Running a family planning clinic without electricity has proven a monumental challenge, with little hope for improving conditions in the coming months. “There is still a lot of work to be done to overcome the devastation in our neighborhoods."

A nurse takes a patient's vital signs at Clínica Celestina Zalduondo in San Juan. The Puerto Rican clinic still lacks reliable power nearly four months after Hurricane Maria.

Profamilias

Running family planning clinics without electricity on the island of Puerto Rico has become routine for Blanca Cuevas, executive director of Profamilias.

Small generators power two Profamilias clinics in San Juan, the capital, more than three months after Hurricane Maria tore through the commonwealth. A larger generator is on order from the Dominican Republic.

The strongest hurricane to hit the island in nearly a century, Maria ripped roofs off some 250,000 homes, flooded neighborhoods, and toppled tens of thousands of power lines. The hurricane raked an island already mired in a debt crisis and reeling from the effects of Hurricane Irma just two weeks earlier.

Nearly half of the island still lacks power. Reports suggest parts of Puerto Rico are expected to remain without electricity until May.

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The plight of Profamilias, its patients, and employees reflect widespread struggles on the island to regain a semblance of normalcy in a post-Maria world. Cuevas called the pace of government assistance “slow and inadequate.”

Dark streets, she said, have become dangerous. Shops have closed. Residents lack basic necessities. Workers are left jobless. Hundreds of thousands have fled.

For Cuevas, among “the hardest challenges have been to open the clinics without electricity,” she told Rewire.

Profamilias operates two clinics in San Juan, and eight family planning centers around the island. Its clients are largely folks with low incomes who rely on the facilities for affordable gynecological services, sexually transmitted infections tests, contraceptives, and sex ed, among other services.

In a physical sense, Profamilias was lucky.

Two Profamilias clinics are in what Cuevas described as an old working class residential area of San Juan. The mostly concrete and cement structures were spared major damage. The clinic had prepared for the worst, protecting vulnerable equipment.

Still, signs of devastation have scarred the surrounding neighborhood, Cuevas said. Downed trees clog the San Juan clinic parking lot. Fallen power lines, electric cables, and debris have been pushed off the streets and now block sidewalks. No one has cleared the wreckage.

“There is still a lot of work to be done to overcome the devastation in our neighborhoods,” Cuevas said.

Cuevas has watched two clinic workers and untold patients leave the island, seeking stability and steady work. Reports suggest more than 200,000 Puerto Ricans have fled to Florida.

Running a health-care clinic without electricity, phones, or internet access is not an exercise for the faint of heart. In the days after the hurricane, Profamilias warned patients on Facebook of the closures, with a promise to reopen. “We continue to work hard for the restoration of services,” said an October 6 Facebook post. The pharmacy reopened a few weeks later, in late October. Clinical services restarted in mid-November.

The clinics rely on generators that were never intended as a full-time power supply. Profamilies must turn away patients when the generators break down. Cuevas said spare parts and repair services for the generators are in short supply. Profamilias is not alone in this plight. Estimates suggest as much as 90 percent of the island runs on small gas- and diesel-powered generators.

Cuevas, who has been with Profamilias for two decades, said she’s never seen a catastrophe on this scale. The aftermath of the hurricane brought widespread shortages of food, water, gasoline, batteries, propane tanks, and hygiene products. Infectious diseases broke out from mosquito bites and contaminated drinking water.

Residents in the countryside fare worse. Despite dangerous road conditions, Profamilias and other volunteer organizations have mounted a mobile health brigade to bring remote residents a range of free services, including mammograms and contraceptives. Last month, “Caravana Violeta,” as it’s called, traveled to Arecibo, on the northern coast about 50 miles from San Juan. The brigade has visited the towns of Mayagüez, Ponce, and Río Piedras.

Along the way, Cuevas has met people who still lack food and safe drinking water. She’s seen families without a roof over their heads and children without schools.

“The pain of seeing people living in homes without roofs or walls, abandoned homes, small businesses closed, and thousands of children without access to their schools, this has definitely touched my heart,” she said. “It is very sad to witness the suffering of so many people.”

Before the hurricane, close to half of Puerto Rico’s residents lived below the poverty line. One study suggests the number will grow to nearly 60 percent if relief efforts drag on.

The caravan, for Cuevas, is an exercise in heartbreak and hope. She said she expects the need for the kind of services Profamilias provides to only increase as more residents are gripped by poverty. She’s already planning how to meet their needs.