D j Vu All Over Again The Disappointing Health Status of Canadian Op APOLLO Afghanistan

1. �D�j� Vu All Over Again�The Disappointing Health Statusof Canadian Op APOLLO (Afghanistan/SW Asia) Returnees Mark Zamorski, MD, MHSA Post-deployment Health Section Directorate of Medical Policy Canadian Forces Thank you very much for providing me the opportunity to provide this training on the Op APOLLO Post-deployment Follow-up Interview process. By now, you all should be aware that this process is being piloted with the Rotation (Roto) 0 Op APOLLO returnees. Based in part on the results of the evaluation of this pilot, it may be expanded in some form to other rotations and deployments. By way of introduction, I am Mark Zamorski from the Post-deployment Health Section of the Directorate of Medical Policy, under Col Ken Scott. I am one of two people in our small section, which eventually will have 4 or 5 staff members. Our area of attention is the health of CF members after they have been deployed. Another directorate (Forces Health Protection) is responsible for health matters preceding and during deployments, but our work obviously overlaps quite a bit, since events before and during deployment affect a member�s health after deployment. Please be patient with my French�it has been about 20 years since I have spoken it regularly. I would have liked to have this presented by someone who was fully bilingual, but my section currently does not have any bilingual staff. I may need to read some parts of my presentation, which I have had translated. If there are things you do no understand (or if you have any questions at all), please don�t hesitate to stop me at any point. My verbal comprehension is the weakest part of my French language skills, so I may ask for help in translation. Is there someone here who speaks English reasonably well? Thank you very much for providing me the opportunity to provide this training on the Op APOLLO Post-deployment Follow-up Interview process. By now, you all should be aware that this process is being piloted with the Rotation (Roto) 0 Op APOLLO returnees. Based in part on the results of the evaluation of this pilot, it may be expanded in some form to other rotations and deployments. By way of introduction, I am Mark Zamorski from the Post-deployment Health Section of the Directorate of Medical Policy, under Col Ken Scott. I am one of two people in our small section, which eventually will have 4 or 5 staff members. Our area of attention is the health of CF members after they have been deployed. Another directorate (Forces Health Protection) is responsible for health matters preceding and during deployments, but our work obviously overlaps quite a bit, since events before and during deployment affect a member�s health after deployment. Please be patient with my French�it has been about 20 years since I have spoken it regularly. I would have liked to have this presented by someone who was fully bilingual, but my section currently does not have any bilingual staff. I may need to read some parts of my presentation, which I have had translated. If there are things you do no understand (or if you have any questions at all), please don�t hesitate to stop me at any point. My verbal comprehension is the weakest part of my French language skills, so I may ask for help in translation. Is there someone here who speaks English reasonably well?

2. Acknowledgements Mr. Terry Humeniuk Col Ken Scott LCol Henry Matheson CF members who participated

3. Rationale Following certain deployments, CF members have an increased risk of: Mental distress and diagnosable mental illness Medically unexplained physical symptoms [�MUPS,� or �Gulf War Syndrome�] Numerous prevention strategies have been undertaken� The first part of the rationale for this interview process is the fact that deployment can cause certain problems. Following deployment, CF members do experience: Higher levels of stress; this makes perfect sense. And you know, of course, that the stress is not just the adverse effects of deployment-related trauma such as being injured or seeing others injured or killed. In addition there are things like: separation from family and friends crowded, primitive, and uncomfortable living environments that offer little privacy Culture shock that occurs on exposure to a different cultural group. While most people expect culture shock when you go to a foreign country, many people do not expect to have then same thing in reverse when you return home. In fact, I personally find the culture shock of returing home to be more intense and more upsetting because it is not something that you expect. For me at least, I find that the environment feels almost sureal in that it is highly familiar and recognizable but it feels so strange and foreign. Etc. There is some interesting research on sources of stress among Amercian servicemen and women while deployed in the Persian Gulf War. The most commonly endorsed source of stress was not fear of being harmed in an attack or anything like that, but instead lack of contact with the opposite sex, if you can believe that. And the second most frequently endorsed source of stress was flies. Apparently there are a lot of some sort of really annoying flies in the Gulf Region.In most members, of course, these stresses are coped with and people do fine with the resources they have. And many more soldiers are likely to frame deployment as an overall positive experience than a negative experience. In addition, there are higher rates of diagnosable mental illness after deployment, particularly mood and anxiety disorders. So not only are members stressed as a result of a deployment, but they also suffer from symptoms strong enough to merit a formal diagnosis, such as depression or posttraumatic stress disorder. And lastly, they have higher rates of what we call �medically unexplained physical symptoms� or �MUPS,� which are what you might think of as �Gulf War Syndrome.� I will talk about this phenomenon of unexplained physical symptoms related to deployment at some length. The first part of the rationale for this interview process is the fact that deployment can cause certain problems. Following deployment, CF members do experience: Higher levels of stress; this makes perfect sense. And you know, of course, that the stress is not just the adverse effects of deployment-related trauma such as being injured or seeing others injured or killed. In addition there are things like: separation from family and friends crowded, primitive, and uncomfortable living environments that offer little privacy Culture shock that occurs on exposure to a different cultural group. While most people expect culture shock when you go to a foreign country, many people do not expect to have then same thing in reverse when you return home. In fact, I personally find the culture shock of returing home to be more intense and more upsetting because it is not something that you expect. For me at least, I find that the environment feels almost sureal in that it is highly familiar and recognizable but it feels so strange and foreign. Etc. There is some interesting research on sources of stress among Amercian servicemen and women while deployed in the Persian Gulf War. The most commonly endorsed source of stress was not fear of being harmed in an attack or anything like that, but instead lack of contact with the opposite sex, if you can believe that. And the second most frequently endorsed source of stress was flies. Apparently there are a lot of some sort of really annoying flies in the Gulf Region.In most members, of course, these stresses are coped with and people do fine with the resources they have. And many more soldiers are likely to frame deployment as an overall positive experience than a negative experience. In addition, there are higher rates of diagnosable mental illness after deployment, particularly mood and anxiety disorders. So not only are members stressed as a result of a deployment, but they also suffer from symptoms strong enough to merit a formal diagnosis, such as depression or posttraumatic stress disorder. And lastly, they have higher rates of what we call �medically unexplained physical symptoms� or �MUPS,� which are what you might think of as �Gulf War Syndrome.� I will talk about this phenomenon of unexplained physical symptoms related to deployment at some length.

4. �when they fail, will early intervention help? Depression, problem drinking: YES PTSD, MUPS: Maybe At best, the potential benefits are modest And harm is a possibility�