National Defence Committee on March 4th, 2008

[Denis Coderre, Liberal, Bourassa, QC]

So that's pretty strong stuff too, I guess. Are those medications pretty strong?

I'll tell you why, because when we spoke with General Jaeger--

[LCol Theresa Girvin]

They're effective, yes.

[Denis Coderre, Liberal, Bourassa, QC]

--we were talking about reinsertion, and it seems that right now we have some soldiers whom we want to reinsert and send back into the field, and they're doing transportation or whatever.... Is it a different type of medication? And what's your say on that, sending a soldier back to the field while under medication?

[LCol Theresa Girvin]

The real advantage of these medications is that they're actually quite well tolerated. They actually don't have much in the way of side effects initially.

If you're going to prescribe a medication, whether it's in Canada or on Kandahar airfield, first of all you want to see that the person is tolerating the medication. So my practice is that if they're going to accept a prescription, they get some counselling on what side effects are most common, what they might expect, how to deal with the nuisance level of side effects. Then I get them back fairly shortly after they start the medication to see how it's sitting with them. If it's causing them problems, then we can look at alternatives.

[Denis Coderre, Liberal, Bourassa, QC]

What would be the ratio of people we're sending back? Do you have any percentage of soldiers we want to send back under medication to the field? What would be the percentage?

[LCol Theresa Girvin]

I want to clarify your question. You're asking me about the situation in Kandahar, when I was seeing patients who came in with difficulties--what percentage of them subsequently went back to work and may have been on medication?

[Denis Coderre, Liberal, Bourassa, QC]

Yes.

[LCol Theresa Girvin]

I don't have those figures for you, but they're pretty low. I don't have exact figures.

[Denis Coderre, Liberal, Bourassa, QC]

Then overall, do you have any figures? I know you're working on the base, but do you have any numbers in general? Of course, we have Mr. Brunet's study, but right now can you say there are a lot of those soldiers who are being sent back to the field under medication?

[LCol Theresa Girvin]

No, I would say there are not a lot.

[Denis Coderre, Liberal, Bourassa, QC]

There are not a lot.

[LCol Theresa Girvin]

I can't be more specific than that. I believe General Jaeger is trying to track down numbers for the committee.

[Denis Coderre, Liberal, Bourassa, QC]

I think it's important. Some people will have some doubts about sending them back to the field. I heard also that there are some soldiers who, because of the macho culture, will get rid of those medications when on the field. What's your say on that?

Would you please tell us, also, about the security of other members of the troops in the field when you have that kind of individual who is under medication?

[LCol Theresa Girvin]

It sounds to me as though you have three questions there. The first one--

[Denis Coderre, Liberal, Bourassa, QC]

Go for it.

[LCol Theresa Girvin]

--was something to the effect of what the others would think if their corporal came back and he was taking a medication. It's up to that corporal whether or not he wants to share with his co-workers that he's taking a medication, if in fact that happens. I would remind you again that I believe these numbers are quite small.

Also, probably the majority of these medications might be, for example, sleep aids. And in fact--and this is related to your second question, and I don't have any numbers to back this up--I believe probably a lot of them don't take their medication when they go out. In fact, they'll make that decision based on whether or not they think it'll impair them in any way in doing their job.

When I see patients in Kandahar, if I'm going to make any intervention, I don't want to put that person at any higher risk or put any of his colleagues at a higher risk in the operation. So any of my interventions are going to be geared to lowering that risk.

[Denis Coderre, Liberal, Bourassa, QC]

But do we agree, Colonel, that we don't know what the eventual reaction might be? Because we never know what kind of stress--and it might pop up and cause some flashbacks.... How do you do the follow-up to make sure there won't be, as we say in French, une rechute?

How do you say rechute in English? You're the wrong person to ask that of.

[A voice]

Relapse.

[Denis Coderre, Liberal, Bourassa, QC]

Thank you.

[LCol Theresa Girvin]

If I see a person and I'm very concerned about them, I'll arrange for a follow-up. Also, one of the really great things about being in the military is that you're part of a team. You don't work in isolation; you have colleagues and supervisors, and people all watch out for each other.

I suppose at any time--

[Denis Coderre, Liberal, Bourassa, QC]

That explains that, then. I'm just trying to put myself in their body. They're shy. Probably they don't like being different. They have to take those medications, and everybody is all together, so that's why sometimes for them it's stressful even to take a medication with the troops. You have that comorbidity, and they try to find some other auto-cure, whatever it may be.

That's why, if they're having that medication at a certain level, and if they get rid of it.... You provide that individual medication to help, and if he's not taking it, he's maybe becoming a problem for the troops themselves. How can we do that kind of follow-up to make sure those individuals are doing what they're supposed to do?

[The Chair, Conservative, Rick Casson]

A short response, if you have one, Theresa.

[LCol Theresa Girvin]

You're asking about the issue of compliance when medications are prescribed. Most of the time when the medications are prescribed, they're for symptom improvement. I suppose you could draw an analogy between this and giving someone a Tylenol for a headache. They are free not to take the Tylenol and have a headache. The question is whether that headache will impair their functioning, and that's what I look at.

[The Chair, Conservative, Rick Casson]

Mr. Bachand.

[Claude Bachand, Bloc, Saint-Jean, QC]

Thank you, Mr. Chairman.

You mentioned in your presentation that you had gone to Kandahar. I would like you to tell us more about that. How many psychiatrists were there in Kandahar? Were you the only one? Were there other psychiatrists with you at the camp in Kandahar?