Will the new health center in Vieques deliver long-awaited services in 2026?

Donned in a neon yellow safety vest and hard hat, I walked through a construction site near Isabel Segunda in Vieques, Puerto Rico. Though incomplete, the site is supposed to become Vieques’ new Centro de Salud in 2026. This marks the inauguration of a much-needed healthcare facility for Viequenses, who have lacked adequate services for many years. But what should be a welcome hope for Viequenses is being referred to by some locals as “un elefante blanco” – an unwelcome, costly project.

I visited Vieques, my grandmother’s hometown, this summer to study Vieques’ history of access to healthcare. After reaching out to Perfecto Ocasio, the head engineer of the Centro’s construction, he agreed to meet with me to discuss my research and give me a tour of the facility. I followed Ocasio through the winding halls of brand-new shiny floors and walls. He explained each room’s eventual function to me: there would be rooms for dialysis and chemotherapy, pediatric care, a pharmacy, and several specialty units.

I was impressed. The large building included general, emergency, and specialized units of care. If the plans are met, the new health center should provide long-awaited obstetrics and cancer care to Vieques in 2026.  

Caribe Tecno CRL, the construction company, is set to hand in the building to Puerto Rico’s Department of Health in December 2025, said Yesarel Pesante Sanchez, Assistant Secretary for Medical and Hospital Services of such agency, in an interview with 9 Millones in August. 

“As soon as the developer provides us with the spaces and the corresponding procedures, the department begins the processes of permitting, operational licenses, certifications of use, or whatever else is necessary,” Pesante explained, avoiding giving a specific date for the opening.

Caribe Tecno has already handed the dialysis center and trauma and obstetric units to the Government of Puerto Rico, Ocasio mentioned. Dialysis operations officially began in mid-October, unlike the other services planned for the units completed in this first phase.  The Health Department is preparing the request for proposals for administering dialysis services, which Pesante anticipated would be very complex, with only two companies operating in Puerto Rico.

The second phase of construction is the emergency room, and phase 3 is the chemotherapy and specialty units, all of which are set to be completed in December 2025, both Pesante and Ocasio confirmed.

However, many residents worry that the newly constructed facility will not deliver on its promised services. In order to understand residents' suspicions, we need to look at Vieques’ history with healthcare access and facilities. 

A history of negligence in public health

For the first half of the 20^th century, Vieques operated a municipal hospital. Zaida Torres Rodriguez, a community leader, recalled working at the old hospital as a nurse, remembering the provision of all necessary services, including dental and emergency units, and surgeries. However, in 1978, Vieques followed the healthcare shift in the rest of Puerto Rico and transformed the hospital into a health clinic (CDT, in Spanish). Torres claimed that this CDT still offered some general and emergency services, but did not perform operations or facilitate births. 

“We lost the ability to be treated here,” regretted Torres Rodriguez.

The CDT system forced Viequenses to leave the island for all types of specialized care. Cancer and dialysis patients must seek care on la Isla Grande, relying on the ferry and spending entire days to be seen by their doctors. The Susana Centeno CDT was inaugurated in 1996, but failed to open for an additional year and faced many of the same operational problems as the prior CDT. 

Hurricane Maria partially destroyed the Susana Centeno CDT in 2017. No repair ever took place, stripping Viequenses of their major healthcare outlet on the island. Instead, the Government of Puerto Rico and FEMA planned for its demolition, replacing it with an entirely new Centro de Salud.  With the construction facing several delays, residents are still demanding that healthcare services be returned to Vieques. 

What lies ahead? Questions and concerns

Although the Centro’s construction and planning seem promising, Viequenses have raised several questions and concerns that I hope to provide some answers to.

1. How will the facility’s maintenance and services be financed?

Some Viequenses worry about how such a large and expensive facility will operate and how it will impact the island’s economy. “Grandísimo, (huge)” candidly responded Torres and other Viequenses when referring to the Centro. The Centro’s construction cost an exceptional $75 million, leading residents to stress over how maintenance and services at the Centro will be covered. 

The majority of the Centro’s funding came from FEMA in response to the damage caused by the hurricane to the Susana Centeno facility. The agency, which Trump wants to eliminate, provided $48 million to the municipality of Vieques. Pesante said that the Puerto Rican government identified additional funds, which the Fiscal Control Board approved, to ensure the completion of the project.

The financing of the Centro’s services varies by department. The dialysis unit, Pesante explained, will be mostly self-funded. Dialysis services would be covered by the patient’s insurance, whether from Plan Vital—the local version of Medicaid— or private plans. For other sectors of care, the Centro will rely on subsidies from the Department of Health to provide 24/7 services in the island municipality. Part of these subsidies is a $500,000 annual budget allocation for a plane that transfers patients to other facilities in Puerto Rico when necessary. Pesante also addressed equipment maintenance, assuring that licensed engineers are currently in training to ensure the lifespan of the CDT’s equipment. He expressed that all aspects of the Centro’s costs are accounted for in a business plan.   

2. Will the new Centro de Salud be able to facilitate safe births in Vieques?

Vieques’ tumultuous history with healthcare access includes barriers to obstetrics, birth, and post-partum care. Vieques has no maternity ward, leaving pregnant Viequenses to leave the island to give birth. This resulted in several complications, especially for women with medical conditions or who went into early labor. Torres described children being born on airplanes and women dying on route to a hospital on la Isla Grande. 

When asked about safe deliveries, Pesante informed that there will be an operating room specifically for births in the new Centro de Salud and two additional operating rooms with the capacity for delivery. Additionally, an OBGYN from the Health Department visits Vieques at least twice a week to provide care, at no cost to Viequenses. However, Pesante admitted that Vieques does not have the resources or funds to support the complicated additional needs of pregnant women pre- and post-partum. Due to the lack of specialists and services for emergencies and complications, as well as neonatal care, Pesante’s recommendation is that women prepare for the island [the Isla Grande] so that in case they have a challenge or a prognosis, and have a challenge during the birthing process.‍

3. Will there be enough medical personnel? 

Many residents worry that – even with the space and medical equipment – experienced doctors will not come to the island. Due to Vieques’ location and isolation, there are fears that professionals will not have an incentive to come to Vieques to work. As Viequense Gordy Ruiz expressed simply to me, “No doctor is going to come here to work.” Additionally, Viequenses like Ruiz and Torres worry that Vieques professionals will be students and less experienced as opposed to more experienced ones. 

Pesante addressed these questions, explaining that the Centro’s employees will be appointed from the Department of Health and will have living spaces near the Centro. “All of the people we've recruited are Viequense citizens. The latest nurses we recruited are Viequenses, and the radiology technicians are Viequenses, with the exception of the doctors.” 

Pesante also expressed a willingness of Isla Grande doctors to come practice in Vieques. “I didn't see any challenge, any objection[…] with any employee who wanted to move there,” he said. 

The agency expects to have pediatricians 24/7, doctors in the emergency room, a general practitioner, and an emergency physician.

4. How will it provide continuous services during a power outage? 

Another challenge is power outages. Next to the large building are three equally large water towers that hold 70 thousand gallons of water. In the event of a hurricane, the towers provide enough water for 21 days. The building’s roof also hosts two large generators and extra water chillers. 

“We have redundancy. In case the power goes out, we have two generators,”  Ocasio assured. “We have redundancy in the chillers. If one fails, the other kicks in, and we're covered.” 

“A day without diesel fuel for the electric generator is a day without service,” anticipated Hilda Bonilla, who heads the American Red Cross in Vieques and belongs to the island municipality's emergency operations center. She explained that because the room must be sterilized, if the power goes out, the water that sterilizes the system also goes down. “At the moment, this is not being prevented,” lamented Bonilla, who did not receive a satisfying answer from government officials at the last meeting of the emergency operations team.

Pesante added that they will also have an aircraft and pilot available 24/7,  at a cost of approximately half a million dollars per year. 

Last year, the Puerto Rico Energy Bureau approved a $122 million microgrid project for Vieques and Culebra to operate independently from the main island grid. Additional approvals and funding are pending.

Looking ahead

The new Centro de salud could make a difference of life or death for Viequenses. A proper health center with varied services and resources can help people get specialized care without having to leave the island. A working emergency unit can save lives like that of Jaideliz Moreno Ventura, a thirteen-year-old Viequense girl who died in 2020 due to the lack of basic emergency services in Vieques. 

Pesante seems to have high hopes for the Centro de Salud’s benefit to the island of Vieques. “I believe that the most important thing is that the Vieques community or the citizens who visit regularly know that the Department of Health and the government of Puerto Rico have optimized public funds, both federal and local, to the greatest extent possible to create a new health center that responds to the needs of the island municipalities,” he said. 

Still, Viequenses’ skepticism is justified. Remembering the life of Jaideliz emphasizes the critical need for functional health facilities in Vieques, an island isolated by both sea and politics. 

Come 2026, we hope that the Centro de Salud finally does respond to Viequenses’ health needs after a long history of neglect. 

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Lucia Alexeyev is a student at Emory University studying Latin American history and global health. Her grandmother is from Vieques, and inspired Lucia to pursue a senior honors thesis investigating the history of health and healthcare in Vieques.

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