Sometimes, Lieutenant-Commander Peter Collins has to be what he calls a “chaplain wrangler,” at the acute-care hospital the Canadian Forces run for NATO in southern Afghanistan.
When alliance soldiers suffer mass casualties, Lt.-Cmdr. Collins helps direct which padres go to offer spiritual help and where it is they go.
The 56-year-old reservist is also this huge base’s unofficial rabbi, gathering Jewish soldiers serving with many different armies for religious events in conditions far different from their home countries.
Lt.-Cmdr. Collins’s additional duties here include assisting other physicians in the trauma bays and on normal rounds, as well as attending morbidity and mortality rounds.
But his real job is as the psychiatrist for the more than 21,000 International Security and Assistance Force troops serving in Sector South, which is the epicentre of the war against the Taliban and al-Qaeda. The only other military psychiatrist in the region works directly for the U. S. marines hundreds of kilometres to the west in Helmand province.
“I see patients for major depression, anxiety disorders, panic disorders, insomnia, cumulative stress, operational stress, anorexia and bulimia,” Lt.-Cmdr. Collins said, counting off the afflictions matter-of-factly on his fingers.
Most of Lt.-Cmdr. Collins’s psychiatric patients are Americans, which is not surprising, as so many of the soldiers now in Afghanistan are from the United States. But Lt.-Cmdr. Collins has also seen Bulgarian, Slovenian, Dutch, Australian, British and, of course, Canadian soldiers, as well as civilian contractors and Afghan civilians and detainees with psychiatric issues.
“Frankly, most of the patients that I see would likely have these difficulties whether they were here or not,” he said in an interview conducted in his spartan, plywood office only a few seconds away from where the hospital’s surgeries take place.
“Some of the soldiers have witnessed terrible things here, but are able to walk away unscathed. Others have problems that if not addressed, may develop into something later on. The goal is to treat them here so they don’t develop PTSD (post-traumatic stress disorder) at home.”
Lt.-Cmdr. Collins is assisted by two nurses from Canada and one from Britain as well as a Canadian social worker. These soldiers and sailors go out regularly to forward operating bases from which the ground war is largely being fought.
Like the neurosurgeon and the radiologist who work at what is called the Role 3 hospital, Lt.-Cmdr. Collins is not allowed to leave the base because there is no one to replace him. So his mental-health staff make house calls, while he is available for telephone consultations.
“It is very important that we have people going to the [forward-operating bases] because the soldiers
there sometimes come to them with issues,” he said. “They can put out fires or direct people to see me here.”
Practising general psychiatry in Afghanistan has been “a great breath of fresh air” for Lt.-Cmdr. Collins, who has handled some of the most notorious cases in Canadian criminal history as a forensic psychiatrist for the Ontario Provincial Police and other police forces. He works for Toronto’s Centre for Addiction and Mental Health, is an associate professor on the medical faculty of the University of Toronto and consults with law enforcement agencies such as the FBI, New Scotland Yard and Interpol on serial killers, sexual homicides, sex crimes against children, child pornography and child abductions.
The only problem here is that there is work for more than one psychiatrist,” Lt.-Cmdr. Collins said, adding that he had worked every day since arriving three months ago.
“I have ended up seeing cases that [have] been mentally and intellectually challenging. For example, there have been psychological presentations that have turned out to be neurological.”
The most hectic times have been when a lot of casualties arrive from the battlefield at the same time by helicopter.
“I assist those who need to talk to someone, whether it is one of the casualties or a member of the staff, and do assessments for traumatic brain injuries,” he said of the busiest days. “The way this war is fought, there are a lot of concussion injuries.”
Practising medicine in a war zone is obviously not for everyone. However Lt.-Cmdr. Collins said he would promote serving in Afghanistan back in Canada, which has a critical shortage of military doctors, and especially of such specialists as psychiatrists.
“I think that it is a fascinating way for any medical specialist to expand a career or to make a career because you see very interesting things in a war zone, deal with interesting conditions and meet unique people.”
He joined the Yukon Regiment about 30 years ago and has served on and off as a reservist ever since.
“Being here has made me a better psychiatrist, while helping the men and women of the Canadian Forces. My only regret is that I did not come to Afghanistan earlier.”
With a supportive wife and two children at home, Lt.-Cmdr. Collins hopes to return every year to Kandahar for three months until he is obliged to retire from the Forces at the age of 60 in 2013. If this date cannot be pushed back, he said with a conspiratorial look in his eye, he already has an offer to become a psychiatrist in the Australian Forces, which allows soldiers to serve until they are 65