The project placed its early emphasis on constructing a small hospital by remodeling an old barrack style structure.  The renovation included installation of concrete piers for the foundation, leveling floors, interchanging wall sections, erecting partitions, overhauling the electrical and plumbing systems, constructing cabinets prior to painting the structure inside and out.  The PRRA supplied the materials and the unit men completed the work. 

The building included a large kitchen, dining room, operating room, obstetrics room, wards for men, women and children, doctor’s office and X-ray room.   The facility also housed a diagnostic laboratory set up by one of the CPS men so the hospital could service the community and also other rural dispensaries.  An ambulance sent from the United States made it possible to provide service to the area as well as to hospitals on both the north and south coasts. 

As was the model in the PRRA, community centers provided schools, recreation and health services to the farmers and families living in homes clustered around the major fields.  Within the first year of construction and operation, the doctors had performed nearly 200 operations, given 827 typhoid injections and 220 smallpox vaccinations; first aid classes were organized along with nurses’ training and training of local persons as nurses’ aides.  The community center had also instituted a recreation program for indoor and outdoor games.  (Eisan p. 337)

The community center program grew with the addition of a recreation program, courts and equipment.   The unit organized a small public library with Spanish language books on loan from San Juan as well as a movie series.  The center housed community meetings, and later supported clubs for boys and girls, crafts, classes in English, child care, and carpentry.   Then summer camps for boys and girls began.

In the next year, the project added a medical dispensary in Rio Prieto several miles from Castañer.  Each Saturday a hospital group delivered services (medical examinations, prescriptions, dental extractions) as well as provision for ambulance service, lab exams, hospitalization and surgery at Castañer as needed.

In addition to the CPS men, medical doctors, nurses, others with professional training, wives of unit members, and native Puerto Ricans staffed the project so that the total personnel numbered around sixty.  This permitted the expansion of public health projects to include school and home visitations, health education, hookworm control and a tuberculosis survey. The hospital proved to be such a successful model for rural health care delivery that in 1945 the Insular Legislature approved $20,000 to be used towards its operation.

J. Kenneth Kreider reports that one of the CPS men, Caleb Frantz, who first worked as an orderly in the men’s ward, was later trained to assemble surgical instruments and supplies, and eventually learned to serve as an assistant in surgery and the delivery room because of the shortage of trained nurses.  Frantz told Kreider this story of a memorable delivery.

. . . his task was to dispense drops of anesthesia for the mother-to-be on command from the physician, Dr. Everett B. Myers. The birth was imminent, so with the next contraction he asked the woman to push.  She did, whereupon she also started choking and gagging in great distress.  Frantz, suspecting vomit, grabbed an emesis basin.  Just then, out of her mouth shot several inches of an adult ascaris worm, (an intestinal parasite, ascaris lumbricoides, thick as a pencil and often ten inches long).  Not wanting to seek instructions from the doctor or nurse at a critical moment of delivery, Frantz looped his finger around the worm and “delivered” it from the woman’s throat.  Her eyes opened wide in astonishment; such worms are normally eliminated in the other direction!  Moments later, the healthy baby was born.  When things settled down after the excitement and stress of delivery, Frantz showed Dr. Myers and the nurse the contents of the emesis basin, saying, “A minute before you delivered the baby, I delivered this”!  Were they surprised?  To say the least, that was a new twist on multiple births for everyone concerned. (J. Kenneth Kreider personal correspondence November 27, 2010)

Throughout the life of the unit, men performed construction and maintenance work on buildings, remodeled and repaired equipment, creatively using whatever materials were available. 

When CPS ended, the Brethren continued to sponsor the program of medical and social services with an increased emphasis on religious ministry.  In 1958, Nathan F. Leopold, Jr., infamous as half of the Leopold-Loeb murder of a young boy in Chicago in 1924, upon his parole and release from Stateville Prison in Illinois to the Brethren Executive Secretary W. Harold Row, operated the x-ray facility at the hospital.  Row personally accompanied him to Castañer on March 15, 1958, after having secured permission from the people at the hospital and the governor of Puerto Rico.  Of this unusual arrangement, Leopold later wrote:

So far as I am aware, mine was the first case in which the Brethren sponsored a man released from prison on parole.  To me the Brethren Service Commission offered the job, the home, and the sponsorship without which a man cannot be paroled.  But it gave me so much more than that—the companionship, the acceptance, the love which would have rendered a violation of parole almost impossible.  A man would have had to work hard indeed to violate parole in such an environment.  (in Kreider p. 28) 

In 1976, the Brethren Service and Church of the Brethren, as had been the original plan, turned the hospital over to the local board of directors.