CAP HAITIEN, Haiti – Women and children crowd up to the door of the Justinian Hospital’s pediatric outpatient clinic, waiting to see the health agent, who can help them with basic needs such as vaccinations or checkups.

Inside, a newer power backup system keeps the lights on at night, even during the frequent blackouts. The hospital was able to put away the kerosene lamps it had lit – a serious danger around the oxygen used for patients.

And in a neonatal intensive care unit, family members watch over quiet babies in incubators, as doctors talk to parents of new patients.

”Every bit of equipment in there is from Maine Med,” said Nate Nickerson, executive director of Konbit Sante, a Portland-based nonprofit. The group has been working for nine years to help improve northern Haiti’s health care system through its work at the Justinian Hospital and a clinic at Fort St. Michel, Cap Haitien’s poorest neighborhood.

In fact, signs of Maine are everywhere in the Justinian Hospital.

Over the years, Konbit Sante has secured donations and equipment for Justinian. The pediatric outpatient clinic was built by the group, which also pays for the health agent. The power system was installed by Konbit Sante volunteers from Maine. Maine Medical Center’s equipment donations came through Konbit Sante. Doctors, engineers, electricians and others from Maine are often at the hospital.

”Twice a year they come with big containers, with many materials,” said Angelina Laine, director of the nursing school at Justinian. ”We get good help from Konbit Sante.”

Cap Haitien’s faded pastel buildings weren’t damaged by the earthquake that killed thousands in Port-au-Prince, though residents here definitely felt the earth move, and victims from Port-au-Prince continue to arrive at Justinian.

Dr. Jean-Gracia Coq, the hospital’s medical director, said Tuesday that victims started to arrive at Justinian on Jan. 13, the day after the earthquake. Through the weekend, the hospital saw 130 patients and operated on 34, with a half-dozen now waiting for surgery.

Without the years of support from Konbit Sante, the hospital’s situation would have been ”catastrophic” in the aftermath of the earthquake, Coq said.

Throughout this sprawling hospital, which treats the poorest people in the Western Hemisphere’s poorest country, Konbit Sante has made significant improvements.

A new pump house is right off the main courtyard, with a conspicuous Konbit Sante sign and the International Rotary symbol. Painted inside the door are the names of all the New Hampshire and Maine Rotary clubs that funded the project – Gardiner, Newcastle, Scarborough, South Portland-Cape Elizabeth, Bath, Windham, Oxford Hills, Bethel, Portsmouth and others.

The sophisticated system was installed by Gary LeClaire of Eddington.

LeClaire, Nickerson’s uncle, is a member of the ”nuts and bolts” team that Konbit Sante brings to Cap Haitien to work on plumbing, sanitation, electrical, computers and other systems. He has made 10 trips since 2004.

”I’m not a doctor, but we try to help,” LeClaire said in a recent interview.

The well and another one on the property pump water up to a 40,000-gallon water tower that the U.S. military installed in the mid-1990s. LeClaire’s electrical work ensures that the pump works even when the power is out, maintaining the water supply.

LeClaire also helped to ground the hospital’s electrical system and installed uninterrupted power systems to the operating suites. Before the improvements, the system was ”deplorable,” he said.

Since Konbit Sante has been at the hospital, three buildings have burned down because of faulty wiring and residents of nearby homes splicing in to get power.

Once the fires started, nothing could be done – there’s no real fire department, and there were no extinguishers at the hospital.

Through Konbit Sante, Maine Med has donated old fire extinguishers that it had to replace but were still usable in Cap Haitien.

Konbit Sante built a supply depot for the hospital. Its shelves are stocked 12 feet high with everything from infant formula to hospital gowns – ”everything you need to have a hospital,” Nickerson said.

Dr. Marie-Carmelle Leconte, who is in charge of the operating room and anesthesiology, said there were some materials she had never heard of except in books or documentaries, such as specialized cardiac monitors for the vascular system. She has been able to get those things, she said.

”They talk to us and they offer their help, their support,” said Leconte. ”It was like a miracle coming down from the sky that improved the condition of our work.”

Konbit Sante is developing a supply chain for the hospital, so it can order supplies ahead of the need. Now, said Nickerson, the hospital buys its supplies after they have run out, often in emergencies, and at full price.

The reasoning is simple. When you don’t have much money, you don’t buy supplies when you run out because you don’t know what you’re going to need.

”It’s the economy of poverty,” Nickerson said.

With a bit of planning, the hospital could get medical supplies and medicine at discounted prices, through agencies like the World Health Organization.

To find out what needs existed, Konbit Sante worked with a Harvard School of Public Health student to do a women’s health study. One of the basic needs applied throughout the hospital.

It was difficult for patients to find their way around the hospital campus. So Konbit Sante worked with a Portland artist to develop signs with Creole words and images depicting the specialty practiced in the buildings – a person with a broken arm and a broken leg for orthopedics, a woman with a bulging belly for maternity, for instance.

Those signs from Maine are everywhere.

Beyond the strictly physical, Konbit Sante helps with personnel. The group funds 26 positions, including doctors, nurses and health care administrators.

”Before Konbit Sante, we had a lot of trouble to fund drugs, supplies to be used for the patients. We are a university hospital – we didn’t have enough attending (physicians),” said Dr. Rony St. Fleur, one of two pediatricians who are funded by the nonprofit. ”Konbit Sante is very useful for us.”

Leconte and Coq have visited Maine through Konbit Sante. Both spoke of their appreciation of the state, and of the relationships the nonprofit has worked hard to build in Cap Haitien.

”We appreciate the relationship. It’s very respectful for Haitian people, for Haitian leadership,” said Coq, who visited Maine in 2007. ”We are hopeful that Konbit Sante will stay longer and longer in the country, and always in the Justinian Hospital.”

The members of Konbit Sante are ”like brothers and sisters,” said Leconte. ”They support you, they appreciate you, they love you.”

Leconte, whom Konbit Sante brought to Portland to visit Maine Med in July, said she thanked the people in Maine. ”Thank you for understanding us, for supporting us. Psychologically, it is important to me.”