National Defence Committee on Nov. 27th, 2006

[Cmdre M. F. Kavanagh]

Anything we have requested we have received. We have ongoing acquisitions through our specialists in operational medicine who are constantly reviewing the literature and looking for new things. The surgeon general made her comment about the one-hand tourniquets and the special dressings. That all came about by constantly reviewing the literature, looking for things we learn ourselves, looking and learning from our allies, and going out and acquiring it if we need it.

In the health services, we're not equipment heavy. We don't buy airplanes and tanks and things. We're relatively equipment light. Our key piece is personnel, but anything we've needed has been provided.

As the surgeon general also said, we acquired and deployed a CT scanner for the first time in our history on this mission. It's better than the ones the Americans have in Bagram. For the first time in our history, we had teleradiology capability, so the images are transmitted back to Canada for review. That was provided to us specifically for this mission. So we've received what we've asked for.

[The Chair, Conservative, Rick Casson]

Mr. Cannis, and then back to the government.

[John Cannis, Liberal, Scarborough Centre, ON]

Thank you, Mr. Chairman.

Commander Kavanagh and General Jaeger, welcome, and thank you for sharing all this information with us.

As you've probably observed, there are many important questions, but one question that keeps coming up is the recruitment and retention of medical professionals, and it is a great concern. I have heard the military family is a unique family. And as much as it's important to address the needs and concerns, from equipment to everything with the men and women who go to theatre, we all believe it's just as important that the peripheral family, the partner, the spouse, etc., also has services available to them. How is the family treated that is left behind here in Canada, the children, the mother, etc.? Because we've heard that sometimes there's been some difficulty in offering, and I assume part of the medical services for a military family includes the family as well. Am I correct in that?

[Cmdre M. F. Kavanagh]

Actually not.

[John Cannis, Liberal, Scarborough Centre, ON]

I needed to know that, because we're confronted with that.

[Cmdre M. F. Kavanagh]

As I read in the minister's testimony when he was here, I believe he was asked this question. We do not provide health care on a regular basis to the family members of the Canadian Forces.

[John Cannis, Liberal, Scarborough Centre, ON]

Why would you say “regular basis”?

[Cmdre M. F. Kavanagh]

That is the purview of the provinces in this country. That's the way our health system is designed, and it is our responsibility to look after members.

There is a caveat to that, which is isolated posts. We do it overseas, but there are very few isolated posts left in this country any more. There was a time when Cold Lake was deemed isolated for medical services, but no longer. When we used to have bases in Masset and in Holberg on Vancouver Island and the Queen Charlotte Islands, and so on, those places were deemed isolated, but they are no longer. So it is the responsibility of the Canadian Forces health services to provide health care to uniformed personnel only.

That said, there is, as General Jaeger has already alluded to, a member assistance program that we established—as a matter of fact, I established it myself—that's open to family members. The family resource centres have resources that are put in place, not by us, not by the Canadian Forces health services, but by the Canadian Forces, which have access to specific counselling services, and so on.

[John Cannis, Liberal, Scarborough Centre, ON]

Commander Kavanagh, I have to interrupt, because I know the chairman is very strict on time.

What you are really saying to us is that it varies from province to province. Is that what I'm led to believe?

[Cmdre M. F. Kavanagh]

It doesn't vary, in the sense that we don't provide health care in Canada to dependants unless the place is deemed isolated. I can't think of anywhere in Canada.... Goose Bay is the only place I can think of at the moment.

[John Cannis, Liberal, Scarborough Centre, ON]

Maybe given that the military serves the country as a whole, we should look at standardizing something like that.

[Cmdre M. F. Kavanagh]

But, sir, health care in this country is a provincial responsibility.

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

That's a good response.

[John Cannis, Liberal, Scarborough Centre, ON]

I know; I'm simply saying that it is provincial, but the soldier who's serving Canada doesn't cross borders, in my humble opinion.

We're obviously finding it difficult, because as our military is expanding and recruiting to address our domestic and international obligation, we're obviously, as you clearly indicated earlier, going to run into problems with the shortages that we have.

What is the tenure if somebody is recruited and brought on board from the outside? How long is their stay, on average?

[Cmdre M. F. Kavanagh]

There are many ways you can be recruited, but if you're already a qualified physician, we call that a direct-entry officer. You can enroll, and we even have a signing bonus. You can enroll for as little as two years and decide to give it a try, to see if you like it or don't.

You can even work for us as a civilian. We've actually had people come to work for us on contract as civilians, who've liked it so much that they put the uniform on. There's one in Germany right now, as a matter of fact.

Or if you take a larger signing bonus, you are obliged to provide us four years of service in uniform. If you go through our education programs, the medical officer training plan, they have a four-year commitment of obligatory service as well, after we train you in the school. And we have opportunities to train people as specialist physicians. There is a variety of ways we can enroll you or train you and turn out a physician.

[John Cannis, Liberal, Scarborough Centre, ON]

Lastly, because I know my time is going to be up in a minute, when our men and women who have served in theatre return due to injury and what have you, and they need special attention that for whatever reason you cannot provide, would you then contract it out or would you send the person outside for proper treatment?

That's it, Mr. Chairman. I got my question in. So would you give her a second to respond?

[Cmdre M. F. Kavanagh]

First and foremost, the right treatment for the person is job one, as General Jaeger said. We use a variety of mechanisms. We will engage the local health care sector where they are, if it's the appropriate care. Because of the nature of the fact that where they are is too remote to provide what they need, we will move them to where they can get it. There is a variety of mechanisms.

[The Chair, Conservative, Rick Casson]

Good. Thank you.

We'll go over to Mr. Hiebert, and then back to the official opposition.

[Russ Hiebert, Conservative, South Surrey—White Rock—Cloverdale, BC]

Thank you, Mr. Chair, and thank you both for being here today.

I really only have one question, and I'll share the balance of my time with my colleague Mr. Hawn. It has to do with the work we're doing in Afghanistan.

You talked about the use of advanced technologies, a CT scanner in theatre, which I think is fantastic. I'd like you to elaborate further on the types of wounds that are being experienced and how they're unique from other theatres that we've been involved in. And secondly, what else would you need? Is there anything that's lacking in terms of technology or requirement of personnel to do the job in Afghanistan?

[BGen Hilary Jaeger]

I have a wish list now.

I'm afraid I lost track of the first part of the question. What would I like? What's lacking?

[A voice]

What types of wounds.

[BGen Hilary Jaeger]

Oh, the types of wounds. I'm sorry.

Before everybody got very good at wearing body armour and before we bought good stuff that covers more of your body with ceramic plates and things, typical war wounds from conflicts like Vietnam, Korea, and the Second World War were a combination of shrapnel wounds and ballistic projectiles or aimed rifle rounds. We see very few rifle rounds now. There are some shrapnel wounds, but because of the protection that's offered to the trunk, they almost all involve the extremities.

The typical gut shot wound that was very messy and very difficult to deal with in the Second World War and Korea and Vietnam is not commonly seen and is certainly not one that is associated with other things that are more of a problem. Those were commonly fatal wounds. Different chest wounds and getting a bullet through the heart are not likely to lead to your survival.

Because we have fewer of those, proportionately we have far more of the extremity wounds and the head traumas. We have been amazed at the ability of some of our people to bounce back from serious closed head trauma. Dr. Bennett will tell you that a Glasgow coma scale of three can be awarded to a dead person. We have had people who have arrived at our treatment facility with a Glasgow coma scale score of three who walked out of hospital two and half to three months later, and none of us would have predicted such an outcome. So we're learning a lot from these new injury patterns.

What would I want in theatre? I don't really want anything more in the way of medical equipment. What I would like is to have twice as many general surgeons and orthopedic surgeons, so that we can keep the rotation going indefinitely. I need well-trained, experienced, highly motivated specialists.

Do you want anything else?

[Cmdre M. F. Kavanagh]

No, that would be on the top of my wish list.

As I said earlier, we aren't equipment-heavy. We have our basic needs. The key piece that makes us effective is what's between our ears, along with some technical skills and the hand skills of the surgeons. We need people. That's what we need.

[The Chair, Conservative, Rick Casson]

You have a minute and a half.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

We've heard before how the military does not provide medical care for dependants. I certainly have lived that, and I understand why, but there seems to be a bit of add-to that maybe we should. Setting aside the fact that that's not the way health care in Canada is set up at the moment, can you give us just an assessment for general edification? I know you can't give me a number, but I'm going to make a wag and suggest there are probably 200,000 dependants for the 60,000 or so military. In terms of small, medium, large, or “you've got to be kidding me”, what's the amount of money, infrastructure, and personnel it would take if the CF were to ever embark on providing medical care for dependants?