Fishing industry Fishing industry issues: International issues: International

and National and National implications. implications.

Environmental Environmental characteristics and characteristics and

Risk PreventionRisk PreventionM. Luisa Canals M. Luisa Canals PhD, MD. E-mail: lcanals@comt.esPhD, MD. E-mail: lcanals@comt.esMaritime Health Occupational MD, ISM Tarragona - Spain; Maritime Health Occupational MD, ISM Tarragona - Spain; Co-ordinator of the Postgraduate URV Course “University Specialist on Maritime Co-ordinator of the Postgraduate URV Course “University Specialist on Maritime Health;Health;Former IMHA President (International Maritime Health Association); Former IMHA President (International Maritime Health Association); Former SEMM President, Tech. & Scientific Direction of SEMM (Sociedad Española de Medicina Former SEMM President, Tech. & Scientific Direction of SEMM (Sociedad Española de Medicina Marítima)Marítima)

TRAINING COURSE ON MARITIME HEALTH, VININAM & UBOTRAINING COURSE ON MARITIME HEALTH, VININAM & UBOHaiphong - Vietnam, 20-26, Feb. 2006Haiphong - Vietnam, 20-26, Feb. 2006

Main contents of the Main contents of the presentation:presentation:

1.1. Global vision of fishing as an Global vision of fishing as an occupational activity and its health occupational activity and its health relations.relations. - International implications: ILO Conventions, IMO - International implications: ILO Conventions, IMO STCW-F … , Scientific societies IMHA …STCW-F … , Scientific societies IMHA …- Psychosocial factors - Psychosocial factors

2.2. Occupational risk preventionOccupational risk prevention-- Related to fishing tasks, environmental Related to fishing tasks, environmental conditions …conditions …- National implications: Organization in Spain- National implications: Organization in Spain- Research “- Research “SEGUMAR"SEGUMAR" study in Spain study in Spain

OCCUPATIONAL MARITIME MEDICINE - OCCUPATIONAL MARITIME MEDICINE - Maritime Med.Maritime Med.

OCCUPATIONALMEDICINE

MARITIMEACTIVITIES

ACCIDENTSPROFESSIONAL D.

PATHOLOGIES

FISHING MERCHANT M. PASSENGERS

• COASTAL• DEEP SEA

-COASTAL-OCEANIC

FERRIES CRUISES

PORT

NAVAL M.

SPORT

PREVENTION

INCAPACITYINVALIDITY

•SAILING•SURF•SWIMING•OTHER ….DIVING

APNEACOMPRESSED AIR

ESPECIAL MIXTURES

Global vision of fishing Global vision of fishing as an occupational as an occupational activity and its health activity and its health relationsrelations•Ergonomics: Ergonomics: Physic R: Physic R: vibration, ventilatvibration, ventilatioion, n, noisenoise

•Hygiene on Board: Hygiene on Board: Biological R: sanitation, water, Biological R: sanitation, water, food food

•Medical Fitness ExamsMedical Fitness Exams: : Health surveillance --- Health surveillance --- individual and collective epidemiology, COMPULSORY individual and collective epidemiology, COMPULSORY in Spainin Spain

•Welfare and sWelfare and social aspects: ocial aspects: mood, personal mood, personal and occupational and occupational ( (Stress, fatigue …Stress, fatigue …))

•SafSafety – ety – Survival: Survival: Disasters prDisasters protection …otection …•TrainingTraining – risk – risk preventpreventionion (O.health (O.health

educaeducattiioon)n)

Internacional Labour Organization:Internacional Labour Organization:Conventions OIT/ILO/BIT - Fishing Conventions OIT/ILO/BIT - Fishing Ind.Ind.

• C 112. Minimum age (1959)C 112. Minimum age (1959)• C 113. Medical Fitness Examination of fishermenC 113. Medical Fitness Examination of fishermen• C 114. Fishermen enrolmentC 114. Fishermen enrolment• C 125. Competence certificates (1966)C 125. Competence certificates (1966)• C 126. AccommodationC 126. Accommodation----------R 7. Hours of work (1920)R 7. Hours of work (1920)R 126. Professional training (1966)R 126. Professional training (1966)----------Tripartite Meetings of Experts – 1999 – 2003 – 2004 Tripartite Meetings of Experts – 1999 – 2003 – 2004

… … 2005 Superconvention + a complementary 2005 Superconvention + a complementary

Recommendation have not been approuved Recommendation have not been approuved because one vote.because one vote.Internacional Maritime Internacional Maritime

Organization:Organization:STCW-fSTCW-f

1.1. Infectious Diseases, Antwerp 1999 Infectious Diseases, Antwerp 1999 2.2. Cruise Medicine I, Miami 2000 Cruise Medicine I, Miami 2000 3.3. Practical Guide on Maritime Medicine, Vigo Practical Guide on Maritime Medicine, Vigo 4.4. Cruise Medicine II, Philadelphia Cruise Medicine II, Philadelphia 5.5. Health & Occup. Risk Prevention in Harbours, Health & Occup. Risk Prevention in Harbours,

Barcelona, 2002 Barcelona, 2002 6.6. Telemedicine, Rome Telemedicine, Rome 7.7. Health in the Fishing Industry, Cádiz, 2002Health in the Fishing Industry, Cádiz, 20028.8. 7th ISMH: 4 Seminars (G.B. Aspects, Med. Exam. 7th ISMH: 4 Seminars (G.B. Aspects, Med. Exam.

Standards, Occupational accidents & Diseases, Standards, Occupational accidents & Diseases, Maritime Activities), Tarragona, April 2003Maritime Activities), Tarragona, April 2003

9.9. Continuing Education in Maritime Health, Barcelona, Continuing Education in Maritime Health, Barcelona, Nov. 2003Nov. 2003

10.10. Working at Sea, Psychological Health Problems, Working at Sea, Psychological Health Problems, Riga, May, 2004Riga, May, 2004

11.11. Collection and Validation of Data in Maritime Collection and Validation of Data in Maritime Medicine, Brest, July 2004Medicine, Brest, July 2004

12.12. Drug and Alcohol Policies, Odessa, Sept 2005Drug and Alcohol Policies, Odessa, Sept 2005

IIMMHHAA

WWOORRKKSSHHOOPPSS

IMHA WS: Gral.: S. Fdo (Cádiz-Spain), IMHA WS: Gral.: S. Fdo (Cádiz-Spain), 2002 & Psychosocial Aspects: Riga 2002 & Psychosocial Aspects: Riga (Latvia), 2004(Latvia), 2004

• Directly related to fishing tasks (monotonous, Directly related to fishing tasks (monotonous, variable, unsafe, uncertainty, …)variable, unsafe, uncertainty, …)

• Overwork, rhythm, time pressure, especial Overwork, rhythm, time pressure, especial conditions (fatigue, nocturne work, number of conditions (fatigue, nocturne work, number of crewmembers …)crewmembers …)

• Sensation of control (stress, no decision …)Sensation of control (stress, no decision …)• Environmental conditions, work equipment,Environmental conditions, work equipment,

multiple risks and expositions: accidentsmultiple risks and expositions: accidents• Culture & organization: loneliness, Culture & organization: loneliness,

interpersonal relations, role conflicts, lack of safety interpersonal relations, role conflicts, lack of safety in work, low salaries, hard work, immigration, in work, low salaries, hard work, immigration, interferences with family life, social value …interferences with family life, social value …

Psychosocial factors Psychosocial factors characteristics – characteristics – A work culture in the fishing A work culture in the fishing industry – Difficulties in risk industry – Difficulties in risk prevention:prevention:1.1. Personal, Personal, attitud: fatality attitud: fatality

resignation, environmental, resignation, environmental, lack of training …lack of training …

2.2. Organizacional: Organizacional: group group relation, salary based on relation, salary based on the catch, lack of rest, the catch, lack of rest, insuficient crew, family, insuficient crew, family, multicultural, rights???multicultural, rights???

3.3. Institucional: Institucional: inspection, inspection, ergonomics, competence ergonomics, competence conflicts, rules and conflicts, rules and regulations, small ships ???regulations, small ships ???

22

Wilderness Medicine

Fishermen: work related Fishermen: work related exposuresexposures• Access:Access: risk different levels - to risk different levels - to

jumpjump

Fishermen: work related Fishermen: work related exposuresexposures• to walk on board:to walk on board: risk of slipping, strings, risk of slipping, strings,

cables and cables and other things other things like fish … like fish … on deck, on deck, water, grease, water, grease, narrow spaces narrow spaces …. ….

Fishermen: work related Fishermen: work related exposuresexposures• While fishing:While fishing:

trawling doors, pulleys, trawling doors, pulleys, cables , cables , nets ...nets ...

falls, bruises, contusions,falls, bruises, contusions,smashed, crushed ...smashed, crushed ...

Fishermen: work related Fishermen: work related exposuresexposures• Different risks according to the Different risks according to the

type of type of fishing and tasksfishing and tasks

Fishermen: work related Fishermen: work related exposuresexposures• Environment:Environment: noise, isolation, fatigue, hot, noise, isolation, fatigue, hot,

cold, nocturnes, stress, bad weather cold, nocturnes, stress, bad weather

PREVENTION:PREVENTION: recommendations E.g. Knees recommendations E.g. Knees and back painand back pain• Change position while Change position while

working, balanced weight, working, balanced weight, feet position, to facilitate feet position, to facilitate movements.movements.

• Adapt ergonomics till find the Adapt ergonomics till find the height to the efforts neededheight to the efforts needed

------------• Relax muscles: exercisesRelax muscles: exercises• Suitable equipment: clothes, Suitable equipment: clothes,

shoes, …shoes, …• Combine ergonomics of the Combine ergonomics of the

ship and psycho-sociology of ship and psycho-sociology of fishing work tasksfishing work tasks

IMO: IMO: STCW ConventionSTCW Convention [Ch. VI: sections A-VI/4.1 [Ch. VI: sections A-VI/4.1 minimum for all seafarers (pre-sea training) and 4.2 for minimum for all seafarers (pre-sea training) and 4.2 for persons in charge of medical care on board ships] persons in charge of medical care on board ships] (1978,1995)(1978,1995) … …

Directive 92/29/EECDirective 92/29/EEC [health, medical chest, [health, medical chest, medical assistance, safety, training]medical assistance, safety, training] RD RD 258/1999 258/1999 ... in Spain. ... in Spain.

31/1995 Occupational Risk Prevention Law,31/1995 Occupational Risk Prevention Law, special RD for fishing ships > 15-18 GT …special RD for fishing ships > 15-18 GT …

TrainingTraining(first-aid and medical care on board)(first-aid and medical care on board)

Health EducationHealth Education

CampaignsCampaigns

BOTIQUÍN ACAJÓN 2

BOTIQUÍN ACAJÓN 3

R.D. 258R.D. 258

B.O.E. 24/02/1999B.O.E. 24/02/1999

The system of health care for The system of health care for seafarers and fishermen in seafarers and fishermen in

SpainSpain

The SpanishThe SpanishRadio-Radio-MedicalMedicalAdvice Advice CenterCenter

HospitalHospitalShipsShips

An integrated system on board and ashoreAn integrated system on board and ashore

Coordination Data base

The maritime health programme The maritime health programme combines Health carecombines Health care & &

PreventionPrevention(A common computerised data base of (A common computerised data base of medical examinations, medical examinations, hospitalizations ,rediomedical consultations, repatriations…)hospitalizations ,rediomedical consultations, repatriations…) • On board:On board:

- Hospital ships taking care of the- Hospital ships taking care of the fishing fleet fishing fleet

- Telemedicine RMA … by Radio- Telemedicine RMA … by Radio (from 1979 in Spain) (from 1979 in Spain) • In the port of call: In the port of call: aand even and even abroadbroad• Occupational or General PractitionersOccupational or General Practitioners

NumberNumber ofof SeafarersSeafarers in in SpainSpain::((specialspecial nationalnational systemsystem andand data base)data base)

Instituto Social de la MarinaInstituto Social de la Marina

•• Social S. Social S. 20042004: 88.066 sea : 88.066 sea realatedrealated workersworkers•• Active Active workersworkers shippingshipping 6969.217 (2432 .217 (2432 foreignersforeigners))•• 10081+agreement 3707=merchant seafarers 10081+agreement 3707=merchant seafarers (588 (588 SpanishSpanish

flagflag merchantmerchant shipsships, , SpecialSpecial registerregister in in TheThe CanaryCanary IslandsIslands))

•• MostMost ofof themthem fishermenfishermen ((offshoreoffshore oror coastalcoastal andanddeepdeep sea sea fishingfishing) ) aboutabout 11442 11442 fishingfishing shipsships

•• AuthorisedAuthorised doctorsdoctors in a net: in a net: forfor medical medical fitnessfitnessexaminationexamination (2003: 64490), (2003: 64490), preventionprevention ......

SPAIN: Instituto Social de la SPAIN: Instituto Social de la MarinaMarina (1919) (1919) • It belongs to the State It belongs to the State

(Labour and Social Affair (Labour and Social Affair Ministry) About 100 Ministry) About 100 doctors in the Maritime doctors in the Maritime Health Programme Health Programme (1984)(1984)

• 35 Coastal Maritime 35 Coastal Maritime Health Centres and 7 Health Centres and 7 Abroad. Data base net.Abroad. Data base net.

• Radio-Medical Advice Radio-Medical Advice Centre, Hospital Ships ...Centre, Hospital Ships ...

National and connectedNational and connectedsystem: medical care, system: medical care, prevention, training, prevention, training, welfare, social ...welfare, social ...

Training centre in Bamio – Galicia - SpainTraining centre in Bamio – Galicia - Spain

Spanish doctors abroad Spanish doctors abroad (because of the fishing fleet)(because of the fishing fleet)

• St. Pierre et Miquelon St. Pierre et Miquelon (1968) - St John’s (1970-1998) / (1968) - St John’s (1970-1998) / • Beira Beira (Mozambique 1989 -1994)(Mozambique 1989 -1994)• Nouadhibou Nouadhibou (Mauritania - 1970) *(Mauritania - 1970) *• Dakar Dakar (Senegal - 1972)(Senegal - 1972)• Luanda Luanda (Angola - 1973) *(Angola - 1973) *• Walbis Bay Walbis Bay (Namibia - 1973) *(Namibia - 1973) *• Seychelles Seychelles 1987 - Mahe ….1987 - Mahe ….• -Madagascar – Monbasa (Kenia)-Madagascar – Monbasa (Kenia)• - Ship- Ship• Abidjan Abidjan (Ivory Coast - 1992) (Ivory Coast - 1992) (*) some few years interrupted activities because of (*) some few years interrupted activities because of

war, logistics. war, logistics.

2009

2659

2815

2714

2536

2502 1856

1836

1858

1821

1921

1946

1887

1811

1714

16271587

307

474

439

488

547

546

393

473

453

547

578

629

625

628

513

453430

0

1000

2000

3000

4000

5000

6000

7000

1987

1989

1991

1993

1995

1997

1999

2001

2003

From 1987 to 2003 (activities started in 1979)

number of calls number of cases evacuations

The Spanish Radio-Medical Advice CenterThe Spanish Radio-Medical Advice Center

Centro Centro Radio-MRadio-Méédicdicoo EspañolEspañolProportion calls:1 merchant /13 fishemenProportion calls:1 merchant /13 fishemen

Diseases: reumathology-MS, digestive, Diseases: reumathology-MS, digestive, neurology, dermatology, bad defined.neurology, dermatology, bad defined.

Satellite, 1.5 consultations /caseSatellite, 1.5 consultations /caseAccidents: Deck 76.8%, Engine 8.7%Accidents: Deck 76.8%, Engine 8.7%

0 0,2 0,4 0,6 0,8 1

diseases(22,6%)

accid(77.4%)

radio(32.4%)

inmarsat(67.6%)

Evacuations 27.1%

Treatment on board48.7%Athlantic O 64.3%

Africans 10.3%

Spaniards 75. 6%

Fishing 91 %

5

77

116

155158

500

510

309

55

VideosVideos

Research: e.g SEGUMAR Research: e.g SEGUMAR projectprojectIntroduction:Introduction: the SEGUMAR project is a the SEGUMAR project is a

research about the general state of the research about the general state of the Andalusian fishing fleet from the point of Andalusian fishing fleet from the point of view of the safety and the prevention of view of the safety and the prevention of occupational risks. As part of this survey we occupational risks. As part of this survey we analyze the health of the fishing personnel analyze the health of the fishing personnel (morbidity, use of medications and (morbidity, use of medications and lifestyles), work related accident and some lifestyles), work related accident and some aspects of the life at sea related with aspects of the life at sea related with fatigue.fatigue.

Methods:Methods: Cross-sectional study with Cross-sectional study with proportional sampling by conglomerates. proportional sampling by conglomerates. Questionnaire of health and lifestyles were Questionnaire of health and lifestyles were administered to a sample of 247 workers in administered to a sample of 247 workers in 19 of the 23 Andalusian ports.19 of the 23 Andalusian ports.

Results in coastal fishing:Results in coastal fishing: It's a population of middle age (40 years) with 17% of It's a population of middle age (40 years) with 17% of

workers with declared pathology. Within the main workers with declared pathology. Within the main problems of health, respiratory, digestive and problems of health, respiratory, digestive and musculoskeletal illnesses were the most frequently musculoskeletal illnesses were the most frequently presented. presented.

The use of medications on shore is high, analgesics, The use of medications on shore is high, analgesics, antibiotics and antacid were the most widely used. antibiotics and antacid were the most widely used.

Approximately 56% smoked, 8,5% of the fishermen Approximately 56% smoked, 8,5% of the fishermen recognizes consumption of illicit drugs and 6,5% with recognizes consumption of illicit drugs and 6,5% with a consumption pattern "regular". a consumption pattern "regular".

During the periods of boarding, medicines consumption During the periods of boarding, medicines consumption reaches to 20% of the fishermen and 6% show reaches to 20% of the fishermen and 6% show worsening of their health, emphasizing the digestive worsening of their health, emphasizing the digestive problems and mental health problems with no problems and mental health problems with no conditions of family isolation were verified. 76% of conditions of family isolation were verified. 76% of the workers has suffered some injuries on board the workers has suffered some injuries on board during their labour life, and a 43% of labour low during their labour life, and a 43% of labour low them for injuries at sea.them for injuries at sea.

• Health status damage is Health status damage is due in most cases to the due in most cases to the worsening of previous worsening of previous medical pathologies,medical pathologies,and less to incident problems and less to incident problems , emphasizing the , emphasizing the musculoskeletal, digestive musculoskeletal, digestive and mental health problems.and mental health problems.• A 76% of the fishermen A 76% of the fishermen have had some accident on have had some accident on board during their labor life, board during their labor life, and a 43% of them had sick and a 43% of them had sick leaves for injuries on board.leaves for injuries on board.

Conclusions:Conclusions:• Working injuries, actinic keratoses and Working injuries, actinic keratoses and

lesions in areas of exposed skin, lesions in areas of exposed skin, rhinosinusitis, bronchitis obstructive rhinosinusitis, bronchitis obstructive and high consumptions of medicines, and high consumptions of medicines, and tobacco were associated with and tobacco were associated with fishing.fishing.

• The recognized pattern of illicit drugs The recognized pattern of illicit drugs consumption doesn't show excessive consumption doesn't show excessive differences regarding the values differences regarding the values registered in Spanish adult population. registered in Spanish adult population.

• The injury rate in our environment is The injury rate in our environment is high but similar to the registers in high but similar to the registers in other studies on fishing population. other studies on fishing population.

• The concern about the fishing, and the The concern about the fishing, and the long work shifts are factors that the long work shifts are factors that the fishermen relate to the labor fatigue. fishermen relate to the labor fatigue. The diet on board should be related to The diet on board should be related to the digestive illnesses and with the the digestive illnesses and with the work shifts to the labor fatigue.work shifts to the labor fatigue.

Coastal fishingCoastal fishing

CONCLUSIONSCONCLUSIONS• In any country In any country

we have to make anwe have to make aneffort to adapteffort to adapthealth services to seahealth services to seafarer’s needsfarer’s needs, , deep sea and coastal fishermen deep sea and coastal fishermen should not be forgottenshould not be forgotten

•More research on their health has to More research on their health has to be implemented, we can share our be implemented, we can share our experiences in the next International experiences in the next International Symposium MH. Denmark, June, 2007Symposium MH. Denmark, June, 2007