National Defence Committee on June 12th, 2008

[Cdr D.R. Wilcox]

I'll add one little bit about nutrition. I know there's a movement afoot now--this is not necessarily under the auspices of mental health, but under fitness--to get a dietician who's at a certain level, maybe even at a master's level, to act as a consultant when selecting the diet. It's under the auspices of a new weight wellness program. Other groups will benefit from it, but again, the emphasis is on an evidence-based approach to nutrition as well.

[Maj S. West]

We also have food services officers within the Canadian Forces. They're involved in continuous quality improvement of things like our IMPs, our hard rations. Of course, one problem is that no matter how palatable you think you've made the rations, there'll be some soldier who would rather carry 50 pounds of beef jerky than eat the balanced meal that's in his IMP.

[A voice]

Salt.

[Maj S. West]

Lots and lots of salt, which you need in Afghanistan.

[The Chair, Conservative, Rick Casson]

Thank you, Mr. Lunney.

That ends the second round. We'll start the third round.

The official opposition: you're good?

The government, the Bloc...?

Mr. Bouchard, do you have a question?

[Robert Bouchard, Bloc, Chicoutimi—Le Fjord, QC]

Thank you, Mr. Chair.

Welcome. Thank you for being with us.

In Afghanistan, I met with soldiers who told me about their deployment. For some of them, the duration of that rotation was six months, seven months and even nine months. In Valcartier, I met with spouses who told me that the decompression week should be included in these six months. They have a 15-day break between the first month and the fifth month. Often, when the soldier comes back home for this 15-day break, he seems to be elsewhere and keeps watching the news.

Do you believe that we should shorten the rotation in Afghanistan? Would it be better not to change anything? I would like to hear you on this issue.

[Maj S. West]

I've just been there, dealing with many other nations in the Role 3 hospital. It's Canadian-led, but we have the Dutch and the Danes and the Americans. I can tell you that every single country has a different approach. The approaches range from four-month tours with no break to fifteen-month tours with a three-week break in the middle. Ours is six months with a three-week break. We do have some people on nine-month tours, but the norm is a six-month tour.

When I talked with my colleagues over there, I found that everybody had a different opinion on what would be an appropriate thing. Personally, I always advise my patients when they are going over that they do not come home for their three-week break, if at all possible; they should meet their family somewhere else. That's not always possible. Children are in school, or you can't afford to move everybody that far. You can reverse your funding and give it to your spouse instead, but if you have a spouse and four kids, that can become quite an expensive proposition.

Personally, I don't think they should come home. However, for a lot of people that's what works out best. And for a lot of people, that break is wonderful. It's a chance for them to meet their spouse in an exotic third location and have a break.

Again, the time zones become a problem. When you come home from Afghanistan, you have to adapt to a nine-and-a-half-hour change. You get almost three weeks as a break, but you spend the first week adapting. So I question the value of it.

One way or another, you do keep connected. I went to Disney World for a week with my family. I spent my time trying to avoid young men with missing limbs in wheelchairs, which was exactly what I'd been dealing with for the previous three months in Afghanistan. It was not a shock for me, so I was okay with it, but for some people that would be a bit of a problem, I would think.

So yes, it's something the forces needs to examine.

[LCol H. Flaman]

All I can add is that I think the forces are looking at...and this isn't a medical thing. Whether or not they keep it or whether or not they lengthen tours will be based on how many soldiers they have to meet the requirements.

Again, it's positive and it's negative. I've heard spouses say, “I'd rather he didn't come home; it traumatizes the kids when they have to say goodbye again.” But it is seen as a benefit. The soldiers see it as a benefit.

When you start taking anything away, it will always be met with some resistance.

[Robert Bouchard, Bloc, Chicoutimi—Le Fjord, QC]

Thank you.

[The Chair, Conservative, Rick Casson]

Thank you.

Mr. Lunney.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

I have a short one, and it picks up on Monsieur Bouchard's comment.

That certainly was my observation as well about coming home; the time lag is a week, and it really hits you both ways. You have to deal with that coming back again. But I certainly support it for those who are able to do it.

I appreciate the advice you're giving, Major West, to your clients, encouraging them to try to find a way to meet in a third country. That might be a bonus for the spouse as well. They might both come out a winner in that regard, because the spouse absorbs that travel time.

I also appreciate the remarks that were made earlier about learning. I appreciate, in the time that I've been on this committee and working with our military family here, that the military is a learning organization, or organism, if you will. You're learning from experiences. Unfortunately, when you're talking about notifying family members, difficult assignments like that, you're learning through those difficult experiences, starting with the west and the east, coming forward as rotations move.

Our military is taking on a task that we haven't asked them to do for some time in this capacity. It's great to see the way learning is taking place. We just want to make sure that we use all of the best tools available and make sure we maximize the learning experience. Maybe Canada could lead the world in some regard. And I appreciate that we're exchanging data and experiences with those various other countries.

At any rate, I just want to say that I appreciate the way in which that sharing is going on, the multi-modal component that you described earlier, and that we are doing our best to meet the needs of the soldiers. I thank you in that regard.

[Cdr D.R. Wilcox]

I would just echo that. What I found amazing was how responsive the system was to body armour improvements. The turnaround time to enact an improvement was amazing. Again, it was collecting the data, analyzing the data, making a recommendation, and then trialing it--all evidence-based. It was amazing.

[The Chair, Conservative, Rick Casson]

Thank you very much.

Ms. Black, your patience has been rewarded. You're going to get the last word here.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

Thank you very much.

I just want to refer back to some statements that I think you made, Major West, around Canadian Forces members being screened before deployment for any mental health issues--maybe for other things as well, but including—

[Maj S. West]

They are extensively screened for many, many things, including their weapons preparedness.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

But you don't do that as a doctor?

[Maj S. West]

I'm lucky they actually let me have a weapon.

A large portion of that is medical, including a psychosocial screening, where the spouse has to come in to the base social worker and sit down and say, “No, there really are no problems at home with my spouse deploying”.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

Someone else said there are systems in place that prevent someone from being deployed if they do have a problem.

I wanted to contrast that with what you said earlier about when you're trying to make a diagnosis or understanding if a person has post-traumatic stress disorder or a brain injury, that you depend on self-disclosure. How do you weigh both of those?

You're saying there's a screening in place. I'm wondering how that screening works before deployment. Why wouldn't you use a similar kind of screening...? We've been informed that screening takes place two months after deployment, again when they return, and then six months later. What's the difference between the two?

[Maj S. West]

If you understand how physicians operate, you go to see your doctor for your medical--and you're a woman, so I know you actually will show up, as opposed to most of your colleagues here. You tell your doctor the issues that are important for you to put forward. Your doctor is still going to screen you for cardiac disease if you're at the right age. If you're a female, he or she is still going to say to you, “When was your last pap? Should we do that while you're here? Are you due for a mammogram?”

There are a number of things we're going to screen for. That includes mental health. However, people are very good at presenting the picture they want to present. No screening system is completely infallible. Mental health, due to the nature of it, is particularly difficult to screen, but we do actively screen for it.

However, if someone has identified themselves--or we have identified them or their chain of command has identified them--and is undergoing treatment, we have a system within the military to label that person as unfit for deployment until they have completed treatment. Our goal always, whether it's a physical injury or a mental injury, is to return the soldier to full duty. Failing that, it's to make him function as well as he can before he moves on to a civilian position.

We are constantly screening in our offices when we do our periodic health assessments, or when the patient shows up with back pain that in fact is a manifestation of severe mental distress. No, it's not infallible. We do miss people. It is easier if they self-report.

[Cdr D.R. Wilcox]

But we react whatever way they come in. It's brought to our attention by spouses, by co-workers. Any time there's an alcohol-related incident, the MPs will inform us. We rely on a lot of sources, not just self-referral.

The screening is one. Every second year they have a questionnaire they have to fill out that has mental health questions on it. We do as much as we can.

[LCol H. Flaman]

And we are company docs; we work for the company, but.... Therefore, at my level, I review the medicals done, because we don't want to send someone over who should not be over in Afghanistan—

[Maj S. West]

For a number of reasons.

[LCol H. Flaman]

—and then have to be sent back and use resources that are there, which are our own resources, medical resources, and cause the mission to have to find a replacement and whatever. So we're not going to send somebody over there who is not....

[Cdr D.R. Wilcox]

I wouldn't say that we're company docs; we're occupational medicine specialists.

Our business is to put them in harm's way, so we're trying to make sure we don't exacerbate that. I like to call us occupational specialists.

[LCol H. Flaman]

We're here to preserve the manpower, which is really what the old mantra was.