LES CAYES, Haiti — When shaking started on the morning of Aug. 14, Dr. Antoine Titus was still in bed.
It was 8:29 a.m., and the 32-year-old emergency room physician was about to get up and get ready for work at the general hospital in Les Cayes.
What should have been an ordinary Saturday at the ER instead became a day he cannot forget. For what seemed like 10 minutes, Titus watched the earth shake and homes collapse as his neighbors — the ones who survived, at least — prayed and cried.
"After that, immediately, I put my clothes on, cleaned my teeth, washed my face and came to the hospital," he said.
He hasn't slept at home since.
The 7.2 magnitude earthquake that struck Haiti's southern peninsula buckled cinder block walls and sent heavy cement floors collapsing atop one another like grim stacks of pancakes, crushing arms, legs and entire bodies.
By the time Titus arrived at the hospital, desperate families with gravely injured relatives had packed its courtyard. Several hospital employees left to check on their own homes and families, leaving Titus with only about half a dozen colleagues to work with.
With so many crushed limbs and broken bones to treat, there was little time to move those who died to a proper morgue. Instead, Titus and his staff stacked the bodies in a corner and directed panicked people looking for missing relatives to sort through the bodies on their own.
The worst part, he said, was the crying parents holding terrifyingly still children and infants, pleading with him to help.
"Their parents were like, 'Please do something, do something for us.' We tried to do our best, but the kids were already dead," he said.
That night — and the next, and the next — he slept in an ambulance in the courtyard.
Aid groups have arrived, but their reputation is mixed in Haiti
Now, with two weeks passed, the courtyard is more orderly, with a set of benches underneath the shade of a UNICEF tarp serving as a waiting room. Staff from humanitarian groups Doctors Without Borders and Team Rubicon are helping triage and treat patients.
They are seeing more than 100 patients a day — but Titus said the difference now is he has time to breathe.
"There's a big difference, because right now I can talk with you. And I'm not sweating," he said with a laugh.
Titus is thankful for the help of the aid groups, who arrived several days after the earthquake.
But humanitarian groups have a mixed reputation in Haiti. Their expertise, supplies and staff are badly needed, but they are dogged by criticism that they parachuted in and pushed aside Haitians during previous disaster responses — especially the 2010 earthquake in Port-au-Prince.
"I think the field of humanitarian response has learned a lot from the 2010 earthquake and tried to change a result," said Dr. Morgan Broccoli, an emergency physician at Brigham and Women's Hospital in Boston, who flew to Haiti to participate in the response with Team Rubicon. "It was important for us to be directly invited into a hospital by the leadership and to work in close collaboration with the Haitian doctors and nurses."
Team Rubicon says it is working under the strict direction of Titus.
When Titus first learned that aid groups would be arriving to help, he said he worried about how they might interact with him — especially given that the American-based crews are mostly white, and he is not.
"I was like, I'm a Haitian. Are they gonna act like — ," he said, hesitating, before adding: "Because I'm Black, and all that? No. They are family."
Now that the acute medical needs have waned, one aid group has already left, he said. Team Rubicon is preparing to pull out in the next few days.
The long-term picture is filled with challenges
Unresolved are questions about the hospital's longer-term needs. Its two main buildings, both multiple stories tall, have cracked walls, making them unsafe to use. Hospital staffers are using them for administrative purposes, but no patients can stay inside. Titus said structural engineers from international aid groups came out to survey the damage, but there's no word on when repairs might be made.
Other medical facilities in Les Cayes are damaged or entirely out of commission, including the Lix medical clinic, where the ceiling of the second story collapsed onto the floor.
This month's earthquake dealt yet another setback for Haiti's beleaguered health care system, which faces chronic underfunding, understaffing and lack of access in rural areas.
In Haiti, there are about 25 doctors and 11 nurses for every 100,000 residents, according to the World Bank. In comparison, the U.S. has roughly 10 times the number of doctors and 20 times the number of nurses. And doctors are often lured from Haiti's public health system to higher-paying jobs with international aid groups or abroad.
Titus said he feels the pull. He wants to open his own emergency health care facility. Before this month's earthquake, he had committed to leaving Les Cayes for a three-year residency program at a prestigious hospital to continue his training in emergency medicine.
But he insisted he will open that facility here in Haiti.
"I want to do that for the country. There are so many people that are leaving the country," he said. "I have a brain that has so [much] in it – I have to give them to my people. I have to help them."