When Jim Smith leaves this week for his third trip to Haiti since January's earthquake, he will take an electrocardiogram machine to replace the one that broke in his destination city of Gonaives.
The Pueblo general surgeon's 17 traveling companions, however, won't include an orthopedist. What would be the point of focusing on broken bones when X-ray equipment in the city's makeshift hospital isn't working?
Gonaives, one of Haiti's largest cities, is miles from the front lines of the disaster left when a magnitude 7 earthquake smashed Haiti's capital city of Port-au-Prince, killing hundreds of thousands and leaving a million-plus homeless. But flooding from 2008 hurricanes had already destroyed Gonaives' main hospital, and now the city of some 300,000 has swelled with about 50,000 earthquake refugees, many of whom have wounds and injuries that have gone untreated for weeks or months.
So the situation is dire, with the rainy season starting and hurricane season still to come. And yet Smith, 55, is already starting to see a replay of the cycle he has observed in nearly 10 years of doing medical work in Haiti.
"You get a lot of attention," he says, "then it kind of dies down to those of us who got hooked for more of a long-term relationship."
Three months after the tragedy, it takes someone like First Lady Michelle Obama, who made a surprise visit Tuesday, to bring the media's attention back. And away from the photo ops, Russell Park, a Colorado Springs resident who's spent long days with Smith and other physicians on two trips to Haiti since the earthquake, says it's often hard to see progress.
"The medical need is as much today as it was during my first trip," Park says, mentioning a private Port-au-Prince hospital that closed this month after running out of money.
Though the American Red Cross alone has collected $409 million to help Haiti recover, Park says private citizens like Smith have done most of the work he's witnessed.
The Red Cross is holding about $200 million for longer-term projects, which Park equates to "ordering dishes for the man who's starving."
Red Cross spokesman Eric Porterfield says his agency is just one of dozens helping in Haiti, with others focusing on medical needs. (Only 1 percent of Red Cross spending has been on health.) Through early April, the American Red Cross had spent $111 million on earthquake response, half for emergency relief operations, chiefly food and deploying 165 disaster specialists to the island nation.
Looking ahead, Porterfield says, the Red Cross plans to allocate nearly 40 percent of its funds to building shelters, with other large chunks going to food, water and sanitation, and programs to help families rebuild their lives.
"We have a ton of experience responding to situations like this," Porterfield says.
Though the suffering in Haiti is still overwhelming, Smith hopes that all the rebuilding efforts will lead to positive change, perhaps helping Haiti escape a health care system where only those with money are able to get care.
"It's going to be a new kind of system for Haiti that's going to evolve," he says.