PORT-AU-PRINCE, Haiti -- The orphanage that was the focus of a dramatic rescue of Haitian children after the Jan. 12 earthquake remains in crisis, with ailing youngsters -- one of whom died -- and a director who plans to leave soon for Florida.

Approximately 34 children were still at BRESMA -- short for Les Brebis de Saint Michel de l'Attalaye -- as of last week. Most of them are destined for adoptions in France, while 12 are stranded with no pending adoptions.

Jamie and Ali McMutrie, the sisters from Ben Avon who cared for the orphans at two of three homes BRESMA keeps in Haiti, have been struggling for weeks to bring the stranded children to the United States.

The McMutrie sisters last flew to Port-au-Prince on Jan. 30 to deliver supplies to the orphanage and to make a brief, unsuccessful bid to bring the stranded children with them on the flight back to Western Pennsylvania.

They had attracted earlier international attention as part of a rescue mission led by Gov. Ed Rendell and Rep. Jason Altmire. That delegation managed to land on Jan. 18 at the Port-au-Prince airport, which has been closed to most civilian traffic, and arrange the return of the McMutrie sisters, along with more than 50 orphans with pending U.S. adoptions.

The orphans who remained at BRESMA were to be taken by other nations. But since that rescue, the sisters learned that 12 children who they believed would be among those taken for adoption by the French were not accepted.

Those children now sleep outside in tents and under tarpaulin canopies because managers fear an aftershock might topple the orphanage, which overlooks a crevasse along a dusty, unpaved road in one of this city's poorest sections and among the places hardest hit by the quake.

Cribs line a porch, and children play on a cement driveway amid swarms of flies. Until last week, there was no medicine to be found. Several children were taken to a hospital in the nearby city of Tabarre, and one of them died Tuesday morning of intestinal illness.

Conditions at BRESMA improved slightly after a medical team from Puerto Rico rushed in at midmorning Tuesday, examining dozens of children. The timing of the team's arrival was a coincidence -- the medics were alerted by officials at the University of Pittsburgh Medical Center, but they did not know some children had been hospitalized.

One child was diagnosed with malnutrition and pneumonia. Another has a congenital heart defect that a doctor said will likely kill the boy if he does not undergo an operation to repair a faulty heart chamber.

"It looks like something out of Somalia," said Tomas Ortiz, the leader of the Puerto Rican medics, as he watched a nurse feed nutrient water to a child identified as Peterson Pierre.

The boy's legs were spindly and thin, and he had been unable to eat for several days, staff said. Before the doctors arrived, he lay in a crib near the locked, steel front gate, motionless.

Mr. Ortiz said the youngster likely would have died in three days if no one had intervened.

"This was a good day for these kids," Mr. Ortiz said.

Doctors set about corralling some of the children for exams, making balloons by inflating latex surgical gloves, then drawing faces on them. One doctor lay on a mat that was stretched on the driveway and amused a youngster.

Mr. Ortiz complained that the orphanage staff appeared disorganized and did not immediately produce medical records for the children. Because of this, the medics assigned each child an identity letter, applied with tape to their clothes, to correspond with new records generated by the exams.

Shortly afterward, the existing records came out from a back room.

"Their mind is not engaged in what they're supposed to be doing," Mr. Ortiz said.

The orphanage's executive director, Margarette St. Fleur, identified the child who died last week as Vaniola Zamy and gave her age as 1 year. Two other children were later brought back to the orphanage after their hospital stays.

The child was among those scheduled for a French adoption, according to Jamie McMutrie. The sisters are now planning to go back to BRESMA, possibly this week. Jamie McMutrie said they will either come home with the stranded orphans or stay to watch over them.

As the medics arrived, Ms. St. Fleur was preparing to leave Haiti to join her family in Miami. She agreed to delay her departure by a few days to allow the McMutrie sisters to travel here to oversee the children.

By week's end, it remained unclear when she planned to leave or who would be left in charge. The development sent volunteers in the United States scrambling for a way to rescue those children.

"She's not normally at the orphanage. She's a businesswoman," said Jamie McMutrie, who said Ms. St. Fleur rarely shows up at the BRESMA buildings and lives in a separate house. Ms. McMutrie said Ms. St. Fleur had never allowed her or her sister to know the location of her home and said they became disillusioned with her management of the orphanage even before the quake.

Ms. St. Fleur hurried to the orphanage Tuesday when the medical team showed up. She then announced that four of the children were about to be sent to France and left the building with them before doctors could look at them.

"They really didn't look that healthy, either," said Mr. Ortiz.

Miguelangel Marzan, one of the doctors, went on an unsuccessful search of the house for basic medicines. He said he could find none.

"Every one of them is dehydrated. And that sun is warm. They're all warm," he said.

Doctors examined several children for stomach parasites -- worms, which required a simple pill to resolve. Others were found with scalp infections.

"I want you to listen to this," said another of the doctors, Hernan Gaztambide. He walked to a crib where a toddler named Schneider Marie-Charles lay sleeping. The boy is among the BRESMA orphans slated for adoption in France.

Pressing a stethoscope to the child's chest, Dr. Gaztambide found a heartbeat that included a whooshing sound.

"The heart has four chambers. In his case he has a congenital malformation in which one of the walls is incomplete," he said. "With that defect, we're talking [survival] not past five years. It's a 11/2-hour operation in the United States."

It is not clear if or when Ms. St. Fleur plans to return to BRESMA.

While the American government had granted clearance for children who had adoptions pending prior to the quake to enter the country, the dozen still at BRESMA had no prospects.

Lawyers for the McMutries last week remained in negotiations with the Department of State in an effort to get clearance to bring those children to the United States. Efforts on their behalf were stepped up after the sisters learned of conditions at BRESMA.

Ms. St. Fleur said she has sent paperwork for the 12 remaining children to the McMutries so the sisters can take charge.

Asked if the children were ill, she said, "not really."

Ms. St. Fleur's visit was brief.

Unnoticed for most of the time, sitting side-by-side on a bench at one side of the yard, were Jean Luckson Lubin and his wife, Vita Lebreton. They had come to ask about two of their children, whom they gave up for adoption.

Thousands of Haitian children are given away every year by parents who say they cannot care for them in this poorest nation in the Western Hemisphere. The Lubin children, their parents learned, were among a group sent to American families after the quake.

The couple had nine children in all, and gave away their daughter, Dayana, 7, and son, Moise, 5, for BRESMA to put up for adoption. Of their remaining seven children, they said, one was killed in the earthquake.

"We don't have enough for the children," Mr. Lubin said. The couple traveled from a town outside Port-au-Prince to ask who got their children and how they were doing.

"I just want to know how the children are going to be," he said. "I just want the children to have a better life. I would be happy to see them again."

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