As a nurse working in northern Haiti, Melissa Curtice doesn't have the luxury of modern medicine.
In one corner of the room - a baby born prematurely weighs less than three pounds. In the other, pregnant a mother struggles. The only oxygen machine in the clinic is taken from the preemie to help save the unborn baby.
The head nurse says the clinic does not have the capability to do a cesarean section so "so what's going to happen is going to happen."
Haiti "has one of the worst maternal mortality rates in the world - the numbers in Haiti speak for themselves," says Curtice, the assistant medical director of the Northwest Haiti Christian Mission.
About a hundred miles northwest of Port-au-Prince, the city of Port-de-Paix - population 250,000 - has no paved roads and limited electricity. It's the poorest part of Haiti and a stark reminder of the state of health care even before the earthquake struck on January 12.
By 8 a.m., 400 patients are lined up at the Northwest Haiti Christian Mission. It has one of the best medical clinics in the area.
The mission saw the effects of the earthquake immediately, Curtice says.
As many as 700,000 people left Port-au-Prince after the quake. An estimated 50,000 came to the Port-de-Paix area. Mary Saintfluer.
She says her house fell down on her, the roof literally landing on her head.
A steel door crushed Mary's leg and broke her foot. The leg is badly swollen and she came to the clinic because she's afraid of losing it.
Even a simple x-ray would help the doctors figure out why her thigh is so swollen. But there's no x-ray machine here and Mary can't afford the fifteen dollars it would cost at the public hospital.
At the hospital, Dr. Milon Osnel can do x-rays but little else. They have little equipment, he says. His patients don't have enough food or medicine. There aren't even any toilets inside the hospital.
Usnel especially worries about the sickest patients.
"They are going to die," he says.
The earthquake crippled a health care system already desperate for a government overhaul. But the disaster incapacitated the government too.
Forty-nine of the 80 public hospitals in Port-au-Prince were damaged or destroyed. An estimated 10,000 non-governmental organizations, or NGOs, have stepped up to care for the 2 million homeless living in tents.
Dr. Reginald Lubin is a Haitian doctor working for the NGO World Vision. He calls the situation a "formula for disaster."
"When you look behind you there is not enough space, not enough sun. People are living in proximity and you have all the risk of epidemics," he said.
Diseases like typhoid and hepatitis are particular threats. And without clean water or proper shelter, the best efforts of NGOs are not enough.
The Ministry of Public Health building in Port-au-Prince lies in ruins. But rebuilding it will be the easy part. The hard part: creating, for the very first time, an effective public health system.
But to do that there needs to be leadership and coordination under a strong central organization.
Dr. Gedeon Gelin is a former government health official. He says the outlook is not good.
"In my mind, it is very clear that the health system will fail," he said.
To keep the system from failing there is a call to decentralize Port au Prince, moving the resources into outlying provinces. Meanwhile the NGOs must work to train the Haitians they are working with so that ultimately it's the Haitians helping Haitians.
As the nation struggles for survival, back at the clinic the two babies do the same.
"My heart was breaking because I see that my child is so weak," the mother of the premature baby, Dealereau Klevilla, says through a translator. "God gave me this child. If he takes it, it's his will."
In the U.S., over 90 percent of such babies survive. But after five days, the baby boy died.
While one mother grieves, the mother who struggled welcomes her healthy baby girl into the world - a six pound, 11 ounce symbol of Haitian resilience.