More than four months after Hurricane Maria tore across Puerto Rico, over 450,000 people are still without power. For critical facilities like hospitals, the lack of electricity has meant cutting services and relying on generators until power is restored.

Nexus Media joined Vittoria Energy, a team of clean-energy evangelists, for a trip around Puerto Rico in November to learn how healthcare facilities are surviving without electricity and to explore the role solar power is playing in the rebuilding process. Stops included hospitals and clinics in San Juan and Humacao, as well as facilities in smaller mountain towns like Orocovis and Castañer, where power isn’t expected to be restored for months.

In San Juan, the specialty clinics run by the University of Puerto Rico’s School of Medicine get more than 90,000 visits in a typical year. Patients come from all over the island, many of them without insurance. The clinics closed for almost a month after Maria and then reopened with limited services. Onsite generators couldn’t power all the facilities— as of November, the children’s psychiatry clinic was still closed.

Elsewhere, generators provide sufficient power but are prone to breaking down. Castañer General Hospital, which serves 11,000 people in the mountainous Lares district, installed a new generator before Maria hit, which allowed it to stay open. But after running for weeks, the generator started to leak coolant.

“The day that generator started failing, it was the worst day of my life,” said Adrian Gonzalez, the hospital’s chief operating officer, who is responsible for keeping the power on. Federal relief workers gave the hospital a backup generator, which allowed workers to repair the leaky generator. But getting technicians up from San Juan to work on the generator was yet another challenge, and the stress of keeping the lights on still keeps Gonzalez up at night.

“Generators could fail at any time,” Gonzalez said. “As soon as we get power back, we’re going to be able to normalize our operations and focus on things we haven’t been able to do.”

In parts of the country, however, administrators are turning to a high-tech solution. At a small children’s hospital in San Juan, Tesla installed an array of solar panels and batteries in the parking lot. The hospital’s administrator, Juliana Rivera, said she would like the array to continue powering the hospital even after Puerto Rico Electric Power Authority (PREPA) restores service.

“Right now, the reality is that PREPA is so unstable, I’d rather be off the grid,” Rivera said. “We want to make this a permanent solution.”

Restoring power is the first step. Building a more resilient grid is next. José Roman, head of the Energy Commission, which oversees PREPA, has expressed interest in investing in renewable power from distributed sources, like the solar array at the children’s hospital. But Governor Ricardo Rosselló recently announced plans to privatize PREPA, and it’s unclear what role the Energy Commission will have, or even if it will continue to exist.

In the meantime, for hospitals still without consistent power, the task of generating electricity is an ongoing distraction from the necessary work of treating patients.

Owen Agnew writes and produces videos for Nexus Media, a syndicated newswire covering climate, energy, policy, art and culture. You can follow him at @OwenAgnew.