The Battle is Not Over
CHRIS LINFORD
© 2013 FrontLine Defence (Vol 10, No 1)

Lieutenant Colonel Chris Linford always wanted to be a soldier, and he wanted to help people – a career as a medical professional with the Canadian Forces combined both ambitions. Over a 24-year career, he treated the injured during Desert Storm in 1991, the aftermath of the Rwanda genocide in 1994, and at the Role 3 hospital in Kandahar, Afghanistan in 2009-2010. However, in the process of caring for the wounded, he became one of the wounded himself. His experiences created a long and arduous struggle with Post Traumatic Stress Disorder and depression, but they eventually led him to a developing understanding of how to treat the psychological wounds of war. He has written a book about his experiences, as yet unpublished and, in this article for FrontLine, LCol Linford looks back at his experience and forward to how it can help others. Read on.


Cpl Linford in Afghanistan

I felt at the top of my game, both physically and professionally, as I began my 1994 deployment in Rwanda as a Nursing Officer. I already had the deployment to the first Gulf War under my belt, so I was feeling more confident than most of my peers who had deployed with me. It didn’t take long to get into the full swing of Humanitarian operations at our tiny field hospital at Mareru Rwanda, just 20 kilometres east of Goma.

In Africa, it can truly be said that “If you build it, they will come!” The daily line-ups of Refugees were significant, offering considerable challenges as the full gamut of illnesses were presented to us.

It was the daily death of children, however, that really took the wind from our sails! None of us had ever dealt with that kind of situation previously, and to complicate matters, the parents of the dying children seemed detached from the situation, seemingly un-phased by the death of their child; perhaps they were in shock! We often received children at the front gate who had been handed over by a parent who could not care for the child, or they were delivered by locals who had found them.

The daily grind included managing significant amputation wounds from machete attacks, some small arms fire wounds, as well as a myriad of diseases – all looking like the photos in one of my Nursing School text books! We had never before seen such diseases, including full-blown HIV and AIDS.


Afghanistan

We worked two eight-hour shifts a day, with eight hours off in between. During that time we ate, slept and got ready for the next shift. This went on for 90 days; the schedule truly challenged us and brought me to the edge of my professional and personal competence. The fatigue, poor eating and sleep patterns, plus the exposure to incredible trauma, disease and death over the short time period broke me down to the point where I began to consider that I may require redeployment. Fortunately the mission ended at the 100-day mark, and we made our way back to Canada. I felt exhausted but good about what we had accomplished; we treated 26,000 patients during that deployment, and saved many lives. I returned to Petawawa and began my family life again, thinking that was the end of it.

Ten years later I was in real trouble as my world closed in on me! I felt as though I was unraveling at home and at work and I didn’t know why. I could no longer manage anything at work and struggled at home with outbursts of anger. I wasn’t able to sleep due to nightmares, and I was consumed by traumatic memories of Rwanda. I met with the Base Surgeon at CFB Borden Ontario and received psychiatric care for one year, during which I was diagnosed with PTSD and depression. Therapy and medication for depression and sleep really got my brain “glued” back together again, and eventually I returned to full duty. I was pleased with my progress and looked forward to further success in Canada’s ­military.


Rwanda

In 2009 I was the Commanding Officer of 1 Field Ambulance in Edmonton and was responsible to provide highly trained medical practitioners in support of combat operations in Afghanistan. I was selected to deploy as the Deputy Commanding Officer of the Combat Hospital in Kandahar; which was a dream come true! During this 7-month deployment I was exposed to daily trauma and death of young NATO troops including our own Canadian men and women. We also took in local Afghan casualties as well as their military and police forces. The injuries from Improvised Explosive Devices (IED’s) were devastating as they killed and tore limbs from bodies leaving only torsos and the broken hearts of their loved ones. I hadn’t previously experienced the death of our own troops during deployments and this took a significant toll on me! The frequency of these injuries and their incredible impact on the casualties also wore me down. I started to consider the price our troops were paying was far too high. My sleep medication failed and I began to slip back into a PTSD state. I knew I would become very ill again but I had to make it to the end of the tour; going home early was not an option. After seven months in Kandahar I came home to Edmonton and was quickly posted to Victoria to be the commanding officer of the medical clinic in support of the Navy. I was already struggling to even get out of bed in the morning and knew the road back to health was going to be ugly, and in fact I even doubted it was possible.

My formal therapy spread over a one and a half year period, and once again included anti-depressants and sleep medication. My clinical team was excellent and challenged me to do the work required to get well again. I found the motivation, somehow, and slowly made my way through the many setbacks and disappointments. I contemplated suicide often as I struggled to find a way to make the sorrowful pain in my chest just go away. I felt as though I had lost my identity as a person and an officer, and felt my soul’s absence every day. This injury impressed me frequently!

Since my first deployment in 1991 I have seen new understanding of invisible injuries from military Healthcare Professionals, and the resources to assist those suffering have grown considerably. Within the combat arms world, the experiences with mental health issues have had a huge impact – many long serving, solid, military professionals have suffered – forcing an early end to their careers. PTSD knows no boundaries; it has impacted all ranks, from the Private to the General, and if not treated early destroys them and their loved ones.

Not that long ago, the stigma of mental health issues prevented many from coming forward and asking for assistance, silently suffering with PTSD and depression. Over the years, education and the development of resources have improved, both within and outside the CF, and are now available for the asking. But some do not even realize the severity of what is happening or that can they can get better with help. The stigma still exists at some levels, but the recent CF Mental Health Symposium in Ottawa (late October 2012) was attended by several of the highest ranked military officers and senior non-commissioned members – signalling a much greater understanding and respect for this insidious injury across the CF.


Rwanda

One of the most devastating effects of this injury is the overwhelming feeling that you are alone. In a military construct, all personnel are forged out of individual civilians and made into a team. They take an “I” and make them a “we”. This is both magical and required when forming a warrior spirit for when the team is placed under the incredible stresses of war; they will support each other to the end. However, PTSD forces a withdrawal from the “we” and moves the injured person back into an “I” situation. This is done for good reason in that the injured is no longer capable of functioning in that plural environment and could degrade its capability to function.

Being made into an individual again to stabilize with therapy and medication is important and really allowed me to get back to a state of functionality. I then began to communicate with others who were similarly afflicted, and began to talk with them on a “peer” basis. Resources within the CF for providing this exposure are OSSIS, MFRC and Soldier On. Outside the CF there is Outward Bound Veterans Program, the Veterans Transition Program, and Project Healing Waters, to name only a few. These organizations allow CF personnel with operational stress injuries (OSI) to get together without judgement and relate deployment stories or other difficult military/domestic experiences. This community environment is powerful in putting those injured at ease, and encourages them to be honest and embrace their vulnerabilities.

 
Command Team in Kandahar (from left): U.S. Navy Captain Darin Via; LCol Chris Linford; and U.S. Navy Command Master Chief Rick Anderson.

I attended the Outward Bound Veterans Program near Lake Louise Alberta on a back country skiing trip where I experienced a “we” situation again. I discovered for the first time that I truly was not alone with my injury. This was a powerful message and gave me hope that I could improve and potentially learn to give strength to others. I went on to participate in Soldier On activities involving both veterans with physical as well as stress injuries. I believed in this so much I offered to work directly for Soldier On concurrent to my therapy to strengthen my healing and find new resources to specifically assist those with OSI’s. I eventually discovered the University of British Columbia’s Veterans Transition Program and attended a 10-day residential program spread out over three months. This was the “icing on the cake” – meeting facilitators who knew exactly what our CF veterans needed in order to “drop the baggage” from military deployments that had prevented them from living healthy and happy lives! I have spoken publicly on several occasions, requesting audiences to go forth and speak to friends and family members who may be suffering but refusing to seek help. It is imperative to come forward sooner rather than later, as years of suffering can make the road back to health difficult. It is never too late however, so even a World War II veteran can and should be helped. There is no time to waste, and it is the community of Canada that must step up and demand that our veterans be taken care of. These are the men and women who fought Canada’s wars and sacrificed so much during the brutality of war. Soldiers are sometimes forced to take lives, and they see friends killed or injured. These veterans have deep injuries, and the best way to rid their tortured minds is for the community to accept them back with open arms and insist they receive the care they need to go on to live healthy productive lives. Anything short of that is criminal.

(See also: http://cnews.canoe.ca/CNEWS/Canada/2010/04/21/13661491-qmi.html)

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LCol Chris Linford is now a frequent speaker on the subject of post traumatic stress and other forms of mental illness.

© FrontLine Defence 2013

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