Textbook of Maritime Medicine

The ILO (International Labour Organization) convention C 164 (1987) states in article 7: « The competent authority must ensure that physicians giving medical advices covering the field of the present article undergo an appropriate training and are fully aware of the existing conditions on board vessels at sea »

The 1997 ILO and IMO (International Maritime Organization) guidelines concerning the conduct of pre-sea and periodic fitness medical examinations provide information on the qualification of practitioners in charge of such examinations. Hence, the competent authority requires that the practitioner must be:

a fully licensed physician

competent as a general practitioner, occupational physician and/or occupational maritime physician

fully aware of the living and working conditions on board ships. This knowledge should be obtained either through appropriate learning, or by practice on ships.

These three requirements, ratified by all national signatories to the ILO and IMO conventions, summarize what is expected from medical doctors who intend to practice for seafarers, as occupational and fitness physician, or as on board physician.

Possibilities for a physician to acquire competence in the field of general occupational medicine and occupational maritime medicine are now available in all seafaring nations. However, to achieve full awareness of the living and working conditions that prevail on board a ship is more problematic.

No course is offered to the aspiring maritime physician to obtain this kind of knowledge, and relevant employment on ships is hard to get. The national military service (draft) used to offer some opportunity to learn about the details of medicine on board, particularly in the navy.  However, in France this possibility is restricted to the active or reserve military physicians.

The international maritime labour convention (ILO 2006) states that « all ships carrying 100 or more persons and ordinarily engaged on international voyages of more than three days' duration shall carry a qualified medical doctor who is responsible for providing medical care ». Because few ships meet these requirements, the opportunities to sail as an embarked physician are scarce. Some oceanographic vessels on long and distant missions, passenger liners or ferries on long range cruises, the high sea fishing fleet, cable ships and  scientific or exploration vessels offer such employment. Physicians who want to have this experience must contact the ship owners and commissioners.

This kind of experience is essential because no textbook can compensate for the hands on activity on board.  No textbook can account extensively for the physical environment of a ship at sea, and particularly not the situations created by the occurrence of an accident or any medical event. However, the knowledge of the different duties on board and visits to ships at quay may bee a useful approach. .

Only large ships (500 or more gross tons) carrying 15 or more seafarers and engaged in a voyage of more than three days' duration) are equipped with an infirmary or accommodation dedicated to medical care. On smaller vessels there is no space that comes next to a dispensary, and if a medical condition occurs, the primary duty will be to locate where the intervention shall take place. This will often have to be a tiny cabin on a berth with limited access and  poor lighting. To perform the necessary medical procedures, the physician may have to ask the master to temporarily modify speed and course to provide better working conditions.

The conditions described above vary with regard to which trade the vessel is engaged in (fishing, merchant or service), and to the sailing zones (temperate, tropical or polar). An on board physician must obviously be familiar with these conditions, as must the practitioner who is responsible for the fitness examination. This kind of knowledge is essential also for the physicians providing medical training to the seafarers who are in charge of medical care on board (according to the STCW 95) and also for the physicians in TMAS centres providing medical advice to ships. In France, introduction to occupational medicine and training of medical skills are provided by the governmental health service and by the physicians at the maritime consultations centre (Toulouse based CMM).

Beside medical care, the 2006 ILO convention also directs maritime physicians to engage in preventive medicine, by making programs for the promotion of health and for health education, and to establish international co-operation in these fields. The role of the human element as a major factor in prevention is emphasized. Actions to be taken within prevention can only be based on close observation of workers in their working environment. This is another argument for the physician engaged in preventive medicine to take employment on ships and be a part of the working environment.

Conclusively, there are many arguments to support the demand for a significant maritime experience that can be best obtained by taking employment as physician on a ship. This pertains to all physicians interested in maritime medicine: to the maritime physicians performing fitness examination son, to practioners of occupational medicine and to physicians giving medical advice to ships.

Telemedicine has become an important part of maritime medicine. The transmission of ECG recordings, digital pictures and videos offer great help in the diagnoses of diseases and in the care and follow-up of patients. The maritime physician must be familiar with the continuing development of telemedicine and be able to take advantage of it.

Finally, a minimum of fluency in the English language is a necessity to be able to communicate with crews of different nationalities. English is also the official language used by radio stations, search and rescue centres and port services.