The great roar sounded like the end of the world.
At first Jim and Sandy Wilkins thought the shaking was coming from the generator for their second-floor apartment in Gressier, Haiti. Then ceiling tiles began to drop and the floor cracked apart. They leaped to safety through a hole that had opened in the wall.
Within minutes, the first truckload of injured arrived at what was left of their medical clinic.
The victims were mostly children, Sandy Wilkins, 54, wrote in a text message to her family in southeast Kansas. Gruesome injuries: crushed skulls, torn-off limbs. Tiny children, some dead, some paralyzed forever.
"Six people died in our immediate work. Many more will. Many open fractures. Two little girls paralyzed, horrible lacerations that you cannot imagine... they come in droves, desperate for help... We had only two docs, although our eye doc is sewing up head lacerations.... We are exhausted. We have almost no supplies and medicines left. Please pray for us..."
Sandy, a nurse, and Jim, 59, a family physician, moved to Gressier from Girard, Kan., 11 years ago.
Haiti needs us, they told friends and family. They had been on medical missions to many places, but Haiti grabbed their hearts.
Investing their life savings in a tiny patch of land, they set up a clinic in the area nicknamed Christianville, west of Port-au-Prince. They embraced the hardships of their new home in a Third World country.
Just last year, their nonprofit Haiti Health Ministries Inc. treated more than 25,000 patients. A typical day begins with people lining up at 4 a.m. and waiting for their turn to see a doctor.
Now the clinic is destroyed, along with medical equipment that took years to buy. Their supplies of medicine, buried under rubble.
But the patients keep coming.
Daughter Rachel Stevens, 29, a family physician, learned about the earthquake in a phone call from a friend. Within the hour, three more friends had called. The first news reports were sketchy.
Everyone waited hours to hear anything more.
"I have cried more in the last 24 hours than in my entire life," Stevens said. Finally, an e-mail came from another missionary, alerting her and her sister that their parents were safe. "We're so relieved to hear they're OK but the physical and emotional toll this is taking.... They are seeing things people shouldn't see."
Stevens, her husband and her younger sister, Amanda Lehman, a nurse, are organizing medical supplies and physicians to go to Haiti to help their parents. Both daughters have spent hours on the telephone and online, trying without luck to arrange transport.
They hope to get to their parents, with supplies, within the next week, Stevens said.
"Right now, the most pressing issues they have are survival. There is no clean water. They're boiling whatever they can with a small amount of the fuel they have left. They need food, water, clothing. People need surgeries but they can't do it without supplies. And without supplies, they're only able to do basic first aid."
She knows her parents are triaging each patient, working with those they can, trying to ease the pain of those they know will not survive. Difficult decisions that must be made in a disaster, she said.
"They're focusing on saving who they can save... but the basics of this country are gone.... Everything's gone. They'll need a lot of help to rebuild what they had."
Stevens, a University of Kansas graduate, worked at Research Medical Center before moving back to southeast Kansas three years ago to practice family medicine.
Last year her best friend, Amber Botros, a family physician from Kansas City, worked two weeks at the Christianville clinic. Botros returned to Kansas City changed by her time in Haiti.
"The Wilkinses are amazing people," Botros said. "They devoted their lives to helping the people of Haiti. In the two weeks I was there I saw so many illnesses and injuries, sick people who, if they were here, would be immediately admitted to a hospital.
"But there, you have to perform bedside surgeries.... Everyone was so appreciative. What the Wilkinses are doing with their lives, showing love like that, is absolutely amazing. This is a time when they need our love and support."