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Canadians living in larger cities are familiar with the problem of emergency department overcrowding, where people waiting for beds languish on gurneys in hospital corridors – or what’s become known as “hallway medicine.”

But in small-town Canada, there is another problem, one that has been dubbed “highway medicine.”

Hi, my name is Tu Thanh Ha and since the pandemic began I have often written about issues stemming from personnel shortages in Canada’s public health care system.

Last April, a headline on the website of the Newfoundland radio station VOCM caught my attention: “‘Fortunate’ outcome despite locked emergency room in Bonavista.”

It was just a four-paragraph item. There was no name, just the tale of a man with a hand badly injured by a power saw. He went to the emergency room in the small town of Bonavista, only to find the doors locked. Fortunately for him, he found a nurse who got him transported by ambulance to another ER for surgery.

It so happens that for the past few months, I had been working with two colleagues, health reporter Kelly Grant and data editor Yang Sun, on a deep dive into the issue of hospital emergency service disruptions – night-time closures, weekend closures, shortages of doctors and nurses.

The incident in Bonavista, N.L., was a concrete example of the impact of such periodic closures. A local resident wasn’t aware on the day a chainsaw ripped through his hand that his local ER would be shuttered for 48 hours because of staffing issues.

Kelly was able to identify the man, Derrick Maloney, and interviewed him during a reporting trip to Bonavista. Maloney, and a photo of him and his bandaged hand, are featured in our in-depth feature article on ER closures.

We worked for seven months on this story as part of our “Secret Canada: Your Health” series.

One of the big problems with emergency service disruptions is that there is no systematic, nationwide tracking of these incidents.

We set out to compile a dataset of ER closures since 2019, the last year before the pandemic. This meant contacting dozens of health ministries and health authorities across the country. Most told us that we would have to submit access-to-information requests, which can be slow going.

It was a painstaking process but the nature of journalism is often that long, mind-numbing work is required to shed insight into complex issues.

In the end, only New Brunswick and Manitoba were able to provide a detailed set of closure statistics. Many provinces didn’t begin tracking closures until after the pandemic started.

The data we collected show that this is almost exclusively a rural problem that touches all provinces, but particularly Manitoba, with 70 per cent of ERs having experienced closures, Nova Scotia (66 per cent), and Saskatchewan (57 per cent).

We found that rural hospitals in various provinces tried to deal in various ways with their ER staffing problems. Some never closed but advised the population that they would only treat the most urgent cases. Others would only take walk-in patients. Certain places switched to office hours, shutting down at night and during weekends.

The reality was that in many small communities, dealing with a pressing medical problem meant driving to another town because the local ER was closed – “highway medicine.”

But we were able to conclude with a positive development.

In Rivière-Rouge, 170 kilometres northeast of Montreal, local residents rallied against the scheduled nighttime closure of their ER, went to court, got an injunction, and are now working hand-in-hand with hospital administrators to recruit and retain workers and keep medical services running.

You can read our whole story , including a visual overview of the data we collected and our methodology. You can also explore which emergency rooms in your area have closed, temporarily or permanently, with our interactive map.