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MAYAGÜEZ, PUERTO RICO — Abigail Matos-Pagán entered a bright-blue house in Mayagüez earlier this summer and was met by Beatriz Gastón, who quietly led the way to her mother’s small room. Matos-Pagán had come to provide a covid-19 vaccine for Wildelma Gastón, 88, whose arthritis and other health concerns confine her to bed.

Wildelma Gastón asked for her rosary to be placed on her chest and motioned to her “good arm,” where Matos-Pagán injected a first dose of the Moderna vaccine. The Gastón household, made up of five family members, breathed a collective sigh of relief. Though the vaccine had been available for months, Wildelma had been unable to reach a vaccination site. According to the Centers for Disease Control and Prevention’s COVID Data Tracker, Puerto Rico’s vaccination rate in March was one of the lowest among U.S. states and territories despite receiving more than 1.3 million vaccine doses. The rollout highlighted disparities in access to medical services, and the challenges of tracking and reaching remote citizens, such as Wildelma.

With each trip to school or work, family members worried about bringing the virus into their home and the threat to Wildelma’s life. Matos-Pagán also vaccinated two of Beatriz’s children, who are students at the University of Puerto Rico-Mayaqüez, during her visit.

“We have been waiting a long time for this moment,” Beatriz Gastón said as she hugged Matos-Pagán goodbye, expressing gratitude for the home visit. To her, the vaccine is more than protection from the coronavirus — it clears the way for the family to be together with her mother.

To Matos-Pagán, it is her latest calling. The nurse practitioner, who has guided relief efforts after hurricanes and earthquakes in Puerto Rico and elsewhere, has made it her mission in the U.S. territory to vaccinate as many people as possible against covid. Some residents of Mayagüez, a city on the western shore of the main island, candidly call her “The Vaccination Queen” and show up at her home asking for help in getting a shot.

According to The New York Times' case tracker, as of Friday, Puerto Rico has had more than 182,000 covid cases and at least 2,594 deaths. About 57% of the population is fully vaccinated, but many of the unvaccinated are hard to reach because they live in remote mountainous communities or have chronic illnesses that leave them homebound. Matos-Pagán has vaccinated around 1,800 people in Puerto Rico so far, including 1,000 who have chronic illnesses or are bedridden.

In the pandemic’s early days, Carmen Blas’ health declined, and she began using a wheelchair. Blas, 78, was confined to her home, on the third story of an apartment building, which kept her safe from contracting covid, but later she couldn’t find transportation to a vaccination site. In June, her two children, Lisette and Raymond, visited from Wisconsin to help and immediately called the public health officials to get Blas inoculated.

“I usually come back every year and this was the longest I’ve ever been away. It was especially hard as my mother’s health worsened, and I worried I might never see her again,” said Raymond, who planned to extend his visit for as long as he was needed.

Matos-Pagán came to Blas’ home in Aguadilla, Puerto Rico, to give her the vaccine. The family cheered the moment the vaccination was over.

“It’s been really special to have intimate moments in someone’s home during vaccinations. You can tell how much it means to their entire family,” Matos-Pagán said afterward.

Mobilizing during a crisis is nothing new for Matos-Pagán. In the aftermath of Hurricane Maria, which cut off water and electricity to the entire island and claimed more than 3,000 lives, Matos-Pagán conducted initial community assessments in Puerto Rico’s remotest and hardest-hit cities. Flooding and debris made many roads inaccessible, blocking these communities from basic needs such as food, water, prescription medications and transportation. Then, after a series of earthquakes in 2020 rocked the island, leaving even more people without housing or in substandard structures, Matos-Pagán organized local nurse practitioners to provide community health care. They supplied at-risk populations with their medicines when pharmacies closed, and teams set up mobile medical tents near overcrowded hospitals.

“I’m hyper and busy in my daily life, but when there is a crisis, I am calm and still. Grounded. I feel like I’m where I belong,” she said.

Matos-Pagán was born in New York City. She became interested in medicine after watching nurses support her mother, who died of complications from an aneurysm when Matos-Pagán was 9. Her mother’s death taught her “nothing was permanent,” she said, which has inspired her to act when disaster strikes and support people through personal tragedy and loss.

Matos-Pagán returned to Puerto Rico to study nursing and later earned a master’s degree and a doctorate at the University of Puerto Rico-Mayagüez. Through her work, she holds various titles: first commander of the Puerto Rican Disaster Response Team, and director and founder of the Coalition of Nurses for Communities in Disaster.

Her experiences managing medical professionals and resources during hurricanes have taken her to locations across the U.S. Atlantic coast and the Caribbean. During the covid pandemic, she was recruited to assist in triage leadership for an ICU floor short on resources in El Paso, Texas, and a hard-hit senior living facility in Maryland.

“Not everyone is built for this. It’s really sad, depressing work,” Matos-Pagán said. “But even when there are mass casualties, you can still save lives and get people’s basic needs met. I’ve seen communities come together in the most incredible ways. It’s a challenge, but that’s what keeps me going.”

And, even as she is rapidly trying to get more covid shots into the arms of Puerto Ricans, Matos-Pagán is preparing for the next crisis. Hurricane season officially began in June, and she will be on disaster-ready duty until the end of November.

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