UTUADO, PUERTO RICO — Carmen Ortiz can manage without electricity because outages are a routine part of life on an island with a dysfunctional power grid.
But living without potable water? That might mean having to flee her family's mountain home overlooking the tiny parish of Caonillas. In the two weeks since Hurricane Maria crippled Puerto Rico's infrastructure, there has been no water service here, and it is unclear when it will be restored.
"If there is no water, disease will come," said Ortiz, who is a nurse and a mother of three. "Right now, we are rationing what we have in the house because we haven't seen a water truck come by here."
Water service had been restored to nearly half of the island's customers as of Tuesday, according to government officials. While the San Juan metropolitan area and points in the south and east now have water, 1 in 5 households in the north and west — especially in rural areas — do not.
Eli Díaz-Atienza, president of the Aqueduct and Sewer Authority, would not say how long it could be before full water service is restored as government officials struggle to rebuild a power grid that supplied electricity to water treatment plants and pumps. Government officials said it could be months before power is fully restored across the island — with a maze of poles and wires down and severed — which means it could be similarly difficult to get water flowing.
Generators are now powering the plants and aqueducts, but that leaves the commonwealth's water service at the mercy of disrupted diesel supply chains. National Guard troops and aid services are just beginning to reach some of the most isolated communities in Puerto Rico's mountainous interior with water trucks and cases of bottled water.
Without this most basic of human needs, some residents have had to resort to their primal instincts, to a time before modern plumbing.
Along Puerto Rico's Highway 10, which cuts a jagged north-south route through the center of the island, cars line up against the columns of granite on each side of the roadway. While it is now normal to see dozens of vehicles on highway shoulders as drivers search for cellphone reception, these drivers are searching for spring water.
Between the craggy rocks flows the bubbly life-giving liquid. Years ago, someone tapped the mountainside, installing a piece of PVC pipe that now acts as a crude spigot for the natural water that flows through the region.
Samuel Colón, 56, and his wife, Wanda López, 51, brought plastic soda bottles, old paint buckets and coolers to collect the water and load it into their pickup truck.
They drove from their home about 15 minutes away in Campo Alegre, a barrio in Utuado, where they have no running water. Every two or three days they come to collect water they use for bathing, to wash clothes and for drinking.
"We do what we have to do," Colón said, wiping his glistening face with a towel. Behind him, his 11-year-old son Luis Ángel Colón pulled off his shirt to play in the pool of clear water. "We are blessed," his father said.
Every half-mile into Utuado, the scene is repeated, any area of exposed mountain rock becoming a gathering place for the makeshift fountains.
In Comerio, another mountainous municipality, flooding from the Rio de la Plata inundated the city and left residents destitute. It took days before any help arrived from the central government, municipal officials said, and residents used plastic pipes to install a crude system to reroute spring water to a clearing where, one-by-one, people could shower and fill containers.
Deeper into the mountains, where landslides have washed away roads and toppled homes, residents are trekking to nearby cascades and creeks to bathe. They have set up makeshift shower curtains using towels and rope.
Luis Morales lives atop a steep hill where the bloated creek destroyed his driveway, cutting him and his sister off from the main road.
They have had to rely on their brother, Miguel Morales, who lives in another town, to drive as close as he can to deliver jugs of water. There, the brothers meet every so often to cross the sediment-filled creek bed and replenish the family water supply.
"They can't use this water," Miguel Morales said indignantly, pointing to the brown, murky stream flowing beneath them. He said he has seen women bathe their children in the water that flows through the town of Utuado, water that carries sewage, trash and pollutants. In some places where the roads are gone, people are using ropes to cross rivers or embankments to get to the more-populated areas where they can find bottled water, but it can be an all-day operation in towns like these.
"There has been so much disorganization," said Luis Morales, a retired government worker.
New U.S. Surgeon General Jerome Adams visited Puerto Rico on Monday to review operations set up by the U.S. Department of Health and Human Services. Although some worry that a lack of water for sanitation could lead to the spread of diseases, Adams shot down as unfounded recent rumors of cholera outbreaks. But medical professionals and volunteers working with patients coming to the University of Puerto Rico's central medical campus are on guard for disease.
HHS has set up triage tents at the medical campus to help relieve the influx of patients to Centro Medico's emergency room, treating mostly orthopedic injuries such as broken bones and supplying medication to adults who have high blood pressure and diabetes and have lost access to their pharmacies.
"Puerto Rico needs to prepare itself" for what's coming, said Ortiz, the nurse living in the mountains outside Utuado.
Her family is using a cistern and worries about the water running out. She is trying to decide whether to wait for the government to solve the water problem for her community or to join her son in Pennsylvania, taking her daughters with her so they can continue their studies.
Ortiz cannot imagine that the schools in the region will reopen without having running water. And she has no idea how long that will take.
So Ortiz, a devout Catholic, asked for a sign.
A few days after a mudslide destroyed her orchid farm and broke the east wall of her church, she saw her priest's head pop up over the mud looking for her.
"We are fighters," Miguel Morales said, just as one of the island's famous nocturnal singing frogs let out a rare daytime melody. "The coquí is a symbol of who we are. We will find a way to survive and keep singing."