Textbook of Maritime Medicine

R.C. Verbist, C.Schlaich

13.1 Introduction

The Maritime Labour Convention 2006 has spelled out a standard for medical care ashore as a requirement to state parties. Nowadays, medical care available to seafarers differs substantially between ports: In some ports private practices are tailored to serve the needs of seafarers and shipping- managements, others entertain governmental port health services including clinical care but there may also be ports where seafarers need to be referred to the general medical system of the port city. The Maritime Labour Convention 2006 requires that shore-based medical facilities for treating seafarers should be adequate for the purposes and the involved doctors, dentists and other medical personnel should be properly qualified. Globally, it is up to the local agent or fleet managers who are medical lay persons to coordinate medical care. In case of serious incidents, government agencies of the flag state or insurance companies may take over. The companies’ priority will not only be on quality but on the availability, cost and timeliness of the service chosen. Also, the companies view may be on acute care to assure fitness for duty rather than prevention or rehabilitation.

Experts in maritime health do agree that despite there is no regulating body which oversees the quality and appropriateness of port medicine globally, doctors who perform port maritime medicine needs specific knowledge and skills. It is not a specialty in medicine; but it requires knowledge of several medical specialities.

General practice, occupational medicine and tropical medicine are the most important. Medical practice in a port to serve the individual seafarer as well as the companies involved in shipping, calls for a particular organization.

This text gives suggestions on the basic characteristics of an ideal port medical clinic. Seafarers are among the most isolated people on the planet regarding access to medical care, in case of emergency as well as for primary health care. On a large, slow vessel in the middle of the Pacific Ocean, a seaman may be several days away from qualified medical services.

Health care on board may be organized with fully equipped hospitals, full and up to date medical chests, well-trained officers and telemedical support. It can although never offer more than basic medical treatment.

Evacuations by helicopters are spectacular and sometimes get the headlines of the news but they are exceptions and the range of a helicopter is limited indeed.

Many seafarers remain on board worried and afraid, longing to get professional assistance as soon as possible. The majority of cases are first seen by a physician on arrival in the port of call. These port physicians and port clinics therefore have to meet certain criteria to assist seafarers in an appropriate way. A port clinic has to be the easiest way for a seafarer to get medical help on arrival in a port. It has to be nearby and should be easy to access.

The seafarer has to find help there for any medical problem or related request he might have. This implies a well organized referral system to all kinds of specialized consultations and care, but also the possibility and skill to assist in questions on fitness for duty, vaccinations and other work related health issues.