Yasmín Porrata Morán, GPJ Puerto Rico
The Ramos Serrano family, one of the greatest beneficiaries of the free community health clinic, poses for a photo in the doorway of their house in Utuado.
UTUADO, PUERTO RICO — In the neighborhood of Mameyes, community members have learned that their survival is entirely in their own hands. When Hurricane Maria hit in 2017, it left these residents of the Central Mountain Range without electricity or a means of communication for 11 months. Far from any urban center and without hospitals or even a doctor’s office, neighbors came together and started a health care facility, deciding to run it themselves to protect their health and meet the needs of the neighborhood’s marginalized populations. Since its founding in 2018, this community health clinic has treated more than 20,000 people at no charge, a unique phenomenon in Puerto Rico.
Ruth Alicia Ramos is one of its beneficiaries. The clinic’s medical services have changed the lives of six of her 10 siblings — adults with health conditions — as well as her 77-year-old mother. “My siblings are like my children. The youngest one is 43, but mentally they’re children,” she says.
Ramos’ siblings have conditions that range from epilepsy and diabetes to thyroid problems and high blood pressure. Four brothers and one sister have an intellectual disability, Ramos says. The lack of medical services in their region used to mean that obtaining treatment was a complicated endeavor and moving them to medical facilities far from home was not viable for the family.
This community, in which older adults make up 89% of the population, is almost an hour from the nearest town. And having access to medical services can be a question of life or death. “One patient died because it took the ambulance two hours to arrive here due to the roads being difficult,” says Karina Quiñones, who works at the community health clinic.
The facility has become an oasis for those who need not just health care services but other types of assistance, such as well-being workshops; items to ease daily life; and help repairing their homes, paperwork, and obtaining fresh food. But above all, someone to support them.
The history of the facility dates back to Hurricane Maria, when medical attention arrived via the military, along with a delegation that included Antonia Coello, the first woman, Puerto Rican and Hispanic person to be named surgeon general of the United States. The health care assistance was originally set to last one month, but it was extended to four and served as the foundation for today’s facility. It is the first community-style health clinic in Puerto Rico, run exclusively by area residents under the auspices of the Corporación de Servicios de Salud Primaria y Desarrollo Socioeconómico El Otoao (COSSAO, for its initials in Spanish), a nonprofit that advocates for transformation in health care, education and community development.
Neighbors, some of them doctors and nurses, salvaged a building that had been abandoned for 20 years and established the facility there, naming it Clínica Comunitaria Dra. Antonia Coello, in honor of the woman who inspired its foundation. But everyone in the neighborhood calls it COSSAO’s clinic. In addition to medical services, the facility offers workshops on natural disaster preparedness. It also provides tax filing services every April, when tax returns are due, and, on a seasonal basis, runs Cajita Saludable, a program that connects local farmers with area residents and the facility’s patients to encourage healthy eating.
“The COSSAO clinic is a blessing. Wherever there is a need, they are there. They always try to help people. And they’re still going,” Ramos says, moved at remembering the help — “doctors, medication and diapers” — provided to her brother, Ismael Ramos Serrano, who has been bedridden for six years due to falls caused by epilepsy.
Doctors and members of the facility’s nursing staff, some of whom are volunteers, visit people’s homes to treat such patients. They also arrange for dentists to make house calls. “For Ismael, they brought in a specialist in caring for people who are bedridden, and they cleaned off a lot of calculus that had built up on his teeth,” Ramos says.
The facility delivers personalized in-home care and carries out initiatives that go beyond health care, including modifying homes when necessary. Clinic staff and volunteers built a special room for Ramos, her mother and her siblings, so they could shelter safely after a 2020 earthquake.
The state of their house following the earthquake was such that they had to improvise a shelter outside using tarps and sheets. “We were sleeping outside,” Ramos recalls. When they learned about the situation, facility personnel mobilized to help. “The room was finished in 24 hours. Night fell, and we stayed until all of them were accommodated,” says Leslie Ann Lugo Lugo, another health care worker at the facility. “We identify needs, and we’re a bridge to benefit every individual.”
Nilsa Guzmán Serrano, 60, lives alone. As with Ramos’ family and thousands of other patients, the facility has helped her with issues beyond her health care. Guzmán has fibromyalgia, diabetes, thyroid problems and severe visual impairment. Without a mode of transportation, she “almost never went to the doctor.”
“I lived far away, and I depend on others to take me to doctor appointments. The clinic is close by, and now I feel better,” she says.
Through a program called Mirada, facility personnel provided Guzmán with equipment to help her live independently. “They gave me handlebars for the bathroom because I almost fell once and a pill organizer because several times, due to my vision problem, I’ve taken the wrong pills,” she says. They also furnished her with a wall clock with large numbers, so she can easily tell the time, as well as a magnifying mirror for her personal hygiene. And Guzmán has gotten help at the clinic not only for her physical health but also her emotional health. “When I’m sad, depressed, I go there and chat with the girls,” she says.
Zulma Robles Figueroa, another health care worker, says treatment that is respectful, empathetic and imparted with love is part of the service they provide. These professionals are key in gathering socioeconomic information and medical data on each member of the community. “They enable us to be efficient in a crisis. We can help within the first hours because we know the needs and locations of each one of our residents,” says Francisco “Tito” Valentín, president of COSSAO.
Valentín says the community health facility is COSSAO’s greatest achievement. The organization relies solely on donations and nongovernmental funding to finance its operations. What began as a general and pediatric medical service ended up becoming a system of alliances among those who are adding mental health, gynecological, vision, dental and vaccination services for local residents. Plus, there are nontraditional services like workshops, tax assistance and the Cajita Saludable program.
Support for the facility has grown so much in terms of donations and other forms of help from humanitarian organizations, foundations and businesses that the organization is now building a radiology facility, a laboratory, an emergency room and a gymnasium for rehabilitation and physical therapy.
“It’s the hospital that a community was able to build by itself. This expansion is a great achievement that allows us to offer more services, create new jobs, and give hope to our communities,” Valentín says.
More than six years after Hurricane Maria, the facility’s impetus, its neighbors anxiously await the new services and spaces, expected in January.
