I stepped off the dry, dusty main road in Lillooet on a Tuesday afternoon in July, the kind of scorching day when the mercury pushes past 35 degrees. The St’át’imc territory’s dramatic landscape of sage-covered hills and the mighty Fraser River usually draws visitors for its natural beauty. But today, I was here to understand a crisis.
“I’ve lived here all my life, and I’ve never seen it this bad,” says Maureen Pugh, a 72-year-old elder who has spent the last five decades in this remote community of 2,500 people. “When my grandson fell and split his chin open last month, we drove two hours to Kamloops because our emergency room was closed. Again.”
The emergency department at Lillooet Hospital and Health Centre has been closed 26 times so far this year, forcing residents to travel up to two hours on winding mountain highways to reach alternative care. For a community where forestry accidents, heat-related illnesses, and an aging population create regular medical emergencies, these closures represent more than an inconvenience—they’re potentially life-threatening.
“It’s like playing Russian roulette with somebody’s health,” says Dr. Sarah Kendall, one of the few remaining physicians in Lillooet. She invited me to meet at a local café, her exhaustion evident even before she spoke. “We’re down to three doctors covering the hospital and the clinic. The math simply doesn’t work.”
According to Interior Health data, the emergency department closures have increased 85% compared to 2023, when there were 14 total closures for the year. Most shutdowns were announced with less than 24 hours’ notice, leaving residents scrambling to make contingency plans.
Chief Shelley Leech of the T’ít’q’et First Nation tells me these closures disproportionately impact Indigenous communities. “Many of our elders don’t drive. When the hospital closes, they’re completely cut off from emergency care,” she explains as we sit in her office, where a map on the wall shows the significant distance between Lillooet and the next nearest hospital. “We’ve started community carpools, but what happens in the middle of the night when minutes count?”
The crisis in Lillooet reflects a broader healthcare staffing emergency across rural British Columbia. A 2023 report from the Rural Coordination Centre of BC showed that 75% of rural communities in the province are experiencing critical physician shortages. The report pointed to housing affordability, professional isolation, and lack of specialized support as key barriers to physician recruitment.
When I visited the hospital during its operating hours, the waiting room was surprisingly empty—not from lack of need, but from community adaptation. “People have stopped coming unless it’s dire,” explains Jamie Robb, a nurse who requested a pseudonym to speak freely. “They worry the ER might close while they’re waiting, or they’ve been burned before by eight-hour waits.”
Robb describes working shifts alone that should be staffed by three nurses, triaging patients in hallways because beds are full, and the exhaustion that comes from consecutive 12-hour shifts without proper breaks.
“When I started here 15 years ago, we had seven doctors and a full nursing complement,” she says. “The system was stressed but functional. Now it’s broken.”
The hospital’s staffing crisis gained provincial attention in April when Interior Health issued a public call for healthcare workers to relocate to Lillooet. The health authority offered signing bonuses of up to $10,000 for nurses and temporary accommodation subsidies. Three months later, community members say the initiative has brought in only one new nurse.
According to the BC Nurses’ Union, the challenge isn’t just attracting staff but retaining them. Data from the union shows that rural communities like Lillooet have turnover rates three times higher than urban centers, with burnout cited as the primary cause.
“The province treats these as isolated crises, but they’re symptoms of a system in collapse,” says Dr. Kendall. “When I call a specialist in Kamloops for a transfer, they’re overwhelmed too. It’s dominoes falling.”
Mayor Peter Busse told me the town council has taken unprecedented steps to address the crisis, including purchasing a house to offer subsidized accommodation for healthcare workers and establishing a healthcare recruitment committee that meets weekly.
“We’re doing things far beyond our mandate as a municipality because we have no choice,” he says. “But a town of our size can’t solve a provincial healthcare crisis alone.”
For Indigenous communities, the hospital closures represent another layer of systemic barriers to healthcare. A 2020 study from the First Nations Health Authority found that Indigenous people in BC already face significant disparities in access to care, with rural Indigenous communities experiencing 30% higher rates of preventable hospitalizations.
“When the ER is closed, our members often avoid seeking care altogether,” Chief Leech explains. “Historical trauma with the healthcare system means many are already reluctant to go. If they finally decide to seek help and find closed doors—that reinforces everything.”
The wildfire season adds another dimension of urgency. Last August, the Casper Creek wildfire came within 10 kilometers of town, forcing partial evacuations. Community leaders worry about what would happen if a similar emergency coincided with an ER closure this summer.
Walking back through town, I notice handwritten signs in shop windows announcing the next scheduled ER closure. The community has created an informal notification system, including a Facebook group where members share real-time updates about hospital services.
As the sun begins to set behind the mountains, casting long shadows across Main Street, I think about what Maureen Pugh told me earlier: “We take care of each other here. We always have. But we shouldn’t have to choose between our home and our health.”
For the residents of Lillooet, that impossible choice has become daily reality. As British Columbia grapples with broader healthcare challenges, communities like this one demonstrate both extraordinary resilience and the profound human cost of a system in crisis.
While Interior Health has promised a comprehensive recruitment plan, including increased salary premiums for remote communities, the residents I spoke with remain skeptical. They’ve heard promises before. As Dr. Kendall put it: “We don’t need another strategy document. We need doctors and nurses in this building tomorrow.”
As I prepare to leave town, following the winding highway that residents must travel to reach alternative care, the stakes of this rural healthcare crisis come into sharp relief. For Lillooet, the closed emergency room doors represent more than statistics—they’re a matter of survival for a community fighting to maintain its lifeline.
