Textbook of Maritime Medicine

13.15.1  Welfare organizations

Of 1,549 complaints by seafarers to the ministers of the Mission to Seamen in five years(1994-1999) 123 or 7.6 percent were about illness (1). It may be understood that these complaints did not go to a port clinic through the normal procedure of the ship or did not get properly solved or dealt with. In a personal communication a welfare worker declared that very often seafarers are reluctant to trust the port maritime physician because they think he might have links to the captain, the agency or the company and therefore a seafarer sometimes does not report personal and more delicate problems like STD for treatment. A good contact with the welfare organizations is therefore very important so that also the patients that report themselves to the ship visitors do get proper treatment and do not lose their rights (1). Chapter 5, Shipboard life and work II, SIRC, Cardiff. Welfare organizations also play a very important part in visiting hospitalized seafarers. There should be a system to report hospitalizations to them and team working with volunteers to visit the seafarer regularly in the hospitals, to offer them newspapers or a telephone card. Sports activities in ports are organized by welfare centres and seamen’s clubs, a medical support for these activities is important and should be provided by the port physician, like some guidance and a small medical chest for first aid.

13.15.2 Port Authorities

Because a port maritime physician is operating in their area the port authorities should be aware of the activities in the port clinic. Permission may be needed to enter port areas, to go on board ships and to enter specific installations like locks and terminals. Even if the port clinic is a private enterprise the port authority should know about the activities and services given. In case of a major health problem in the port, the port clinic may be asked to help and assist in a specific task. It is important to be prepared for such actions.

13.15.3  Emergency services

Emergency medical services in or around the port area should be informed and instructed on how to cooperate with the maritime physician. Procedures and protocols may be installed to allow a good communication between these services and the port clinic. Should a seafarer be brought to such service directly, the port physicians have to be informed about it and contacted to organize follow-up and further care. A system could be that the emergency centre is responsible in such cases for the diagnosis and treatment, but that the port physician is involved in making up a report for the patient and ship and has a word to say in the decision on duty status and eventual disembarkation or repatriation of the patient. Not only medical emergency centres are important but also the fire brigades that are in many ports, also taking care of the ambulance transport, are most important partners to locate, evacuate and transport injured seafarers. The port maritime physician has to keep good relations with these services to always trace a seafarer down who has been evacuated to a hospital urgently.

13.15.4  Port coordination centres

In case a ship has announced a medical problem before arriving in the port, asking for immediate assistance of a doctor on arrival, it is very important that coordination centres are aware of this. They can give the ship priority to enter the port and they can arrange to let the ship go alongside at a special quay for easy access. The centre can advise the doctor and emergency service on the exact time and place to go on board. Also in case of departure with a medical case not finished or if it is necessary to put the seaman back on board at the last minute, the coordination centre may give important information about the exact time of departure, possibilities to bring the seaman back on board in the locks eventually etc.

13.15.5  Hospitals

Not many ports have a special harbour hospital or a service for seafarers only. The coordinating role of the port maritime physician has been mentioned. The port maritime physician should carefully select the hospitals and departments to cooperate with for specific hospitalizations. It may well be that in one hospital the surgery section is very cooperative for seafarers but another department is not, very often this depends on the personality of the head of department or a personal relationship. Also for hospitals the geographic position of the hospital may be important not only in respect of the port or the ship but more in relation with the agencies and the welfare centres so that they can visit the hospitalized seamen regularly.

13.15.6 Universities

Some departments of a university hospital may be of importance for port maritime physicians. The department of Tropical Medicine for example is very important and a special interest of the specialists in tropical medicine in seafarer’s pathology is helpful. The department of the University Hospital where the seafarer is eventually hospitalized should again be briefed about the special procedure for seafarers by the port maritime physician.

13.15.7. Ship supplying pharmacies

In most ports specialized pharmacies which supply ships are functioning. These pharmacies will be able to deliver needed drugs with short notice to ships.

13.15.8. Port Clinics in other ports

The port maritime physician is working in an international sector. He should therefore look further than his own port. Every time when a seafarer is sent back on a ship he should carry a report, all results and technical documents concerning his examination and treatment and a clear instruction to contact a port physician with these results in hand in case it is necessary. All printed material of a port clinic should mention something like: “In case you consult a doctor in another port about the same problem, show him all results you have got from us”…
An informal meeting between maritime physicians of an area or country can be helpful in establishing a network. It is very helpful if a report coming from another port is signed by a person well known.