By David Colbert, MD for The New York Post

Forgotten sometimes in the heartbreaking death count from the Haiti earthquake — more than 200,000 at last estimate — is the toll on the survivors. Loss of relatives, children, businesses, homes, sanity, all of these, but also, in a shocking number of cases, the loss of a limb. The quake will leave its mark for a generation, you’ll see it in the absence of arms and legs.

In only my first few days volunteering in Haiti last week, I witnessed 40 amputations, performed without the benefit of standard operating room conditions. International aid groups say the final tally could number in the thousands.

I arrived in Santo Domingo on late Friday, Jan. 29, with my medical assistant Paul Hogue, lugging monstrous black duffel bags packed with medical and surgical supplies. At 4 a.m., we boarded a bus for the border crammed with some 20 surgeons, several operating room nurses, anesthesiologists, intensive care unit specialists, counselors and medic-volunteers. Many of us had gotten the invite from the Dominican Republic-based Esperanza Foundation. Mass e-mails went out across the world, bringing wave after wave of medical personnel, who, despite the numbers, would still be hard put to handle the task at hand: a city of 4 million people, many of them survivors desperately in need of immediate medical attention. The five-hour ride is somber. What we’re feeling mostly is fear.

The hospital is a makeshift MASH-style unit without the bravado. We drive in through heavy iron gates and see a big white plantation house surrounded by Haitian mountains, the sky and the landscape transformed by Red Cross trucks and US military helicopters. There are patients on stretchers being pulled off of jerry-rigged truck-ambulances, which appear to arrive every five minutes. Many of the wounded have been literally dug out from the rubble with bare hands. Some survived up to a week without food and water. It hardly seems possible.

Inside, the first floor had been set up as so many operating rooms. Cafeteria tables serve as surgical ones. Just about any direction you look, there’s blood. The noise level is notable: children sobbing and doctors and nurses shouting. This is a kind of systematized pandemonium — a field hospital in every sense.

The surgeon looks up. “Hey, doc. Please explain to this patient we are NOT going to amputate her foot any further. We are simply planning to clean the wound.” The 23-year-old woman looks at me, expectant and terrified. I try my Parisian French, dressed up for some reason with an authoritative Southern American accent. Voila, I am apparently speaking Creole. She smiles beautifully when she hears what I have to say.

In the next room are three little girls, all under 10. Each has a broken leg, none are casted. Young orthopedic surgeon Dr. Meredith Warner of New Orleans explains that the large metal posts on the table are used instead of casting because they are both stable and carry minimal risk of infection. It’s not pretty. The metal protrudes out from the bone and through the skin, with the overall effect of an erector set. Paul and I exchange glances, wondering who will remove the metal rods in six weeks. When I ask Meredith, she shakes her head ruefully. Another orthopedist answers, “One step at a time.”

The facts are not lost on any of us: When the dire urgency of life or death is over, the survivors will be in chronic need of follow-up medical care. Nobody here yet knows where that’s coming from.

In the next room is Wilfrid. He is 19 years old. He cries that he will lose his leg. He knows this, but still hopes to hear otherwise. He tells me he was trapped for days under piles of bricks. The morphine gives him temporary emotional relief from the enormity of what is about to happen, and he is wheeled into operating room No. 4, a former pantry. Wilfrid attempts to make the sign of the cross, but the drugs kick in before he’s finished. Later I’m told that he had been on a gurney in a Port au Prince emergency room for four days, but there were so many cases even more acute, he didn’t get care. The leg could have been saved.

Young, healthy, and naturally sunny, Wilfred does well post-operatively. When I go to see him the next day to change his dressings, he’s in unaccountably good spirits. He tells me, “J’etais libere,” that he feels he has been “set free” by the surgery. The worst is apparently over: the pain and the fear. But several times, he asks me where he will get a new leg. His concern is about going back to work at his factory, and he can’t work with just one leg. “Je dois travailler” he keeps repeating. Perhaps unwisely, I say, “The Americans can get you a new leg. It may take time. But we’ll get you a leg.”

I’m not sure I believe “we” will. As he repeats his mantra, I begin to think the thing through: Who can I contact to ask about prosthesis? Who will measure it, make it, ship it, attach it? How will all this actually happen?

I write down Wilfrid’s name and his cell phone number. Perhaps it’s a small irony of modern life, but the leg had been crushed by the earthquake, but not his Nokia. I add his name on my BlackBerry contact list. He has no address anymore. I’ve heard it so many times, that each of us can make a difference. If we all do one small thing, we can tackle something big — even as big as this. As Wilfrid and I say goodbye, I figure mine will be to get him his leg.