There is some good news coming out of what Dr. Peter Melchert describes as the "awfulness" of post-quake Haiti.

Melchert, an internist and pediatrician working at Abbott Northwestern Hospital and Children's Hospital in Minneapolis, is an active member of Children's Surgery International. He's in Haiti caring for victims of the quake. I spoke to him Wednesday evening.

"The whole crisis is evolving," Melchert told me. "Today's the 22nd day after the quake, and I got here on the 16th day after the quake. So day number 16,17, 18, 19, we were still seeing a lot of acute injuries that had received no care at all, but thankfully those types are declining."

Prior to his arrival, twice daily truck runs into the tent cities of Port au Prince typically returned with 15 to 20 patients, most of them new. But an occasional run would bring back only five or six patients, leading the clinic staff to think, wishfully, that perhaps the flood of unattended injuries had crested. Until the next truck showed up with 20.

The Heartline Ministries field hospital where Melchert is working is still hopping busy, but the number of never-cared-for patients is dropping, and their wounds are of a different nature.

"There's still some new patients coming in, but those are patients who had a puncture wound to the hand, or a puncture wound to the foot, rather than an acute fracture that would have brought them in earlier," Melchert explained. Initially, puncture wounds can be deceptively innocuous looking; but with time, a small number of bacteria buried deep inside muscle or bone can become a very serious problem as the bacteria multiply.

"Something has been smoldering, smoldering, and then they come in with a septic [deeply infected] limb," Melchert explained as he described a few recent cases: a young man with a big abscess at the base of one of his fingers, and a 75 year-old woman with a puncture wound to the foot. "She's the oldest person we've cared for — 75, that's a rare thing in a place like this."

The falling number of new cases is great news, but there's still plenty to do. "We're seeing lots of patients who've had some care, but they're coming in with infections of whatever was sewn up, or their amputation stump is infected, their cast is falling apart, their fracture is completely loose and not healing," he said.

I ask about a young woman Melchert described to me earlier in the week, a 15-year-old girl with what he termed a "crucifix injury." During the quake, both of her feet were punctured through and through by rebar, the metal rods placed inside of concrete.

"Her wounds are healing really nice. She's a really beautiful girl. We actually call her 'princess' because she is so pretty and her family surrounds her like a royal court, they just dote on her," Melchert said. "But she's sweet, and her wounds are healing nice, and I'm switching her to oral antibiotics." If the rebar hasn't infected the bones of her foot, she might well be in the clear.

Even as the number of new cases falls, the clinic staff remains busy with dressing changes — and also with more routine cases like pneumonia, diarrhea, dehydration and stomach pain. "I saw a 4-month-old with RSV [respiratory syncytial virus] bronchiolitis, which is what I would be seeing at home," Melchert told me, adding, "except this baby was severely malnourished, weighing less than a newborn baby does."

There was even a birth at the clinic, a healthy baby born to a young couple. "We're trying to get them a tent so they have somewhere to live after we discharge them from the hospital. The whole thing was a little bit of joy amongst this awfulness."

Transitioning into after-care
Heartline Ministries has been positioning itself to where it thinks it can be most helpful: providing post-hospitalization wound care and rehabilitation to the injured. While they've accepted small numbers of patients from other institutions, the transfer process seems to be hobbled by unseen forces.

"Our plan for this week was to accept post-op patients from other hospitals in town, and primarily from the Mercy Ship," Melchert said. "Every day for the last several days, there's a list of patients that the Mercy Ship needs to unload so they can take more patients. And we're part of those groups that accept them. Something's been going on, though, and they've not been allowed to be transferred and go to other clinics like us. And we're not sure why.

"We're still trying to figure it out, but we think it has something to do with how UNICEF was saying that the adoption out-of-the-country process needs to be more regulated." (Melchert hadn't heard of the Idaho Baptists arrested at the Dominican Republic border with a busload of orphans from Haiti.)

Fear remains endemic
As busy as the hospital is during the day, at night it's completely empty except for Melchert, resting in his bunk. All of his patients — 25 to 30 of them, plus any family members who are caring for them — sleep outside on the concrete pad at the front of the building. 

"It's crazy. We have all this space, but nobody wants to sleep inside. They all sleep outside on the cement," Melchert said. "But after what they've seen and experienced, can you really blame them? One house got demolished and the one next to it is still standing. What is it that keeps that one still standing, and can it fall tomorrow? So that fear still grips the population.

"There's a ton of people living in tents. We went on a tour around the city, into the center of the city to look at the government buildings, and every few blocks there's a whole block of tents just mashed next to each other. And our understanding is that many of the people living in those tents still have a home, they're just afraid to go back."

I asked them if there were really some standing homes — the news footage hasn't shown many.

"Yes. There are places like Leogan where 90 percent of the buildings are flat. But there are parts of the city that were not that severely affected. And so there are homes, there are lots of homes, but people won't go to them, because they're afraid to. And here's an example why: yesterday afternoon, we had a 1-year-old baby came in. A wall that was unstable fell, and a cinder block chopped off both of her heels, and her right foot was badly broken."

And there are other less ugly reminders. Ten minutes after I asked Melchert about aftershocks, which he hadn't felt in several days, he stopped mid-sentence and said in a hushed voice, "Dude…I just felt an aftershock. Yeah... My bed was just shaking. That was bizarre. Wow. That was funny."

Cockroaches and a big spider
Aftershocks funny? Melchert says he is tired but intact. The incivilities of disaster-zone life can get to a person. He occasionally interrupted our conversation with obscene references to the chickens in a coop outside of his bunk window, whose raucous crowing interrupts our phone call, and also the little sleep he gets. In the middle of our conversation he interjects, "These mosquitoes are just chewing me alive — I've got to crawl underneath my netting."

There are the huge cockroaches; bucket-flush toilets; the hot, stale, motionless air; spiders.

"I have a huge spider in my bathroom. The thing is like five inches in diameter. He sits at the base of my toilet. He scares the crap out of me. And he's so fast, no matter what I do I can't kill him. They tell me that he eats insects so he's good. I hope, but...."

And then there's the darkness, the penetrating blackness of a city without power.

"We all wear headlamps. We all have our little REI headlamps that are battery powered, the kind you bring camping. We use them constantly. In fact I use them during the day to get adequate light to do procedures and stuff.

"At night there's no electricity unless our generator runs, and we don't do that to save fuel. The city is dark at night. It's just creepy."