By Catherine Bremer PORT-AU-PRINCE (Reuters) - The key to working in a disaster zone hospital, where casualties pile up faster than patients can be discharged, is to avoid getting emotionally involved, says Dr. Ofer Merin, an Israeli army trauma surgeon working in the earthquake-shattered Haitian capital.
Dr. Merin, heading a fully equipped hospital brought in by the Israeli military, said the hardest job was triage -- deciding which casualties were most likely to live with quick treatment or most benefit from intensive care without blocking up beds.
It also is vital not to fret about what will happen to orphaned children with limbs in casts who have to be discharged to free up needed beds, Merin said.
"These are ethical decisions we're not used to taking," he told Reuters on a break from his around-the-clock schedule.
"You try to have almost no emotional connection with the patients, which is so different to what we do back home. You just cannot get emotional in a disaster this big."
He breaks into a grin, though, over four babies born at the camp hospital. One of them is a tiny girl named Sourire -- French for "Smile" -- whose two-months-premature birth may have been triggered by the trauma of Tuesday's massive earthquake.
As Merin shows off the facilities, a skinny 6-year-old girl called Jessica is carried in, plastered with grime, dust and flies, and is scrubbed from head to foot with disinfectant.
Six days after the quake, she has just been dug out of the rubble of her collapsed family home. She is too weak to stand so her aunt, who cannot stop repeating "Thank you, God," holds the trembling girl upright for a nurse.
"When they lifted her out we could not believe she was alive," the aunt told Reuters. "She opened her eyes wide and said, 'My name is Jessica Chatain and I am hungry and thirsty.' She didn't cry but her parents wept a human sea."
The magnitude 7.0 earthquake killed up to 200,000 people and has left countless victims with horrific injuries.
Foreign governments and aid agencies have flown in medics from around the world but they were only able to get to work in the past couple of days. Some are working in dilapidated hospitals crammed with wailing patients in insanitary conditions.
HARD NOT TO CRY
Set up in green army tents on a soccer field near the airport but equipped to treat even complex injuries, the Israeli military hospital is strangely quiet and scrupulously clean. Patients are identified with bar codes and their progress is tracked on a computer network.
Within hours of the surgeons, paramedics, nurses and soldiers landing late on Friday, people on makeshift stretchers with crushed, gangrenous limbs were lined up outside for beds in the intensive care, pediatric, orthopedic and other wards.
More than 300 patients have been treated and discharged.
In intensive care is a woman whose arm was cut off at the rescue scene to free her. In the operating theater another woman is having her leg amputated above the knee to save her from a potentially lethal infection.
Experts say that with earthquakes, trauma to the head often means instant death and chest trauma can mean dying a day later. With damage to limbs victims can survive a few days before the infection of an open wound or broken bone sets in.
"That's why at this stage most of what we're seeing are orthopedic cases," Dr. Merin said.
He tries to stick to his ban on sentiment but wavers at the sound of nurses cheering on another woman in labor in the maternity ward tent.
Jessica was buried alive because she tried to hide under stairs when the rest of her family jumped out of the window of their home. Now she lies contentedly in the pediatric ward with a drip in her arm and Dr. Merin cracks a little bit.
"Six days underground and look at her now," he mutters. "She's going to be fine. These are the times it's hard not to cry."