Veterans Affairs Committee on Nov. 9th, 2023

[The Chair, Liberal, Emmanuel Dubourg]

I call this meeting to order.

Welcome to meeting number 70 of the House of Commons Standing Committee on Veterans Affairs.

Pursuant to Standing Order 108(2) and the motion adopted on Monday, October 3, 2022, the committee is resuming its study on the experience of women veterans.

As far as interpretation, you have a choice, at the bottom of your screen, between French, English, and floor audio.

Although this room is equipped with a high-performance audio system, feedback can still occur. This can be extremely harmful to interpreters and cause them serious injuries. The most common cause of feedback is an earpiece getting too close to a microphone. I would therefore invite all participants to handle their earpieces very carefully, to avoid handling them as much as possible and to make sure they speak clearly into their assigned microphones.

I would also remind you that all remarks should be directed to the Chair.

In accordance with our routine motion, since some witnesses and members are participating in the meeting virtually, I am informing you that all connection tests have been completed in advance of the meeting.

Before welcoming the witnesses, I'd like to issue a trigger warning. We'll be discussing issues related to mental health, which are liable to trigger some of our attendants, viewers, MPs or staff members qui have had similar experiences. If you feel any distress or require assistance, please let the clerk know.

[Fraser Tolmie, Conservative, Moose Jaw—Lake Centre—Lanigan, SK]

This is a point of order. There's someone taking pictures in the middle of committee. I was under the understanding that we're not allowed to take pictures during committee.

[The Chair, Liberal, Emmanuel Dubourg]

You are not allowed to take pictures.

[A voice]

I thought you folks were FaceTiming and stuff, so that's why we thought it was—

[The Chair, Liberal, Emmanuel Dubourg]

Thank you.

I would also like to inform you that we have the witnesses with us for two hours, so I'd like to let you know that we're going to take a short break at some time, a five-minute break.

I will introduce our witnesses for today.

As an individual, we have Marie-Ève Doucet, non-destructive testing technician, by video conference. We have Madam Jennifer Smith, veteran; and Stéfanie von Hlatky, full professor at Queen's University and Canada research chair in gender, security and the armed forces. From the Quinism Foundation, we have Dr. Remington Nevin, executive director.

Welcome. You will each have five minutes for your opening statement.

I'm going to start with the video conference. I would like to invite Madame Marie-Eve Doucet to start.

You have five minutes for your opening statement. Please open your mike and start.

[Marie-Ève Doucet, Non-Destructive Testing Technician, As an Individual]

Good day.

My name is Marie-Ève Doucet. I am 42 years old. I presently live in Chicoutimi, Quebec with my 10-year-old special needs son and my husband, who is still serving.

I accumulated over 20 years of service on the CF-18 Hornet as both an aviation and a non-destructive testing technician. I was medically released in 2021 from Bagotville, Quebec.

I would like to focus our discussion today on my service-related exposure to hazardous chemicals. I believe that the chemicals I was exposed to during my career not only caused my medical release and my poor health today but were also the cause of the ongoing problems with my son.

In 2018 I was diagnosed with a grade 2 pineocytoma, a tumour of the pineal gland. In 2020 that tumour spread from my brain to my spinal cord. I have already had extensive surgery and maximum radiation treatments. Due to the ongoing progression of my cancer, I recently started to begin chemotherapy treatments.

I thank the committee for giving me the opportunity to speak. I don't know for how much longer I will be able to continue to advocate for myself on these important issues that I know also impacted other women in the military, especially from my trade.

You have probably never heard of my type of brain cancer before. It's a very rare and unusual condition, making up less than 1% of all brain cancers. What is known about it suggests that this type of cancer tends to be due to one of two things, either genetics or occupational and environmental exposures. Cancer of any kind does not run in my family. I therefore have no evidence of any predisposing genetics for this cancer or any other cancers.

This leaves us with the logical alternative that, after 20 years of significant exposure to multiple carcinogenic chemicals and ultrafine particles that are known to negatively affect the central nervous system, it was my workplace in the military that aggravated if not directly caused my present cancer, and also negatively affected my unborn son during my workplace pregnancy.

CAF does not presently keep a list of our workplace chemical exposure in our medical files. I think they should. Maybe then, when I filed a VAC claim for brain cancer on March 3, 2021, I wouldn't have received a refusal decision on March 24, a mere three weeks later, due to lack of proof of my medical condition being related to or to the case of chemical exposure of my workplaces.

For my appeal, I was informed that I had to provide them with information that was impossible for me to obtain; therefore, I couldn't move forward. Like so many other veterans before me and after me, I was caught in a Catch-22 situation. There was no way for me to win. I had to abandon my appeal.

Demanding that the impacted veteran provide researched proof for determining a cancer's original cause, as requested by VAC, is an unfair expectation or ask. I also believe that women are disproportionately burdened by this systemic unfairness, as the entire adjudication system was set up for men and to support men. Quite understandably, the foundational research for military-related chemical safety and harm has been done on men. There is still little to no government-sponsored research on how women may, if at all, present medically in different ways from men after having workplace chemical exposures.

Even though I was medically removed from continued work directly on aircraft while pregnant, I still had o continue working inside that same aircraft hangar with constant exposure to many known occupational hazards, including jet fuel fumes, ultra fine air particles and noise and vibration. Once again, I have absolutely no genetic predisposition to neurodevelopmental or any other disease in my family.

My child was the only one in my family born with issues. The pediatrician diagnosed him with autistic-like socialization, communication challenges and dyspraxia, a condition impacting his motor skills, coordination and overall development. Most of the cost of his ongoing therapy in the present has come from our own pockets.

I will always wonder if my son's issues are from the chemicals and ultra fine particle exposure I was ordered to sustain while working while pregnant.

Moving forward, I ask the committee to recommend that all reasonably sustained chemical exposures in military women causing even plausibly-related medical conditions be presumptively approved as service related.

I ask the committee to recommend this proactive approach until such time as government has a strategic military research plan in place, specifically for veteran women. Such a research plan would hopefully be able, once and for all, to prove the workplace safety of these military-specific roles and environments, versus expecting the impacted veterans to individually prove their harm.

I also request the committee to recommend that DND, CAF and VAC come together to investigate the possibility of military women's workplace hazard exposure causing direct harm to their offspring.

Thank you.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you very much for your testimony, Ms. Doucet. I wish you much courage.

I'd now like to invite Ms. Jennifer Smith, veteran, for five minutes, please.

[Jennifer Smith, Veteran, As an Individual]

Good afternoon, Mr. Chair, and the committee. It’s a privilege to be here today, and I thank you for this opportunity.

My name is Jennifer Smith, and I am 52 years old. I present here today as an individual, one without rank, without a retired title, medals or other special commendations. I identify solely as a woman veteran, a distinction that's as complex as it is seemingly simple. Since being forced to escape CAF as a necessity of survival, the term “veteran” is a title that I struggle to connect to, or find any pride or honour in.

In 1990, I was just 18 years old. I was healthy, vibrant and had a promising athletic career ahead of me, but I chose to serve my country.

I started regular force basic training with CAF, and I was at CFB Cornwallis. I was one of only seven women in a platoon with nearly 100 men. Sexual harassment by male recruits and instructors was daily, including dehumanizing jokes, sexual gestures and lewd sexual comments. My bras and underwear would be displayed in front of the platoon and run up the flagpole and out the barrack’s windows.

This pattern of sexual harassment persisted through basic training and continued into my Naval QL3 trade training, where I was singled out again as the only female in the group.

During my time in the military, I was repeatedly physically and sexually assaulted, including being raped by a drill instructor at basic training, gang-raped in barracks by other male recruits and sexually assaulted during a dental procedure by the military dentist.

I was a navy “hard sea”—combat—trade recruit. This was at a time when these occupations had just been opened to women, and I was terrorized in that trade. I was never safe, and I had a string of death threats against me because I was a woman.

Prior to my Atlantic fleet posting, I was taken by multiple assailants—all military members—blindfolded, tied up, and forcibly confined for what I believe was three days. I was stripped naked, deprived of sleep, repeatedly raped, sodomized, water boarded and submerged in ice water. During this ordeal, I was repeatedly told that females were not wanted aboard a warship, and that I had better figure out a way to quit the military if I wanted to live. They stuck a bayonet into my chin and told me how they would kill me, saying, “A sailor can slip and fall off the ship during night watch easily and silently.”

I left the military after 13 months for fear for my life. I was given a one-way ticket to my originating city and nothing else—no contacts, no supports, nothing. I had been dumped at an airport and abandoned to navigate a life that had been irreparably altered by the devastating violence I experienced in CAF.

Although over 30 years ago, the brutal attacks, lack of safety and constant psychological abuse have severely impacted all aspects of my life. I have severe and chronic PTSD and depression, chronic and severe pain due to physical injuries, chronic infections, sexual, urinary and reproductive issues, and stomach and bowel conditions.

I am unable to function day-to-day and spend much of my time in my darkened bedroom, severely isolated, and unable to look after even my most basic needs. I have been homeless for extended periods; multiple hospitalizations have impacted being with my children, and I am alone as I am unable to feel safe in a relationship.

Since connecting with VAC five years ago, I have not felt supported, understood or heard by the VAC system. Because I left the CAF in 1991, my pension is the lowest it can be, meaning I have ongoing financial hardship that will worsen as I get older. Because I live alone and have no family or spousal assistance, I do not qualify for benefits such as caregiver allowance or attendant care. When I was homeless, I couldn’t receive many benefits and services because I didn’t have a stable address.

A repetitive pattern with VAC has been to ask for an updated assessment from a nurse or OT, have recommendations made, and then to have no follow-up. Months later, when I ask for the services I need, I am told I need another assessment.

The assessments are very difficult due to my trauma history as each assessor comes into my ever-changing housing arrangement and asks questions about my history, even though the history and numerous assessments have already been completed—VAC has this information.

I have yet to receive support to pay for a personal support worker to help me with basic tasks of life, for example, getting out of my bedroom, eating, and showering. I have been judged as difficult and uncooperative because I don't fit into the boxes that the VAC system expects.

The details of my experience and the extent of the lack of support are difficult to describe in a short speech. I hope that what I have said has an impact.

Based on my experiences I have a few recommendations for VAC that can be addressed later in questions.

Thank you.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you, Ms. Smith.

If you are able to, you can tell us what those recommendations are. I will allow you a few minutes to do that. Please go ahead.

[Jennifer Smith]

Thank you, Chair.

This is brief and, again, feel free to ask me to expand on them if you like. I have many lived experience examples.

One, I would increase benefits for women living alone who are often without a caregiver or family member.

Update the claims process to better reflect women's physical health issues, including female-specific forms for sexual, urinary, and reproductive issues. I've included in evidence one of the medical questionnaires, and I can go into that further in question period.

Specially train a group of case managers in regions of Canada who are knowledgeable of women's issues, including that of housing insecurity and homelessness, and military sexual trauma.

Create systemic changes to ensure that medical and psychosocial recommendations made to help women veterans are acknowledged and followed.

Finally, invest in women veterans-specific research, preferably carried out by women veterans themselves.

Thank you, Chair.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you very much. We are so sorry to hear the story of what you went through. It really took a lot of courage to come to share that with us. Thank you so much.

Now I'd like to invite Mrs. Stéfanie von Hlatky for five minutes please.

[Professor Stéfanie von Hlatky, Full Professor, Queen's University, Canada Research Chair in Gender, Security, and the Armed Forces, As an Individual]

Thanks, Mr. Chair.

I also want to acknowledge the testimony of Madame Doucet and Madame Smith and to thank them for it.

My research to Queen's on the topic of this study has focused on the differentiated impacts of military service on women, and also on the military-to-civilian professional transition.

Every year, thousands of service members leave the military, typically in their late 30s, to join the population of Canadian veterans. Almost 75,000 veterans are women—over 16%—which mirrors their representation in the Canadian Armed Forces.

Recognizing this, all programs in support of veterans should take into account the changing demographics of the Canadian veteran population. This means a focus on the growing participation of women in the Canadian Armed Forces. Not only are there more and more women in the military, but also since the late 1980s, they no longer face formal employment restrictions in the military and can compete for all roles, including combat roles. Their representation among regular force officers has even gone past the 20% mark.

We have more women, yet the military is still struggling with gender integration. As my colleague Maya Eichler has noted, tracking the proportion of women veterans is important but tells us little about the specific challenges they encounter on the road to civilian life, as it overlooks gender norms and inequalities based on gender. It's important to draw this parallel between women in the armed forces and women veterans because the experience of women while in the military influences their experience as they transition to civilian life.

As we focus on improving services and programs for veterans, I would invite us to think about the military-to-civilian transition as a distinct but related phase of the military career cycle. For example, when the federal government offers programs for mental and physical health, it is important to identify women's differentiated needs and how these needs may have been shaped by their experiences while in the military. For example, women are more often exposed to cumulative stressors over the course of their career, which may include intense operational experiences, combined with sexual harassment and military sexual trauma, and separation from family as a primary caregiver.

Some not-for-profit organizations have developed programs to support women military veterans and other marginalized groups who experience PTSD related to sexual trauma, deployment and other causes. The government has recognized the importance of using a GBA+ and intersectional lens to identify areas of policy reform as the military responds to the recommendations in the Arbour report, as it aims to respond to unhealthy attrition in the Canadian Armed Forces retention strategy and, increasingly, as it designs veteran support programs.

These approaches have even led to greater coordination between the Department of National Defence and Veterans Affairs, allowing service members to engage in longer-term preparation for transitioning to civilian life. However, much more, of course, needs to be done. Efforts should continue to improve continuity between a life of service and a life after service, as well as public facing efforts that recognize the changing demographic of veterans.

A challenge with this kind of research continues to be the availability of data, given the lack of gender-differentiated research on military-to-civilian professional transitions. The few Canadian studies that have been published are based on interviews and exit surveys done with female military personnel, and are consistent with cross-national trends. They identify professional challenges that are specific to women, who have reported that they never felt fully integrated into the military and that their ability to be promoted while in the military, or their ability to find good jobs after leaving, was hindered by the lack of experience, brought on by exclusionary professional environments while serving.

Even more generally, drawing from the evidence provided in exit surveys as members leave the military, the CAF retention strategy emphasizes that “certain dissatisfiers associated with voluntary release may be more prevalent amongst women than men”. The report cites the lack of fit with the military lifestyle, dissatisfaction with the advancement and promotion system, training and development requirements, as well as workload demands. The document recognizes that gender bias “can negatively affect access to opportunities for leadership roles, career advancement, and the preponderance of women as role models or mentors to aspiring leaders within the CAF.” This, in turn, has an influence on the well-being of serving members and newly releasing members, as well as on the professional opportunities that come after a career in the military.

In a co-authored article with Meaghan Shoemaker, we note:

These experiences that women face while serving, from social isolation and stigmatization by their peers to outright harassment, are important to address for a successful military-to-civilian transition, as they impact mental health.

It continues:

Moreover, part of service members' social networks carries over with them as veterans, which provides additional peer support during transition. Women’s experiences where professional exclusion and workplace harassment were the norm shed light into the difficulty of securing peer support both during and after service.

My past research at Queen’s on this topic, through an initiative called the Gender Lab, aimed to connect these dots between the professional experiences of women and men while in the military to their professional experiences after the military.

It's the right thing to do. We need to stay focused on understanding how we can improve the well-being and transition of veterans, enhancing service provision in the process. Understanding that professional fulfillment contributes to mental health, there is also an opportunity to improve the employment prospects of veterans in a range of sectors given that former military personnel represent a skilled, trained and experienced labour force.

Our research focused on doing an environmental scan of veteran services and programs, as well as conducting interviews and focus groups with members of the armed forces who were considering leaving the military or who had recently released. In addition to the programs offered by Veterans Affairs, there are provincial-level services in health care and employment, in both the public and private sectors, which are designed for veterans, as well as a programs emerging from charities and the not-for-profit sector.

A few findings to highlight from our research indicate that, given the diversity of veteran service providers, attempts at coordinating what is being offered to veterans as well as identifying potential gaps are essential. In one of our publications, we suggest that a collective impact model would be favourable to encourage collaboration across the different sectors and partners involved in veteran service provision.

While the literature has recognized the importance of employment training to improve the labour force participation of veterans, we cannot just put the burden—

[The Chair, Liberal, Emmanuel Dubourg]

Mrs. von Hlatky, please conclude.

[Prof. Stéfanie von Hlatky]

—of the transition on veterans. We can also work to better prepare employers for veterans' integration into a new workplace culture. While programs that encourage the employment of veterans abound, so do harmful stereotypes about military service, which might impact the hiring prospects or integration of veterans in their new workplace.

I'll stop there, but I emphasize that my last point is about the broader cultural environment of society.

Thank you.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you very much, Ms. von Hlatky.

Now I'd like to invite Dr. Remington Nevin, for five minutes, please.

[Dr. Remington Nevin, Executive Director, The Quinism Foundation]

Thank you very much, Mr. Chair.

My name is Dr. Remington Nevin. I'm a former U.S. Army physician and preventive medicine officer, trained in epidemiology and drug safety at Johns Hopkins. During my 10-year active duty military career, I conducted research and published extensively on various topics in military medicine, including mental health and malaria.

I now serve as executive and medical director of the Quinism Foundation, a charitable organization that supports research and education on the adverse effects of the class of anti-malarial drugs known as quinolines, which include the drug mefloquine or Lariam. For many decades in western militaries it was widely used to prevent malaria.

Malaria is, of course, a mosquito-borne disease that can infect military personnel deployed to certain tropical areas, particularly in Africa and the Middle East, where many Canadian veterans have served in recent decades.

It is this issue that I wish to speak to today, the prevention of malaria and the use of anti-malarial drugs in military women—particularly those of child-bearing age. This poses unique challenges, which, in my opinion, have not yet been adequately addressed by policy-makers.

Most of my testimony today is drawn from my chapter in the book Women at War, which discusses these issues in greater detail and contains references for many of the statements I make.

The primary point I make in this chapter, and which I wish to make to the committee today, is that the widespread deployment of women of child-bearing age calls into question western militaries' traditional one-size-fits-all policies for the prevention of malaria.

For historical reasons, most preventive anti-malarial drugs were tested predominantly among men, and therefore in many cases direct human safety and reproductive hazard data are not available to inform their rational use in women.

For example, the Canadian product monograph for atovaquone-proguanil, a popular anti-malarial drug marketed as Malarone, notes that “there are no studies in pregnant women”, and that the safety of the drug combination in pregnancy “has not been established”. Likewise, the Canadian product monograph for doxycycline, another popular anti-malarial drug, warns that it “should not be administered to pregnant women”.

These warnings are particularly relevant in that U.S. military experience has shown that women of child-bearing age are at high risk of pregnancy during deployments, where the use of these or other drugs has typically been mandatory.

For example, while in Afghanistan I and a colleague, Jen Caci, found that in an eight-month period in 2007, there were 49 pregnancies identified among 3,298 U.S. military women. That's equivalent to a rate of pregnancy of 22.3 per 1,000 women-years or over 2% of deployed women per year. For various operational and personal reasons, many of these pregnancies were not diagnosed until well into the first trimester and occasionally well beyond that.

If the Canadian experience is similar, this means that among Canadian military women, some degree of unintentional and potentially prolonged fetal exposure to anti-malarial drugs and other preventive measures, such as insect repellants, with unknown reproductive toxicity will have occurred. In many cases, such potentially toxic exposure will have occurred as a direct result of traditional one-size-fits-all policies that mandate the use of these measures under command direction.

The deployment of large numbers of women of reproductive age and the risk of pregnancy that accompanies these deployments provide an opportunity for western militaries to re-examine previous one-size-fits-all malaria-prevention policies and to consider adoption of malaria-prevention strategies that are customized to the individual.

As I describe in my book chapter, in many cases these can include a transition away from mandatory or command-directed use of anti-malarials and towards an emphasis on mosquito-avoidance measures. Such customized measures can reduce the risks potentially posed to the developing fetus while also reducing the risk that these measures may pose to the women service members themselves, such as we have seen, for example, with the mandatory or command-directed use of mefloquine.

Mr. Chair, thank you very much for the opportunity to address the committee on these issues. I'd be happy to answer any questions.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you very much, Dr. Nevin.

Thank you to all the witnesses.

Now, we're going to start the first round of questions of six minutes each.

I'd like to start with MP Cathay Wagantall.

Go ahead for six minutes, please.

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

Thank you so much, Chair.

Thank you all for being here and for your bravery in presenting your circumstances. We have a lot of work to do at this committee, and you will make a significant difference to that, so thank you very much.

My focus right now is on you, Dr. Nevin. In 2015 you wrote a research paper, “Issues in the Prevention of Malaria Among Women at War”, and my colleagues and I look forward to hearing your findings about how that can have significant implications, as we're hearing, on the health care of Canadian female military service members today.

However, I think it's really important for the current members of this committee to also know the concerns of our armed forces with respect to the anti-malarial drug mefloquine, which has been the required drug of first resort for Canadian Armed Forces members—both men and women—in the last three decades.

In 1992 on a deployment to Somalia, Canada's elite airborne paratroopers received the then-unlicensed drug as part of a drug study. Military personnel were told they must take the drug or face disciplinary actions. Very clear protocols were set forth, yet few, if any, were followed by either DND or Health Canada. Although the drug was administered, no proper testing was done and no results were noted.

In January 1993, Health Canada, in advance of its own research being completed, approved the drug for civilian use in Canada. Three months later, a young Somali boy was murdered on a Canadian base in Somalia. This event would later become known as the Somalia Affair.

After the 1993 federal election, Jean Chrétien's Liberal Party initiated a highly visible inquiry. However, a year later, in 1994, just as data was being collected on the role mefloquine played in the event, the Chrétien government abruptly shut down the inquiry just ahead of the 1997 election.

This report, the 1997 Somalia inquiry report, should be read by all members of this committee. The abrupt shutdown was questioned in 1999 at the Standing Committee on Public Accounts when former MP John Cummins stated that he was in personal possession of an October 1997 departmental note to the then-defence minister advising the DND to mislead the Somalia inquiry on the status of mefloquine and advising him to mislead the public as to where DND got the drug.

While the Liberal government continued its cover-up, ignoring its veterans while requiring service members to continue to take mefloquine, the U.S. military responded to the Fort Bragg murder-suicides of 2002, in which four military wives were killed and two of the partners that killed them then committed suicide. There was research into the potential impact of mefloquine on those partners who were required to consume mefloquine while in Afghanistan.

Dr. Nevin, I have two questions that I'll put together for you. What was the 2009 decision made by the U.S. military because of their research? We know that many of our other allies were also using mefloquine at this time, and in response to the U.S. decision, I believe, they held inquiries of their own that responded to the concerns of their veterans. I'm wondering if you're aware of which other countries made changes to the use of this drug within their forces and what they did specifically.

Could you succinctly respond to that?

Thank you.

[Dr. Remington Nevin]

Mr. Chair, I thank the member for the question.

The member is, I believe, referring to the 2009 policy decision made by the U.S. Army. I believe that was in response to some research that I had published that had demonstrated that the drug had been used improperly on a large scale, particularly in Afghanistan. The drug had been prescribed to a growing number of service members with mental health contraindications. I think the U.S. Army was quite happy to dispense with the use of the drug. It had developed, by that point, plenty of experience with the drug's very unpleasant and dangerous adverse effects, and subsequently the rest of the U.S. military followed suit.

By 2013 when the U.S. Food and Drug Administration had mandated a boxed warning on the mefloquine product insert, the U.S. military had issued a policy that mefloquine be essentially a drug of last resort only, and that the two drugs that I referenced previously—atovaquone-proguanil and doxycycline—be used primarily in almost all circumstances.

I believe the Canadian military by this point had also moved away from mefloquine as a first-line drug, as did militaries around the world. I recall that when I was overseas I spoke with some French officers, and this was in the mid-2000s. They had long since abandoned the use of mefloquine because of operational experience with very unpleasant side effects of some operational significance associated with the drug. Germany, I believe, completely banned the use of the drug in their military around the time of our boxed warning. Essentially few countries if any make any significant use of mefloquine today. The drug remains on many formularies. It may be used by old-timers who have had favourable experience with the drug, but it would be very unusual for new troops to be issued mefloquine on deployments today.

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

Thank you very much.

Dr. Nevin, it was your research that brought new hope to Canadian veterans and serving members who'd been suffering with a physical brain stem injury due to mefloquine toxicity while being told that their issues and prescribed treatments were due to PTSD.

You testified at this committee on May 1, 2019, along with several Canadian veterans injured by mefloquine, contributing to our study and our report on the effects of mefloquine use among Canadian veterans. Of course, that report from the 42nd Parliament is available. It is report 14. The Conservative Party of Canada also submitted a supplementary report.

Can you please share the eventual changes and your perspective on the changes Health Canada and the surgeon general and commander of the Canadian Armed Forces health services made in 2016 regarding the use of mefloquine in Canada after a significant amount of challenge at this committee and also from veterans?

[The Chair, Liberal, Emmanuel Dubourg]

Excuse me, Dr. Nevin. I can give you only 20 seconds to respond.

Please go ahead.

[Dr. Remington Nevin]

I would say that what is missing from those reports is an acknowledgement of the most important thing with mefloquine and that is that the use of the drug must be discontinued at the onset of psychiatric symptoms. It is this critical warning that I think has been ignored and that has still not been acknowledged by Canadian officials.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you very much.

For the next question, for six minutes, I invite MP Randeep Sarai.

[Randeep Sarai, Liberal, Surrey Centre, BC]

Thank you, Chair.

I want to thank all of the witnesses, but specifically Ms. Doucet and Ms. Smith, who had to share their personal experiences, which we all understand is very difficult.

My first question is for Ms. Smith. It appears as though we opened up the Canadian Armed Forces to women and they were plopped in with no support mechanisms, no systems, no checks on how biology would come into play and no complaint methods—a real “cluster-F”, if you want to call it that. Pardon my language, but I really feel for you. What you went through in a very short period of time was unacceptable.

You gave five great, concrete recommendations. Can you maybe help us more? Based on your own experience, how would specially trained case managers who deal specifically with sexual trauma be helpful?

Also, with regard to medical records and having to repeat the trauma over and over when you go to a different case manager or when a file goes from CAF to VAC, if you could make some recommendations or some solid suggestions, that would be very helpful so that we can make those changes going forward.

[Jennifer Smith]

My goodness, there's a lot to unpack there.

With respect to case managers being trained specifically on military sexual trauma and housing insecurity or homelessness, I think there's just this ingrained, unaware bias that presupposes that women have spouses or that they have support systems in place. When that is not the case, having case managers meeting the veteran without these pre-existing biases and suppositions would help build rapport and trust between the case manager and the veteran.

So many veterans, including me, are just not heard at all. With respect to homelessness, I had a case manager I repeatedly told I was homeless. Let's expand that to be a more inclusive definition—housing insecure—because women veterans, as we know, do exist. They are not invisible. They are out there. They do present in a much different way from what we're typically led to believe. They are couch surfing or perhaps staying in different shelters.

I had a case manager who said that VAC did not have a housing mandate and to just look on Kijiji. That was as far as I got with that. I skipped around from couch to couch, to short-term Airbnbs, to my car, and I was being denied services because I didn't have a fixed address. I know that maybe doesn't necessarily answer that question directly, but there needs to be more awareness and more special training. These are specific topics.