As the Victoria Day long weekend approaches, and thank God for it, I have watched with interest news reports about a small hospital in central Ontario. The Minden hospital, located (as you’d guess) in Minden, is a local health-care hub for Haliburton County, an area that sees a considerable influx of tourists and part-time residents during the warmer months. For those not up on Ontario’s cottage traditions and norms, the warm-weather season, regardless of the actual temperature, is roughly considered to run from Victoria Day to Thanksgiving.
It’s starting now, in other words. And the Minden emergency room is closing. If all proceeds as scheduled, that’ll happen as early as the end of this month.
Rural health care is a particular challenge in Ontario for all the reasons you’d expect. The population density is low, the territories requiring service are vast, and the populations have complex health-care needs. Recruiting and retaining staff are constant challenges; many new graduates prefer to live in more densely populated areas for family, or simply lifestyle, reasons. Not everyone prefers the city, of course. The more rural areas have many, many advantages all their own, as anyone who spends much time there knows. But there’s enough of a preference for a more urban lifestyle to prove hellish for many rural systems. Recruiting is a major challenge, as is retention. Even if you find a doctor or nurse or other medical practitioner able and willing to work in a rural area, does that work for their family, too? Are there job opportunities for the spouse? Educational and cultural opportunities for the kids?
Again, I feel I have to stress that our rural areas are not wastelands. They’re gorgeous and full of wonderful communities. But they aren’t for everyone, and that’s fine. They still need to recruit enough people to staff some essential services. And they’ve been struggling to do that.
That’s the explanation for why the Minden hospital will be closing its emergency room. (The rest of the hospital will remain open.) The local health board has concluded it does not have enough staff available to properly operate it, and the available doctors and nurses will be consolidated into a nearby emergency room in Haliburton, roughly 25 minutes away. Nearby is, of course, a relative term. If you live 20 minutes from Minden, on the opposite side as the Haliburton ER, you’re now 45 minutes from an ER. In an emergency when seconds count, that can matter — a lot.
I don’t dispute the necessity of shutting the ER in Minden, nor do I endorse it. I honestly don’t know enough about the local system to say, and I’ve circled around the sun enough times to know that sometimes painful decisions are announced precisely to trigger a public backlash, which in turn draws the necessary political attention to shake loose resources and fix the problem. Maybe the Ford government will see the bad press and, voilà, money and resources will present themselves. It’s happened before, and it’ll happen again. It might happen here.
In the meantime, I’ll be watching this with interest, both professional and personal. The Minden situation speaks to the broader state of our health-care system, which is still struggling to recover from the COVID-19 pandemic and, in some metrics, seems to be heading in the wrong direction, not back into stability and balance. That’s my professional interest. As for my personal interest, I spend most of my summers not far from Minden. In case of a medical emergency, Minden wouldn’t be the hospital we’d go to — there are two others that are closer. But in the broader community, the Minden ER had a really good reputation. No one ever wants to need an emergency room, but if and when one is required, Minden is one of the ones you’d want to go to.
Agenda segment, May 11, 2023: Can the Minden emergency room be saved?
The timing of the announcement of the Minden ER’s imminent closure is … interesting. The announcement is, to put it mildly, not going over well with local residents and officials. A recent public meeting required an OPP presence, tensions were so high. There’s no good time to shutter an emergency room in a community, but there are particularly bad times, and right at the start of the summer season is about the worst possible time. People who don’t spend much time up there probably don’t appreciate how radically the warm-weather seasons depart from the cold-weather ones.
The pandemic scrambled the usual order of things a bit; people who’d normally snowbird stayed home, and some Toronto residents shifted to secondary residences up north on a more full-time basis. But, typically, the population in these rural areas can explode in the warm months. Years ago, I remember talking with a local chamber-of-commerce official for one of the small cottage-country towns, and her best guess was that the summer population exceeded the full-time population by as much as 20 times. This is not a minor seasonal bump. It can mean the difference between a January population of 2,000, for instance, and a July population of 40,000. Or more.
Those 38,000 extra souls will, in the main, not require any extraordinary health care in the summer. Anyone who has chronic conditions or sees more minor illnesses crop up can seek and receive care through their usual medical team (if they have one) close to home. But you can’t drop tens of thousands of extra souls into an area and avoid some surprises — emergencies, as it were. You’ll have some heart attacks and strokes, some accidents, some babies deciding to arrive early, and all the rest. And those people will need an emergency room.
In Minden, they have a pretty good one. Or they did, at any rate. It’s not implausible that the political blowback here will result in some ad hoc solution coming together to get the hospital through the summer. But if the staffing situation is so bad that local officials are considering closing the ER — indeed, if they’ve concluded it’s necessary to shut the ER — then that’s a warning sign for all of us. Closing the Minden ER will be politically painful and could cost lives. If things are that bad, and we should accept that they are, we also have to accept that the Minden ER won’t be the last to close. Stay tuned.
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