Crew Health

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Crew Health

• ICMA
• Bremerhaven

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Crew Health

• Pre-employment Medical Examination
• Vaccination and Prevention
• Medical Training
• Medical Chest / Equipment
• Tele-medical Assistance
• Case management

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Crew Health

• Pre-employment Medical Examination
• Flag State / PI Club / Company
• Evidence Based Medical Examination
• Equity / HIV AIDS / DA
• Individual assessment

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PEME

• Shortcomings
• Lack of international recognition
• Limitations in freedom of movement
• Different criteria in different countries
• Growth of discriminatory systems
• Failure to look for harm to health from work at
  sea
• Lack of concern for long term health effects

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PEME

• Leading to
• Discrimination
• Risks (colleagues, safety, ship)
• Claims
• Avoidable ill-health

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Crew Health

• Vaccination and Prevention
• Vaccination policies
• Obligatory vaccines YF
• National schemes / basic vaccinations DTP / Hep
  AB / Typhoid / Meningitis / Influenza / Jap.
  Encephalitis
• Malaria policies
• Prophylaxis / Treatment / Onboard testing

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Yellow Fever

• Aedes aegypti
• /-200.000 cases/year
• 90 Africa
• South-America sporadic silvanic cases

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Yellow Fever 07
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Yellow Fever 07
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Important Vaccines
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Crew Health

• Medical Training
• Model Courses / STCW
• Practical Training / Hospital Emergency Dept
• Refresher courses
• Onboard Training / Evacuation

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Crew Health

• Medical Chest / Equipment
• WHO / EU / National
• AED / Training
• Narcotics
• Medical Guide
• Medical Logbooks

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Crew Health

• Tele-medical Assistance
• National RMAC / TMAS / SAR
• Private companies / Evacuation / Repatriation
• Insurance / Referral Networks
• Knowledge / Training hands, eyes, ears...

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Crew Health

• Case management
• Cost control
• Claims
• Revalidation
• Insurance

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Does the maritime industry

• Evaluate effectiveness of PEME?
• Customise PEME?
• Is the PEME system equitable?
• Have a vaccination and malaria policy?
• Evaluate and update the malaria and vaccination
  policy?
• Train the crews on prevention and protection?
• Know the level of training of the crew?
• Organise medical refresher courses?
• Instruct crew on the use of (new) equipment,
  techniques?
• Have a company medical chest?
• Have an effective medicine inventarisation /
  replacement system?
• Analyse the medical logbooks
• Evaluate the quality of the tele medical advice?
• Cost effectiveness of the tele medical advice?
• Compare commercial services / free services?
• Analyse specific health needs?
• Control medical costs?
• Follow up cases after repatriation?
• Have a claims policy?

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MEDIPORT
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Hospitalised population
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ICD 9 codes for hospitalised seafarers
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• URINARY STONES ARE THE FIRST REASON FOR
  HOSPITALISATION
• ENGINE (OFFICERS) HAVE MORE STONES
• INSUFFICIENT FLUID INTAKE?
• IS IT BECAUSE ENGINEERS WORK IN A HOT
  ENVIRONMENT?
• IS SCREENING FOR STONES POSSIBLE?
• IS SCREENING FOR STONES CORRECT?

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• YOUNG SEAFARERS HAVE MORE ACCIDENTS
• ADAPTATION TO LIFE AND WORK ON BOARD?
• RISKS?
• FRACTURES OF HANDS AND FEET ARE MOST FREQUENT
  ACCIDENTS
• FINGERS AND FEET PROTECTION?
• MANY ACCIDENTS HAPPEN IN PORT
• CARGO HANDLING?
• REPAIRS?

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• CATERING STAFF HAS LESS ACCIDENTS BUT MORE
  DIABETES AND CARDIOVASCULAR PROBLEMS
• SELECTION LESS STRICT?
• LIFESTYLE?
• ABOVE 50 YRS CARDIOVASCULAR RISK GOES UP

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• ANAL AND RECTAL ABSCESSES, FISTULA AND FISSURA
  ARE FREQUENT
• ASIANS
• SCREENING?
• FOOD?

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• MALARIA IS THE FIRST INFECTION IN
  HOSPITALISATION
• MALARIA KILLS!
• PLASMODIUM FALCIPARUM IS DOMINANT
• ASIAN AND AFRICAN SEAFARERS HAVE MORE MALARIA
• PROPHYLAXIS?
• KNOWLEDGE?
• TRADE AREA?

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• Seafarers cancer index is 1.2 1.3
• Seafarers have more serious accidents compared to
  land based workers.
• R. Nilsson
• H. Hansen

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• Seafarers cancer index is 1.2 1.3 Higher
  cancer index on lifestyle related cancers!
• Seafarers have more serious accidents compared to
  land based workers. But they also have more
  accidents before and after being seafarer.Risk
  behaviour!
• R. Nilsson
• H. Hansen

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• Stimulate seafarers to take responsibility for
  their health in the living and working
  environment onboard.
• Healthier, fitter, safer

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What Are We ?

• A Charity registered in the UK
• An international umbrella organisation dedicated
  to the implementation of the ILO Instruments on
  Seafarers Welfare.
• Convention 163
• Recommendation 173

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Ten Topics

1. Food Safety
2. Fit Onboard
3. Safe travel
4. Healthy food
5. Malaria
6. Overweight
7. HIV AIDS STD
8. Mental Care
9. Dental Care
10. Skin Care

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How?
Multi-route approach

• Leaflets
• Guidelines
• Trailers
• Comic books
• Stickers
• Gadgets
• Course material

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How?
Contact points

• Pre-employment examination clinics
• Onboard policy and quality management, peers
• Transit points seafarers centers
• Ports ship visitors
• Training courses
• Home create a supportive environment
• Website
• Sports events ISS

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Psychological risk factors

• The risk of psychological problems is increased
  for seafarers because of
• Overwork, c.q. labour intensification
• Fatigue
• Stress
• Dangers of being at sea
• The fear for criminalisation
• More inspections
• Greater commercial pressure from ashore
• Fewer opportunities to de-stress, e.g. going
  ashore, or leisure activities onboard
• Restrictions to shore leave by authorities
• Multinational crews with reduced ability to
  communicate between each other in a meaningful
  way

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Mental problems

• Performance may be reduced
• Risk to the individual
• Risk to colleagues
• Risk to vessel and cargo
• Need for help and support puts strain on the rest
  of the crew
• Anti social behaviour causes tensions
• Feelings of persecution or hopelessness can make
  any form of interpersonal contact difficult

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Stress

• Job stress can be defined as the harmful physical
  and emotional responses that occur when the
  requirements of the job do not match the
  capabilities, resources, or needs of the worker.
  Job stress can lead to poor health and even
  injury.

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Harassment and bullying

• a form of discrimination when unwanted conduct
  takes place which has the purpose or effect of
  violating the dignity of a person and of creating
  an intimidating, hostile, degrading, humiliating
  or offensive environment
• Harassment includes any act which creates
  feelings of unease, humiliation, embarrassment,
  intimidation or discomfort to the person on the
  receiving end.
• Bullying includes any negative or hostile
  behaviour that makes a recipient feel fearful or
  intimidated.

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Mental care onboard

• Demands of work may play a role in initiating or
  sustaining mental problems
•  
• More severe psychotic conditions like
  schizophrenia pose a safety risk and can only be
  allowed on a ship after full recovery and no
  relapses over a lengthy time
•  
• Some of the treatments used can have adverse
  effect on performance at work. If medication has
  a warning against driving or working with moving
  machinery fitness for safety critical tasks may
  have to be reviewed
•  
• With multinational crews and casual employment,
  sensitivity to mental problems is not always easy
  in those with diverse backgrounds but it remains
  at the heart of good management and efficient
  ship operations as well as being common humanity.

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Mental care onboard

• Having a useful job as member of a mutually
  supportive team can be one of the best
  protections against mental health problems.
• The mental state is part of the human condition.
  Disease and medical involvement are only relevant
  at the extremes. Many of the remedies for minor
  problems are in the hands colleagues and friends
  who create the conditions under which we work and
  live. We can help others in the same way.
• Variety, as the opposite to monotony is a key
  element and so is the promotion of sociability
  rather than individualism

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XI. THOU SHALT KEEP THY MIND FIT