Last December, when physician Victor Heitor Gomes became health director for Rafard, a municipality 150 km northwest of São Paulo, he knew he had a challenge ahead.
The only clinic in the town of 9,000 had been through hard times: heavy rains in mid-November caused part of a meeting room wall to collapse and a month later more rain flooded parts of the building, including the surgery room and common areas.
The problems forced the clinic to relocate some services to other rooms - and repairing the meter-long hole in the meeting room wall had to be put on hold because of ongoing rain in the Brazilian summer.
Harsher rains and increasingly scorching temperatures have made life tough for doctors in other ways as well, Gomes said.
"They're changing the seasonality of certain diseases. You don't expect to see dengue in the winter, but it's getting more common now," he said.
Extreme weather, like the floods that ravaged the Maria Tereza Apprilante Gimenez Basic Healthcare Unit in Rafard, are increasingly a threat throughout the region as climate change takes hold - and are creating an additional burden for health workers struggling to battle the coronavirus pandemic.
According to the Pan American Health Organization, almost 70% of the 18,000 hospitals in Latin America and the Caribbean are located in areas highly vulnerable to floods, major earthquakes or hurricanes.
Inundation is the most common threat. Nearly 550 floods hit the region in the two decades between 2000 and 2019, affecting over 40 million people and causing almost $26 billion in damages, according to a 2020 report from the U.N. Office for the Coordination of Humanitarian Affairs (UNOCHA).
Brazil is the most flood-prone country in Latin America, the report said.
The storms that hit Rafard are a worry as well for nearby São Paulo, the largest city in Brazil and in South America.
Concrete-filled urban areas act as "heat islands" that absorb and then slowly release the sun's heat, making them hotter than surrounding rural areas.
In cities like São Paulo, that extra heat combines with humidity arriving from the nearby Atlantic Ocean to create heavier rain, said Tércio Ambrizzi, an atmospheric scientist at the University of São Paulo.
"The heat lifts and condenses the humidity, making it rain," often more intensely than might happen elsewhere, said the scientist, who co-authored a 2020 study on changing rain patterns in metropolitan São Paulo between 1930 and 2019.
Using data from the Brazilian National Institute of Meteorology, researchers found that heavy rain is becoming more concentrated in shorter periods, while dry spells stretch longer.
The changes have been particularly noticeable over the last decade, they said.
In 2014, Sao Paulo's hottest summer in seven decades, water reservoirs for the city dropped below 20% capacity, in the city's biggest water crisis on record and a serious threat for healthcare facilities.
Extremely heavy rainfall events - the kind that can trigger disasters - similarly nearly doubled in the last decade compared to 1971-1980, researchers found.
The extremes are most apparent in Brazil's southern and southeast regions, and are a particular problem for heavily populated cities such as Rio de Janeiro and Porto Alegre, which are highly vulnerable to floods and landslides in part because of poor urban planning, Ambrizzi said.
Eduardo Trani, Sao Paulo state's environment sub-secretary, said his office is aware of the challenges.
A 2009 law passed by the state established policy to curb greenhouse gas emissions and adapt to climate threats, including an effort to map climate risks in all the state's 645 municipalities.
Almost 250 have been completed so far.
"The mapping is fine-grained to the scale of neighborhoods, so that local city halls can study precautionary measures to take against floods and landslides," Trani said.
What the results so far have found is that basic healthcare units, particularly in the São Paulo metro area, often lie in flood-prone areas or are surrounded by them.
That can be addressed in part by infrastructure changes, such as building floodwalls around hospitals and relocating vulnerable ventilation, heating and air-conditioning systems to higher ground, resilience experts say.
Having backup power sources - including solar panels or other renewable energy - also can keep hospitals functioning when broader power systems go down in extreme weather.
Mariana Silva, a infrastructure and sustainable finance specialist at the Inter-American Development Bank, said building resilience also is a matter of planning for decades ahead.
"If a hospital is to be built in a place which is highly prone to disasters, we must ask ourselves what can we change in its engineering. You'd be surprised how small changes can make a project resilient," she said.
Shifting designs can add to costs - but ignoring the risks will cost more, she said.
"Making those changes costs extra money - but now Latin American governments know climate change is not a matter of 'if' but 'when'," she said.