It's hard to believe that it's been one year since the devastating [article id="1633731"]earthquake hit Haiti[/article] on January 12, 2010, leveling much of the impoverished island nation's capital, Port-au-Prince, and killing more than 250,000.

The world came together in the weeks after the natural disaster, when Americans donated nearly $1.5 billion to help Haiti recover from the 7.0 magnitude quake. Another $5.3 billion was pledged at a donors conference two months after the earthquake. Every penny was needed, as nearly 2 million people were left homeless, many of them forced into ramshackle tent cities, and nearly 400,000 children were made orphans by the latest natural disaster to strike the poorest nation in the Western Hemisphere.

The 12 ensuing months have not been any easier, with the combined force of hurricane season, a bitterly divisive election and a mysterious cholera outbreak that has taken the lives of more than 3,600 and infected more than 170,000.

Medical student Alison Smith has been to Haiti four times on medical relief missions since last January, and she told MTV News that, unfortunately, the situation on the ground remains quite dire, and the world must not forget the work that still needs to be done.

"Every time I go, it doesn't seem like there's a whole lot of progress," said Smith, who just returned from her most recent trip last week. "You try to be optimistic about it, and you see certain areas of Port-au-Prince where they've really tried to clear the rubble ... [but] you don't see many aid groups anymore."

While she saw a rush of assistance from aid groups from all over the world a year ago, Smith said many have dialed back their work since then, while some of the Haitian people have developed a resistant attitude about foreign help.

The picture she painted was very different from the one MTV News got from relief workers for two organizations, World Food Programme and Partners in Health, who said the aid they received as a result of MTV's record-setting [article id="1630365"]"Hope for Haiti Now"[/article] telethon has made a tremendous difference to the lives of sick and struggling Haitians. They agreed that much work still needs to be done, but said great strides have been made to feed and tend to the sick in the large tent camps.

But Smith said from what she's seen, many Haitians have become suspicious of foreigners and dispirited about their squalid living conditions. "People in Haiti are disheartened because they're still living in really bad conditions, really not much improved since last January," she said. "They're really concerned about how the world is still viewing them, if people really are still caring about it, because that initial outburst of support has really gone away."

Things were not helped by November's cholera outbreak, which some Haitians believed was brought to the country by relief workers from the United Nations.

"When you fly into the country, now all you see is tents," she said. "All the public areas people gravitated to are still inhabited by people."

If anything, she feels like there are more tents than there were when she first started visiting after the earthquake in January, as very little debris has been removed and living conditions remain poor as a result of no sanitation in the camps, some of which house more than 100,000 citizens. The vast tent cities outside of the capital have blossomed into makeshift refugee camps that lack any food and water sources and are completely dependent on foreign aid. A promising recent sign, however, were some Western-style houses being built near the airport by the Red Cross. But, so far, Smith said, they are an anomaly in an otherwise still bleak countryside.

Smith, who lives in New Orleans, said the lesson she learned from that city after Hurricane Katrina is that recovery takes a long time. One good sign she's seen is that some schools in Haiti have been rebuilt and are back up and running.

"It will be hard on the future of the country if you're not able to educate your children," she said, noting that the destruction of the country's main medical school will also hamper the ability to educate a new generation of indigenous doctors.

"Haiti's always struggled with civil war, with disaster, it's always been at that point. Everybody's been asking themselves, 'What's next for Haiti? How do you solve the situation?' " she said.

For now, Smith, 26, a medical student at Tulane University, still holds out hope that things can change in Haiti. And she, for one, is not giving up. She's planning another trip to the country within the month and continued visits for as long as her services are needed.