Veterans Affairs Committee on May 18th, 2023

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Thank you.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you, Mrs. Wagantall.

Now I would like to invite Mr. Wilson Miao for six minutes, please.

[Wilson Miao, Liberal, Richmond Centre, BC]

Thank you, Mr. Chair.

Thank you to all the witnesses for appearing today for our important study for women veterans.

Thank you for the service you provide to all the veterans and to our country.

I would like, through the chair, to direct my first question to the Chronic Pain Centre of Excellence.

With more than 40% of Canadian veterans suffering from chronic pain, the centre focuses on pain management research and on evidence-based therapy that addresses veterans' complex chronic pain challenges and needs.

After Dr. MacDermid's remarks, are there any recommendations that you would suggest or that you would provide to our committee to be included in our study report?

[Dr. Joy MacDermid]

The one study that we just reported on has implications for us. We know that it confirms what we believed—that there's a link between psychological distress caused from sexual discrimination and the experience of chronic pain—but it also means that when people.... The first recommendation is that people of course have to be able to come forward without concerns about retribution or about being safe. Also, then, when they come forward, they have to know that they're going to get treatment, not just for the psychological distress but also for the physical pain that is often going to be accompanying that.

We can't treat all cases of chronic pain the same and we can't treat them like they're coming just from a physical injury. Chronic pain can also come from sexual assault, sexual discrimination and chronic stress from these kinds of traumatic psychological exposures that women veterans are exposed to. They're going to need special treatment programs that help them deal in an integrated way with the psychological trauma as well as the physical pain.

I think that really confirms that the Chronic Pain Centre of Excellence needs to put forward and test new treatment approaches that incorporate a specialized approach that takes into consideration the unique nature of chronic pain when it's associated with sexual harassment and assault problems and the psychological distress that arises from them.

Ramesh is the expert in chronic pain management and is seeing many of these patients, and I'm hoping that he will also confirm what I've just said to you.

[Dr. Ramesh Zacharias]

Thank you, Joy.

Also, thank you for your question, because, as I mentioned in the opening remarks, about 60% to 70% of the people I treat today are veterans. About 25% of them are female. The remainder are male. In fact, just today I saw four veterans whom I treat and who are in the program.

You cannot separate the two. As I mentioned, 60% of veterans with chronic pain also have mental health issues, and 63% with mental health issues have chronic pain. It's really two sides of the same coin, so if you're just going to give them a physiotherapy clinic or treat the musculoskeletal issues, you will not get the success.

In fact, the research goes back to 2012, when the International Association for the Study of Pain looked at 43 countries around the world. Their conclusion was that the best model is a biopsychosocial model, with physicians, pharmacists, psychologists, psychiatrists and addiction experts in one facility.

I feel very blessed to be working at the DeGroote, where we have 12 different health professionals, including addiction experts, psychiatrists, psychologists and psychometrists. When a veteran comes into our program, they get all the resources in one place, and that's probably why our success has been published in peer-reviewed journals. We have the best success.

Interestingly enough, veterans do better than civilians in our program, partly because of what Hélène said: They're “mission first”. They're very committed. They're dedicated to things that will help them. That was the remark:from the four veterans I saw today: “You tell me what to do and I will do it, and, by the way, I am feeling better.”

In just treating the physical aspects without addressing the psychological issues, you will not succeed, and that's been our mantra for three years with Veterans Affairs Canada. You must send people to interdisciplinary care as opposed multidisciplinary care. In multidisciplinary care, they see different specialists in different locations without a holistic one-centre approach. That has been part of our recommendations.

[Wilson Miao, Liberal, Richmond Centre, BC]

Thank you for sharing that with us.

In your opening remarks, you mentioned that this is being funded by our government and that it started in April 2020. Can you give us a sense of how many female veterans since then you have served in that 20% you just mentioned? Also, what is the success rate and how long does the pathway to recovery take? Could you give us some insights on that, please?

[Dr. Ramesh Zacharias]

The centre itself does not provide care. The centre is a research centre. We fund researchers like Dr. MacDermid. We fund master's and Ph.D. students like Hélène, and others who are involved. I have a clinical practice apart from the CPCoE, but the CPCoE is a research centre. It is not a treatment centre.

I can give you a response on the basis of my clinical practice at Hamilton Health Sciences, but the CPCoE is not involved in treating veterans.

[Wilson Miao, Liberal, Richmond Centre, BC]

Thank you.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you, Mr. Miao.

I will now turn the floor over to the second vice-chair of the committee, for the next six minutes.

Luc Desilets, the floor is yours.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

Thank you, Mr. Chair.

Good evening, colleagues.

Thank you to all of our guests for giving us this time.

Mr. Chair, I'd like to begin with some brief remarks out of context.

Today, we can see that the French name of the study is now “Expériences vécues par les vétéranes”, in which the term “femmes vétérans” has been replaced with “vétéranes”. As you recall, we had a discussion about this last week. I'd like to thank the analyst, the clerk and you for considering the request of Sandra Perron, a woman veteran who appeared before the committee. We've also received a number of other emails in my office here in Ottawa to highlight that. This request has come a long way.

Now, I hope that this term will be used across the country from now on, and that it will be the only term used.

Thank you, Mr. Chair.

[The Chair, Liberal, Emmanuel Dubourg]

Briefly, I want to thank you on behalf of the entire team, but I also need to mention to committee members that the department has decided to adopt the term “vétérane” and so we opted to go ahead with it, because when we were using the masculine form “vétéran”, we didn't feel that women were included, necessarily, and we wanted to avoid that. So the department has adopted “vétéran” and “vétérane”.

Thank you, honourable member. Your time is still at zero. The floor is yours.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

Oh, how nice. Thank you.

This goes to show that what goes on here on this committee can have a meaningful impact, so thank you very much.

My first question is for Dr. Zacharias.

I understand that your organization was founded in 2020, but one thing isn't clear to me. Whose initiative is it? Is it Veterans Affairs Canada, the Ontario government, or private citizens?

[Dr. Ramesh Zacharias]

Thank you for your question.

I will answer it in English so that you'll actually understand what I say.

This centre was funded by Veterans Affairs Canada. We have two stakeholders, one of which is McMaster University. The second stakeholder is the Hamilton Health Sciences Corporation. We are located in McMaster. All of our funding comes from Veterans Affairs Canada through a contribution agreement. Initially it was for three years, and as of April, we have signed a five-year extension.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

Can we ask what the operating budget is?

[Dr. Ramesh Zacharias]

Of the funding we get, between 65% and 70% go toward research and around 30% to overhead. The majority of the funds are used.... As I said, in the three years, we have funded almost 43 research projects involving 25 universities and seven scholarships. Hélène Le Scelleur is one we have funded for the last three years as she has done her Ph.D.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

That's perfect, thank you.

When I look at your 21 research projects currently under way, I see that none of them are being piloted by a university, a francophone centre or a centre in Quebec.

Is that correct, Dr. Zacharias?

[Dr. Ramesh Zacharias]

In fact, last month we signed a contribution agreement with QPRN, which is the Quebec Pain Research Network. We have scholarships for students who are in Quebec at Sherbrooke and Laval. Our scientific director of partnerships is Professor Luc Hébert, who is a 28-year veteran based at Université Laval. We have a significant presence within the province of Quebec.

In fact, we have universities coast to coast that we have funded, and students in New Brunswick, Quebec and Manitoba. We're a national contractor. We try to make sure there's representation across the country.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

I'm very pleased to hear that. This is the first time I'm hearing this. Quebec women veterans would also like to receive information like that. It would obviously be very appropriate to share it with francophone women veterans.

My understanding, though, is that it started this year.

[Dr. Ramesh Zacharias]

No. In the very first year, we had scholarships for students in Quebec as well.

What we have done more recently is develop a relationship with QPRN, which is a large network. It's easier than finding individual researchers in Quebec. Our agreement is with Université de Sherbrooke and Dr. Hélène Beaudry, who is the head of QPRN. The contract is with them. We've worked with Ste. Anne's Hospital in Montreal, as well as McGill, over the last three years, but we formalized our relationship with QPRN this past year.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

I'd like to ask a really quick question along the same lines. This has made headlines in Quebec in recent weeks. We're seeing that French is really losing ground in science and that very little research in French is being funded.

Are you experiencing this or have you seen this happen within your organization?

[Dr. Ramesh Zacharias]

Did you say more work in French or less work in French?

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

Since you're in research, I'd like to know whether you've noticed that research doesn't get funded as often when it comes from francophone institutes, centres. Have you observed that?

[Dr. Ramesh Zacharias]

I cannot comment on that. I can only comment on what we have done and what we are doing.

Probably the best-developed research network is QPRN in Quebec. They have a formal structure and a good connectivity among them. That's the reason we established that relationship with them. Dr. Luc Hébert, who is our director of strategic partnerships, is the one who has been driving a greater presence for us in Quebec.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

From what I can see, Ms. Le Scelleur may want to weigh in on this.

[Hélène Le Scelleur]

Today, we held our first official meeting as a research consortium for francophone veterans. This is really an initiative that I'm championing as co-chair of the Advisory Council for Veterans at the Centre of Excellence. This is a very important element that I brought in when I joined the team. I made the point that we have to represent francophones, research in French.

I did study at the University of Ottawa, but I do my research in French and Quebec veterans are the population I study. This effort is gaining momentum. I believe Dr. Zacharias said that this new consortium had received funding. It's taking shape and will include veterans as partners in the research.