A local man rides in the back a pickup truck while assisting with the transport of a critically ill clinic patient to one of the hospitals in Port au Prince. Most hospitals are gated and guarded by armed guards, and will refuse outright all patient transfers, as hospitals are already overwhelmed, overcrowded, understaffed, and undersupplied. In the absence of reliable phone service, facilities cannot be called ahead of time to arrange transfer, and patients must be driven from site to site, often lying in the bed of a pickup truck exposed to sun and rain, in hopes of being accepted somewhere. Due to poor roads and chaotic traffic, this process can often take 4-5 hours.