By Lawrence Jacobson, Managing Director P&I, Future Care, Inc.
Presented by Yuki Yu, Director of Asian Marketing for Future Care, Inc.
Good afternoon to you all. My name is Yuki Yu. I am the Director of Asian Marketing for Future Care, Inc., a provider of medical management and cost containment services to the maritime industry. I have been asked to speak to you briefly today on Fulfilling the Shipowner’s Duty of Care to Crewmembers Through Shipboard Wellness.
As you know, the shipowner’s duty of care owed to the seafarers within his employ has grown dramatically since the Code of ancient Rhodes. The twelfth century AD Rolls of Oléron provided that if a seafarer fell ill in the service if the ship, “the master ought to set him ashore, to provide lodging and candlelight for him … and likewise to afford him such diet as is usual in ship.”1 Happily for the mariner and shipowner alike, healthcare for seafarers onboard the ship and onshore has improved since 1160 AD.
The Maritime Labour Convention, 2006, (MLC) represents the latest step forward in improving the seafarer’s healthcare. The MLC includes specific requirements for both shipboard and shore medical treatment. In particular, the Convention mandates that the shipowner make available “health protection and medical care as comparable as possible to that which is generally available to workers ashore” for the crew onboard ship. 2 Today, through the marriage of modern medicine and the wonders of technology this seemingly impossible obligation is not only increasing in practicality, it is inexpensive.
Telemedicine in 2018 brings diagnostic capabilities formerly unimaginable in the ocean’s midst directly to the mariner onboard ship. Equipped with a smartphone and a few relatively inexpensive instruments and/or “apps” the ship’s medical officer can measure the crewman’s: sugar level, blood pressure, heart electrical activity, blood oxygen level and capture ultrasound images of internal organs. Ear, eye, nose, throat and skin examinations can be accomplished with medical microscopes attaching to the phone. With minimally-priced shipboard software these readings can be relayed from the ship to a shoreside physician in real time. Virtual consultations can be arranged onboard ship between mariner, medical officer and shoreside physician for more extensive consultation. In other words, today’s shipowner has the means at his disposal to meet the standard of medical treatment required under the MLC.
The shipowner’s duty to provide medical care to the mariners in his employ is not limited solely to emergency treatment. The Convention makes it abundantly clear that the shipowner’s medical response must also “include measures of a preventative character such as health promotion and health education programmes.”3. Again, telemedicine can help make a shipboard wellness program a realty, utilizing the same comparatively inexpensive technology I just described. With a minimum investment of time and planning a schedule of shipboard virtual medical consultations can be established, with no loss of ship’s work time.
Regularly scheduled virtual doctor visits, at least once during the mariner’s voyage, can do wonders for prevention and health promotion. During a 15 or 20-minute session the physician can review both the mariner’s objective and subjective medical complaints. Chronic conditions, which follow the seafarer onboard ship, can be monitored and controlled. Minor ailments can be treated before escalating to more serious conditions. These telemedical consultations can catch and treat the beginnings of serious illness; reinforce beneficial behaviors in treating chronic conditions previously diagnosed, and review medications, among other benefits. Additionally, the knowledge that medical help is available at sea yields psychological advantages through the crews’ increased sense of wellbeing which, in turn, increases efficiency and productivity aboard ship.
As you know, the shipowner is required to provide the ill or injured mariner with medical treatment until a return to Fit for Duty status or Maximum Medical Cure. This obligation is reinforced in the MLC’s Standard A4.1, which is titled “Medical care on board ship and ashore”. Virtual consultations with a medical professional during shoreside convalescence can encourage efficiencies of recovery and promote the seafarer’s overall wellbeing and return to the ship. The MLC requirement should not be viewed however, solely in the context of convalescence from serious illness or injury while ashore, although certainly it does apply. The proactive shipowner will want to ensure that the mariner has adequate medical resources available while ashore. Simply providing a contact to the mariner for physical and mental health issues can be of great benefit. A more comprehensive approach could include resources on education, lifestyle assessment and even wellness coaching.
As I have indicated, the issue of mental health cannot be overlooked in a discussion of the shipowner’s duty of care to crewmembers. It is well known that a number of aspects of modern seafaring life can lead to anxiety, depression, anger and in extreme cases, suicide. Factors such as social isolation aboard ship, lack of sleep, cultural differences in language, food and social norms; separation from family and overall shipboard working conditions can all weigh, at times, on the mariner’s mind during the extended time aboard ship. Not surprisingly, anxiety about physical health can be a major concern while at sea. Untreated physical ailments can lead to feelings of inadequacy; poor job performance; fatigue and a sense of loss of control and depression. 5.
There are many steps that can be taken onboard ship to improve the mariner’s feeling of mental and physical wellbeing, including improved work environment and increased communication with family and friends. While I do not have time today to review them in detail, I would emphasize the value of having available both screening and expert medical responses to identify and respond to mental and emotional problems arising at sea. Here again, telemedicine and a virtual wellness consultation with a trained professional can be quite effective in spotting and addressing mental health issues before they worsen.
A key element is a dedicated 24/7 helpline available to the mariner, at sea and preferably also at home. When properly staffed, the helpline can serve a variety of functions, conveying psychological telemedicine, general counseling, wellness coaching plus functioning as a gateway to other resources. This does not have to entail great expense. There are a variety of charitable, educational and commercial services available, knowledgeable in treating the problems of life at sea.
I don’t want you to think that what I have said is all gloom and doom for the shipowner’s financial “bottom line”. Far from it. The reason for this is simple: Shipboard wellness is essentially preventive medicine, and preventive medicine is universally cost-effective.4 Responding to emerging illness before it demands more immediate and extensive medical treatment is tremendously effective financially. When a seafarer requires shore-side treatment during the voyage a number of distinct costs may arise, including: medical treatment itself; transportation; unscheduled repatriation; replacement labor; lost productivity and occasionally, Medivac or ship deviation. A very simple shipboard wellness program of scheduled, brief virtual consultations will catch and cure a great many chronic flare-ups or budding illness without the need for intervention ashore.
I would like to leave you all on an optimistic note. While the law of nations is undoubtedly moving the shipowner toward the mandatory provision of improved medical treatment for seafarers onboard ship and ashore this is, in fact, a beneficial development for the entire community. Improving the mariner’s overall health will result in increased productivity and greatly reduce the shipowner’s costs of medical treatment and multiple associated expenses, too numerous to mention. The means to bring shipboard and shoreside wellness to the mariner are available, now, and they are inexpensive. Telemedicine provides a simple and cost-efficient method of addressing both reactive and preventative medicine onboard ship and ashore. Can there be any doubt that good health is an asset for both the crew and their employers?
I thank you for your time today and wish you all good health.
- When Should Seamen Maintenance and Cure Benefits Terminate?Jason Minkin, DePaul Journal of Health Care Law 1996 Article 6; see: https://via.library.depaul.edu/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=1287&context=jhcl
- Maritime Labour Convention, 2006, Standard A4.1 http://www.ilo.org/dyn/normlex/en/f?p=NORMLEXPUB:91:0::::P91_SECTION:MLCA_AMEND_A4
- The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Institute of Medicine (US) Roundtable on Evidence-Based Medicine; Editors: Pierre L Yong, Robert S Saunders, and Leigh Anne Olsen; Washington (DC): National Academies Press (US); 2010; see https://www.ncbi.nlm.nih.gov/books/NBK53914/
- Screening and Assessment for Suicide in Health Care Settings: A Patient-Centered Approach; Gregory K. Brown, PhD Anthony R. Pisani, PhD Leah Harris, MA October 27, 2014 (published by Action Alliance for Suicide Prevention Copyright © 2010-2014 Education Development Center, Inc.)
Seafarers’ depression and suicide; Alex Mellbye, Tim Carter 1ITF Seafarers’ Trust, United Kingdom 2Norwegian Centre for Maritime Medicine, Haukeland University Hospital, Bergen, Norway