On the island of Vieques, eight miles off the coast of Puerto Rico, cancer is a serious problem. One study, released by Puerto Rico’s Health Department in 2003, found that residents of Vieques were 27% more likely than other Puerto Ricans to have some form of cancer.

But historically, cancer care has only been available on the mainland – a journey that requires a plane or ferry and an expensive taxi to San Juan or Fajardo. In general, Vieques, which has about 9,000 residents, has only a handful of health care services. “We don’t have specialty providers. We depend on primary care doctors for referrals,” said Sandra Meléndez, a long-time resident of Vieques and president of the organization Vieques en Rescate (VER).

VER was formed to address precisely these kinds of health problems. Zaida Torres Rodriguez, who has lived in Vieques for 77 years and is a part of the grassroots organization Alianza de Mujeres Viequenses (Vieques Women’s Alliance), explained that community activism on the island comes from a desire to “be part of the fight against military occupation and the health of the people in Vieques.”

The military occupation to which Torres refers is the U.S. Navy’s use of Vieques as a site for military training and bombing. As The Atlantic reported in 2016, some believe that the military’s presence contributed to widespread illness on the island, including high cancer rates – although it’s proven difficult to pinpoint a cause for Vieques’s health issues.

Caring for cancer patients

To address health issues on the island, Alianza de Mujeres Viequenses founded VER in 2013. The goal of the nonprofit was to “rescue cancer patients in Vieques,” Torres said. The organization focused on providing patients with supplies like diapers and nutritional supplements – and on transporting patients to their medical appointments on the main island of Puerto Rico.

To date, VER has helped over 60 Vieques patients with cancer.

With funding from AbbVie, Direct Relief is supporting VER with a $75,000 grant to cover transportation costs for Vieques’s cancer patients and to provide nutritional supplements and diapers for more than 60 patients. The funding will also subsidize salaries for a part-time coordinator and driver.

A typical transfer involves taking the ferry from Vieques to Ceiba, where patients are met by the driver who will take them to their appointments in San Juan or neighboring municipalities. For patients undergoing chemotherapy, this can be taxing.

“It’s a difficult process,” said Torres, who has had cancer. “Sometimes I wouldn’t have the energy.” She remembers having to lie down at a nearby aunt’s house after receiving treatment before taking the ferry back to Vieques.

VER also has a new plan in place to increase cancer are on the island. In collaboration with Puerto Rico’s Department of Health, VER is coordinating for an oncologist and oncology nurse to see patients locally once a month. Currently, around 15 patients a month are benefiting from these consults. In the future, they are hoping to expand their offerings to include chemotherapy services.

Responding to challenges

Caring for Vieques’s cancer patients means adapting to the situation. In the aftermath of Hurricane María, when the island experienced power and communications outages for nearly six months, VER’s facility became a de facto community health center, powered by solar energy.

“In case of any event, we have the capacity to attend to various needs for our patients and the community,” Meléndez said.

While María was challenging, Covid-19 has caused even more significant disruptions. Patients have been hesitant to risk exposure; a lack of comfort with technology has made it challenging to implement telemedicine, and maritime transport is limited due to capacity restrictions. That last hurdle has forced patients to spend weeks at a time away from Vieques – and their families – while undergoing radiotherapy.

And Torres isn’t just worried about cancer. She knows that, on Vieques, primary and preventative care have vital roles to play. As a former nurse, she is on the board of directors for the federally qualified health center Health Pro Med, representing and voicing fellow residents’ needs and ensuring access to health services.

To support health services, Direct Relief and AbbVie provided Health Pro Med with more than $510,000 in grant funding to outfit their Vieques, Carolina and Cataño’s clinics with specialized equipment. In Vieques, funding was allocated to purchase clinical laboratory equipment, a state-of-the-art dental clinic, and vehicles to facilitate patient transport and mobilize personnel for community outreach programs.

The newly inaugurated clinic will offer primary and preventive healthcare services, including pediatrics, gynecology, and, for the first time in the island’s history, optometry. These additions will significantly improve access to care for residents and curtail the need for travel to receive essential services.

Doctor Ivette Pérez, medical director of Health Pro Med’s Vieques clinic, explained that they can support patients through referrals for specialized medicine and keep the patient’s medical history updated – an essential component of successful cancer care.

Additionally, without the patient transport offered through Health Pro Med, there’s a risk of patients not getting to appointments – and thus receiving much-needed care.