came up to me in the dark as I walked past the nursing school with 150 nurses still buried in the rubble, the smell of rotting flesh floating in the hot, heavy evening air. They have helped out for the last week at the hospital but had no food to eat and only a little water to drink. Their homes were destroyed and most of their families were dead. Yet they showed up to help. They came to me to ask if they could get a job, a way to feed themselves and what family they had left. But the hospital's personal system is not functioning yet. Our first priority has been saving lives.

I went to get them food; high-energy biscuits (dry cookies) that were dropped off by the World Food Program too feed 5000 people on the hospital campus for five days. The food has been dropped off, but is locked behind three doors and there is no clear distribution system yet. It took me two hours to get them food and then find some more food for the new group of surgeons, doctors and nurses that arrived from Children's Hospital in Boston for Partners in Health. The three medical students slept out on the ground, with home to go back to, and with food in their stomachs for the first time in a week.

Please note: This blog is a reprint of an article that appeared on Huffington Post a few weeks ago.

I slept through the aftershock this morning, a small 6.1 earthquake that has had no real impact because everything that could be destroyed was already destroyed. But the aftershocks that will ripple through the lives of the Haitian people will last for decades. They will for Mitch, who I met the first morning at the hospital grounds. He was laying in the back alley, unattended for four days except for a small bandage around his knee. He called out softly in English for me to stop, to help him. He had not eaten nor drank water since the quake and was still smiling at me. He lost his entire family -- a wife and three children -- and home. He was alone with no one to care for him, unlike some of the other patients who were tended to by their less-wounded family members, bringing what food and water they could.

I kneeled down and opened his dressing. A quart of foul pus spilled out from his knee, which was shattered and crushed. Pier, my wife, is an orthopedic surgeon. She came over and said he needed to be the next surgery case.

Please note: This blog is a reprint of an article that appeared on Huffington Post a few weeks ago.

The country has one doctor for 11,000 people. Electricity and running water are available in Port-au-Prince for two hours -- on a good day. The chief surgeon at the General Hospital (the largest public national hospital) told me that patients often die in the operating room because the generator fails -- on a good day. Under these circumstances, a small group from Partners in Health, led by Paul Farmer, is trying to resurrect the city's most important hospital from the rubble.

I have been there with a small group of seven surgeons, doctors and nurses who performed the first surgery. That was four days after the quake shook for 15 seconds -- flattening the city and over half of the buildings, including the hospital where 150 nurses remain buried in the nursing school. The sickly, sweet stench of death and rotting flesh fills the air as I walk by.