Textbook of Maritime Medicine

The history of maritime medicine was very well presented in the “Handbook of Nautical Medicine” written by W.H.G.Goethe, E.N.Watson and D.T. Jones and published in 1984.

What has changed during the last 3 decades which could justify adding this subchapter to the text of our book published in 2009?

Several points may be discussed.

Until the beginning of the 20th century, nautical and tropical medicine were closely linked, and in countries which had colonies in Africa and Asia research centres for each subject were placed in the same institute, such as in the Bernhard Nocht Institute in Hamburg in Germany. Today, this link is not longer that close. Tropical and infectious diseases are not as important for seafarers as they used to be, and ships much less frequently carry infectious agents from country to country. In this regard air traveling plays is more important.

Still, tropical malaria should not be forgotten and neglected, since there is no answer yet found for this health risk to the crews of ships.

The important changes during the last decades affecting the health and work safety of crews of ships are the following:

• the globalization of the shipping industry,
• automatization and mechanization of work on ships and transport of cargo in containers,
• progress in navigation techniques,
• decrease in the number of crews on ships, lack of stability in the employment of seafarers,
• re-flagging of ships and multicultural crews on ships operated under flags of convenience.

Even if the common medical challenges on board remain the same as before, and physical, chemical and biological health hazards continue to face the seafarers on ships, their life has still changed, and not always for the better.

The standard of accommodation for crew members on board has improved. Systems for communication with shore are also continuously improving. Contact with the doctor on land in case of need is easily established, and more detailed information on the condition of a sick or injured crew member can be forwarded. Communication with the family at home has also been facilitated. The load of hard physical work during voyages has decreased (which is a mixed blessing and may lead to overweight and obesity of some seamen).

The size of crews on ships has been drastically reduced. For instance from about 40 crew members on a cargo ship of medium size to about 24, or even less. Given their varied responsibilities, this reduction will increase the work related stress. The other effect is that on modern ships there are not many opportunities to meet other free from duty seafarers onboard during the long oceanic voyage of the ship, speak to them and enjoy their company.

Seafarers of various nationalities are employed on the same ship. Due to language barriers and cultural differences, this complicates the social contact between them. This in turn affects the social wellbeing of many seafarers.

The technical progress in loading/unloading cargo in ports, and the use of containers very much shortened the time of stay of the ship in ports. This limits the opportunities seafarers have to spend time on shore, for example to visit a dentist or a doctor i, go to the cinema or have a drink in a bar there, see places of interest. The service at sea may be more boring now than it was few decades ago.

The above mentioned changes and their effect on the health and wellbeing of seafarers will be presented and discussed in other chapters of this book.