LEOGANE, Haiti -- This city vanished in a cloud of brick, dust and blood, and a team of Pittsburgh doctors is attempting to piece the survivors back together.
"There'll never be an accurate account of how many people are dead," said Dave Lebec, a doctor from Bradford Woods who was among a team that flew here on Sunday, part of a crew working with the Medical Benevolence Foundation.
Leogane was at the epicenter of the Jan. 11 earthquake that flattened so much of the western hemisphere's poorest nation. In this town, 80 percent of the population was already living in poverty. Now, they also are living outdoors.
Taxpayers will be able to deduct donations for Haiti earthquake relief on their 2009 returns instead of waiting until 2010, under a bill Congress unanimously approved.
The Haiti Assistance Income Tax Incentive Act passed unanimously in the Senate and House last week, and President Barack Obama signed the measure into law.
The legislation allows taxpayers to claim charitable contributions to relief efforts until March 1 as deductions on their 2009 tax returns.
-- Bloomberg News
"It's very much hand-to-mouth living right now," Dr. Lebec said.
Much of the city's remaining census could be taken outside the chain-link gates of the FSIL Nursing School. It somehow survived the quake and became headquarters for a clinic that sees an unceasing stream of wounded.
Tents, shacks, lean-to sheds and anything else that resembles a shelter are lined up in a grid. Haitians driven from their homes expect to be here a while: they have numbered the sectors, put up signs and given their makeshift streets names.
A crew from CARE came through town to assess needs. Klaus Palkovits of the Austrian Red Cross did an assessment for the U.N.
"You can see the destruction here is almost 100 percent," Mr. Palkovits said.
Dr. Lebec recalled his ride into town.
"The buildings were collapsed. Some of the roads were impassable," he said. Professional schools around the island were especially hard hit. Institutes for economics, universities, training schools -- almost all of them multi-story buildings -- toppled.
"A lot of the Haitian leaders of tomorrow are lost," he said.
He is an anesthesiologist -- a profession deeply needed in this city where limbs were crushed as buildings pancaked onto themselves, trapping the survivors.
Initial surgeries, by a team from Japan, lacked pain killers.
The doctors, led by Chip Lambert of Allegheny General Hospital, set up in the FSIL Nursing School. The hospital nearby fell in the quake.
Since that time, with colleagues from Pittsburgh, Iowa, Maine and New Jersey, they are treating hundreds of patients a day. Each emergency doctor sees an average of 50 patients a day. Orthopedic surgeons handle from 20 to 30.
"We go nonstop from the time we get up in the morning to the time we go to bed. We never turn away a case," Dr. Lebec said. The utter devastation of the town and surrounding villages left an uncountable number dead and still more homeless.
Barely a person in this city of 200,000 escaped some sort of loss or injury.
How much of the city is gone?
"All of it. All of it. All of it," said Armand Herve, who lost his home, his work and his mother. He shook his head, staring at a three- story building that tipped over. "Everybody's in the street now," said Mr. Herve. "I ain't got nowhere to stay right now."
At the clinic, Dr. Lebec and a Pittsburgh colleague, Jeff Mulholland of Heritage Valley Health System, attended to Anita Aristil. Her leg was lacerated to the bone. The idea was to save it.
Dr. Lebec, an anesthesiologist, rushed into the operating room: it is one of two bedrooms. The school never had operating rooms.
"We'll go in there, get out all the dead and diseased tissue," he said. "We're trying to save as many arms and legs as we can."
Earlier in the day, Dr. Mulholland had hiked three kilometers to the beach where he discovered two young boys with injured limbs. Crews had to walk because the quake split the road apart and a truck couldn't pass.
The pair took their spots in the recovery room alongside Mrs. Aristil.
It is a canopy on the lawn outside. Next to it is the waiting area. Across, under another set of tents, is the outpatient treatment area.
Mrs. Aristil waited for the anesthetic to wear off while her husband harried doctors with a question: Why can't she stay here?
The simple answer is there is no room. Every inch of the clinic is filled. The waiting room is outside. The recovery room is near it. Bedrooms are operating rooms and a hallway is where X-rays are taken and casts plastered on.
"Look at this," said Dr. Shane Hollawell, who waved an X-ray negative, reading it in the sunlight. Side-by-side were a broken leg and a fractured wrist.
"She had some buildings fall on her wrist and her leg," said Dr. Hollawell, an orthopedist from New Jersey.
He called the woman lucky.
The bone didn't break the skin. Festering wounds atop fractures have cost thousands of limbs in Haiti.
"We've done some amputations because of open fractures," he said. "We've had some loss. You have to see the bigger picture and the greater good that's going on. You have to move on to the next patient."
Dan Towle, a doctor who flew in from Kansas City, arrived in time to treat a premature infant. Unable to digest his mother's milk, the child's bowels burst. Infection set in. Dr. Towle was holding him in the back of a military Humvee, waiting for a medical helicopter to take him to the hospital ship Comfort, anchored outside Port-au-Prince.
The infant died in his arms.
"You're not going to forget something like that," he said.
Haitian resilience struck Dr. Mulholland with particular force. He saw the new shantytown go up outside the gates of FSIL, he saw the locals pray.
"They're up early every day, praying and singing," he said. Then they go to what could become a permanent set of homes, covered with plastic and loose tin. "But the problem," he added, "is when the rains come in."
Last night, the clear Haitian sky clouded over. A few drops were felt in Port-au-Prince. At some point, that rain will come to Leogane.
Dennis B. Roddy: firstname.lastname@example.org or 412-263-1965. First Published January 27, 2010 5:00 AM