Before their resilient power system, a power outage could shut down the clinic at Profamilias, said services manager Michael Domínguez.

At Profamilias, a San Juan healthcare organization that provides sexual and reproductive healthcare, gynecology, and prenatal services, as well as chronic disease treatment and vaccinations, their two facilities have long had generators, but “mostly the generator was used to keep the pharmacy running and the medications refrigerated,” he explained. A number of contraceptive methods require medical refrigeration storage to remain effective, as do the vaccines the clinics offer.

And during hurricanes, those medications were in danger: “Employees had to take certain products home and keep them refrigerated because there was no way to store them at the facility,” Domínguez said.

But now that Profamilias’s clinics are powered by solar installations, Domínguez told Direct Relief staff, outages don’t affect clinical care.

Since 2017, Direct Relief has funded 52 power resiliency projects across Puerto Rico, including 15 solar installations in community clinics and two fire stations, as well as resilient power for 35 wells, located in communities without access to municipal water sources.

After 2017’s cataclysmic Hurricane Maria, which cut off power to parts of the island for more than a year, clinics and hospitals began rearranging staff members’ shifts to maximize time with backup generators. Hospitals had to cut down or halt their outpatient services so they could prioritize critical care in intensive-care units and operating rooms, because generators simply couldn’t keep up with the need. Patients with powered medical devices or temperature-sensitive medications struggled to manage serious conditions.

In the years since Maria, power outages have continued to severely impact Puerto Ricans’ health. Repeated earthquakes and tropical storms have continued to damage infrastructure and destabilize access to healthcare.

“During Hurricane Maria, it was much more difficult,” Domínguez recalled. “People had to buy medications wherever they could, at whatever price. It was no longer the low-cost service we offer because we couldn’t purchase the medications, as we had no way of storing them. For any medications a clinic had on offer, “the employees had to take them home, then bring them back to the office to keep them refrigerated.”

Even in the aftermath of Maria, clinicians struggled with an unreliable grid, and a lack of medicine made patient care more challenging.

But these issues have disappeared with a resilient power system, Domínguez said.

“Not only because of hurricanes but also because of the electrical system we have, it has been a huge impact,” he explained. “Now, medications can be properly stored, and patients will receive the highest quality products, since it allows us to work continuously. The clinics also don’t experience interruptions.”

“It Gets Very Complicated”

Since long before Hurricane Maria, providers across Puerto Rico have worked to address high levels of medical need with often-limited resources, and not enough doctors or staff to meet patient needs. But the catastrophic 2017 storm made that work more complicated. An estimated 4,600 people were killed in the aftermath of the storm, in about one-third of cases, because of delayed access to healthcare.

In the intervening years, clinic closures, ruined medications, and unreliable infrastructure have kept patients from receiving care, harmed access to medications, and driven some providers – often disheartened by the limitations on care they were able to provide in difficult circumstances – away from the island.

La Fondita de Jesús, a nonprofit clinic and mobile healthcare provider, has a Direct Relief-funded mobile medical unit with solar power, but its clinic is dependent on the local electrical grid.

“It’s very challenging,” said Dr. Josue Segarra Lucena, La Fondita’s primary care physician. Because the clinic serves some of Puerto Rico’s most vulnerable people, such as its significant homeless population and residents in remote communities with limited access to care, interruptions to care can be particularly high-risk.

“The main barrier is ultimately that services get interrupted,” Dr. Segarra explained. “Treatments or appointments get canceled or rescheduled…When there’s no power, they have to relocate the clinical services.”

For patients already struggling to access healthcare and transportation, these are serious barriers.

Clinicians often compensate by working out of La Fondita’s mobile unit, which is more expensive and difficult to operate, but which allows them to travel to patients.

“It gets very complicated,” Dr. Segarra said.

“It’s a Long Time This Has Been Happening”

For as long as he’s been working with patients, Dr. Luis F. Gutiérrez Padin has confronted Puerto Rico’s unreliable electricity and frequent power outages – and their impacts on patients.

“It’s a long time this has been happening and it has long-term consequences for the health of people,” said Dr. Gutiérrez, a medical staff member at Corporación de Servicios de Salud Primaria y Desarrollo Socioeconómico El Otoao, or COSSAO, a nonprofit primary clinic based in Utuado.

Since 2024, COSSAO has had a reliable, sustainable source of electricity: a solar power installation, which allows providers to keep seeing patients while also powering medical refrigeration and other vital systems. Having a resilient power source – even when the grid isn’t functioning properly – allows Dr. Gutiérrez and his colleagues to continue providing care, ensuring that patients aren’t forced to wait for essential consultations or treatments.

Direct Relief provided more than $560,000 in funding for infrastructure repairs, electrical systems, and expansions to COSSAO. These repairs and upgrades made it possible for them to install a resilient power system on their own.

As a physician with a separate private practice – in a medical office where he’s unable to install solar panels or a backup generator – Dr. Gutiérrez is keenly aware of the difference. “It causes further delays in treatment” when the power goes out at his private practice, he said.