Report from second International Maritime Health Seminar – Panama City

Sep 20, 2016

by the Rev. David M. Rider, President & Executive Director

On September 15-16, 2016, Douglas B. Stevenson, Esq., the Director of the Seamen’s Church Institute’s (SCI) Center for Seafarers’ Rights, and I made plenary presentations on SCI’s seafarer health initiatives at an International Maritime Health Seminar in Panama City, supported by the Panama Maritime Authority.

The meeting convened maritime medicine professionals—clinicians, public health officials, and academics—to consider the new Maritime Labour Convention, 2006 (MLC, 2006) and its work to strengthen the impact of health and security at sea. Most participants were occupational health doctors charged with completing medical certificates required for seafarers to work aboard ship. Others included public health officials charged with inspecting sanitation conditions aboard ship or dealing with risks for global pandemics. A large Panama contingent joined participants from South America, Asia, Europe, and the Middle East.

Doug Stevenson explored the history of seafarer medical regulation dating back thousands of years—with extant records from the 11th century—to protect seafarers’ key role in securing the transportation of goods around the world. Doug reminded us that seafarers enjoyed medical protection long before land-based workers: to this day, ship owners are required to render medical treatment to members of their crew for the duration of the seafarer’s service to the vessel to the point of maximum cure, whether their ailment is the result of an occupational incident or not.

The seminar focused on MLC, 2006’s impact, and Doug praised the Convention as the greatest achievement in maritime law in human history—no bias here, in spite of Doug’s active leadership in its gestation over many years. Doug drew out the differences between mandatory standards and advisory guidelines. He highlighted practical aspects of medical certificates, valid for two years, which many seminar attendees complete on a daily basis to certify fitness for duty in ways that will not harm the seafarer or those with whom he/she works. Other MLC, 2006 provisions address medical concerns about hours of work and fatigue, medical facilities and treatment aboard ship, access to medical care ashore, and rapidly emerging telemedicine at sea.

I shared initial research insights from SCI’s collaboration with Yale School of Medicine and its highly regarded occupational health specialists. With SCI supporting Yale colleagues’ access to seafarers—for research interviews, not treatment—we are learning about medical/ethical dilemmas from the seafarer’s perspective. Our colleagues at Yale seek to identify unique working conditions, exposures and stressors that accompany life at sea. Seafarers work with multi-month contracts on a 24/7 basis aboard ship; isolation from family; sporadic shore leave and respite from workmates; limited control over diet and exercise; and no presumption of medical privacy when illness or injury strikes at sea. Once medical certificates are issued before deployment, continuity of care at sea for identified medical conditions becomes rare—out of sight, out of mind.

My one hundred seminar colleagues identified with dilemmas like balancing the clinical need of a seafarer requesting a doctor with the Master’s duty to get the ship underway. The multi-cultural reality of life at sea can lead to conflicts surrounding diet, the risk of ethnic stereotyping, harassment, or failure to appreciate how human resilience and illness can be culturally conditioned. Seminar colleagues shared concern that family support and input to medical care—often taken for granted in community medicine—remains largely absent at sea. We ended on a positive note, however, considering health promotion initiatives like smart watches to monitor pulse rates or pedometers to document exercise. One physician advocates for digital medical records on a confidential thumb drive that the seafarer controls until medical care is needed.

The International Maritime Health Association works hard to promote maritime medicine research—scanty to date—commending SCI and Yale for its unique partnership to benefit seafarers. Occupational health research improves seafarers’ lives by reducing injury and illness while improving the standards of medical certificates required to work aboard ship. SCI encourages flag states and Protection & Indemnity Clubs (which pay medical claims) to collect and analyze data on injury and illness to identify trends that strengthen the quality of seafarer life while reducing costs for owners.

At SCI’s seafarers’ center in Port Newark, we collaborate with nursing students from nearby Rutgers University as they conduct voluntary health screenings and health education outreach to visiting seafarers. Recently, SCI installed a HealthCENTER Kiosk that seafarers can use privately to obtain blood pressure checks, BMI calculations, and other health screens. SCI’s fitness center, available to seafarers free of charge, provides another component of our seafarer wellness program.

Taking a preconference fieldtrip, our group visited the Agua Clara Visitor Center at the Atlantic side of the new third lane of the Panama Canal that opened June 26, 2016, arguably transforming global commerce in major ways. When the Port Authority of NY & NJ completes rebuilding the Bayonne Bridge, SCI’s ship visitors and hospitality center will serve the world’s largest vessels and their seafarers that now transit through the Panama Canal.