Textbook of Maritime Medicine

One million seafarers operate on ships worldwide. Ship owners and seafarers are often of different nationalities, and ships often operate under a flag different from their origin or ownership. Seafarers are also frequently exposed to difficult working conditions and particular occupational risks. Only standards observed by all seafaring nations can guarantee adequate protection for workers.

On February 2006, the 94th International Labour Conference (Maritime) adopted the Maritime Labour Convention, 2006, which sets out the conditions for decent work in the increasingly globalized maritime sector 1. The Convention sets minimum requirements for seafarer to work on a ship and contains provisions on many conditions particularly health protection, and medical care.

Standards of medical and physical fitness are mandatory for all those working at sea. There are three main types of medical examinations: Pre-sea or new entrant examination; Periodic examination; Examination post sickness / injury. The health assessment is to ensure that a seafarer is fit to carry out the work for which he is employed, safely. It is the responsibility of the employer to ensure that any seafarer that employ has the appropriate medical fitness certification. Where a seafarer has a restricted medical certificate, the employer should take into account in terms of the particular job for which the seafarer is employed.

A pre-sea medical examination provides an opportunity to prevent a person from embarking on a seafarer career for health reasons apparent at that time. A periodic medical examination provides an opportunity to ensure that a seafarer remains fit for sea service by identifying medical conditions, which may developed since the seafarer entered to the profession.

It is worth mentioning at this stage that the standards set by legislations / directives or conventions represent the minimum acceptable standards.

For example, what should be included in pre-sea and periodical medical examinations?

A carefully completed questionnaire, a physical examination, and functional testing are invaluable step in conducting a medical examination. Nevertheless in spite of the diligence given by the examining doctor, pre-employment medical examinations are poor predictors of a man’s future state of health evidence available to the doctor at the time of the examination. All they can do is assess the seafarer is not clinically unfit at the time for the job.

Guidelines for conducting medical fitness examination for seafarer have been set out. They will, however, serve as a tool to assist in the conduct of examinations of seafarers. A model medical examination has been provided 2. The identity of the person to be examined should be verified. The number of his or her discharge book, passport or other relevant identity document should be entered on the examination form. Information on Occupational history is essential as it may lead to closer attention on potential occupational health hazards. The examinee’s previous medical records should be reviewed. The physical examination and the necessary additional examinations should be checked and recorded according to set procedures. Hearing, eye sight and colour vision should be checked. Eyesight should be in compliance with the international eyesight standards for seafarers set out in the section B-I/9 of the STCW Code 3. In examinations, appropriate equipment should be used in the assessment of hearing capacity and visual acuity, colour vision, night blindness. Vaccination’s record should be examined.

The results of the examination should be recorded and assessed to determine if the seafarer is fit for the work, which will be undertaken. Guidance on medical conditions which should be taken into account when considering whether a person is fit or currently unfit for work at sea has been provided by ILO 4.

If the examinee is found fit for the work to be performed, the medical certificate should be issued 5. The medical examination records should be clearly marked “CONFIDENTIAL” and be retained according to national regulations in the custody of the health establishment where the medical certificate was issued. The file should be kept confidential and shall be used for no other purpose than to facilitate the treatment of seafarers and should be made available only to persons duly authorized in accordance with data protection laws.

After the information is collected the examinee should sign the form to certify it is a true statement.