Keeping Watch on Seafarer Health
(Article originally published in July/Aug 2015 edition.)
There are times when a seafarer might be evasive about the truth. Faced with the prospect of rejection, they may not admit to past medical conditions during their preemployment medical check. There’s a chance they will get away with it because in many countries, including the Philippines, there is no central database that documents medical history.
But seafarers are in demand, particularly those with experience, those in senior roles and those who, having reached their forties and fifties, are more likely to have health issues. Medical care companies are therefore devising solutions that benefit both seafarers worried about supporting their families and ship managers worried about the safety of their operations.
Dr. Jae Salvan, First Response Supervisor and International Case Manager at global health services’ provider Future Care, cites the recent case of a 49-year-old seafarer who suffered a cardiovascular incident that required a triple bypass. It’s part of a wider trend he has seen over the last year of rising occurrences of cardiovascular incidents at sea.
While Future Care has its own tailored preemployment medical examination, Salvan says this is only part of the solution. The company believes a growing number of conditions can be managed on board, especially if they are planned for in advance. For example, Future Care’s medical team can manage some chronic illnesses like hypertension and low-level diabetes through both telemedicine and its “Caring for the Crew” program.
Focus on Primary Care
Physicians are on standby around the clock to identify high-risk or potentially life-threatening conditions and give professional recommendations. However, these situations count for less than ten percent of medical issues faced by seafarers, says Christina DeSimone, CEO of Future Care.
“Our Caring for the Crew program changes the lives of seafarers by attending to normal, everyday primary care medical issues that otherwise go unattended,” she explains. “The lack of focus on primary health care at sea can lead to a decline in seafarers’ health and in their ability to continue working at sea.”
The program includes managing issues such as mild infections, rashes and even apparently serious conditions like chest pain. Using telemedicine, the Future Care medical team is able to differentiate between cardiovascular concerns and conditions – such as less-serious gastritis – that may have similar symptoms.
Future Care also works proactively with ship managers on issues like maintaining a healthy diet for seafarers, particularly during extended voyages. The Maritime Labor Convention (MLC) outlines a range of new health care regulations to enhance seafarer health, says DeSimone, and the Caring for the Crew program meets these requirements.
U.S.-based VIKAND provides medical services to the cruise industry, and the company is expanding its services to shipping and offshore companies through a telemedicine offering that provides a range of seafarer wellness services including the ability to monitor both physical and mental health. VIKAND already has services in place to help seafarers improve their fitness and manage other health risks such as depression. Counseling services are available through mobile devices, and counsellors can alert the ship’s master if issues arise.
Drug and Alcohol Abuse
VIKAND’s monitoring capabilities also include the identification of drug and alcohol abuse. Dr. Bill Heymann, the company’s Medical Director, cites the case of a seafarer currently undergoing rehabilitation for alcohol abuse on shore. The seafarer had relapsed after a successful nine-year career at sea. Random testing revealed the problem before an incident occurred, and VIKAND is working with the seafarer to help him recover and be fit for work again.
“The MLC has a lot of guidelines to benefit the crew, including components that deal with alcohol and drug issues,” says Heymann. “It covers the prevention of illness and the observation of those with a chronic illness that can be controlled so that they are perfectly fit to work. In the past, there was no attention given to this, and ship managers would lose valuable crew members.”
Heymann and his team are working to develop standards for quality oversight, something that is not yet occurring industry-wide. This includes management protocols and covers equipment issues such as the maintenance and calibration of onboard medical equipment and the distribution of drugs and formulary on board.
“The maritime industry is very fragmented,” adds VIKAND President Peter Hult, who sees an opportunity in consolidating medical services to operators across all maritime sectors. “We know our clients spend a lot of time and money when trying to address everything from crew health and wellness to emergency issues. VIKAND aims to be a one-stop shop for medical guidance and services.”
A particular area of focus for VIKAND is communicable disease management, a constantly changing problem that is yet to have a unified, central reference such as the MLC. Currently, VIKAND screens crews and passengers for norovirus, SARS, MERS and Ebola.
“No one would have thought a couple of years ago that Ebola was anything other than a local infection that popped up occasionally in Africa,” Heymann states. “Suddenly it became a widespread concern, and the same now applies to MERS. It started out in Saudi Arabia with some locals who were possibly infected by their camels. Now we’ve had a growing number of serious cases and deaths in South Korea.”
VIKAND monitors public health agencies and local authorities throughout the world. Part of its service is to ensure its medical teams have the latest information on identification and treatment, and this knowledge-sharing is expanding to the First Aid Officer on commercial vessels through telemedicine functionality.
Trauma Treatment and PTSD
Another threat to seafarers that has multiple medical implications is piracy. Incidents are on the rise in Southeast Asia and include a recent one in which a seafarer was shot in the leg. Daren Knight, Founder and Managing Director of security solutions company Knight Associates, acknowledges that such incidents are rare but that the consequences can be serious. His concern is that few ships have suitable medical supplies and few designated medical officers are appropriately trained to deal with the sort of traumatic injuries that can be inflicted by pirates, which include gunshot and blast wounds.
If a crew follows procedures, it would be locked in a safe haven on the ship in the event of a pirate attack and only personnel remaining on the bridge would be exposed to the risk of traumatic injury. To effectively stop a major bleeding wound, Knight says, crew members would have to access the dressings from several first aid kits scattered around the ship. A victim, however, may only have a few minutes before such a wound proves fatal.
Most people who have been exposed to traumatic incidents cope well, but many will experience short-term distress and a minority will develop persistent mental health conditions such as Post-Traumatic Stress Disorder (PTSD), says Professor Neil Greenberg, a psychiatrist at King's College London and Managing Director for March on Stress. “Until recently, however, there has been no specific guidance available on how maritime organizations should help their staff prepare for, and remain resilient after, exposure to traumatic events,” he declares.
Some occupations experience elevated rates of PTSD. For instance, up to 20 percent of war correspondents and firefighters, 10 percent of police officers, and up to 33 percent of military personnel in the U.S. have been found to suffer from PTSD. “While there is less evidence available about the rates of PTSD and other trauma-related mental health conditions in seafarers, studies have found that up to a third of survivors of fatal accidents at sea may suffer from PTSD, and high rates of mental ill health have been found in the survivors of piracy and their families,” Greenberg explains.
Around 70 percent of those who have PTSD don’t seek help for their condition. “This is probably because they either do not recognize that their difficulties are a result of a mental health problem or because they fear what other people will think of them if they do ask for help,” Greenberg says. “Additionally, seafarers who work on contract rather than as employees may fear that if they reveal any psychological difficulties their contract may be terminated.”
PTSD not only causes those affected, as well as their family and work colleagues, to experience a poor quality of life, it is also associated with significant functional impairment. Thus, untreated cases within a maritime organization may substantially increase the risk of accidents.
Human Rights at Sea and March on Stress are preparing a guidance document for maritime organizations that will outline evidence-based approaches found to be helpful in minimizing the risk of seafarers developing PTSD. The document will include information about preparatory training for individuals and managers.
It will also provide information for individuals, colleagues and families after an incident, encouraging seafarers exposed to trauma to initially access social support rather than being referred for counselling. Colleagues of trauma-exposed individuals can support them while watchfully waiting to see if they do require professional assistance.
“There is good evidence that the risk of developing PTSD can be substantially diminished if organizations put in place measures to prevent the development of the condition, detect the early signs of it and manage it actively to prevent its progressing,” says Greenberg. “For those individuals who do develop the condition, there is good evidence about a range of treatments available to help them recover and, in the majority of cases, get on with the rest of their lives.”
The opinions expressed herein are the author's and not necessarily those of The Maritime Executive.