Dr. Ritchie.
Evidence of meeting #116 for Veterans Affairs in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was symptoms.
A recording is available from Parliament.
Evidence of meeting #116 for Veterans Affairs in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was symptoms.
A recording is available from Parliament.
5 p.m.
As an Individual
Let me take your question another way.
There are all kinds of ways to look at these issues. There are cross-sectional studies. There are longitudinal studies. The U.S. Army has done a very nice job of doing some of the surveys in theatre. We call them mental health advisory teams. Unfortunately, we didn't look for the use of mefloquine. We looked for barriers to care in depression and anxiety. For a lot of the time here, we really weren't using mefloquine—especially in Iraq. It was an oversight on our part.
I think that your epidemiologists and our epidemiologists would be happy to go back and flesh out the picture of how many people exactly get symptoms.
Back to the question about women, I'd love to see some longitudinal studies of female veterans—not just exposed to mefloquine, but all female veterans. There's a paucity of data there.
We could recommend some ways to get some more hard data.
5 p.m.
NDP
Rachel Blaney NDP North Island—Powell River, BC
Again, thank you so much for this. I think this is very informative.
I have two questions, but first, I would like to start with the statement that I'm very good with “very likely”, and I'm also very comfortable with what Health Canada put out. I think we must acknowledge that this is not something that we need to spend a lot of time speculating about.
My first question is about when we look at how we're going to connect with veterans and in terms of screening, I know that a lot of veterans in Canada move to rural and remote communities. Access to those kinds of supports and services can be a challenge. I just want to talk about how to make that more accessible.
The second question for you is that what I have learned from this process is that what we don't know is very concerning. What type of research actually would be helpful for us? Earlier I think I heard one of you talk about why some people are more sensitive and some are not. That would be interesting to know.
Is there any specific research that would really help active members and also veterans?
5:05 p.m.
Executive Director, The Quinism Foundation
Canadian mefloquine veterans have been fairly consistent in recent years in calling for three things that they need from the Canadian government: acknowledgement, outreach and research, in that order.
As I mentioned initially, acknowledgement is the single most important thing that can occur. So much will come from an acknowledgement, a mea culpa, or a statement from someone in a position of authority simply stating the obvious that follows naturally from what is in the product monograph and simply acknowledging what is very clearly true.
Individuals within the halls of government who know mefloquine is dangerous, who have patients that they would like to write case reports on, and who would like to fund and conduct research with existing funds will feel empowered to do this. Clinicians will feel empowered to diagnose on paper and for the record what they already know to be true, when previously they had perhaps been hesitant.
Acknowledgement must come first. Someone must say that this drug has caused disability among our troops. It's as obvious as day.
Then there is outreach. With that acknowledgement, which individuals are not reached by the media and which individuals are not reached by social media and word of mouth? We can identify these individuals. We should know who has deployed in the last 25 to 30 years to areas where mefloquine may have been used. Hopefully there's a postal mailing address or some other way to get in touch with them. It could be as simple as saying, “Did you take mefloquine? Did you have problems on the drug? Then call this number and we'll get you the support that you need.”
Then there is research. Research comes in many flavours and varieties. The type of research that you will hear about from government scientists and others who manufacture doubt about the dangers of this drug is not good, quality research. It's retrospective research. It's based on existing data. If we don't ask the right questions about symptoms experienced by individuals who have taken mefloquine and if we don't ask specifically about their mefloquine experiences, the existing data on which many of these studies are based is not going to capture what actually happened. New prospective research at patient level that is conducted with the involvement of clinicians is going to be essential.
It really begins with case finding and empowering individual physicians to identify those veterans who are suffering the long-term adverse affects of this drug. Then it is getting them the type of sophisticated testing that I believe one of your earlier witnesses had discussed, fully describing the extent of their symptoms, and then beginning to count them and figure out what they have in common with each other to identify these risk factors that we're alluding to.
The first step is not to ask Veterans Affairs to look at the existing data again or look at the existing research again and come to the very same conclusions. To solve this problem, we need acknowledgement, outreach and research. A component of that is the screening process that we described.
5:05 p.m.
As an Individual
I will take part two of your question, which was what the big issues are. Again, suicide is an obvious one. In the United States military, it has grown over time, although not all related to mefloquine. I understand that suicides in the Canadian military have also increased over time. I don't know if it's related to mefloquine. That's one of the most tragic aspects when it does happen. If you looked at suicides—and you may have already been doing this; I haven't heard of it being done in the same way that we have in the States—it would inform a lot of things besides just the mefloquine question.
May 1st, 2019 / 5:10 p.m.
Conservative
Cathay Wagantall Conservative Yorkton—Melville, SK
Can I put on record a little bit about the Somalia affair? It was in 1993, a military scandal. It peaked with the beating to death of a Somali teenager at the hands of two Canadian soldiers participating in humanitarian efforts in Somalia. The act was documented by photos and brought to light internal problems within the Canadian Airborne Regiment. Military leaders were sharply rebuked after a CBC reporter received altered documents, leading to allegations of a cover-up. Eventually a public inquiry was called. Despite being controversial, it was cut short by the government. The Somalia inquiry cited problems with the leadership of the Canadian Armed Forces. It led to the disbanding of our elite Canadian Airborne Regiment, greatly damaging the morale of the Canadian Forces, marring the domestic and international reputation of Canadian soldiers, and leading to the immediate reduction of Canadian military spending by nearly 25%.
The concluding observations of the inquiry “Dishonoured legacy: the lessons of the Somalia Affair” were that, “If mefloquine did in fact cause or contribute to some of the misbehaviour that is the subject of this Inquiry, CF personnel who were influenced by the drug might be partly or totally excused for their behaviour.” In other words, they were never given the opportunity to do the proper study of the impact of this drug mefloquine.
In other words, a conclusion has already been made on this without doing the proper study. If you go to the Canadian War Museum, yes, there were issues within the regiment, but it blames the Canadian Airborne Regiment being racist for this happening. We have people here who have been smeared because they did not have the opportunity to do what needed to be done, however long ago.
Given what we know, I want to know whether, in your opinion, it is possible that Clayton Matchee was experiencing a neuropsychic event that led to the death of Shidane Arone.
5:10 p.m.
Executive Director, The Quinism Foundation
Almost certainly he was. There is no more logical or likely explanation for what happened to Clayton Matchee. He was floridly psychotic in the days to weeks prior to the killing of Shidane Arone. Had the Somalia Commission of Inquiry investigated the role of mefloquine, interviewed Marj Matchee and interviewed others on their experiences with mefloquine, this point would have been obvious. Clayton Matchee was hallucinating the presence of camel spiders in the bunker. He was whacking the camel spiders, and that led to the beating death of Shidane Arone.
This needs to be explored more. The lack of curiosity as to the role of mefloquine in the events of that era, the critical events of that era, is remarkable. It's such an important event in the history of Canada. I am from Canada. I was born here. I was a teenager during the Somalia affair. I distinctly remember how ashamed I felt as a Canadian when that happened. I distinctly remember that. Imagine how the disgraced members of the Canadian Airborne Regiment feel. I believe we owe it to them to fully investigate this matter. Now, knowing what we do about how prevalent symptoms from mefloquine were among that group, aren't we owed the benefit of our 25 years of accumulated experience to go back and re-examine the role of the drug in the events of that era?
Our group has long called for a reopening of the Somalia Commission of Inquiry. I wrote to your Prime Minister several months ago. I did not receive a reply, but I simply don't understand how one can accept these questions being unanswered for so long.
5:10 p.m.
As an Individual
Clayton Matchee was not an isolated event. We have so many reports of not only hallucinations but also rage and irritability. It wasn't a one-off. He got the most attention, but a lot of other bad things have happened because of mefloquine.
5:10 p.m.
Conservative
Cathay Wagantall Conservative Yorkton—Melville, SK
We had Roméo Dallaire here giving testimony. I asked him, on the basis of his experiences, whether we should be doing more studying. His response was, “Absolutely not. Get rid of the drug.” I think he would concur with what you're saying.
5:15 p.m.
Liberal
Shaun Chen Liberal Scarborough North, ON
Thanks, Mr. Chair.
This has been incredibly powerful testimony. I want to thank the witnesses again.
I want to go back to the issue of informed decision-making of servicewomen and servicemen taking mefloquine.
According to the American Society of Health-System Pharmacists, mefloquine is contraindicated for individuals with a recent history of psychiatric disorders. Given that service women and men are potentially out in the field experiencing events that can be traumatic, how could we continue to give out this drug? As has been pointed out earlier, 5% of servicemen and servicewomen in this country are taking this drug.
How are we able to give them that informed decision-making if they are put in circumstances that could potentially create situations where they are being exposed to trauma and very challenging situations that increase their risk of the adverse side effects of this medication?
5:15 p.m.
As an Individual
I don't think you can do informed consent.
We've looked at related militaries, the Australians, the Irish. I've heard, and I assume you have as well, this was back when mefloquine was given more commonly. They've thought if they didn't take mefloquine, they wouldn't be able to go. They want to go to wherever....
5:15 p.m.
Liberal
The Chair Liberal Neil Ellis
Excuse me, stop. We've have bells.
I'll need unanimous consent to finish.
5:15 p.m.
Some hon. members
Agreed.
5:15 p.m.
As an Individual
I'll just finish briefly.
If you're looking at a paycheque and feeding your wife and kids and all the other things that come with being in the military, I don't think you can give informed consent.
5:15 p.m.
Liberal
Shaun Chen Liberal Scarborough North, ON
So you're suggesting this drug should not be used or prescribed.
5:15 p.m.
Liberal
Robert-Falcon Ouellette Liberal Winnipeg Centre, MB
Obviously Somalia was a grave crisis within the military leadership. It led to major changes within the non-commissioned members' ranks. They called it leadership 2020, reformatting the military college and a lot of training. It was also related to a lot of hazing incidents that also occurred at that time. Multiple variables led to the disbandment of the regiment. I remember that quite well because I joined the military at exactly the same moment. I'm very proud to have served in the military for 23 years.
I was in the 5th Field Ambulance in Valcartier in the medical field. I wanted to talk about your awareness of the medical training for military medical personnel in their evaluation of military members as well as the medical personnel who work in Veterans Affairs.
Do they have adequate training in relation to the differentiation between PTSD, other disorders and other areas?
Obviously, you have more of an understanding in the United States.
Are there things we could be doing to better diagnose and better treat people who are veterans here in Canada, also who are currently serving in the Canadian Armed Forces?
5:15 p.m.
As an Individual
The short answer to do they have enough training is no. I mentioned, as a military psychiatrist I was not familiar with mefloquine when I was deploying to Somalia with a combat stress control unit. I think that has improved over time. We have been part of that improvement. We have given numerous lectures at various military medical conferences.
In the VA—and I worked for them for a while—I think the knowledge in the U.S. is still very rudimentary. That's been another of our efforts: how can we educate veterans' health affairs personnel to be doing that screening. So far we have been successful in spots, but not across the country.
5:15 p.m.
Executive Director, The Quinism Foundation
With formal acknowledgement by a senior official at the Department of National Defence or Veterans Affairs Canada, the clinical education will naturally follow. It will be recognized that this is a priority among leadership. Individuals will perform a review of the literature and share this with their colleagues spontaneously without further direction. Organizations respond to the priorities identified by their leadership. If leaders at DND and VAC make the acknowledgement of this problem a priority and empower their personnel to begin to solve it, your civil servants, your physicians, your staff will go a long way toward solving it independently.
5:20 p.m.
Liberal
Robert-Falcon Ouellette Liberal Winnipeg Centre, MB
Within the Canadian Forces during the mission in Afghanistan and the war there, it was quite clear that PTSD was a high priority. With regard to psychiatric services and social workers, there was a ramping up of obtaining those services for veterans who needed to be treated. Then suicide prevention and working with...and how we actually deal with disciplinary issues even within the armed forces changed quite a bit. Obviously, this is something that perhaps not a lot of people are aware of. Where should they obtain this training?
5:20 p.m.
Executive Director, The Quinism Foundation
We are happy to assist in providing resources. Our mission is to promote and support education and research on this condition, but I don't think you need us. We're happy to help. For example, in the letter to your Minister of Veterans Affairs, I suggested one possible method of implementing screening for symptomatic mefloquine exposure. We've developed an instrument. We believe it has validity, and we've offered to make it available to use systematically among your population. However, you don't have to use our instrument; you can develop your own instrument.
The response that I received was that they don't think our instrument is very good. However, they didn't say, “We're going to develop our own.” They simply said that ours is no good, in their opinion, so they're not going to do anything. That is why I'm disappointed in the minister's response. Again, this is a reflection of the fact that they haven't acknowledged the problem. Once there is acknowledgement, then much of the problem will be solved by the existing resources.