Lessons Learned

One and a half years into the pandemic, the global community has gained a new appreciation of the importance of public health measures. After years of forecasting that it might happen someday, the world was confronted with a virus that claimed millions of lives – but also reshaped the approaches and delivery of medical care.

While many industries were hard hit, the maritime community faced a unique set of challenges. By nature, it’s a profession that requires long periods of absence and isolation that were amplified by the restrictions enacted around the globe. In the past, if a seafarer was faced with a health issue the shipping line could arrange for the person to be landed in the next port of call and receive medical attention or be flown home.

But pandemic-related travel restrictions brought about the crew change crisis that prevented crew from coming and going from their ships. At its peak, unions and organizations including the IMO estimated that as many as a half-million seafarers were stranded at sea with limited contact to friends and family and lacking any easy access to medical care.

“The shipping industry depends on a set population of workers in close quarters and very remote settings,” says Dr. Edward Kim, Clinical Director for Remote Medical International, a company that provides medical support services to customers in challenging environments like maritime. “Due to the closing of international borders, especially in the early days of the pandemic, routine onshore medical care was extremely difficult to access. We had to prove we had maximized offshore medical treatment options and that a patient direly needed onshore hospital treatment before an onshore referral or evacuation was accepted.”

New Protocols

One of the strategies that helped the shipping industry manage as COVID-19 spread was the development of new health protocols and procedures that provided a structure for seafarers and assurances to onshore authorities dealing with the ships. Kim says access to foreign medical resources is generally better now, but there are still significant limitations compared to the pre-pandemic world.

Shipping lines worked to train seafarers and officers aboard ships to handle the new COVID-related protocols and, as Kim notes, the first significant medical equipment change aboard ships was supplying personal protection equipment (PPE) required for daily operations and adding testing equipment.

Efforts are also underway to train both the home office and ship personnel to better manage healthcare for seafarers. For example, Simwave, a maritime training and assessment company, is teaming up with VIKAND, a provider of outsourced medical services to the maritime industry, to create a training program in infection prevention and control, preparing the maritime industry for future and ongoing public health concerns.

Currently, the emphasis is on vaccinations, but there too the maritime industry faces challenges. The double-dose vaccine only works for a small portion of the population that is on a cyclical schedule or home on leave. Most seafarers need the single-dose option because they cannot return on time for the second dose. Individual countries, private health organizations, unions and charities around the world are arranging for crew members to be vaccinated, but “There’s a patchwork of vaccinations now that needs a more organized approach,” says Len Quist, Senior Vice President & General Manager of VIKAND.

There’s also a need to emphasize testing in addition to vaccination. Both are critical to time management and port access, notes Althea Wright, Director of Maritime Services/Negotiations at Optum, a provider of medical cost-control solutions for the maritime industry.

New Technologies

While near-term concerns remain focused on addressing the challenges of the pandemic, the impact of the past 18 months is also proving to be a catalyst for raising long-term awareness of the importance of health issues, access to medical care and the overall wellness of the seafaring community.

“I equate this outbreak to the lunar landing,” says Dr. Arthur Diskin, Global Chief Medical Officer of Future Care, an international medical management and cost-containment service provider exclusively to the maritime industry. He believes the experiences gained during the pandemic will accelerate new technologies and levels of care that will benefit global health: “Now there’s a focus on having healthier crews and a greater attention to general sanitation on the ship as well as potential exposures coming from onshore.” 

A decade ago, ships didn’t have the bandwidth or technology to support interactive medical care through telemedicine. That has since changed. The pandemic greatly advanced the use of telemedicine, driving it from less than one percent of medical visits to nearly a quarter of doctor appointments. Learning from the lessons of the past year, Diskin predicts that additional small remote medical devices will be made available to provide new advances in the use of telemedicine and create a better environment for the crew at sea.

Aiding the expansion of telemedicine is not only increased bandwidth to the ships but also declining prices of hardware and equipment that can be operated by non-medical personnel. “Telemedicine is revolutionizing commercial shipping healthcare for a post-COVID world,” says Holly Love, Vice President of Medical Operations at VIKAND. In collaboration with FrontM and Inmarsat, VIKAND introduced a telemedicine service providing easy access to healthcare and emergency response.

“The idea of having a healthier crew has risen to the forefront,” for shipowners and operators alike, adds Diskin, saying that the companies also understand that health goes beyond medical care to the broader environment: “Through technology and the use of telemedicine, there will be greater attention paid to a wide range of issues – everything from sleep patterns and food to the level of stress and isolation and how they impact the seafarer.”

Mental Health Awareness

The pandemic also placed crews around the world under far greater levels of stress and anxiety. According to Dr. Diskin, those elements have helped exacerbate potential underlying mental health issues, which shipowners did not historically include in pre-employment screenings. “Some subclinical issues have surfaced due to the new stresses,” says Diskin.

In addition to new screening efforts, the focus has shifted to creating a better work environment. Japan’s Mitsui O.S. K. Lines, for example, committed to increasing the availability of connectivity and Internet access aboard its ships after it was revealed that the grounding of one of its vessels, the bulk carrier Wakashio, causing an environmental disaster in Mauritius in 2020, happened because the ship was attempting to sail close enough to shore to access cell phone signals for the crew to call home.

In the past, mental health was not acknowledged culturally as a concern and was often dealt with on a case-by-case basis. “There’s been a major recognition of mental health issues,” Diskin says. The pandemic helped raise the subject to the forefront, creating a cultural shift where more attention is being paid to the overall welfare of seafarers.

Private organizations and charities also rose to the challenge, seeking to provide for the crew’s welfare, and in some ports even created isolated outdoor spaces to permit crew time ashore without the concerns of virus exposure.

Pandemic Fatigue

“In the current moment, the fight is against pandemic fatigue,” concludes Remote Medical International’s Kim. “It’s vital that we don’t let our guard down. Maintaining precautions remains essential” to help the industry navigate through the pandemic.

However, in the longer term, everyone agrees that a cultural shift in the maritime industry along with advancements in technology will create greater attention and improved health and welfare for the seafarer community.

Allan Jordan is Associate Editor of The Maritime Executive.