In Haiti, collapsed roads threaten to keep desperately needed supplies–water, food, medicine–from the people who need them. The airspace at the airport is currently saturated, all flights barred until 8:00 EST tonight. And when supplies get to airport or piers, how to get them to where they are needed is a quandary.

There is no easy answer, even with the US medical carrier under way. Roads full of gaps, chasms and enormous potholes are presumably not going to be navigable by heavy-duty vehicles, however rugged. This is a tragic tug-of-war between immense need and constricted bottlenecks, millions of people needing help that can get to relatively few at a time. The capital city of Port-au-Prince needs human relay chains, bucket brigades and old-fashioned barn-raising tactics to negotiate the rubble. But how can thirsting, hungry, exhausted or injured people come up with the strength? Ideas needed, to say nothing of supplies: Wagons? Sleds with moon wheels? Hammocks?

Gurneys, surely. Drag stretchers?–looks almost helpful.

Same with approach by water surface, up to a point. If the harbor is too dangerous to navigate by ship and piers are collapsing or unreliable, then other smaller conveyances have to be part of the answer.

Undoubtedly the Army will start helio-lifting as soon as humanly possible. So an immediate aim would have to be communicating, to let the populace know that water bottles etc are en route, that they will be air-dropped, and where to stand out of the way but nearby.

I am no tech, but I understand that pontoons can carry impressive loads. However, the approach of supplies via water would also have to be communicated in some way to local people.

Getting help to Haiti is indeed, as we keep being reminded on the air waves, a challenge. One of the hurdles is getting over that tendency to think big, an almost irresistible tendency given the magnitude of the problem. Looking ahead to rebuilding, it would be a good idea to keep buildings in proportion to the inescapable fact of that massive fault line: Collapsing multi-story buildings caused more casualties than other buildings in the quake. For the immediate future, we have to remind ourselves that help has to get on the ground or into the water, by any means possible, however small.

But it is so hard to improvise–even setting fatigue or injury–when there may well be a shortage even of primitive basics like rope and planks. Hard even to rig up even a makeshift litter, hard to rig up a pallet when there is no surplus of mattresses or sleeping bags.

One bit of good news, one small step in the right direction aside from the outpouring of international support, is that refugees are beginning to congregate in makeshift camps in open spaces in the main city. Undoubtedly, as the worst-hit did in New Orleans after Katrina, they will begin to organize in some fashion.

If only help can get to them in time. It is terrible to feel so helpless to help.