by Tharien van Eck, AWC Antwerp and Health Team Co-Chair
Have you ever considered the health of seafarers, a group of people that we rarely think about?
Seafarers are an essential workforce of almost 2 million strong, responsible for transporting approximately 90% of goods worldwide. But they are not necessarily a healthy group! The Philippines, the Russian Federation, Indonesia, China, and India are countries that supply the largest number of seafarers. The current war between Russia and the Ukraine is resulting in significant stressors for seafarers from those two countries, about 15% of the global number of seafarers. The conflict is preventing seafarers from returning home, and in the case of Russian seafarers, preventing them from being paid, adding significantly to poor mental health in this group.1
Common maritime diseases include Cardio-Vascular Disease (CVD), Hand Arm Vibration Syndrome (HAVS), Musculoskeletal Disorders (MSDS), Infectious Diseases and Sexually Transmitted Infections (STIs). The most common medical issue is not illness, but injuries; it is estimated that more than 30% of all health-related incidences amongst seafarers are injuries.2
The prevalence of CVD is the same as in the general population. Exacerbating factors are smoking, excessive stress, lack of exercise, multitasking, and a general lack of leisure and recreational facilities. All ships carry essential medications to treat chest pain and heart rhythm disorders, but a heart attack or stroke typically requires immediate medical assistance and evacuation, which is not always possible to achieve and a very costly exercise.3
MSDS is another significant health issue that many seafarers will encounter sometime in their careers. This group of injuries develop because of repeated body movements (e.g., bending, climbing, crawling, reaching, twisting), resulting in overexertion and repetitive motions. This can be aggravated by long shifts (often 12 hours at a time, or a 6-on, 6-off shift pattern), which leaves very little time for the body to recover from the strain. The result of this can be that seafarers need to go through more extended periods of recovery, and sometimes they even become permanently disabled. Many new ships have fitness facilities, but lack of time and motivation result in these not being used.4
An article5 published in 2020 states “The issue of sexually transmitted diseases among seafarers is as old as navigation itself and is a public health issue and a matter of concern for seafarers themselves.” It is estimated that anywhere between 10% and 91% of seafarers had been tested for STIs over the past years. The focus for many years was on HIV, but it is important to consider all the other possible STIs as well. The most common risks for the development of STIs include multiple sexual partners, sex with sex workers and not always using condoms. Creating more awareness about safe sex practices is crucial in dealing with this.
Mental health problems and psychological issues among seafarers should also be mentioned.6 Stress, poor sleep quality, long work hours, increased job demands, lack of care and support by supervisors, as well as extended periods at sea and away from family are important contributors leading to the development of stress, depression and burnout.
No overview would be complete without the mention of exposure to infectious diseases while visiting different ports in different parts of the world. Seafarers can be exposed to a wide variety of potential pandemic and epidemic infectious diseases such as malaria, cholera, yellow fever, tuberculosis, etc. Seafarers are typically vaccinated, but exposure to infections for which there is no effective vaccination remains a concern – Chikungunya fever in Paraguay, Lassa fever in Nigeria, Marburg in Tanzania, Ebola in western Africa, etc. The COVID-19 pandemic was difficult for all of us, but have you thought about the plight of seafarers? The cruise industry suspended operations in March 2020, but commercial shipping continued to operate during the pandemic. Crew changes – which are legally required – were interrupted because of travel restrictions, resulting in seafarers remaining onboard for much longer than anticipated and others unable to resume duties. The result of this was a significant increase in fatigue and mental health-related complaints.7
In conclusion, it will never be possible to completely prevent illness and injury happening while working on a commercial vessel, but it is important to provide mechanisms to alleviate some of the exposure. An interesting tool that could provide enormous support is telemedicine,8 but this needs further development.
Next time you are shopping, just take a moment to appreciate the effort that has been made by many to bring products to your doorstep!