Canadians who fell ill in Cuba have brain-injury symptoms, doctor says

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OTTAWA—Canadian diplomats suffering health woes after time in Cuba have symptoms consistent with a brain injury, according to an Ottawa doctor who has assessed them, turning aside speculation that the problems are psychosomatic.

“Do I believe that these people have presentations consistent with someone who has had a concussion or brain injury? Yes,” said Dr. Shawn Marshall, medical director for acquired brain injury rehabilitation at the Ottawa Hospital Rehabilitation Centre.

Canadians and American diplomats and dependants began reporting mysterious health problems in late 2016 and into 2017, setting off an international investigation.

Marshall started seeing the Canadians in mid-2017 at the request of Global Affairs. Marshall, a specialist in brain injuries, said he assessed the patients using a protocol similar to one used to screen people who have suffered a concussion.

“Most of them present with difficulties with physical symptoms,” Marshall told the Star in an interview.

Marshall said that at the outset, there was little known about the potential cause of the symptoms. While the symptoms were similar to those of a concussion, none of these patients had suffered a blunt force blow that might explain it.

But Marshall said there can be a number of causes for such injuries in addition to an external force.

“But those forces or injury to the brain can be from physical forces that aren’t necessarily traumatic strikes or blows. For example, we know that a blast … can cause brain injury,” Marshall said.

“There are different forms of energy that can cause it. Infection can definitely cause it … I don’t have any evidence of that at all or any suggestion of that. But I’m just saying that there are multiple different causes.”

Even now after his assessments, Marshall said the cause remains a puzzle. “The only connection I have is that these patients were associated with a government posting in Havana.”

Global Affairs officials also say that a multi-agency investigation has not yet been able to pinpoint a cause. An examination of potential environmental factors at Havana properties occupied by the Canadians ruled out air or water as the cause.

Some of the diplomats and family members associated the onset of the symptoms with strange noises heard at the time, like grinding noises or the sound of warping metal. However experts aren’t convinced there is a link.

In the absence of clear causes, there’s been speculation the ailment might be mass hysteria or conversion disorder, where a person suffers symptoms that can’t be explained by a physical cause, sometimes triggered by stress. It was a theory most recently advanced in a Vanity Fair feature, titled, “The Real Story Behind the Havana Embassy Mystery.”

But Marshall disagrees. He has also treated patients with such disorders and that’s not what he saw in the Canadians.

“I’m less inclined to believe that. Having seen these patients, that was not my overall impression,” he said.

“I have actually seen a number of patients with conversion disorder, factitious disorder over the years. These patients I’m seeing don’t seem to be like that,” he said.

For starters, Marshall said that some of the Canadians experienced symptoms before they became aware of a broader problem, discounting the possibility that they were influenced by reports of illness among their colleagues.

“Before they even knew something was going on, they were describing some pretty remarkable symptoms that would be hard to explain as it being due to other causes, like social influence or fear, anxiety,” Marshall said.

The union representing foreign service workers has also pushed back against suggestions that the mass hysteria is the cause.

The Professional Association of Foreign Service Officers (PAFSO) wrote to Prime Minister Justin Trudeau and Foreign Affairs Minister Chrystia Freeland a year ago to flag “serious concern” about the government’s handling of the case.

In that letter, obtained by the Star, the association accused Global Affairs of downplaying the impact of the incidents on Canadian personnel, “even going so far as to question whether or not the issues our members were psychosomatic in nature.

“PAFSO consider that the collective hysteria hypothesis is not rigorous and impossible,” stated the letter, dated Jan. 22, 2018.

It said that “repeated suggestions that health issues are imagined or the ‘symptoms of extreme stress’” were only adding to the duress felt by diplomats and family members already struggling with health ailments.

In a statement to the Star earlier this month, Global Affairs said the cause of the health woes was still not known.

“We are investigating any and all possible causes, and we will continue to take the measures necessary to protect our diplomats and their families,” the department said.

“Canada has an evidence-based approach to addressing this situation, and our response is guided by the advice of medical experts and treating physicians. At the current time, the cause of these health problems remains unknown.”

The U.S. State Department is sticking by its claim that its personnel were deliberately targeted. To date, 26 Americans have been identified with “otherwise-unexplained medically confirmed symptoms and clinical findings” and the department isn’t ruling out that there may be more cases yet.

“Given the seeming exclusive focus on U.S. government personnel and their families in Havana, as well as the scope and duration of incidents, the department has categorized the events in Havana as attacks,” the department said in an email to the Star. “The investigation is ongoing to determine the source and cause of the health attacks.”

Marshall said that the Canadians affected by the health problems are improving, thanks to therapy and in some cases medication but cautioned that recovery from brain injuries can take time.

“Life is complicated and other factors affect your function. So if you ask too much of your brain, you may not recover as expected or if you’re asking it to function at high level, you can have other complications, like your mood can change if you can’t do what you need to do and symptoms can persist,” he said.

Meanwhile, Global Affairs refuses to comment on the fate of Canada’s embassy in Havana after a high-level visit by officials last month.

In December, the department revealed that medical testing had confirmed yet another diplomat who had served in Cuba was suffering health problems. That brought to 13 the number of confirmed cases, including dependants.

The discovery of another case prompted the federal government to send a high-level team to Havana to evaluate diplomatic operations in the country to ensure the protection of embassy staff.

But since that visit the department has been tight-lipped on the outcome of that visit or what, if any, changes were made to Canada’s diplomatic footprint in Cuba, despite repeated questions from the Star.

Bruce Campion-Smith is an Ottawa-based reporter covering national politics. Follow him on Twitter: @yowflier

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Inuk woman’s tell-tale botulism symptoms would have been taken seriously if she’d been white, says her widower

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A man from Inukjuak said the failure of a nurse stationed in the northern Quebec community to recognize the signs of botulism cost his wife her life, and it was only after she died that clinic staff took his adult daughter’s symptoms seriously.

Jobie Kasudluak and his daughter Janice travelled to Kuujjuarapik this week to share their family’s story with Commissioner Jacques Viens, who is leading an inquiry looking into how Indigenous people are treated by Quebec government services.

It was the first time the retired judge and his entourage travelled to Quebec’s Inuit territory of Nunavik since the inquiry began two years ago.

Kasudluak testified that his wife, 54-year-old Eva Kullulak-Ookpik, had been telling the nurse for three days that there was something seriously wrong with her.

He said when he brought her to the clinic on Friday, July 7, 2017, she was struggling to breathe, she was dizzy and vomiting, and she could hardly keep her eyes open.

« The nurse on call was a young, new nurse, » he said. « She didn’t seem to know what she was doing. »

He said the nurse had to be persuaded to do blood tests, and once they were done, she sent the couple home.

« She told us there was nothing they could do, » he said. « We’d have to wait for the results until Monday. »

Begged to stay at clinic

Kasudluak said his wife begged to stay at the clinic overnight, where she’d have access to oxygen to ease her laboured breathing.

« The nurse said, ‘Emergency room is for emergencies only. If somebody comes in, you’d be in the way, » Kasudluak told the commission. He pointed out there were two other rooms at the clinic, with two beds in each of them, but still, « they refused her. »

By then it was well after midnight on Saturday, July 8. The couple returned home.

Kasudluak thought his wife was asleep when he tried to nudge her awake the next morning.

« Hi dear, are you OK? » he asked her.

But Eva Kullulak-Ookpik had died overnight, of botulism poisoning, from having eaten an Inuit delicacy of dried beluga a few days before.

[Had she been white,] she would have been on a medevac in an hour.– Jobie Kasudluak, on the medical care his wife Eva Kullulak-Ookpik received

Health Canada describes botulism as a rare but serious illness that should be treated as a medical emergency. It says anyone with the signs, symptoms or history of botulism should be hospitalized immediately.

Outbreaks of foodborne botulism from traditional foods have occurred often enough in the past that posters describing the symptoms are on public display throughout Nunavik.

Retired Superior Court Justice Jacques Viens and his entourage travelled to Kuujjuarapik in Nunavik to hear about Inuit experiences’ with Quebec government services. (Catou MacKinnon/CBC)

Daughter showing same symptoms

Kasudluak’s daughter, Janice, didn’t know her mother was sick when she and her two-year-old daughter ate some of the same dried beluga.

Janice, too, had been calling the Inukjuak health clinic and describing her symptoms: her vomit was yellow, she was having trouble breathing, and her vision was blurred — all signs of botulism.

She said she called three times before she was eventually counselled on Friday to come to the clinic the next day.

On Saturday, she woke up to a phone call from the health clinic telling her that her mother had died and asking her to come in.

Speaking in Inuktitut, Janie Kasudluak told the inquiry that by the time she got that phone call, she was so sick, the caller’s news didn’t even register.

‘I lost my best friend’

Janice Kasudluak was flown to Montreal, and her father went with her.

« I lost my best friend, and I was about to lose my daughter, » the father of nine and grandfather of 21 told the commission, through tears.

Jobie Kasudluak was at his daughter’s side in hospital when she regained consciousness, two days later. By then, Janice’s two-year-old daughter was also sick. (The latency period for botulism can be longer in children.)

She was flown to the nearest hospital, in the Nunavik community of Puvirnituq (often referred to as POV), about 180 kilometres away, but then she was sent home before she had fully recovered.

« Janice’s doctor from Montreal General [Hospital] actually had to request that this little girl has to be medevaced [back] to POV and kept there until she’s better, » Jobie Kasudluak testified.

Coroner never contacted family

The coroner’s office, whose mandate is to find the cause of death and determine if it could have been prevented, issued a report on Eva Kullulak-Ookpik’s death in April 2018.

Coroner Steeve Poisson wrote that when she consulted the health clinic the two days before she died, food poisoning had been suspected. Her lab results, as well as her daughter and granddaughters’ results, confirmed the presence of Clostridium Botulinum. Poisson confirmed the dried beluga had been the source of the bacterial contamination.

He concluded Kullulak-Ookpik had died « a natural death, » and he made no recommendations.

The coroner’s office never contacted anyone in the Kasudluak family to share its findings.

Asked by the Viens commission’s lawyer, Edith-Farah Elassal, whether he believes he and his wife would have been treated differently had they been white, Kasudluak didn’t hesitate.

« She would have been on a medevac in an hour, » he said, matter of factly. « I’ve seen it with teachers and other white people in town — getting medevaced and coming back on a scheduled flight the next day. »

Kasudluak said before his wife’s sudden illness, he’d seen very ill Inuit people turned away from the clinic, only to die a day or two later, and he’s seen it happen since.

« There’s people still being sent home when they should have been sent to a hospital for observation, » he said.

« I just hope that nobody ever goes through what we went through. »

The Viens commission into the treatment of Indigenous people in Quebec held five days of hearings in Kuujjuarapik this month. (Catou MacKinnon/CBC)

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