National Defence Committee on Nov. 6th, 2012

[LCol Alexandra Heber]

Generally, it seems to be that that's what happens. Certainly, if somebody on their recruit medical said, “Yes, I've had a psychotic episode”, they would be looked at very carefully. But I think that even for people who wouldn't tell us, if they're going to have a psychotic episode early in their career, they're going to come to our attention fairly soon—

[John McKay, Liberal, Scarborough—Guildwood, ON]

The interaction of treatment and discipline is a curious challenge, a unique challenge for both of you, because you do have a patient confidentiality understanding, yet you can't be sending people out into highly stressful situations when you have every reason—and maybe you have absolute knowledge—to believe that this person is doing drugs.

[LCol Alexandra Heber]

Well, again, for people who've come forward for treatment, as General Bernier said, again, whether it's illicit drugs or alcohol abuse, we would be treating these people and they would have the appropriate medical employment limitations put in place. So that for a period of time, until they've completed their treatment and no longer had that problem, one of the medical employment limitations would say something like “this person cannot be deployed for x amount of time while they're in treatment”.

[The Chair, Conservative, James Bezan]

Thank you.

I understand that on the Conservative side Madam Gallant and Mr. Chisu want to split their time.

Ms. Gallant, you have the floor first.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Thank you, Mr. Chairman.

Given the reports of a positive correlation between the use of Mefloquine and mental illness—depression and other manifestations—why is it still being used as an antimalarial when other alternatives exist?

[BGen Jean-Robert Bernier]

Thank you.

We list Mefloquine as a medication because it's very effective, and the U.S. continues to use it, contrary to misperceptions misreported in the media. It remains recommended by the Public Health Agency of Canada's committee on advice on tropical medicine and travel, the World Health Organization, and the U.S. Centers for Disease Control. The big advantage is that it's just once-a-week dosing instead of daily dosing. A life-threatening illness like malaria, as a result of missing one dose of one of the alternatives, could cost your life. It's not obligatory; it's elective.

We usually offer a choice usually of three drugs: Doxycycline, Malarone, and Mefloquine. Most people will now take Malarone, but in some cases, because of various contraindications—intolerance of Malarone or Doxycycline—they will decide to take Mefloquine, or simply because of the convenience of having to use it only once a week. Many countries among our allies continue to use Mefloquine exclusively because of its effectiveness against malaria.

In the U.S. and Australia, all they've done is take it away from being the primary drug of choice as an antimalarial to making it one of the second-line treatments. The reason the Americans did that is not because of concerns about mental health or its psychological impacts, but because of the logistical burden of the time it takes them, with the mass number of troops they deploy: to screen them for the potential contraindications was just too much of a burden. For that reason, and that reason alone, they made it a second-line drug.

There has also been a suggestion of a causal link between Mefloquine and post-traumatic stress disorder by one paper in the U.S., but the author of the paper indicated that it was likely an idiosyncratic, unusual, extreme reaction in only one specific case.

We screen people for any of the contraindications that make them more susceptible to potentially having an adverse reaction to Mefloquine should they themselves, individually, choose to take Mefloquine.

[The Chair, Conservative, James Bezan]

Thank you.

Mr. Chisu.

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

Thank you very much, Mr. Chair.

I have three quick questions.

First of all, on the first aid kits for soldiers, when I was in Afghanistan, we used the Israeli tourniquet. Is there any improvement in the first aid kits issued to the soldiers going into combat operations? Are there any new products, and not the old bandages that we had for the last 20 years?

Second, what is the situation for the vaccine? If it's ordered—you need to be vaccinated because you are going to Haiti, or you're going to Afghanistan and so on—you can't say, “By the way, I don't want to have it.” You need to have it.

The third question is about medical files. Do soldiers have access to their medical files? I have put in personally for my medical file.

[BGen Jean-Robert Bernier]

In the kit for soldiers, the two key life-saving additions were: the self-tightening tourniquet—

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

Yes. It's a very good one.

[BGen Jean-Robert Bernier]

—which has saved many, many lives from blood loss, and the use of a concentrated powder substance called QuikClot; and now, a better clotting gauze that doesn't produce a chemical burn, but that can be inserted into areas where bleeding cannot be stopped by compression because of the depth or the extent. Both the QuikClot and the gauze are extremely effective in stopping the bleeding. That has saved many, many lives, and we know that for sure from the analysis

In addition, there's additional training provided to the tactical combat casualty care people who get first-aiders, but with a very advanced, battlefield, traumatic-injury-focused training.

As far as vaccination goes, by Canadian law anyone can decline vaccination. However, should they decline vaccination, then in most cases they would be deemed to be incompatible with military service, so administrative measures would be taken to have them released from the armed forces, or certainly not to deploy. It's not only for the individual's protection. If the individual fulfils a specific function in certain deployed operational settings, and if that individual unnecessarily falls ill, then not only is that individual's life at risk, but he is now placing all of the lives in the whole unit at risk.

As far as access to a medical file goes, yes, people can have either informal or formal access to their medical files, either through a request to their local clinic of through the access to information process, whereby they can get a complete copy of their file.

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

Thank you.

[The Chair, Conservative, James Bezan]

Thank you.

The time has expired on our meeting today.

I want to thank you, General, and you, Lieutenant-Colonel Heber, for coming in and for sharing your thoughts.

I want to thank both of you and all your staff for the great work they're doing in the Canadian Forces, including those who work in all the medical centres across Canada, and of course those who have served on the front lines as well, outside the wire, where they often have to be both a medical professional and a soldier. I know that at any point in time all of our people in the medical services are prepared to make that switch when it's deemed necessary.

Again, thank you so much for coming in and helping us with our study.

With that, I'll entertain a motion to adjourn.

[An hon. member]

So moved.

[The Chair, Conservative, James Bezan]

We're out of here.