Textbook of Maritime Medicine

Introduction

Living and working conditions of seamen differ fundamentally from those of employees working ashore due to unusual working hours, monotony during long cruises, separation from their social environment, especially from their families, as well as psychosocial problems e. g. due to multicultural crews (1). Seafarers often state long separation from their families and long stay on board as the currently most important stressors on board ship (2,3,4).

Welfare on board and leisure time activities including sport events, library and films aim to promote seafarers’ well-being on worksite and during leisure time. According to the Siegrist’s "effort-reward" model threatening job conditions are defined as a mismatch between high workload (high demand) and low control over long-term rewards (5). This model emphasizes that jobs characterized by a perceived imbalance between high effort and low rewards are stressful and will lead to negative health outcomes, particularly in persons with limited coping abilities - such as seafarers. Referring to seafaring improvements of the leisure times possibilities pose a job-related reward and can contribute to seafarer’s health promotion.

The well-being on worksite is not only a matter of medical care (e.g. to prevent burnout or psychosomatic diseases), but has also an impact on economical aspects. Shipping companies have reduced costs related to rescue actions, unintended disembarkation due to health reasons, hospitalization abroad, repatriation, death at sea and lost of well-skilled workers. Considering the care of the human factor and the mentioned economical implications shipping companies should be highly interested to promote the seafarer’s well-being on board. Further, insurance institution will save money for indemnities to be paid if  work-related accidents are prohibited. Additionally, a prolongation of the seafarers’ period of service at sea is of high social importance (6).

In total, there are several reasons to improve the life-quality on board, especially the leisure time as an important source of recreation in a stressful job on ships.

18.1  Welfare on board in general

Knowing the special psychosocial demands in seafaring the International Labour Organization (ILO) has been concerned with seafarers’ welfare since several years. First, in 1936 the ILO Recommendation concerning the Promotion of Seamen’s Welfare in Ports (No. 48) was adopted dealing with the provision of recreational and sporting facilities in ports. The subsequent ILO Recommendation Seafarers’ Welfare at Sea and in Ports (No. 138) adopted in 1970 was much wider in scope and included provisions to organize and fund welfare services, recreation facilities as well as cultural and educational activities. These two recommendations, although not legally binding on member states, had already succeeded in gaining broad acceptance and highlighted the importance of seafarer’s welfare.

In 1987 the ILO adopted two further instruments of Seafarers’ Welfare, notably Convention No. 163 and Recommendation No. 173. To implement these ILO instruments of Seafarers’ Welfare an International Committee on Seafarers’ Welfare (7) was launched as an international umbrella organization. The ICSW includes worldwide several welfare organizations for seafarers and is special concerned with the seafarers’ quality of life - their relationships to family, to shipmates and the community.

With particular reference to countries with a lack of welfare facilities ICSW intends to identify the need for facilities and services such as clubs, advisory centers, welfare officers, sport facilities, entertainment and cultural provisions for seafarers irrespective of their nationality, race, colors, creed or gender. On the basis of identified need the ICSW advises provisions for the best use of available resources concerning welfare (e.g. port welfare services). Seafarers with particular problems of a medical, industrial, social or domestic nature often seek help from a local port welfare service. This can maintain contacts with all local, regional and international organizations which might be able to assist in such circumstances (11.7).

The ILO Recommendation No. 173 encompasses e.g. needed information for seamen visiting foreign ports about available welfare services, medical facilities and any particular hazards or diseases to which they may be exposed in their next destination. According to this recommendation practical assistance should be available for seafarers awaiting repatriation. Also it is recommended that seafarers should be enabled to transfer their wages to their families through regular allotments or by periodic payment.

Related to health issues for seafarers ICSW started a campaign called Seafarer’s Health Information Program (SHIP). This three-year campaign (from 2004 to 2007) focuses on the lifestyle of seafarers’ by taking into account the specific living conditions on board. SHIP is an instrument for health promotion in the workplace. It encourages seafarers to take responsibility for their health within their living and working environment.

Further, ICSW deals with the shipboard feature of seafarer’s isolation from medical care, both in emergency situations and for primary healthcare (see chapter 18.1). The ship, where seafarers not only work but spend all their time during a voyage, is seen as the best place for health intervention.

On behalf of ICSW members additionally activities for seafarer’s welfare have been implemented, notably International Sport for Seafarers (ISS), Training the welfare workers to enhance ship visiting and recreation & Fitness at sea or seafarers’ welfare portal.

Currently, a number of countries with high standards of services and facilities for seafarers’ welfare already complies almost all the requirements of Convention No. 163 but have not  signed the Convention. On the other hand there are also some countries with a high proportion of seafarers in the word fleet which do not have suitable welfare organization for seafarers so that they cannot ratify the Convention.

According to the Maritime Labour Convention 2006 (8)) appropriate seafarers’ recreational facilities, amenities and services as adapted to meet the special needs of seafarers shall be provided on board. Each member which has ratified this convention shall provide and maintain decent accommodations (adequate size, comfort, properly furnished and equipped) and recreational facilities for seafarers. Notably, consideration should be given to including at no cost to seafarer, where practicable, a smoking room, television viewing, showing of films, a library containing vocational and other books (the stock of which should be adequate for the duration of the voyage and changed at reasonable intervals), sports equipment including exercise equipment, reasonable access to ship-to-shore telephone communications, and email and Internet facilities.

18.2  Welfare on Board – Particular Issues

Leisure times

Due to long separation from their social environment, the high job demands and the long-lasting unity of occupational and leisure time area at sea compensation time and sufficient recreation possibilities on board are important for the seafarers’ well-being on board. In recent years, ship terminals have been relocated away from city centers and the cargo handling becomes automated and more efficiently resulting in short port stay (Kaheveci 1999). Nowadays, it is often difficult to have an access to places ashore for relaxation, amusement, friendship and/ or exercise. Thus it is a challenge for the shipping companies, the ship-masters as well as the seafarers themselves to organize the leisure time possibilities, especially the physical activities, social events and other sources of recreation such as library and films. In the ports, welfare facilities and services should be provided by public authorities, shipowners’ and seafarers’ organizations concerned under collective agreements or other agreed arrangements and voluntary organizations (8).

Physical activities

The often restricted leisure time facilities on vessels lead to a lack of exercise and a un- healthy lifestyle. High nicotine or alcohol consumptions are common and may be interpreted as a consequence of missing leisure time facilities aboard and the seamen’ work-related stress (10,11,3,12).

The International Committee on Seafarers’ Welfare recognized the importance of unhealthy lifestyle factors among seafarers and launches the project FIT ON BOARD as one of the topics of the already mentioned Seafarers’ Health Information Program, sponsored by the ITF Seafarers' Trust. For health promotion at sea a manual of onboard exercises (Fit on board; ICSW) was drawn out to help the ship management to promote fitness activities on board. This manual which is available for each seaman at no charge provides worthwhile information for example about several exercises for training with a Dyna band or risks during exercise performance (e.g. in patients with hypertension or joint lesions, by wrong breathing technique).

The benefit of fitness training on board

The benefits of regular fitness training to improve or maintain the physical condition are well established. Regular, vigorous exercises contribute to a general sense of physical, psychological and social well-being. They evoke the feeling of increased energy by developing stamina and higher muscle tone and may reduce the individual risk of cardio-vascular disease. Otherwise, unused muscles become flabby with a consecutively increased risk for accidents or injuries. Especially during long, tedious voyages, seafarers are often subjected to monotone job-related activities leading to an under-challenge of some of their muscles.

Vigorous physical activity may also increase alertness on the job and promotes good sleep. Additionally, it seems that fitness training combined with other times cues such as exposure to light or timing of meals may help to shift circadian rhythm forward or backward to a new work schedule (13,14). This can be beneficial for seamen if they have to sleep earlier, e.g. in case of an east-west voyage (15).

Sport does not only improve health but, due to social interaction, it also encourages team-building. This gain high importance on vessels since isolation often occurs among heterogeneous crews due to communication problems (see chapter 11.7).

Fitness program on board

The crew should be encouraged to spend at least 40 minutes every day with physical activities. A specific fitness plan and the level of exertion depend on the individual condition which can be assessed by measuring the heart rate at rest (Guidelines for Fitness onboard Merchant Ships, ICSW). In general, the exercise should raise the heart rate to three-quarters of the seafarer’s maximum heart rate (calculated by deducing the individual age from 220). Over-training should be avoided because fitness training (in contrast to power training) aims to maintain an aerobic endurance and to gradually improve strength and flexibility. During exertion each of the large muscle groups should be trained.

At the beginning of a fitness training the inexperienced seafarers should define their individual goals and develop a concrete fitness plan (preferably under supervision of a professional trainer) about kind, frequency and duration of training sessions, also to ensure a control and continuity of their physical exercises. The training goals have to be realistic and challenging but achievable (to avoid frustration). Further, the goals should be measurable (e.g. by change in heart rate or weight) since training success as a strong motivator to continue the program becomes apparent. Also the fitness program should be divided into short-term goals to have realistic expectations and an early success.

To prevent injuries during exercise each training session should be started with 10-15 minutes of warming-up with rhythmic movements and slow, continuous stretches. After a subsequent training unit for at least 20 minutes (taking into account the individual target area for heart rate) the fitness program should be finished with cooling-down with reduced exertion for a few minutes.

As vigorous exercise is a high strain the body needs subsequent appropriate rest periods to compensate for the effort. The fitness activities may also not be complicated to prepare and should be linked with breaks and meals. Since the recreation time in seafaring is often limited, especially on board of feeder-ships with national shipping routes, the time for physical activity needs to be organized and has to fit in with the daily work schedules onboard.

Exercise rooms

For successful implementation of fitness on board a positive attitude of the shipping company towards fitness training is necessary and becomes apparent e.g. by providing well-equipped fitness rooms. Although several shipping companies have already improved the shipboard exercise possibilities in the last years there are still a lot of vessels without sufficient or suitable accommodation. A well-equipped fitness room or gym should contain cardio-training equipment such as treadmills, steppers, rowing machines or bicycles. Also weight benches or balls are often used in fitness rooms. For measuring the fitness success a balance, weight scales, heart rate monitors, stopwatches and measuring tapes should be available. Thus, seafarers can repeatedly record their personal biometric or exercise parameters to control the development in the course of time. Also music, positive pictures, sufficient lighting and a view outside the exercise room may raise the motivation for fitness activities. The ICSW offers for example 3 different posters which encourage seafarers to do sports.

If no exercise rooms are available on board the seafarers have to improvise; they can do e.g. sit-ups, press-ups and stretching exercises or use available Fitness Packs (for example containing a pedometer, a stress ball and a Dyna band). It is possible to exercise anywhere onboard, even in the own cabin. Also the seafarer should be encouraged to walk on board and to use the staircases instead of the elevator. But the seamen have to be aware that the deck and floors are not sprung at all so that they are at risk to damage their ankles and calves if no cushioned support is used during the exercises.

Sport events

It is often demanding to motivate seafarers to do enough sports. Many of them may be convicted that their job-associated physical exertions are sufficient enough to maintain a good and balanced physical condition. But this is likely not true for the majority of the crew. Motivation for sports requires that the seamen enjoy the physical activities on board. This may be achieved as a joint group process. Especially the captain and the officers should take part in the fitness program by example. It is beneficial if the ship’s master encourages shipboard exercise and sport events. Also it is advantageous to link the sport events to a company policy on health and sport in order to highlight the importance of these activities.

Exercise in groups is often more enjoyable and the seamen can stimulate each other. Further, seafarers can help each other with muscle building exercises. Organized sport events or competitions on the ships highly motivate for exercises as the seamen or groups of them can pit their strength each other. Especially the offer of incentives and prices for participation and organization of competitions carried out on several vessels raise the motivation to do sports. The publication of the sport events and results enhances the motivation and stimulates for higher level of exertion. Besides the health promotion, such competitions may enhance team spirit on the ships.

During their stay in the ports several seafarers visit the seafarer’s welfare facilities for exercise competitions (e.g. in football, baseball, table tennis). Also the International Sport for Seafarers (ISS) organizes sport events in ports (“Sports of the Seven Seas”; www.seafarerssport.org).

Library - films

According to the ILO Recommendation No. 173 television, radio, video and library should be provided on board ship. The video films should be available for recreational propose as well as for vocational training. Some shipping companies have made arrangements with port welfare services to make copies (of newspapers from the seafarer’s home country, libraries or video films) available on board of their ships on a regular basis. Also ship visitors and port welfare centers are able to supply local newspapers and magazines. By support of ICSW members newspapers from the home countries of many nationalities can be also organized for distribution at port welfare centers. Additionally, on-site in the welfare centers seafarers can find possibilities to exchange books and videos.

By means of modern information technology seamen should be able to access overseas news via satellite television or on the internet (provided that these techniques are available onboard). However, some seafarers still complain to have unsatisfactory possibilities to be informed on board about news of their own culture or politics because of a lack of information sources.

To assess the relevance of media on board the ICSW asked seafarers of 112 ships in 4 different ports about shipboard presence and use of video, DVD and PC (16). This survey revealed that common video recorders were found in 83% of the ships; they were installed in common places or in the cabins of the officers and crew members. About 70% of seafarers used the video recorders on a daily basis to watch movies as well as for training and infotainment. Common computers were on board of 79% of the ships, predominantly used among officers for work. Half of the investigated ships were equipped with common DVD recorders which may gradually replace the video recorder on board. The sending and receiving of personal emails were possible on 67% of the ships, and on 50% privacy of message was guaranteed.

Newspaper and magazines for general information purposes are increasingly replaced by electronic newsletter. The majority of crew members received health information during safety training, booklets and leaflets. According to the mentioned survey several information vehicles should be used to reach seafarers; very effective seems to be messages in movies and electronic newsletters.

Conclusion

Compared with the condition ashore the working situation at sea is less conducive to maintaining good health status because shipboard opportunities for exercise are limited, living quarters may be cramped and the quality of the leisure time reduced depending on the shipboard circumstances (e. g. long working hours, monotony, long-time separation from the families, psychosocial problems). The ship management as well as the shipping company have some possibilities to improve the shipboard leisure time facilities as an important source of recreation. Well-being on board is essential for seafarer’s health promotion and depends e.g. on the shipboard organizational structure, such as the balance of working time and leisure time. Adequate recreation possibilities and sleep are essential for health and efficiency. Sleep requirements and habits may individually vary considerably but everyone requires unbroken periods of rest. According to the Maritime Labour Convention (2006) the maximum hours of work shall not exceed 14 hours in any 24-hour period and 72 hours in any seven-day period. The human dimension of shipping has been recognized as an essential contributor to maritime safety and to protection of the marine environment (17). IMO statistics reveal that 80% of accidents onboard cargo ships are caused by the human factor.

In total, seafarers should know about their possibilities for exercises on board and ashore and they have to take responsibility for their health within their special living and working environment on vessels.

References

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