Crew Health

ICMA Bremerhaven

Crew Health

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

Crew Health

• Pre-employment Medical Examination – Flag State / P&I Club / Company – Evidence Based Medical Examination – Equity / HIV AIDS / D&A – Individual assessment

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

PEME

Leading to: – Discrimination – Risks (colleagues, safety, ship) – Claims – Avoidable ill-health…

Crew Health

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

Yellow Fever

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

Yellow Fever ‘07

Yellow Fever ‘07

Important Vaccines

Crew Health

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

Crew Health

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

Crew Health

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

Crew Health

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

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?

FITNESS EXAM.

37% RMA 1% D & A 10%

MEDIPORT

SHIPPING 29% VOB 7%

immediate hospitalisation 5%

duty status

not fit 22%

VACCINATION 16%

fit 73%

Hospitalised population 140 120 100 80 60 40 20 0

20 - 30 30 - 40 40 - 50 50 - 60 > 60

Accident Disease

ICD 9 codes for hospitalised seafarers Endocrine/metabolic diseases 3% Nervous system 2% Mental disorders 2% Accidents 31% Respiratory System 3% Skin 3% Neoplasms 3% Musculoskeletal system 5% Supplem. Class.

5% Ill-defined conditions 7% Infectious diseases 7% Circulatory system 9% Genitourinary system 9% Digestive system 11% Accidents Digestive system Genitourinary system Circulatory system Infectious diseases Ill-defined conditions Supplem. Class.

Musculoskeletal system Neoplasms Skin Respiratory System Endocrine/metabolic diseases Nervous system Mental disorders

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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?

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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?

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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?

• Seafarers’ cancer index is 1.2 – 1.3 * • Seafarers have more serious accidents compared to land based workers. ** 27 * R. Nilsson ** H. Hansen

• 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 28

• 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

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

How?

Multi-route approach

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

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 • …

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

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

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.

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.

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.

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.

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Variety, as the opposite to monotony is a key element and so is the promotion of sociability rather than individualism

XI. THOU SHALT KEEP THY MIND FIT