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Supplementary Report on Mental Health of Canadian Veterans: A Family Purpose

Background

The basis of this supplementary report to the ACVA Report on Mental Health of Canadian Veterans begins on Parliament Hill and the action of a lone veteran, Claude Lalancette. Mr. Lalancette was protesting September 19th and 20th, 2016 on Parliament Hill about his lack of assistance from Veterans Affairs Canada (VAC) for the treatment of his illness due to the use of mefloquine while he served with the Airborne Division in Somalia. Mr. Lalancette was visited during his hunger strike by VAC Minister Kent Hehr, Defence Minister Sajjan and (then) Parliamentary Secretary to Veterans Affairs and Associate Minister for National Defense Karen MacCrimmon.

Mr. Lalancette was told he would be given the opportunity to speak at the Standing Committee for Veterans Affairs (ACVA), which had just started a study on the Mental Illness and Suicide Prevention of Canadian Veterans.  Mr. Lalancette spoke on 25 October, 2016.  He returned for a second opportunity to speak on 27 October 2016.  It was during his evidence given at ACVA that the committee first heard about the effects he and others would suffer due to the forced use of mefloquine by the Canadian Armed Forces (CAF).  The committee would also hear evidence of the day-to-day effects the use of the anti-malarial drug would have on CAF members in their duty not only in Somalia, but also in other theatres of action.  Lt-Gen. (retd) the Hon. Roméo Dallaire would describe his experience with the ordered use of Mefloquine as he led forces in Rwanda. 

The committee would also hear clinical evidence from experts, more compelling first hand evidence from Veterans and their spouses on the effects the use of mefloquine had on their families after active service.  The committee also heard about treatment for mefloquine toxicity from one Veteran, Dave Bona. 

Rationale for a Supplementary Report

It is the opinion of the Conservative members of the committee that the final version of the ACVA report failed to accurately portray the role that the use of mefloquine by the Canadian Armed Forces had on our veterans and their families when attempts of suicide were made or when a veteran who used mefloquine committed suicide.  Weak recommendations and the removal of the voices of Canadian Veterans were not acceptable to the Conservative members of the committee.

While the evidence presented may seem anecdotal, there was in fact clinical evidence that was key in revealing information that was not on the radar of the committee when the study on Mental Illness and Suicide Prevention was struck.  In a medical sense, patients present anecdotal information on their health and from that information a doctor is to make a diagnosis and present a treatment plan – and so it must be for the use of mefloquine.  The committee is bound to hear the evidence and follow it and present a reasonable outcome and plan of action. 

Recommendations presented in the tabled report by the committee do not, in the opinion of the Conservative committee members, meet the parameters of the report and the recommendations in this document better represents the action the government should take.

Somalia

Much of the witness testimony that was not included in the final version of this report relates to the Somalia Affair of 1993 and the role that mefloquine and its side effects may have played in the matter. The committee heard from Corporal John Dowe, a veteran who was present at the base in Somalia during the incident which caused the death of Somali teenager, Shidane Arone. In his testimony, Mr. Dowe gives his eyewitness account of the actions of Master Corporal Clayton Matchee and Private Kyle Brown, excerpts of which are below[1]:

“… he (Matchee) started swearing and saying ‘F***ing spiders’… and he started beating the baton on the legs and moving backward and then turned around to the rear of the bunker, continually smacking that baton against the sides of the wall of the bunker. There were no camel spiders there.”

“I knew Clayton Matchee prior to the tour, so I have the ability to understand exactly what state Clayton Matchee was in at the moment, and what was going on. His beating camel spiders that weren’t there is absolutely hallucinogenic and so was the psychosis of the rage he was in.”

Master Corporal Matchee attempted suicide two days after the death of Shidane Arone and now has severe brain damage as a result. In his testimony, Mr. Dowe stated the following with respect to the effects this has had on the Matchee family:

“Clayton Matchee’s family have … suffered the most because he’s not entirely lucid to understand what’s going on with him anymore. It’s Marj, his wife, and it’s the Matchee family, the mum and the dad, and the community, all of them, who have had to wear this.”

Regarding Private Kyle Brown, Mr. Dowe stated the following:

“Kyle Brown faced the opprobrium of an entire nation. He was the scapegoat for the entire tour. … Kyle is having difficulty trying to come to grips with all of this. … He understands that there’s a lot out there today that will speak a lot greater to what he had to suffer that night and what he continues to suffer to this day.”

Claude Lalancette echoed this sentiment when speaking about the disbanding of the Airborne Regiment following the Somalia mission[2]:

“… To this day, I feel the shame of the closure, all the blame and shame landed on Canada’s elite. Most of all, I feel shame because I put the blame for the closure of the regiment on two individuals who were innocent: Clayton Matchee and Kyle Brown are victims.”

The Conservative members of the committee believe that a more thorough study should have been conducted to better identify the true impact of mefloquine on this tragic episode in Canada’s military history and on the veterans who, 25 years later, still feel its effects every day. In her testimony Dr. Ritchie said research on mefloquine was “not very deep” and needs to ramp up quickly.[3] In the same meeting, Dr. Ritchie and Dr. Nevin both agreed that the Somalia Commission should be reopened.[4] It is possible that mefloquine was not a determining factor in the tragic events in Somalia, but there is too much room for doubt. This doubt is even greater considering the repercussions it may have had on the lives of Master Corporal Clayton Matchee and Private Kyle Brown. Therefore, the committee recommends:

Report Recommendation 1:

That the Government of Canada mandate an independent body to establish or rule out any connection between mefloquine and the actions of Master Corporal Clayton Matchee and Private Kyle Brown during the event that led to the death of Shidane Arone.

The committee proposes that the final recommendation should indicate that the timeline for the independent body to begin should be no later 12 months from the day the report is tabled in the House of Commons.

Continued Use of Mefloquine

The committee heard of the irresponsible manner in which the CAF undertook a “clinical” trial of mefloquine without any proper record keeping.  There was no follow up on the effects of the use of mefloquine faced by CAF members.  To this day it is not entirely known who in the CAF was given mefloquine, or where they are today after leaving the CAF.  The ability to follow up with these veterans is inadequate to provide either proper medical care or to indicate any level of accuracy in determining the effects of its use. Some Allied partners, notably Australia, have been extremely effective in locating its mefloquine users in the Australian Defence Force (ADF) and being able to ensure proper treatment for these ADF members.

Many of Canada’s Allied partners have either discontinued or drastically reduced the use of mefloquine.  In a June 2017 report the CAF Surgeon General’s Report on mefloquine, the use of the drug has been relegated to ‘third line’ use.[5]

In 2013, the United States military declares mefloquine a “drug of last resort”, to be used only when an individual has contraindications or intolerance to preferred daily antimalarial, doxycycline and atovaquone-proguanil. The drug is “Black boxed” by the USFDA. The warning label states that neurological side effects may persist or become permanent in some people.

In 2002, the French military forces discontinue the widespread use of mefloquine

in Djibouti, in favor of preferred use of the antimalarial doxycycline.[6]

In 2013, Germany designated mefloquine as a drug of last resort after both the USFDA and the European Medicines Agency confirmed in separate studies the side effects could be permanent, both issuing tougher warnings.

In September 2016, the Minister of Defense (MOD) in the United Kingdom (UK) introduced a new policy on prescribing antimalarial drugs, declaring mefloquine a third-line drug, again as with the U.S. military, to be used only when there are documented contraindications or intolerance to both.

The UK House of Commons Defense Committee further stated that they will monitor the MOD’s policy in relation to malaria protection by requesting six monthly updates on the MOD’s use of mefloquine. In order to assess the impact of the revised anti-malarial policy, a new method of data capture through electronic templates was introduced. This allowed better recording of the processes undertaken when prescribing antimalarial drugs at MOD medical facilities.

Similarly, the Australian military for many years has declared mefloquine a third-line drug, essentially also a drug of last resort. In Australia, mefloquine similarly comprises less than 1% of antimalarial prescriptions. This has been policy for well over a decade.[7]

Mefloquine was not used routinely by the New Zealand Defense Force at any point and only “intermittently for personnel intolerant to other meds.

Given the actions of our Allies, the Conservative members of the committee, feel the recent Surgeon-General’s report was not strong enough in its rebuke of the use of mefloquine.   Lt-Gen. (retd) the Hon. Roméo Dallaire stated in his testimony regarding the drug’s effects on him personally:

“I was on mefloquine for a year. About five months into it, I wrote the National Defence Headquarters, and I said this thing is affecting my ability to think. This thing is blowing my stomach apart. This thing is affecting my memory, and I want to get rid of it. … I then got a message back, which was one of the fastest ones I have ever got back, which essentially ordered me to continue, and if not, I would then be court-martialled for a self-inflicted wound because that was the only tool they had. Mefloquine is old-think, and it does affect our ability to operate.”[8]

The Hon. Roméo Dallaire’s evidence is not different from others the committee heard, including Mr. Dave Bona who also served in Rwanda. 

“The first day I took mefloquine for Somalia, in 1992, I almost immediately felt sick. […]My vision would go black and I would see stars, I would feel disoriented and dizzy after. This would happen initially only on mefloquine days, eventually they would occur randomly the rest of the time – lying down, standing in line at super market, sitting at the supper table. … The dreams I suffered from were quite horrific. They involved the violent death by my hand of my loved ones and my section members. They were just like they were happening. I would wake up. I stopped sleeping. The day I took the pill, from then on, early in the tour, I didn't sleep, and that continued all the way through to Rwanda… The only thing that I could control that with, while I was deployed, was alcohol. … The depression started to take over – I would bounce between anger and being so depressed that I would sometimes catch myself holding my rifle in my hands, just thinking how easy it would be.”[9]

Following his unsuccessful treat for PTSD, Mr. Bona’s psychologist altered his treatment to that for brain stem injury:

“Three years ago, Dave's psychologist changed his treatment plan to include the protocol of someone with a traumatic brain injury, a new therapy, one that retrains the brain around injured areas utilizing a type of electronically monitored neurofeedback. Results didn't happen overnight, and there were times that things seemed to get worse, but it finally settled in. The time span between rages lengthened his ability to settle down eventually quickened from a week, to a few days, and eventually a few hours.”[10]

The Conservative members of the committee feel that the evidence provided strongly suggests that a great deal of work is required to further understand the effects and potential treatment for mefloquine neurotoxicity. The committee approved a letter to be sent to the Minister of Health to examine the effects of the anti-malarial drug mefloquine in detail. 

In her response dated February 22, 2017 the Minister stated “the benefits of mefloquine outweigh its potential risks under the conditions of use.”[11]

However the Conservative members of the committee feel that given that the Surgeon General report affirming the testimony of the veterans exposed to Mefloquine at committee,  the government should take immediate steps to contact all veterans treated with the drug to advise them on the reclassification of the drug from first line to last resort and advise them on where they can get more information and what they can do if  they need medical help as a result of their on duty exposure to drug.

The Conservative members of the committee feel that the government should make a concerted effort to study mefloquine and its effects in order to provide the best possible treatment to veterans. In addition the recommendation should be enhanced for the government to be given a timeline to take action on the study.  The recommendation is as follows:

Report Recommendation 2:

That the Government of Canada, in cooperation with all federal, provincial and international institutions concerned, initiate an independent research program to study the long term neurotoxicity of mefloquineThe research program should be in place no later than 12 months from the day the report is tabled in the House of Commons.

Report Recommendation 3:

Based on the Surgeon General report and the reclassification of the Mefloquine drug from a drug of first choice to one of last resort, that the government take immediate actions to contact by all possible means veterans previously exposed to the drug to advise them of their prior exposure to the drug; reclassification of the drug by Health Canada; where to get more information; assistance options and treatment procedures available to them.

Conclusion

The Conservative members of the Standing Committee on Veterans Affairs wish to thank all witnesses that appeared in personal and presented written briefs in the course of the committee’s study on mental health and suicide prevention among veterans.

As we have mentioned several times, the Conservative members of the committee do not take lightly the impact that mefloquine has had on Veterans and their family.  It is clear that these members of our veteran’s community need assistance and support of the government to get the correct treatment for their neurotoxicity because of the forced use and botched trial for mefloquine. 

On October 27, 2016 the committee heard evidence from four veterans; Claude Lalancette, Dave Bona, Brandon Kett and John Dowe – all who experienced the horrible side effects of the drug.  During the evidence the Conservative members were visibly moved by their evidence.  Cathay Wagantall (MP Yorkton-Melville) noted “What I'm learning as a Member of Parliament, more than anything, is that it seems to be the victims who have to go beyond what they've already experienced to get change.[12]  Mr. Brassard (Barrie-Innisfil) was so visibly moved he had Robert Kitchen (Souris-Moose Mountain) question the witnesses as he could not; “The first thing I would like to say, gentlemen, is thank you for your service to our country. Your testimony today has had a profound impact on me.  Robert, please.”[13]

These comments of the Conservative members of the committee were echoed by members from the Government side.  Colin Fraser (West Nova) commented, “I thank you guys for being here today and for sharing your story. I can assure you that all of us listened very carefully to the powerful testimony that you gave. Certainly, we want to take all of this and make recommendations to make this better.”[14] 

Former committee member from the government Jean Rioux (Saint-Jean) welcomed the witnesses of the day by stating; “I've been in politics for a long time, and I have to admit that your testimony today really moved me.”[15]

He went further by stating;   “I especially want to tell you that you are put together. You have presented your case, and I think you have chosen the right place to do it. We are here to represent you. I feel challenged as an MP today. This is perhaps one of the most important roles I will have to play.  Thank you very much for making us aware of this problem. Everything has a beginning, and I think you will be seen as someone who initiated a new and important process.”[16]  Finally, Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley) used few words to express his views of their appearance in committee saying directly to Mr. Lalancette “I can't even begin to imagine what any of you must be feeling with all the things you're describing.  Claude, again, I'm so sorry for the experience you've had. We know you do need help.” [17] 

The committee heard of many unique and regional treatments for PTSD and other mental health issues.  These programs, most often run by volunteer groups many of which were CAF veterans themselves involved canine therapy, equine therapy, musical therapy, yoga and intense retreat programs.  The Conservative members of the committee feel that information on these and other programs must be made available to veterans either through their case manager or independently via the websites listed in the recommendation.

In closing, the Conservative members of the committee felt it necessary that the words of the veterans were not suppressed and that their stories were accurately presented and made public.


[1] ACVA October 27, 2016

[2] ACVA October 27, 2016

[3] ACVA October 25, 2016

[4] ACVA October 25, 2016

[5] S-G Report on Mefloquine June 2017 Recommendation 4, pg. 40

[6] L. Ollivier, R. L. Nevin, H. Y. Darar et al., “Malaria in the republic of Djibouti, 1998–2009,” The American Journal of Tropical Medicine and Hygiene, vol. 85, no. 3, pp. 554–559, 2011). 

[8] ACVA March 6, 2017

[9] ACVA October 27, 2016

[10] ACVA October 27, 2016 Letter from Terese Untereiner, wife of Dave Bona, read by Mr. Bona as an individual.

[11] Letter to ACVA from Minster of Health, date stamped February 22, 2017.

[12] ACVA October 27, 2016

[13] ACVA October 27, 2016

[14] ACVA October 27, 2016

[15] ACVA October 27, 2016

[16] ACVA October 27, 2016

[17] ACVA October 27, 2016