Rebuilding Puerto Rico, one community health center at a time

It was summer 2017, and Dr. Yania López Álvarez had just returned to Puerto Rico. A new doctor eager to bring her knowledge back to the island, the 35-year-old radiologist turned down more lucrative job offers on the mainland for the chance to practice at home close to her family.

But a few months later, Hurricane Irma slammed into Puerto Rico. Hurricane Maria came just weeks after, pummeling the island, destroying homes and causing widespread power outages that lasted for months. The official death toll stands at 2,975 people.

A lack of electricity, running water and jobs prompted many to leave the island. An estimated 135,000 people left Puerto Rico in the six months following Maria, according to a report by the Center for Puerto Rican Studies.

Dr. López chose to stay.

“My heart is just here,” said Dr. López, director of the Imaging Center of the University of Puerto Rico School of Medicine in San Juan.

She represents a small but growing group – skilled Puerto Ricans in the health care field drawn to lead recovery efforts and overcome a shortage of workers post-hurricanes.

This fall, Dr. López will help open Puerto Rico’s first breast imaging center and train Puerto Rican residents at the University. She’ll be able to bring a specialty that the island’s only teaching hospital hasn’t seen for 45 years, the last time limited breast imaging was included in residents’ training.

“As doctors, as members of this community, we need to build our training programs, and we need to encourage strong foundations for doctors to serve in both times of need and of prosperity,” said Dr. López.

Dr. López’s story highlights the ongoing work in Puerto Rico of Direct Relief, a health-oriented humanitarian aid organization focused on improving the lives of people affected by poverty and emergencies.

After receiving an infusion of $50 million from AbbVie six months ago, leaders at Direct Relief focused on executing the first stage of a three-year partnership to rebuild and strengthen primary care on the island. Direct Relief is the largest source of nongovernmental support for Federally Qualified Health Centers (FQHCs) in the United States.

In Puerto Rico, Direct Relief’s work focuses on 68 community health centers that serve mostly medically uninsured patients in underserved areas. Close to 90 percent of their collective patients live below the poverty line. Additionally, Direct Relief supports hospitals and health facilities run by the government.

Direct Relief is a longtime, trusted partner of AbbVie, with the two working together since 2014 on joint humanitarian initiatives that center primarily on disaster relief and emergency work around the globe.

“Direct Relief's work is not about restoring the island's primary health care system to the way it was before Maria struck,” says Melissa Walsh, vice president, AbbVie Foundation. “It’s about building a stronger, more resilient health care system that can hold up against future disasters, so that the people of Puerto Rico can count on reliable, accessible care when they need it the most.”

Learn more: How AbbVie’s long-term efforts to move Puerto Rico from recovery to resilience.

Direct Relief tailors its support based on the unique needs of each health center and the people they serve. For one clinic, this means a new mobile medical unit with four-wheel drive that can travel across roads in disrepair, often in hard to reach places. For another, it means the right resources to treat chronic conditions common on the island like hypertension and diabetes. Each center is receiving a stockpile of medications and emergency medicine to equip first responders.

Improvements at every clinic contribute to the big picture – ensuring health providers on the island won’t have to close their doors or not have life-saving medication available for patients when they need it most.

“At the end of three years, every health center we’re supporting will have solar and battery backup so they’ll never lose critical infrastructure again,” said Andrew MacCalla, director, international programs & emergency response, Direct Relief. “We’ve never been in a position in our 70-year history to think about these possibilities before receiving AbbVie’s support.”

Key to the Direct Relief and AbbVie plan is rehabbing public health facilities and services so they can serve as models for other islands in the Caribbean and beyond. A critical component is Direct Relief’s strategy to introduce the island’s first-ever island-wide telemedicine program.

Hurricane Maria washed out many roads and bridges and left rural communities in isolation. Telemedicine will drastically improve access to health care, especially in these areas, said Ivonne Rodriguez-Wiewall, Senior Advisor for Puerto Rico, Direct Relief.

The organization is partnering with the Puerto Rico Department of Health and the University of Puerto Rico and Ponce Medical School to launch the program. Specialists like Dr. López can consult with patients and their providers directly and help assess how to manage their condition and whether they need to visit a health care facility.

And by equipping more facilities with specialized medical equipment, the vision is that more physicians will be drawn back to lead health centers that serve as the bedrock of communities across the island.

One such clinic is Centro de Salud Familiar, situated on the southern coast of the island where Maria first made landfall with its strongest winds of 155 miles per hour. There, in Arroyo, this center has remained one constant in the lives of residents.

Centro de Salud Familiar clinic serves about 13,000 people annually. It is the only provider of primary and preventive health service for Arroyo, Guayama and the surrounding rural areas.

The clinic received an emergency grant from Direct Relief to help bring it back to full strength after Maria caused wind and water damage. The clinic is also a recipient of the AbbVie donation, which funded a custom-built mobile medical unit to reach community members in rural, mountainous areas.

Yesenia Ortiz, 27, works at the clinic as a health records clerk. Her family home in Arroyo was so badly damaged that it had to be demolished and rebuilt, a slow process that is not quite complete over a year later.

When Ortiz and her family – including her father, mother and sister – bounced from one relative’s home to another during reconstruction, she found solace in her job.

She returned to work five days after Maria, supporting patient intake. Ortiz describes these early days as chaotic, with many patients dealing with both serious physical injuries as well as the aftermath of losing their homes.

Ortiz focused on one goal during these challenging shifts: Make sure everyone got the best service possible. She funneled strength from friends and neighbors who showed resilience, including a nurse at the clinic with two young children whose home was destroyed but was creating a new path forward.

Did the Ortiz family ever consider leaving Puerto Rico? No. They’ve lived in Arroyo for generations, and likened the thought of leaving to letting people down in the town that means so much to them.

“We wanted to be part of the process to reconstruct and rebuild the town,” Ortiz said. “There are still a lot of beautiful places in Puerto Rico, and not just negative news. There is good.”

Mary Kathryn Steel
Email: mk.steel@abbvie.com
Call: + 1 847-937-4111

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