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NEWSLETTER NEWSLETTER July 2009 – page 1 / 1 APRIL 2011 – Volume 10 – N° 2 International Maritime Health Association NEWS Contributions for the next newsletter would be welcomed by the Editor before 01 July 2011 E-mail: [email protected] CONTENT ■ FROM THE EDITOR ■ PRESIDENTS’ PODIUM This is a newsletter of the International Maritime Health Association - IMHA. Opinions expressed in this newsletter do not necessarily reflect IMHA's point-ofview. All correspondence and address changes should be sent to IMHA, Italiëlei 51, B-2000 Antwerp, Belgium, e-mail: [email protected], while the editor [email protected] should be copied on comments on newsletter contents. IMHA Office Italiëlei 51 B-2000 Antwerp - Belgium Tel +32 3 229 07 76 Fax +32 3 225 20 38 E-mail [email protected] Web http://www.imha.net IMHA is registered in Belgium as an international association by Royal Decree of 14/07/1998, identification number: 22285/98 To become an IMHA member and part of the network of Maritime Health Professionals, simply send an e-mail to the IMHA office : [email protected] One year membership: Individual : 125 euro Corporate : 475 euro Student : 60 euro ● Bank transfer or Visa / MasterCard Know it, Share it … ■ 11th ISMH – 6 – 10 September 2011 Sally Bell Suresh Idnani Anatoliy I. Gozhenko INTERNATIONAL PROJECTS ■ Global ■ Partnership on HIV Medine Nebojša Nikolić Nebojša Nikolić CONTINUING EDUCATION ACTIVITIES MARITIME HEALTH JOURNALS MEMBERS’ SECTION ■ LETTERS TO THE MEMBERS & THE BOARD ■ FROM THE OFFICE ■ MARITIME MEDICINE AROUND THE WORLD COLUMNS ■ THE CRUISE CONNECTION Eilif Dahl ■ BOOKSHELF ■ VOICES FROM THE PAST ■ USEFUL WEBSITES ■ UPCOMING EVENTS Ilona Denisenko NEWSLETTER April 2011 – page 2 / 2 FROM THE EDITOR by Sally Bell I’m glad to say that the shortened version of the newsletter has resulted in very few comments, so we’ll continue with this format. As promised in the last edition, we’ll respond to any of your views if you’ll let us know what you think. The only suggestion following the reduction of the newsletter length was that the feature “Voices from the Past” be reinstated, so we have brought it back – but if there are any other views as to whether other items should be added or deleted, please let me know. Would you like it shorter still? Is there anything else you would like brought back? The IMHA Board has been busy, and you will see a report of our recent board meeting as well as information on the Quality Assurance project which is moving ahead well. For future projects we need your advice and assistance, so please respond to our President’s request for suggestions. This week’s history article is perhaps more topical than the usual history section, dealing as it does with conflict in Libya, although in a different age. We are looking forward to seeing many of you at the ISMH in Odessa, so don’t forget to register as soon as possible for this important event when the next IMHA Board will be elected – and start to think about whether you would like to contribute, either as a Board member or simply as a participant in specific projects. There is still some time to send abstracts as well as the deadline has been extended, but don’t leave it too long! As ever we will continue to include as much as we can in the newsletter on current maritime health practice, and for this we continue to need your help and support, whether in the form of articles, pictures, case studies or information about local changes in rules, regulations and practice. My thanks to those who have contributed to this edition, and my encouragement to those who are thinking of sending something for the next. Sally Bell, Editor ([email protected]). PRESIDENTS’ PODIUM by Suresh Idnani Dear Members, IMHA stands tall today, thanks to your support and efforts, not only among the stakeholders of the International Industry, but also the regional and national shipping Industries. Your appointed board has worked tirelessly and surely to take forward the aims and objectives of our association during the past eighteen months. You will have read in our earlier newsletters details of the work done and we will continue to keep you updated and involved. We are exploring the possibility of new projects and are keen to involve you in this process. Some of the projects coming your way for opinion, advice, and involvement are: · · · · A research project on current health concerns affecting seafarers Health & safety protection and accident prevention in seafarers - prevention of occupational accidents and injuries Reporting network of infectious diseases Network of health practitioners to address mental trauma and post traumatic stress disorders We are requesting support from stakeholders of the international shipping industry and we hope that this will be achieved. We are also considering the development of a better institutional and management setup so that we are able to take on these projects in due course with good professional oversight and audit mechanisms in place. On the matter of international relations we are involved in many areas and have actively raised our profile and our commitment to maritime health. I have had the pleasure of meeting several of you at planned events in this regard. ICSW: Seafarers welfare and health initiatives continue to integrate following a successful ICSW SA regional work programme which was assessed independently, documented, and is being benchmarked for other regions as well. Several initiatives concerning health, notably, the proposed QA in maritime health and the SHIP programme were supported by all countries in the region. A Ship Welfare Visitors Course (SWVC) training programme for IMHA members is to be conducted this year. A new project on health and safety using SHIP material as a follow on project is being considered under the ICSW IMHA cooperation NEWSLETTER April 2011 – page 3 / 3 agreement. The ICSW Seafarers Welfare Seminar on the 14th of April in Copenhagen will address current issues and problems facing the provision of welfare services to seafarers. These include welfare services for the families of seafarers affected by piracy, better communication facilities at sea and in port for seafarers, and the use of the Maritime Labour Convention provisions to enhance seafarers’ welfare. The Maritime Labour Convention (MLC) presents an important opportunity to the ICSW, IMHA and other organizations concerned with seafarers’ welfare and health, to increase awareness within the maritime industry and the wider public. The convention breaks new ground by being enforceable and applicable to all, even to those states that have not yet ratified. It is important for both ICSW and IMHA to be ready and to be clear about the role in supporting our respective constituencies and promoting and facilitating the welfare and health components of the MLC 2006. Piracy and its effects on mental health and PTSD are being discussed nationally, regionally and internationally, several IMHA and ICSW members are cooperating to address this issue. ILO: It is expected that the MLC 2006 will come into force in the near future. IMHA has contributed not only in the development and formative process but has also worked actively in the preparatory stage of the development of guidelines for flag and port state inspections in the true spirit of tripartism. IMHA’s significant contributions and interventions at several meetings have been recognized and acknowledged. In anticipation of the MLC coming into force, preparation for inspection and certification of ships under the ILO MLC are already underway. Flag State Inspectors and Port State Control Officers are being trained in this regard. To date two IMHA professionals have undergone extensive training as trainers and for maritime inspectors on the provisions of the ILO MLC 2006. Several IMHA members are also contributing on the revision of medical standards and a second meeting in this regard is planned in Geneva for September 2011. The ILO has also asked Dr Tim Carter to assist with the development of medical standards for fishermen under their ILO Fishing Convention. IMO: The Manila Convention 2010 will be endorsed at the Council meeting this year. IMHA and its members have contributed towards this and will continue to do so when approached during planned safety committee meetings of the IMO. The revised STCW will come into force in 2012. WHO: The consultation process between the ILO, IMO and WHO on the future of the IMGS is under way and it is expected that matters may move forward amicably. We are yet awaiting a response to our letter to the WHO which was forwarded by us on the matter of the IMGS revision. I take this opportunity to thank you for your support and efforts and request you for your valuable opinion, advice and involvement in the projects being undertaken and those proposed for the future. You can always reach me at: [email protected] REGISTER NOW! DEADLINE FOR EARLY REGISTRATION 30th April ! 11th ISMH - 2011 6 – 10 September 2011, Odessa, Ukraine 11th International Symposium on Maritime Health Dear Colleagues, On behalf of the Ukrainian Research Institute for Medicine of Transport, it is my great honour th and pleasure to invite you to the 11 International Symposium on Maritime Health which will be held in Odessa Ukraine on 6 – 10 September 2011. The theme for this meeting is “Maritime Health – an International Challenge” The scientific program of the symposium will cover important problems in research, education and service in the field of maritime medicine. This will be presented in plenary sessions and debated in workshops. We hope that the event will encourage scientific research in maritime health, promote the development of quality international medical service and systems in the maritime sector, and assist with the international coordination of maritime health initiatives. Odessa welcomes all physicians, scientists, legislators, educators and other health personnel involved in maritime health. We look forward to meeting you and hearing your knowledge and ideas in Odessa, the city on the Black Sea, one of the biggest industrial and cultural centres of Ukraine. We will take you to the famous memorials, architectural ensembles and avenues, the port and research institutes, our resorts, parks, museums and everything that will be of interest to you. We shall introduce you to the lively and sociable Odessites and hope that among them you will find many new friends. Professor Anatoliy I. Gozhenko th Chairman 11 ISMH DEADLINE FOR ABSTRACTS HAS BEEN EXTENDED. SEE www.ISMH11.ORG NEWSLETTER April 2011 – page 4 / 4 INTERNATIONAL PROJECTS Global Partnership on HIV and Mobile Workers in the Maritime Sector By Nebojša Nikolić In 2010 with the completion of project budgets and programme budget, the overall Global Partnership Programme Proposal was approved for distribution to potential donors, while from a fundraising perspective, the Secretariat focused 2010 on making strategic connections and developing advocacy and visibility tools necessary for future fundraising efforts. The first funds arrived and the Global Partnership website was set up. The domain name of the Global Partnership website will be www.AnchorHIV.org. The Secretariat is looking into purchasing AnchorHIV.com and .net in addition to .org for the next five years in order to guarantee the branding of the Global Partnership. The Global Partnership was included in an IOM article successfully submitted to a special HIV focused edition of the Maritime Health Journal. Several tele-conference meetings were held and the secretariat will develop a roadmap for 2011 laying out the most important events and activities of the Global Partnership. In addition to raising awareness, this roadmap will allow the Secretariat to prepare and support GP members for upcoming events with materials and strategically targeted information. The next proposed Stakeholder Video Conference Update is to be held in Pretoria, South Africa. It is anticipated that the internal video conference will take place in March. The suggested video conference for external partners would then take place afterwards. It was suggested that the upcoming regional meeting, Regional Transport Sector Health Forum (28-30 March) in South Africa, might be an excellent venue for the external video conference. This is because many of the GPMG members are participating and relevant South African government partners will already be present at the conference. Global Partnership on HIV and Mobile Workers in the Maritime Sector Secretariat - International Organization for Migration 17 route des Morillons C.P. 71, CH 1211 Geneva, Switzerland Phone: +41.22.717 9234 Fax: +41.22.798 6150 E-mail: [email protected] By Nebojša Nikolić MEDINE 2 – Work Package 04: Tuning 1st cycle degrees in medicine MEDINE2 is approaching the end of its first 18 months of activity. At this stage, the Commission has requested that the project submits a full progress report detailing what has been achieved so far. The project co-ordinator’s office is very busy preparing these reports along with the help of work package leaders. All the developmental work packages have now held their meetings for 2011. The meetings held were as follows: • • • • • WP1 and 2 had a joint meeting on the 28th and 29th of October in Berlin WP3 met on the 11th and 12th of October in Krakow WP4 met on 6th and 7th of December in Antwerp WP 5 and WP6 met during the AMEE meeting in Glasgow (4-8th September) WP7 met on 10th September in Madrid NEWSLETTER April 2011 – page 5 / 5 Learning outcomes/competence frameworks promote harmonisation, transparency and consistency in educational programmes. The Tuning Project (medicine) has developed learning outcomes for primary medical degrees, disseminated widely and available freely at www.tuning-medicine.com. IMHA is a partner in WP4 where using Tuning methodology, group will generate an agreed set of learning outcomes/competences for 1st cycle Bachelor degrees in medicine. These will link systematically with Tuning outcomes for primary medical degrees (2nd cycle); they will specify an appropriate degree of vertical curriculum integration and address issues of employability through a competence-based approach. Initially, the working group worked on the set of first-cycle outcomes with these priorities. These will be refined and developed through a series of European workshops. A web-based Tuning opinion survey will be conducted to rank the importance of each outcome. Respondents will include academics, employers, graduates, and students. These results will be subjected to detailed statistical analysis. The findings will inform the decisions of a consensus conference which will generate the final report document. This will be disseminated via the Network website, a printed brochure, conferences and workshops, published papers and presentations The General Partners Meeting for 2011 will be held at Semmelweis University in Budapest, Hungary from 19th of May to 21st of May. The meeting will be an excellent opportunity for partners to hear how the various work packages are progressing and how they can become further involved in the project activities. CONTINUING EDUCATION ACTIVITIES http://imha.net/index.php?option=com_content&task=section&id=20&Itemid=86 MARITIME HEALTH JOURNALS For a list of Journals relevant to Maritime Health, please follow the link below: http://imha.net/index.php?option=com_content&task=section&id=18&Itemid=83 NEWSLETTER April 2011 – page 6 / 6 MEMBERS’ SECTION FROM THE BOARD IMHA Board Meeting 15th March 2011 The IMHA Board met during March in London at the Foundation of St Katharine near the London docks. All board members were present except for Dr Ilona Denisenko whose travel was sadly disrupted by visa problems. Minutes of the previous two meetings were agreed, and the accounts for 2010 approved. Plans were put in place to finalise the budget and work programme for the remainder of 2011. A new Board Rule was adopted covering the detailed framework for project administration. The Board then discussed adoption of a code of ethics, and it was agreed that IMHA would adopt the ethical code of the World Medical Association. Membership continues to steadily increase, although all board members (and indeed all members) were urged to continue with their efforts to introduce more members of the maritime health world to join us. It was reported that the work of IMHA in maritime health has recently been featured on a Philippines TV programme which is accessible by internet on board ship. Our focus will continue to expand to embrace new areas of the world. Links with International Organisations (ILO, IMO, IOM, ICSW, WHO and the EU) were discussed, and remain strong. Particularly important is the progress being made with the Global Aids project reported elsewhere. Topics for future workshops were considered, and a number of workshops will be planned concurrently with ISMH in Odessa. The website will be reviewed, with more current news, more frequent updating and also links to national standards will continue to be built upon. The official Journal, IMH, continues to do very well and is well received. New projects to be developed and the possibility of raising further funding from the ITF and from other bodies were seriously considered, and a number of ideas are now being developed. Management of the Safe@sea project has been handed from Andra Ergle to Rob Verbist, but there will be no significant input required from IMHA until next year. Arrangements for the ISMH in Odessa continue to progress, and the IMHA office will be working closely with the organisers to facilitate communications. Invitations have been sent out to many national and international stakeholders, and members will be encouraged to register soon for this important event. Training for health professionals in seafarers’ welfare is to be arranged just before the Symposium. The meeting closed after four hours, to reconvene on the following day when a stimulating discussion on IMHA’s future ensued. The results of this discussion will be presented at the General Meeting in Odessa. The next board meeting will take place in July in London, in order to finalise arrangements for the GM. Sally Bell, IMHA Secretary SHIP’s Visitors Course, Odessa, SEP 2011 Dear IMHA Members, ICSW and IMHA are planning to conduct an ICSW Ship Welfare Visitor Course (SWVC) on the 3rd and 4th of September 2011 in Odessa. This course is sponsored by the ICSW and is supported by IMHA.The SWVC will be available without charge to the first 20 participants on a first come basis for those attending the ISMH11. IMHA members desirous of attending will need to register with the certified trainer at [email protected]. A minimum number of 12 participants is necessary to run the NEWSLETTER April 2011 – page 7 / 7 course. There will be a system of continuous assessment and an evaluation at the end; successful participants will be informed of the result within three months. The ICSW - Ship Welfare Visitor Course (SWVC) is a two day attendance course designed as an introduction to maritime terminology, organisations, ship types, shipboard routines, protocols, seafarer’s issues, personal safety in port facilities and onboard ship. With increasingly fast turnaround of ships, coinciding with smaller crews, seafarers often have little time to go ashore and there is, consequently, an ever increasing need for ship visitors. Course Aim To equip ship visitors with a full appreciation of protocol, personal safety and security issues relating to port facilities and ships. Course Objectives 1 To provide an overview of shipping organisations 2 To introduce Marine Industry custom and practice 3 To describe ship types, shipboard organisation, trades and specific hazards 4 To highlight the current security issues 5 To facilitate personal safety of people visiting port facilities and ships The course was developed by the Merchant Navy Welfare Board UK and is accredited by the Nautical Institute (an international professional association) as it was considered important to gain proper recognition for the course and to establish an appropriate standard for the training. Successful participants will be issued a SWVC pass. The SWVC pass is not currently required by all ports but, as time passes and the system becomes better known, this system of accreditation will become very useful - especially if security in ports becomes stricter than it is already. For enquiries contact Suresh Idnani at [email protected] Dear IMHA Members, The IMHA board is exploring the possibility of initiating research projects on ‘Current Health Concerns affecting Seafarers’, from the point of view of medical professionals in the field. Some topics already suggested for consideration are: • • • • • • • • • • • Cardiovascular problems, hypertension Diabetes mellitus and other endocrine problems STD & HIV Obesity Malaria and other infectious and communicable diseases Eye conditions Dental problems Emergencies needing surgical intervention Pregnancies and complications CNS & neurological disorders Renal problems including nephrolithiasis • • • • • • • • • • • Hepatobiliary problems including gallstones Gastrointestinal problems Skin conditions ENT problems Respiratory illnesses Psychiatric and psychological conditions, mental stress Back injuries, locomotor & physical disabilities Lifestyle diseases Use of medications Drugs of abuse Other occupational injuries/diseases The board invites all IMHA members to be involved with these exciting IMHA projects, and requests your opinions, suggestions, views and expertise so as to ensure a broad participation with identification of health concerns from across the globe. To take this further, we would like to conduct a simple survey to identify the top ten most relevant medical conditions to explore, either from among the ones above or any others that you have found evidence of presenting an important health concern for seafarers in your geographical area of practice. Please email your list of 10 most relevant conditions, along with any other input or suggestions at [email protected] Suresh Idnani, IMHA President NEWSLETTER April 2011 – page 8 / 8 IMHA QA programme From ALF MAGNE HORNELAND The QA standards are now ready for pilot testing, and we plan a full roll-out of the QA project in 2012. As you all know, a grant from TK Foundation has enabled IMHA to develop a set of standards for describing best practice for medical examiners and their clinics, with regard to the pre-employment medical examinations of seafarers. In conjunction with the board meeting in London in March, an initial group of assessors were trained by CHKS, and we are happy to announce that all assessors passed the exam and are now ready to do their part of the work! The assessors The initial training resulted in the following duly qualified assessors: Joseph Abesamis, Sally Bell, Luisa Canals, Tim Carter, Andra Ergle, Alf Magne Horneland, Suresh Idnani, Nebojša Nikolic, Bas Rikken, and Rob Verbist. Ilona Denisenko should have participated at the training, but unfortunately was hindered from coming to London. Pilot The standards are ready to be tested in a pilot. Thereafter revision or amendment of the standards will take place. By the end of this year the standards should be ready to use in practice, and the programme will be rolled out. IMHA QA Standards and ISO Many clinics today meet the requirements of ISO accreditation. This means that they have pretty good standards regarding bookkeeping, organisation, planning, working conditions and reporting systems. What ISO does not include is a medical best practice evaluation. IMHA QA standards describe a professional level which ranks above ISO, and is a far better marker of medical quality than ISO. Assessor training, London March 2011. Trainees and trainers Improvement or accreditation? The IMHA QA programme is more about participation in quality improvement than accreditation. Of course accreditation will be a part of the programme, but the paramount objective of the programme is to make participant continuously work with quality improvement. Participation in the programme gives access to support regarding how to improve quality. The programme includes both improvement and accreditation. How will it work in practice? On entering upon the programme a self-declaration must be completed, confirming that the clinic or doctor have met the standards marked essential. If the clinic or doctor does not yet meet the essential standards, they will be advised to work towards these standards, and will be included in the programme when essential standards are met. Now starts the real work towards IMHA recommended quality. The clinic is allowed a certain period of time to work towards the higher level. When the clinic through its self-evaluation thinks they are ready for an assessment, this will be arranged by the QA Programme. One or two assessors will arrive for the practical conduct of the assessment. The assessment will include documentation evaluation, interviews, a physical visit to the clinic, discussions etc, to assess whether the clinic meets the standards of IMHA recommended quality. A white list Clinics participating in the programme and meeting the requirements of the essential standards will be listed as participants of the programme on a white list published on the website. Clinics meeting the IMHA recommended quality will be listed as IMHA accredited clinics. NEWSLETTER April 2011 – page 9 / 9 The quality circle When the clinic has met the requirements of IMHA recommended quality, the improvement process does not stop. Within the period of valid accreditation the preparation for a next round will have to take place, and by the end of the accreditation period – at latest – a new assessment will have to take place to ensure a place on the white list for the next period. More than accreditation Participation in the programme will give access to newsletter, guidance to better quality, participation in improvement collaboratives in addition to being a highly reputed clinic or doctor. Further development Maritime medicine is far more than medical examinations. IMHA want to develop standards also for other types of service, such as port health clinics, repatriation services, occupational health services and maritime telemedicine. This will widen the scope of the accreditation system, and make it even more interesting to be a member of the system. Management The programme is supervised by President Suresh N Idnani, acting as Project supervisor in accordance with IMHA Board Rules regarding project administration. The manager is Alf Magne Horneland, and an executive committee consisting of Professor Tim Carter and Dr. Sally Bell in addition to the supervisor and the manager will ensure a smooth and effective management of the programme. LETTERS TO THE MEMBERS and THE BOARD ORTHOKERATOLOGY AND FITNESS TO WORK AT SEA From Tim Carter A number of seafarers have recently come for medical fitness examinations who have been using orthokeratology. This is the use of contact lenses that are worn overnight to correct their distant vision. These lenses are rigid contact lenses that are worn during sleep. They are designed to reduce the curvature of the cornea by applying differential pressure. They are an alternative to spectacles or daytime contact lenses in those needing moderate correction (<4.5 dioptres sphere, <1.5 dioptre astigmatism). They exert their effect after use over several nights and the correction lasts all waking hours if successful. If the lenses are not regularly worn vision slowly reverts to its former state over the next 1-2 weeks. In general they are prescribed for young people without presbyopia who do not want to wear other appliances. A high level of supervision is needed for the first month of use, but about 75% of those who start use continue with these lenses. Complications such as infection are rare but some people do not tolerate night wearing and tear quality is important for comfortable use. Any such problems normally become apparent during the initial trial period and do not usually develop later. Regular six monthly followups are normally required. OrthoK lenses (one of the main brands) are relatively costly: c. £100 for initial fitting and c. £40 per month. A small number of contact lens practitioners specialize in prescribing them. Several features make these devices unsuitable as a means of vision correction for those who do safety critical navigational lookout duties: • Compliance is dependent on the individual and it will not be possible to be sure of the degree of visual correction present at any time. • A regular daily pattern of sleep is needed when the lenses must be worn. Watchkeeping schedules may pose problems with compliance • If lenses are not used for a period and acuity changes it is not possible to use spectacles or conventional day-use contact lenses to correct vision as the prescription changes day by day. • While there is no subjective evidence of problems with low light or low contrast acuity this has not been formally investigated. As with corneal refractive surgery large pupil size at night may lead to light entering the eye from beyond the zone of correction • Spectacles or contact lenses can always be used as a preferred, tried and tested means of improving acuity to meet statutory standards. Given the cost and time taken to gain the benefits from these lenses it is unlikely that they will be used solely to improve vision for a seafarer fitness examination, when spectacles or conventional contact lenses will achieve compliance more simply. Those who use these devices should normally be certified as unfit for lookout duties, except possibly in the case of those who have a history of good compliance and return to home port for a regular pattern of sleep each night. NEWSLETTER April 2011 – page 10 / 10 The above considerations are of less immediate relevance to engineering and other crewmembers, whose need for distant vision is less safety critical. Decisions for these seafarers should be taken on a case-by-case basis. However a good record of compliance with use, a stable level of correction and a pattern of leave that ensures access to the prescribing optometrist for follow up checks is essential. Confirmation should be obtained from the optometrist that these criteria are met. FROM THE OFFICE In January the IMHA Office has sent your MEMBERSHIP RENEWAL FORM by email in an attachment as PDF format. Those who haven’t paid up to now, please do before the end of May, otherwise your membership will be cancelled. Renewal fee for 2011 is still the same as last year : 125€ If you have any question on this, just let us know at [email protected] “HAPPY EASTER !” MARITIME MEDICINE AROUND THE WORLD TRAINING IN MARITIME MEDICINE FOR MEDICAL STUDENTS – A STUDY AFTER 3 YEARS EXPERIENCE Assoc. Prof. Hristo Bozov, MD, PhD – Medical University – Varna Department of General surgery, anesthesiology and intensive care at the Medical University – Varna Although the Republic of Bulgaria is a coastal country, Maritime Medicine has not been taught to students in medical universities and did not exist as a medical specialty until 2008. There were the beginnings of a study of individual directions of Maritime Medicine, but rather fragmented and scattered. Systematic research, in this specific medical field, has also not been accomplished. Training in the other parallel specific medical specialty, Aviation Medicine, which has been available for a long time, shows that Maritime Medicine lags far behind. Initiated by Assoc.Prof. Dr. Hristo Bozov, Chairman of the ‘Maritime Medicine’ Section and Vice-Chairman of the ‘Bulgarian Society of Aviation, Space and Maritime Medicine’, a team of lecturers of the three higher medical and maritime structures in Varna was formed: the Medical University (MU-Varna), the Military Medical Academy (MMA-Varna) and the Naval Academy (NA-Varna). Besides the academic society, a strong interest was shown by the shipping industry and maritime business, the Naval Forces of the Republic of Bulgaria, and because of its present interest by the local and national media. A successful step in terms of educational activity was the launching of a study program of Maritime Medicine as a free elective course for students lasting 30 hours (24 lectures and 6 practical classes). Research and publications could be helpful for the infusion of Maritime Medicine into the scientific specialties. The Maritime Medicine Training Program was adopted in 2008 by the Academic Council of the Medical University-Varna. MARITIME MEDICINE PROGRAMME EDUCATIONAL/TRAINING ACTIVITY Lectures (24 hours): 1. Maritime Physiology – 2 hours. 2. Diving Medicine – 4 hours. 3. Maritime Toxicology - 2 hours. 4. Emergency on board of ships – 2 hours. 5. Water – Rescue activities – 2 hours. 6. Maritime Psychology – 2 hours. NEWSLETTER April 2011 – page 11 / 11 7. Hyperbaric Oxygen Therapy – 2 hours. 8. Maritime expertise – 2 hours. 9. Telemedicine – 2 hours. 10. Sea treatment and Thalassotherapy – 2 hours. 11. Current aspects in the development of Maritime Medicine – 2 hours. Practical classes (6 hours): Organization of Maritime Service and Maritime Expertise – 2 hour. 2. Diving and Hyperbaric Medicine – 2 hours. 3. Maritime Toxicology – 2 hours. SCIENTIFIC ACTIVITY 1. Breathing modes for dives and conduction of hyperbaric oxygenation – research studies. 2. Maritime expertise of seafarers. 3. Psychological help for s undergone pirate captivity. 4. Research and summary of the results of collected database in providing emergency on board of ships 5. Telemedicine – opportunities for seafarers working on board of ships. The management of the program is the first step and the ultimate goal is to create a working group of experts and representatives of the relevant institutions to work in the following areas: Development of a national strategy on Maritime Medicine. Training of specialists/professionals of different levels. Inclusion of Maritime Medicine in the subjects studied at the Medical University – Varna and a creation of “Maritime Medicine” as a separate medical specialty. The team of lecturers chose the coursework as a form of assessment. The topics are formulated in advance of the speakers. Students decide by themselves the field of Maritime Medicine in which they will operate and produce their coursework within a month. It turns out that the coursework is very relevant as it stimulates and enables students to develop their creative potential in the field that most interests them. Analysis shows that there is a majority of high scores. By itself it is a guarantee of a genuine and deep respect of students towards the preparation of the coursework. During the second semester of the course in Maritime Medicine it was necessary to increase the numbers of participants due to the big interest from students. Small changes were made in the lecture course and practical exercises in order to be most effective for students. As an additional speaker was included – Assoc. Prof. Stamat Stamatov, with his lecture “Sea treatments and Thalassotherapy”. For the third training course another speaker was included from abroad – Dr. Ilona Denisenko from Russia. Each participant who has written and passed a coursework, corresponding to the teachers’ requirements, has been evaluated and received a certificate of a successful completion of the course. The top-performing students have been awarded from sponsors and from the MU-Varna. The prize after the first course was a one-year scholarship. Upon the successful student completion in both semesters, the lecturer team decided to organize additional sport activities. Two rowing expeditions were held, together with the marina “Varna - S.T.” and the university “Ski and Tourism” club. Participants assessed them as very useful and interesting, so it is expected for them to become a tradition for the Maritime Medicine course and to be organized annually. NEWSLETTER April 2011 – page 12 / 12 Results: 1. There is an exclusive interest of medical students and graduated doctors. 2. The “Maritime Medicine” course found its place in the curriculum of the Medical University-Varna and does not cause problems such as overlapping themes, duplication of courses, etc. 3. Lecturers from various participating organizations are highly motivated and have an interest in the development of the discipline. 4. A guarantee of the correctness of the decision to introduce the discipline into the curriculum is the increased public interest in Varna. 5. The curriculum of only 30 hours is insufficient for the serious topics of the course. 6. Practical classes cause great interest and should be considered a form and way to increase them. 7. Additional activities in relation with the training include students from the program and others who are interested in taking part. Therefore, these activities should be extended. 8. After clarification and implementation of the working part of the “Maritime Medicine” project, a research activity will be started. To do so, the existing facilities of the participating institutions should be optimum used and MUVarna should develop such by itself. 9. As a result of the experience gained and setting up a team, it is necessary to look for opportunities to participate in research projects funded at national and European level. Conclusion: For a short period of three years, a team of doctors and other professionals succeeded in meeting the public need for the creation and development of a new medical discipline “Maritime Medicine”. Leaders and lecturers work towards its continued development and expansion with the trend to introduce the discipline as a separate specialty in the training of Medical Students in the city of Varna. The ambition is to expand the programme also by attracting more students and teachers from abroad. Address: 9000, Varna, Bulgaria 55 ‘Marin Drinov’ Str Medical University – Varna Department of General and Operative Surgery, Anesthesiology and Intensive Care Assoc. prof. Hristo Bozov, MD, PhD, [email protected], tel.: 052/668 117, fax: 052/ 659 152 References/Literature: 1. Hr. Bozov. Decompression disease – tactics of treatment. Notices of the Union of scientists – Varna, series ”Medicine and ecology” 2/97, 1/98, p. 22-24. 2. Bozov Hr., V. Aleksandrov, N. Petrov. Hyperbaric Medicine – history and development. Medical Journal 2003, p. 3-7. 3. Bozov Hr., N. Petrov. Hyperbaric oxygenation – development and connection with the anaesthesiology and reanimation. Anaesthesiology and Intensive Treatment 2003, p. 65-68. 4. Bozov Hr., A. Klisarova, B. Mednikarov and others. Maritime Medicine in Bulgaria - where and why? Symposium records of VII Conference of the Bulgarian Association of Aviation, Maritime and Space Medicine. 2008, p. 13-17. 5. Vajarov, Iv., Hr. Bozov. History of the MBAL – Varna to the Military Medical Academy: 60 years in service of health, science and education. Historical and medical collection. Museum act and history of medicine, Year 6, 2010, p. 59-62. 6. Zlateva Sn., M. Yovcheva, P. Marinov and others. Early aksonopatia of sensory nerves and late tendinitis in patients after pricking of fish "Sea Dragon" / Trachinus Draco. Symposium records of VII Conference of the Bulgarian Association of Aviation, Maritime and Space Medicine. p. 38-46. 7. Stavrev D., L. Silov./ Ставрев Д., Л. Силов. Водно-спасительная служба города Варны – Вiесник Морскоï Медицины, 2007, 2-3 (36), p. 24-28. 8. T. Stoyanova, Beginning and Development of mud treatment in Bulgaria during the first half of the twentieth century. Historical medical collection. Museum act and history of medicine, year 4-5, 20082009, p. 23-27. NEWSLETTER April 2011 – page 13 / 13 A centre to call their own Condensed from the Times Shipping Journal, India The Seafarers' Health and Welfare programme in India got a boost on February 14, 2011 with the opening of a ‘Seafarers Health & Welfare Centre' in Mumbai, which will try to fill the void that existed in the Health and Welfare programmes for seafarers in the country The Centre was inaugurated by Dr. S.B. Agnihotri IAS, Director General of Shipping, Government of India and S Hajara, CMD, Shipping Corporation of India in the august presence of major stakeholders of the Indian shipping industry. The centre is the result of the tireless efforts of Dr Suresh N Idnani, president of the International Maritime Health Association (IMHA). A trustee of International Committee on Seafarers Welfare (ICSW), Dr Idnani is also president of the Seafarers Welfare Association of India (SWAI). South Asia and in particular India has taken a leading step in furthering the aims and objectives of the associations in the region through concentrated efforts by international and national nongovernment organizations and stakeholders of the shipping industry, and in that the role played by Dr Idnani cannot be ignored. At a recent ICSW awards nominations ceremony, there were only two nominations from South Asia. While Kandla Seafarers Association was nominated in the category of ports, Dr Idnani was credited for the category Welfare Personality of the year 2010. Dr Idnani was nominated for "being at the heart of the movement to put the welfare of seafarers at the top of the agenda. He took up this somewhat thankless task in South Asia at a time when few people were aware of the importance of the issue. As a result of his continuous follow up, efficient delivery systems for seafarers' welfare were established all over the region. More than 10 port welfare committees now function in India. The Colombo Port of Sri Lanka leads the way in welfare matters and countries such as Bangladesh and Pakistan are now on the welfare map," says the nomination. At the centre, Dr Corinne Idnani helps her husband to give shape to his dreams and objectives. The centre boasts of a dedicated room for seafarers’ welfare activity, with internet, library, telephones, TV and DVD and other informative videos. A pantry to serve tea, coffee, snacks and cold drinks and professionals and welfare workers to provide counselling services to address stress, HIV, trauma etc. The centre has arranged to provide the assistance of local Bishops (Catholic and Protestant) to the seafarers, if and when required. Transport to and from the ports and to other destinations like airport, railway station, bus stand, places of worship etc., has also been provided. Provisions have been made to provide onshore accommodation and for meeting the members of Mumbai Port Welfare Committee, for the coordination of ship visiting. The centre will also be open to offer its services for the facilitation and for the conduct of training programmes for ship visitors and port state control inspectors, in consultation with national maritime authorities and stakeholders of the Indian shipping industry. The Idnani Family NEWSLETTER April 2011 – page 14 / 14 COLUMNS THE CRUISE CONNECTION by Eilif Dahl, MD, MHA, PhD University of Bergen, Norwegian Centre for Maritime Medicine Cruising for the health of it When I started as a ship’s doctor for Royal Caribbean Cruise Line, the company had only one ship (now 40!) and one physician. There were few rules and regulations, and the two nurses who were aboard when I arrived, had been told, ‘Just bring a bikini and a long party dress – and enjoy!’ It had taken them by surprise that they occasionally had to work, although it was mostly simple nursing to the next port. There was no lab or monitoring equipment and very limited treatment options. The doctor was introduced at the Captain’s welcome cocktail party to the passengers as follows, “This is the ship’s doctor. He is the only person I don’t like to see busy!” The captains still use that phrase, but today it’s mostly wishful thinking. Like medicine ashore, cruise ship medicine has advanced considerably since my early days. Most crew members have far easier access to medical expertise and better primary health care on cruise ships than at home, and a cruise ship is usually not a bad place for a traveler who suddenly falls ill. The larger ships have diagnostic and treatment possibilities that surpass those of many ports and medical staff qualified to take advantage of them. A smaller ship can also be good for your health. Here are a few cases I saw during my first weeks aboard my latest ship, cruising along the Mexican Riviera with about 600 passengers: * A middle-aged lady experienced some uncharacteristic chest discomfort and when reporting to the Medical Center on board, she had normal clinical findings, a normal EKG and negative cardiac enzymes. Four hours later, after uneventful monitoring aboard, her enzymes had turned positive and EKG showed signs of non-STEMI myocardial infarction. She was promptly hospitalized in a local port and underwent successful cardiac surgery the next day in USA. * An elderly gentleman who presented with fast atrial fibrillation and manifest pulmonary edema was sent by tender boat to a local hospital, which – overwhelmed – started to arrange a 5-hour mountainous ambulance ride to a better medical facility. Instead the then unconscious patient was retrieved from ashore and treated intensively aboard while waiting for a US air ambulance team. When it arrived some hours later, he was clinically comfortable with an irregular but acceptable heart rate and clear lungs. * A 90-year-old lady with an implanted pacemaker was admitted after sudden right-side paralysis followed by seizures. EKG showed atrial fibrillation and no pacemaker activity. After seizure treatment she regained full limb function before debarking for pacemaker correction ashore. * A 90-year old gentleman presenting with ‘the shakes’ (41oC) had 3 years earlier been diagnosed with lung cancer and had both a colostomy and a nephrostomy because of intra-abdominal metastases. He was successfully treated for urosepsis, and at follow-up a few days later his wife had already booked their next cruise. ‘He enjoys life and intends to live forever,’ she said, ‘And, well, so far, so good…’ Despite having to deal with such challenges, cruising is mostly good for the health of the ship’s doctor, too. Living alone ashore with no interest in cooking, I could – and did - sample more different and healthy sorts of food in one day aboard than I see at home in a whole month. But it takes self-discipline, if one doesn’t watch it, it will not be the travel that is broadening, - it’s all the rich food one is constantly tempted to try. Fortunately, the jogging track, the spa, and the pool were only a few decks away from my cabin and the local winter temperatures encouraged pleasant use of these facilities every morning. So despite all the food regular physical activity made it possible to keep shipshape instead of adopting the shape of the ship. Furthermore, the spa offered a wide variety of wellness options and in most cases was not too far off when claiming, ‘We can’t make you younger, but we’ll make you look fantastic for your age’. NEWSLETTER April 2011 – page 15 / 15 Also the friendly and helpful attitude from all crew and coworkers aboard did wonders for the doctor’s mental health. Not many years ago, smoking was allowed all over the cruise vessels. This has now changed – with resulting health and safety benefits. Smoking at sea – as on land - is about to become socially unacceptable, and another serious fire hazard has been reduced if not totally eliminated. On my last ship, smokers were only allowed to light up at one small coffee station in an open deck area. When passing ‘the pariah colony’ one day, I overheard the tail end of a conversation between an old, pale and frail smoker and a nicely made-up, well-preserved lady. While he was recovering after a particularly vile coughing spell and gasping for air, she asked with obvious (prenuptial?) concern, ‘…but I hope your wallet is still healthy?’ BOOKSHELF Medical Handbook for Seafarers The Finnish Institute of Occupational Health By Heikki Saarni, Leena Niemi Now Free of Charge in the Internet This easy readable book with lots of pictures is now available free for everyone in the internet. The book takes into account real, everyday medical needs in board ship. With this book the master will be able to take care of medical situations on board ship until the sick or injured person can be sent for proper treatment on shore. http://www.ttl.fi/en/publications/Electronic_publications/Pages/default.aspx or http://www.ttl.fi/en/publications/Electronic_publications/Documents/Laivasairaanhoito_engl.pdf Anything can happen on board a ship, just as it can on land - for example cuts, abdominal or chest pain, poisoning, hypothermia etc, requiring stitches, fast pain relief, first aid, and other treatment. This new, practical handbook gives clear instructions concerning medical first aid and treatment required on board ships until the sick or injured patient has been healed or transported to land for further treatment. The Medical Handbook for Seafarers helps those responsible for medical treatment on board to decide on the best action to take based on the symptoms and situation at hand. The handbook provides advice on when to consult a doctor by Radio Medical or when to urgently transport the patient to land for medical treatment, depending on the different complaints and illnesses. Clear, illustrative photos, key-point tables and diagrams make the treatment procedures simpler. The handbook is also suitable as a textbook for seafarers undergoing STCW basic and further medical training. VOICES FROM THE PAST THE MARINES’ HYMN By Ilona Denisenko Few US Marines know and even fewer Greeks, that the Marine's Hymn celebrates the very first joint Greek and American military cooperation. It took place in 1805 and resulted in the release of 308 Americans held hostage for ransom by pirates. The reference to American Marines in action on "the shores of Tripoli” commemorates the attack on a stronghold of the Pasha of Tripoli (Libya), who along with the rulers of three other petty North African states, Morocco, Tunis and Algiers, practiced piracy against commercial shipping in the Mediterranean in the eighteenth and nineteenth century. Known as the Barbary pirates, these tribal autocrats sent their sailing ships known as corsairs to attack merchantmen for loot and to capture sailors and travelers whom they held for ransom. The Americans, who were commercially active in the Mediterranean, suffered numerous humiliations at the hands of the pirates and were forced to pay substantial amounts of tribute money to them. At one time a man-of-war, the USS George Washington, was forced by the Bey of Algiers to haul down its flag, replace it with that of the Bey and carry the Bey's Ambassador to Constantinople carrying presents for the Sultan. When the American captain protested the Bey told him: "You pay me tribute, by which you become my slaves. I have therefore, the right to order you as I may think proper.” NEWSLETTER April 2011 – page 16 / 16 Inevitably things came to a head and war broke out between the US and the Pasha of Tripoli. However, one of the frigates, the Philadelphia, sent to block and bombard the port-town of Tripoli, hit a reef and its captain and 307 men were taken prisoners by the Pasha. A small contingent of U.S. sailors in a disguised USS Intrepid (which looked like a local vessel because she had been captured by the Navy when she left Tripoli three months earlier) and led by Lieutenant Stephen Decatur were able to invade the harbour of Tripoli and burn the Philadelphia, denying her use to the enemy. A subsequent naval attack against Tripoli resulted in a series of inconclusive battles. At this point the American Consul at Tunis William Eaton, a former army officer, decided to act. He persuaded President Thomas Jefferson that neither bombardment nor a blockade would yield results and that only a land attack on Tripoli would force the Pasha's hand. Eaton's plan, accepted by Washington, called for an alliance with the pretender to the Tripolitan throne, who was in exile in Egypt, to aid him militarily to overthrow the Pasha of Tripoli. The implementation of Eaton’s plans is detailed in his papers and correspondence, which Professor Harry Psomiades, Director of the Centre of Byzantine and Modern Greek Studies, Queen's College, made public in 1977. A detachment of nine Marines were sent to help Eaton under the command of Lieutenant Presley O'Bannon. After reaching an agreement with the pretender, they proceeded to organize a small army comprised mostly of Arabs and a few Europeans. The most reliable contingent other than the Marines was a company of 40 Greeks, fully armed and led by two captains. Eaton's army made an epic march across the Libyan desert from Egypt and stormed Tripoli's second most important city, Derne. Eaton then made preparations to attack the main port city of Tripoli. In his report Eaton cites the number of casualties his army suffered which included three marines. He adds that the rest were "chiefly Greeks, who in this little affair, well supported their ancient character.” He also notes that the Greeks had saved the whole operation, including his own life and that of the Marines, when prior to the attack the Arab recruits conspired to rebel, kill the Americans and steal the war chest they were carrying. Fortunately the Greeks got wind of the conspiracy and neutralized it. The fall of Derne alarmed the Pasha of Tripoli who compromised with the Americans and released the prisoners. President Jefferson conducted secret negotiations without Eaton's knowledge and paid $60,000 for the release of the prisoners. Washington also signed a peace treaty with him. In agreeing to pay a ransom of sixty thousand dollars for the American prisoners, the Jefferson administration drew a distinction between paying tribute and paying ransom. At the time, some argued that buying sailors out of slavery was a fair exchange to end the war. William Eaton, however, remained bitter for the rest of his life about the treaty, feeling that his efforts had been squandered by the State Department diplomat Tobias Lear. Eaton and others felt that the capture of Derne should have been used as a bargaining chip to obtain the release of all American prisoners without having to pay ransom. Furthermore, Eaton believed the honour of the United States had been compromised when it abandoned Hamet Karamanli after promising to restore him as leader of Tripoli. He accused Washington decision makers of "betrayal,” submitting to a "dishonorable peace” and for "stabbing in the back” the American fighting men who had risked their lives. This first Greek-American military venture is now immortalized in the Marines’ Hymn: http://www.usa-flagsite.org/song-lyrics/marines-hymn.shtml USEFUL WEBSITES For useful websites with information relevant to maritime health, please follow the link below: http://imha.net/index.php?option=com_content&task=section&id=19&Itemid=84 UPCOMING EVENTS http://imha.net/index.php?option=com_content&task=section&id=15&Itemid=79
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