ASHCROFT - He purchased the tiny house on a downtown street nearly two years ago.
The dirty white stucco Brink Street home was so run-down that few would look past its knee-deep weeds, its flaking and faded wood trim.
But Joris Ekering, an electrician with a passion for setting up sound and electronics at music festivals, saw past the feral cats living inside, past the acrid stench of urine that had become the home's hallmark.
It was Ashcroft's stark desert vistas, budding arts scene and the fact the town had its own hospital that originally lured Ekering and his now ex-wife across the country, from Lunenburg, N.S.
The little stucco-sided house was a chance to get his financial house back in order, and his life out of a trailer home.
There were other complications, however.
A decade ago, Ekering was diagnosed with type 2 diabetes. It was well controlled with insulin and the drug metformin. Four years ago, doctors told Ekering he also had chronic lymphatic leukemia.
The slow-moving cancer of the blood and bone required no treatment in its early stages. He took on the job of rebuilding the house and boosting his income with small electrical jobs.
A year and a half later, he started the difficult process of moving out - back to his trailer.
"I just don't have it anymore," declared the 67-year-old with a shrug of his wide-set shoulders.
Renovation tools, furniture and sound equipment were strewn around Ekering's house as he prepared to leave.
He made a deal to give low-cost rent to a tenant in return for renovations he can no longer muster himself.
Adding to Ekering's list of worries was the chilling news that first trickled out of Ashcroft Hospital and Community Health Centre in the spring: Dr. Anwar Khan, who has practised here for three years, is gone.
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Ashcroft's median age is 55 years, 13 years older than an already-grey B.C. population.
"It's a mostly geriatric practice," acknowledged Dr. Antoinette Kitschoff, currently Ashcroft's only physician.
The hospital's emergency room is no longer open 24/7, as it was before 2008 when three physicians sacrificed their lives, at times clocking 130 hours a week to keep it open.
Dr. Kitschoff immigrated to Canada from Pretoria, South Africa, with her husband, who was trained in business computing at home, but now works in a utility job at Highland Valley Copper.
Outside her regular attendance at the hospital clinic, Kitschoff's on-call hours - hours outside the normal work week that drove doctors Raymond McConville and Abu Maher out of town - are limited to 24 hours on Wednesdays as well as around the clock one weekend a month.
The shortages of physicians here along with limits succeeding physicians typically set - limits that those in administration and academia say are the new norm - often result in a sign placed in the middle of the road leading to the hospital. It warns the emergency department is closed. Those seeking help should go to 100 Mile House or Kamloops.
In September, the Interior Health Authority reduced hours again due to a lack of physicians, essentially keeping it open little more than business hours Monday to Thursday as well as two weekends a month.
In January, two new doctors from South Africa are scheduled to begin practice, something that is expected to expand those hours.
"The sign says, if you're sick, drive to 100 Mile," said Esther Darlington MacDonald, an artist who has lived most of her life in either Ashcroft or Cache Creek.
"That's fine if you don't have a serious illness or had an accident on your motorcycle."
According to Interior Health Authority figures, in the last budget year ending in March the emergency room was closed 65 full days.
Kitschoff said she's used to working alone. The most serious traumas or acute heart or stroke problems, for example, go straight to Royal Inland Hospital.
The emergency room physician is able to call colleagues at RIH if she needs advice.
But if a patient requires physical support - say intubation whereby a tube placed through an incision in the upper airway to remove or add fluids or air - "you don't have that extra set of hands," she said.
"You still always worry when you're in that position."
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Darlington MacDonald's husband, Sherman, suffered a massive stroke when he was in his late 50s. After six months at Vancouver's GF Strong rehabilitation centre, he regained some mobility but was left with aphasia, limiting his speech.
A year ago, Sherman, who now has a high propensity for strokes, "woke up grey-faced," she said.
He was able to mutter "weak, weak."
On that day, Ashcroft's emergency room was open.
Sherman was spared a long ambulance ride to get to the doors of RIH and its emergency physicians.
Sherman also cuts easily, his skin now fragile as onion paper from being on the blood thinner warfarin for nearly two decades. The last time he cut himself badly, the emergency room wasn't open. There was no doctor and he was bleeding profusely.
Desperate to stop the bleeding, Darlington MacDonald drove Sherman to the Ashscroft hospital. She is uncomfortable driving farther than Cache Creek or Clinton.
"The emergency room wasn't open. I just went to the public health nurse. She told me, 'We're closed.'
"I said, 'I know, but my husband is bleeding.' "
The nurse at the hospital didn't turn Sherman away. She bandaged and settled him, without an ambulance trip to Kamloops.
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Ekering also faced a closed emergency room after waking in the night from occasional panic attacks. Late last year his leukemia became acute, requiring agonizing chemotherapy at RIH. At the same time he lost control of his blood sugar.
The result was occasional bouts of extreme anxiety, often late at night.
"When I have a panic attack, I need help," Ekering said.
Residents say nurses on staff at the hospital will assist, even when the emergency room is closed.
The Daily News arranged an interview with a semi-retired nurse living in Ashcroft. But after contacting the health authority, the newspaper was told the nurse had a change of heart and wanted the interview conducted through the agency's public relations staff.
"There are standard codes for staff and the employee had a chance to look at that," said Darshan Lindsay, a manager of public affairs at IHA.
Tracy Quewezance, a B.C. Nurses Union representative in Kamloops, said a protocol is in place for nurses to assess patients in Ashcroft.
"When there's not a doctor in, they call 911 and triage," she said. "It depends on the expertise of the nurse."
Quewezance said nurses have put forward proposals to IHA to better utilize their expertise but the agency has expressed little interest.
"Nurses are willing to take training to be available. There are other options they could look at."
Ekering recalled being welcomed after he went to the hospital in midst of a period of extreme anxiety.
"She told me, 'Come on it,' " Ekering recalled.
" 'If you have to go to Kamloops, I'll send you there.' "
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Ashcroft health centre by the numbers
Population of Ashcroft and Cache Creek: 2,600
Main health facility: Ashcroft Hospital and Community Health Centre, built in 1972, with 2002 renovation for residential living.
Number of beds: 0 acute care; 25 residential beds.
Number of Ashcroft patients admitted to RIH in 2010/11: 207
Number of Ashcroft patients admitted to RIH in 2002: 132
Number of family physicians in Ashcroft: in 2002, four; in 2012, one, with commitment for two more in the new year.
Emergency services: designated as 24/7 service but due to physician shortages is regularly closed through the week. Generally emergency room is open 24/7 on Tuesdays, Wednesdays and occasional weekends.
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