In the best of times, keeping ship crews mentally and physically healthy is a challenge premised on the inherent nature of and dangers in the job, plus the proximity of ship from ready, shoreside help. Add a global pandemic and the situation becomes untenable. We checked in with a select group of maritime medical care organizations for mitigating COVID-19 maritime medical risk.
Seafarers are an essential workforce to the global economy with as many as 1.5 million working day and night, securing the safe and efficient transportation of more than 90% of the goods that move across the globe.
This fact has never been more apparent than during the recent COVID-19 pandemic, which has shuttered many industries and countries globally, leaving seafarers as the primary conduit to keep commerce flowing.
“COVID-19 is absolutely incomparable and unprecedented in recent human history,” said Natalya Butakova, AP Companies Global Solutions, an international medical assistance company, providing medical assistance services to seafarers and cruise lines. “All previous medical problems, such as epidemics and serious chronic diseases (like AIDs) have always been localized and never interrupted in one way or the other, the life of the entire planet.”
While “maritime” is deemed essential by most every country with waterway access, in many cases the raw materials and finished products carried by ship are welcomed ashore, but the men and women who deliver them, in many cases, are not.
The plight of the seafarer has been brought further into the spotlight during the COVID-19 pandemic. While the seafarer historically has been ‘out of sight, out of mind’ to the general public, when global supply chains are upended, the value of the world commercial fleet and the people who run them starts to crystalize. Yet this importance is not reflected in the treatment of this group, as many ports globally refuse to allow seafarers ashore for crew changes, fearing a possible injection of COVID-19.
The remote character of that working environment defines them as a ‘hard-to-reach’ population group. And, the vulnerability of these seafarers makes their health and well being a concern and a priority in a public health point of view. Nevertheless, their collective well being is an under served aspect of the global supply chain and one which, if left unchecked, could place us all in peril.
COVID-19 … It’s not just a strain on the physical
While much of the focus today is on stopping the spread of COVID-19, some see the mental strain on seafarers as an equally serious situation.
“As an ex-seafarer I have been saddened by the deterioration in the attitude towards, working conditions and treatment of seafarers. I honestly believe the situation has only worsened since I left the sea,” said Frank Coles, CEO, Wallem Group, in a recent article written for MarineLink.com. https://www.marinelink.com/news/opinion-getting-ahead-reality-477040
“Studies suggest one-in-five seafarers have considered self-harm. About 85 seafarers die on the job every month. Of these, around five take their own lives. These are staggering statistics and ones we should be utterly ashamed of,” Coles continued. “Our industry talks incessantly about safety, yet the figures suggest we are failing to deliver because a major part of achieving a safe ship is a crew who are happy, respected and feel supported.”
“Probably the most serious and concerning matter on board in these challenging time is not even COVID-19, but mental health issues arising from the situation,” AP Companies’ Butakova concurs. “The seafarers feel isolated and struggle to get the news from home, therefore they are not sure if their loved ones are safe or were affected by the pandemic. On the other hand, they also have fear on what will happen if they get ill on board, during the time of pandemic, many ports have closed and do not accept COVID infected nonresidents. The majority of medical facilities have restricted capabilities. All these circumstances, of course, create additional anxiety, which adds to usual matters that cause mental health issues on board.”
While the majority of focus and concern rightfully is on COVID-19, Dana Erskine-Pando of Flying Nurses International reminds us that normal health issues found onboard working ships continue. “Just because this pandemic is going on, does not stop the number of injuries and illnesses that are occurring that have nothing to do with COVID-19; these people still need to be able to get off the ships and get home,” said Erskine-Pando. Flying Nurses International has for more than 20 years escorted patients via airplane to domestic and international destinations. With the majority of commercial flights shutdown, and with entire countries shut in, and she said the company has not flown anyone in about a month, and she has 10 patients waiting for transport home. “Depending on where they call home will determine if we can get them there.”
New Problem Demand New Solutions
Believing ‘necessity is the mother of invention’ companies engaged in supplying maritime medical services have been busy creating new solutions to assist seafarers and shipowners in a time of need.
“We have recently introduced new product: Mental Health Solutions – psychological teleconsultations for the seafarers,” said AP Companies’ Butakova. “It is a psychological hotline, that can be used for different kind of short-term and long-term psychological treatments.”
AP companies has also enhanced its capabilities for telemedicine and now we can offer it in 168 languages. “Essentially this is not just a regular telemedicine services,” said Butakova. “AP Companies has brought online it’s global network of the best medical providers around the globe to give seafarers, members of their families and all AP members access to the best medical providers, get access to routine medical care with the doctors they have been visiting all these years in their native language.”
Future Care is an international medical management/cost containment and telemedical service provider exclusively to the maritime industry, serving shipowners and P&I Clubs in fulfilling the medical needs of seafarers, aboard ship and on land. Founded in 1996 by CEO and President Christina DeSimone, today about 50,000 seafarers have, through shipowners, access to Future Care services (a number which includes its joint venture partnership with MedSea).
Future Care offers its services primarily via four dedicated call centers – in Beijing, Manilla, Johannesburg and the U.S. – for commercial shipping, staffed with maritime trained doctors and nurses. According to DeSimone “we have, with Dr. Arthur Diskin, Future Care’s Global Medical Director, devised alternative solutions for our shipowner customers, such as pre-boarding screening and onboard protocols for crew members that may have the COVID symptoms. Future Care developed these programs, which do not fall under our standard suite of services, in anticipation of our clients’ needs. The response has been overwhelmingly positive.”
Future Care developed these protocols, including the pre-board screening questionnaire and review to assist the captain in mitigating the chances of infected crewmembers and others from boarding the ship. As noted by Dr. Diskin“… you can’t take the risk to zero, but you can mitigate.”
Future Care has also addressed onboard response to crewmembers presenting with Covid-19 symptoms for its clients through interactive telephone conferences and initiating quarantine protocols, among other recommended measures. While underway, some of the problems prevalent on land hold true at sea, namely the ability to quickly, accurately test someone with COVID-19 symptoms to determine if they do indeed have the disease, allowing for an accurate course of treatment and return to work. As on land, if a crewmember shows symptoms at sea it is incumbent first to isolate them, followed by identifying any recent, close contacts.
“I’m recommending that everyone wear a mask (on the ship); if you’re wearing a mask, that will mitigate the risk of transmission,” said Dr. Diskin. “We have learned more about this virus in just the last five months than any illness that’s existed in the history of the planet over a similar time period, but there is still more to learn.”
Dr. Diskin recommends that common sense and planning play a big role in success if there is an ill or injured crewmember onboard. “You have to make important calculations based on where you are. For example, if you’re in the Solomon Islands (and they have minimal ICU facilities), and your next stop is Sydney, you might want to keep them on the vessel and head to the better equipped stop.”
The big questions today:
When is it safe to go back to work on a ship
How do we prevent transmission from people who are asymptomatic to people who are immune compromised?
Do we let a captain go back who has pre-existing conditions such as diabetes and/or hypertension because he/she is at higher risk to become critically ill if infected? “There are still a lot of questions.”
He said that there is a lot of strategy and logistics that is involved with this, but the unpredictability mandates that it is handled on a case-by-case basis; a problem with the maritime industry (like others) is that owners and operators want an algorithm to make treatment predictable. “But that’s not the way it’s working out. You wake up every day and it’s a different algorithm, which is hard on any industry, particularly the shipping industry.”
Telemedicine on Ships ‘101’
As medical care onboard ships is a challenge during the best of times, we spoke with Dr. Arthur Diskin, MD, FACEP Global Medical Director, Future Care, Inc., for his insights on making the most of modern telemedicine now, arguably the worst of times. He said that telemedicine is a tremendous tool, particularly on a ship “where it’s telemedicine or nothing.”
It is a tremendous tool in certain silos, he said, for example as a screening tool so you can more quickly screen out people that don’t need a shoreside medical facility. It is also a useful tool to check in on people with chronic medical problems. In addition, he recommends:
1.IDENTIFY: First and foremost, it is critical to identify your medical officer onboard, and to distribute your medical officers widely throughout the fleet, so there’s someone with some medical experience, ideally, onboard every ship.
2.PLAN AHEAD: Plan ahead for a potential COVID-19 (or other) medical emergency so you know your options in advance. For example, if you’re sailing from Hawaii to Long Beach, know the point where it’s better to proceed east or west. If you are more aware you can provide your telemedicine provider a clearer picture and receive better options.
3.STOCK UP: Owners should review their onboard medicine cabinets, and go “above and beyond the minimum level” to provide more treatment flexibility if needed.