Overnight, several patients have died, of a combination of their injuries and sepsis; we have run out of antibiotics We have never had enough pain medicine, and the usually stoic patients are now succumbing to days of unrelieved pain.

There is a gap between the images of the national news media of incoming flights and media moments with senior visiting dignitaries, and our reality here. Our surgical and nursing team is overwhelmed by the need.

Their days of non-stop work will not end today or tomorrow. At the same time, teams of qualified surgeons and other specialists are at airports in Miami and the Dominican republic, trying to get here to help. For many, it will be too late. We must find a way to speed up arrivals for these key people to come in.

We still do not have cell phone connections inside Haiti, and the few international cellular systems are overloaded, so we can speak by phone to the US only at night. The Internet has been a great help - our new satellite connection was installed the day before the earthquake, and we have good contact through that system. But it doesn't do much good, if all we can talk about is how it is impossible to get here.

This afternoon, a small group of surgoens might arrive overland through the Dominican Republic, which will be a great help, but we are also hoping for several specialists in orthopedics and neurosurgery who are waiting to get here, will be able to arrive soon.

This is only the second phase of a 3-phase disaster; after next week it will be clear that the quake has destroyed the capital's health infrastructure, and the emergency tent hospitals will not be a long-term solution. HAS will need to be able to make substantial changes in order to assist in the design and management of a decentralized hospital system for the future.

Ian Rawson