Courtesy of the Edward Via Virginia College of Osteopathic Medicine

Students Max Bursey (left) and Austin Nabet work with a patient. They were part of a group from the Edward Via Virginia College of Osteopathic Medicine who helped after the earthquake.

Courtesy of Dr. Jeannette Capella

Dr. Carol Gilbert, a Carilion trauma surgeon, hears a report from a Belgian doctor while checking on a young patient.

Courtesy of Dr. Jeannette Capella

Medical student Lauren Mientkiewicz with a few Haitian children in one of the clinics that the team from the Edward Via Virginia College of Osteopathic Medicine visited. Courtesy the Edward Via Virginia College of Osteopathic Medicine

The rain is coming in Haiti and health concerns are mounting.

Aid workers who have recently traveled to the quake-stricken country are worried.

"When the rains come, there is going to be immense flooding where all these people are," said Genie Lindsey, a nurse with Carilion Clinic who recently spent a week providing health care in Haiti. "Malaria is going to be just unstoppable, tuberculosis will come as they crowd closer and closer."

Spring rains typically begin in February, building up to hurricane season in June.

People living in makeshift tent communities along rivers filled with debris are susceptible to disease.

Lindsey was one of several health care providers from Roanoke who recently spent time in Haiti. Surgeons from Carilion, community doctors and pediatricians, and a group of 38 students and faculty from the Edward Via Virginia College of Osteopathic Medicine in Blacksburg also have made the trip.

The VCOM trip had been planned as a weeklong educational trip before the earthquake. The group intended to head to the Dominican Republic to teach medical professionals emergency response techniques. But the trip turned into a response effort, with the team traveling to the Haitian border to help treat victims.

"All of them were extremely grateful and pleased and asked us to come back on a long-term basis to assist in a variety of medical outreach," said Dean Sutphin, assistant vice president for international and Appalachian outreach at the school.

The group was there from Feb. 1 through 7.

By last week, the World Health Organization estimated 160,000 people had come from Port-au-Prince to the Dominican Republic border.

VCOM already operates a clinic in the Dominican Republic, where about 50 percent of the people served are Haitian, Sutphin said.

Lindsey worked with the nongovernment humanitarian aid organization Operation Smile from Feb. 2 through 13, treating patients with amputations, wounds and injuries.

Other area medical professionals are also trying to raise awareness about the ongoing needs in Haiti.

"I just want people to keep an awareness that this is real and it is happening," Lindsey said. "These are families and children. If there are doctors and nurses who can go down, they should."

Dr. Adam Sarbin, a pediatrician at Physicians to Children in Roanoke, spent a week in Port-au-Prince with about a dozen other volunteers in a group organized by Roanoke-based Angel Missions Haiti. They returned Tuesday.

"Under the best of circumstances in Haiti, there will always be a need for not only medical help," Sarbin said. "Now, having been there, it's clear it will be years before that need is satisfied."

Sarbin also noted rebuilding the country's buildings, homes and infrastructure will all play a role in meeting the medical needs of the country.

"There are a lot of skills that are going to be necessary, there are many needs," he said.

Health care workers also notice that although they are still treating earthquake victims, many injuries and illnesses are shifting away from emergency status.

Dr. Carol Gilbert, a trauma surgeon at Carilion Clinic, said during the two weeks she spent in Port-au-Prince she not only treated injuries from the disaster, but also saw many patients with chronic diseases and conditions that predated the earthquake.

"There were quite a few who were very sick and had never had access to care," she said.

Gilbert and Dr. Jeannette Capella, another Carilion surgeon, have been trained for a federal program providing medical care during disasters. Gilbert responded after Hurricane Katrina; Capella had assisted after Hurricane Rita.

In Haiti they both worked 12-hour shifts at a field hospital set up by the U.S. Department of Health and Human Services and guarded by troopers from the U.S. Army's 82nd Airborne Division.

Both doctors said helping in Haiti was an entirely different experience than helping after U.S. disasters.

"It was way more intense and way more austere," Capella said. "We saw many more sick patients, a lot more as far as volume."

Austin Nabet, a first-year medical student at VCOM, was a paramedic for nine years before deciding to attend medical school. He has also responded to past disasters and said many people could slip through the cracks in Haiti.

"People were so sporadically and randomly coming in," he said. "They were lost track of. ... They just don't have infrastructure to handle that load."

The International Medical Surgical Response Team, the group Gilbert and Capella worked with, treated 1,300 patients in two weeks. The group performed 258 medical procedures, including 50 major operations, Capella said.

Forty percent of the patients were children, and Gilbert said 15 babies were delivered while she was there.

With medical supplies scarce, the volunteers had to make do. They used rubble as weights and splints. They made incubators for babies from cardboard boxes lined with reflective foil emergency blankets. They substituted an old army gurney for a backboard and used taxis as ambulances.

Officials and medical personnel say the needs will grow. But the Haitian health care community could be overwhelmed by the shift as emergency response teams leave, Gilbert said.

VCOM is planning a second trip in April to the Dominican Republic to do the emergency response training they had intended to do this month.

"It is still important to have the training for disaster preparedness and emergency response," Sutphin said. "We're not sure if we will include a response component near the Haitian border, but we are paying attention to the situation."