Every time Arborg Mayor Peter Dueck walks out his front door, he’s reminded his community is missing a critical service.
The small Manitoba town’s hospital, right across the street from Dueck’s home, often has a sign reading “emergency services are not available today.”
“That sign seems to be out there almost 30 days every month,” Dueck said in an interview with CBC in late March.
The Arborg & Districts Health Centre’s ER shut its doors indefinitely Nov. 6. Before that indefinite closure, it was closed 72 times in 2023 — adding up to an equivalent of 332 days.
The Interlake community’s ER is not the only one that’s seen frequent closures.
Emergency departments across Manitoba closed their doors 1,828 times in 2023, according to data obtained by CBC News through a freedom of information request. That amounts to more than 80,000 hours worth of closure — the equivalent of 3,348 days.
Some closures were for a few hours, while others lasted weeks. Four ERs, including Arborg, closed their doors indefinitely last year.
“None of that’s good,” said Dr. Alecs Chochinov, an emergency physician at Winnipeg’s St. Boniface Hospital and a past president of the Canadian Association of Emergency Physicians.
“It’s reflective of problems in the system in staffing EDs,” and of “a growing existential problem around the country with ERs,” he said.
Historically, there’s been “one in every town,” and the sense was that “the way you need to have a safe town is to have a hospital and an ER,” said Chochinov.
Emergency departments should be able to look after the initial stage of any acute injury or illness and be accessible 24 hours a day, seven days a week, he said.
“You can’t, by definition, schedule emergencies,” Chochinov said.
“[If] you don’t have the resources, human or otherwise, to deal with that stuff that’s going to come in that’s life-threatening or you don’t have the 24/7 capacity, you’re not really an emergency department.”
Long drives for care
ERs in three other rural Manitoba communities closed their doors indefinitely in 2023: Carberry on Aug. 23, and Melita and Morris, both on Sept. 1.
The ER in Leaf Rapids closed in July of 2022, but Northern Health still lists it as a “temporary” closure.
There are also three ERs that have been closed indefinitely for years and no longer log closures with the province: Shoal Lake, Winnipegosis and Teulon.
Dr. Nichelle Desilets, a family and emergency physician in Neepawa, Man., is shocked by the duration of the closures.
“Rural patients and their families are potentially living in uncertainty, because they know they might have a complicated cardiac history, they might have heart problems where they’re reliant on expedient medical care, and when their local emergency room is closed, I’m sure it’s stressful,” said Desilets, who is also a board director with the advocacy group Doctors Manitoba.
Some residents wonder what will become of rural ERs, like Arborg’s, that close frequently or indefinitely.
“I’ve had to go to Gimli, I’ve had to go to Stonewall, I personally had to go to Selkirk,” said Caitlyn Chorney, a mom of two who lives just west of Arborg.
Even Gimli’s Johnson Memorial Hospital, which is a nearly 50-kilometre drive from Arborg, closed 55 times in 2023, for a total of 696 hours (the equivalent of 29 days).
Selkirk’s ER, which serves as a hub for the region, closed only once last year for a few hours, but it’s even farther away for Chorney.
“That’s a good hour [drive]” she said. “If it was an emergent situation, it would take quite a while to get some kind of attention.”
Eugene Zubriski, who also lives near Arborg’s hospital, is concerned the emergency department won’t be open when he needs it.
“If it’s an emergency, the ambulance will just zip you off to Gimli or Selkirk,” Zubriski said. “You got no choice.… What are you going to do? Sit and die?”
But Mayor Dueck said wait times for ambulances are also a concern in Arborg, leaving many feeling their only choice is to drive themselves, or a loved one, to the nearest ER.
“If you can’t count on it, why waste the extra five, 10 minutes … [going to the ER] here if you think you have an appendix attack or whatever? You’ll just have to drive yourself to Gimli or Selkirk,” Dueck said.
Hard to reopen ERs
Compared to other regions, emergency departments in the Interlake-Eastern Regional Health Authority — where Arborg is located — were closed far more frequently and for longer total amounts of time.
Its ERs accounted for more than 34,000 of the 80,000 hours Manitoba emergency departments were shut down last year, according to the data obtained by CBC.
The Arborg ER isn’t expected to reopen in the near future, said Dr. Charles Penner, the regional lead for medical services and chief medical officer for the Interlake-Eastern authority.
The hospital remains open for in-patient care, he said in an email. Hours at the primary care clinic have also been extended into some evenings and Saturday mornings, he said.
People in the Arborg area having a health emergency should call 911 to be taken “to the most appropriate care facility,” said Penner.
But Dr. Desilets said the consequences of short-term, intermittent ER closures include uncertainty for people about where to access care.
“Sometimes they won’t even bother stopping into their local emergency room because they’re stressed, and they just go to the next one that they know is guaranteed to be open,” she said.
The implications can be greater if closures are prolonged.
“Once a hospital loses its acute care services and its emergency room, if that’s been the case for a long time, it can be hard to re-establish that service,” said Desilets.
“Health-care workers may no longer feel confident in their acute care skills that are needed to run an emergency room.”
ER in every community not an option: Chochinov
But governments are in a difficult position of feeling they need to support more ERs than they have the capacity to keep open, said Chochinov, who co-authored the Manitoba government’s 2017 wait-time reduction task force report and was lead author on a national report about the future of emergency care.
“I think to some extent governments have been uncertain about how to go about dealing with that and sometimes afraid to deal with it,” Chochinov said.
“Communities, on their part, have also misunderstood what this means for them, and maybe they’re also afraid. They have a fear that anybody would have, for the potential of them or their loved one to be sick.”
Solutions will require convincing people they’re better served by a different system that doesn’t rely on an ER in every community, he said.
That includes having well-trained paramedics who can transport people by ambulance to emergency departments in larger centres with more staff and better equipment, said Chochinov.
“If you have a heart attack, under which system are you going to get better service? And you have to convince the townspeople who will be very suspicious that their teeny little ER that isn’t open all the time isn’t necessarily serving their needs,” he said.
“It should not be a badge of glory to have a half-assed ER.”
When asked what the province plans to do with currently closed ERs, Manitoba Health Minister Uzoma Asagwara said the recent provincial budget includes investments in rural health, and their NDP government is looking to repair relationships with front-line health-care workers.
“We didn’t get here overnight and it’s going to take us time to really move things in the right direction,” Asagwara said.
The Interlake community’s ER shuttered indefinitely in late 2023 after frequently closing its doors to patients throughout the year. It’s not the only rural community to experience that, according to data obtained by CBC News through a freedom of information request.
Staffing shortages are a key issue, health regions say.
In some cases, they’re able to find doctors to staff weekends. In Morris, that approach worked for a month.
Some are turning to other solutions. In Carberry, two nurse practitioners provide care at a walk-in clinic four times a week. Melita also uses nurse practitioners to supplement the two doctors that each handle a day a week at a medical clinic.
Arborg’s mayor said he understands everyone is facing a shortage of doctors and nurses, but thinks the idea of not having an ER in his community is a problem.
The Interlake town is a growing community of about 1,300 people and home to hundreds of manufacturing jobs, Dueck notes.
He worries about parents needing to make long drives to access the nearest open emergency room when their kids require emergency care — and what that would ultimately mean for the town.
“We need to have awareness, because smaller communities are losing their voice.”
