Even at the best of times, Sherril Nolan’s dialysis isn’t easy to manage.

“I don’t wish it on my worst enemy,” said Nolan, who cleans homes and lives with her son in the municipality of Bayamón, outside Puerto Rico’s capital city, San Juan.

There’s the constant watching what she eats. The three-and-a-half-hour dialysis sessions.

And now, because of Covid-19, a new, unexpected outbreak of challenges.

Nolan first moved to Puerto Rico nearly three decades ago, after a recession on her home island, St. Kitts, made it difficult to find employment. “I had three kids, and there was nothing there for me to do,” she said. Puerto Rico offered better opportunities.

But things have changed. As Covid-19 gains ground, Puerto Rico has responded by shutting down most businesses, instituting a curfew, and asking people to stay inside.

According to Ivonne Rodriguez-Wiewall, Direct Relief’s senior advisor for Puerto Rico, it hasn’t been good for morale.

“Everyone is scared, desperate, going through all kinds of emotions,” Rodriguez-Wiewall said.

Nolan, cut off from work and community, and concerned because of her existing health condition, is among them.

“I used to go to work two days [a week], even though I take dialysis, to help my son pay the bills around the house. Now I cannot go to work, I cannot go to church,” Nolan said. “I do not go outside because I don’t want to get contaminated.”

And perhaps most crucially, public transportation on the island was shut down – effectively cutting Nolan off from her dialysis sessions, which take place three times every week at the Hospital Universitario De Adultos in San Juan.

Nolan doesn’t know the name of her kidney disease, but she knows that letting it go untreated is dangerous.

So at first, she asked a neighbor with a taxi to bring her to the hospital, but he charged her $25 each way. “I don’t have money like that,” she said.

Puerto Rico does have a system, called Transcita, that provides transport to patients around the island. But Nolan doesn’t have legal status, which means she’s not eligible for insurance or for coverage through Transcita.

Damaris Arroyo, a social worker contracted with Puerto Rico’s Department of Health, heard about Nolan’s situation. And Nolan wasn’t the only dialysis patient for whom the island’s lockdown was devastating. Other patients whose conditions required regular dialysis or chemotherapy were left essentially stranded.

While the health care itself was still available to them, transportation – an often-overlooked expense that can significantly affect a patient’s access to care – was proving impossible without access to trains and buses. “A couple that usually uses public transportation were scared of what would happen,” Arroyo said through a translator.

Arroyo felt she had to act – lives were at stake, she explained.

Through the grapevine, she heard about Direct Relief’s work in Puerto Rico, which ranges from providing support to people in recovery from addiction to increasing the resiliency of remote communities.

The organization stepped into action, paying Uber Health to transport patients, including Nolan, back and forth to their dialysis and chemotherapy appointments. First, it made sure that the company was taking measures to ensure its drivers were healthy and cars were sanitized, Rodriguez-Wiewall said.

For Nolan, it’s made a tremendous difference. “Every day, I make sure to tell the Uber driver, ‘Thanks, I really appreciate it,’” she said.

“It’s very important for us to take dialysis. Missing one day of dialysis is like missing two weeks of dialysis.”