The health care standards for merchant seafarers in WA need to be raised, according to Pilbara rural generalist Dr John van Bockxmeer.
COVID-19 has highlighted the issues that international merchant seafarers face when receiving health care in Australian waters. Over the course of the pandemic, the International Maritime Organisation estimated 400,000 seafarers globally were stranded on ships that were unable to be repatriated due to border restrictions.
While restrictions have now been lifted, secure border operations in Western Australia imposed barriers to receiving timely care during this period.
For those working in our northern regional hospitals, many of the issues seen pre-dated the pandemic. Doctors in port cities such as Karratha, Hedland and Geraldton frequently attend to the medical needs of these individuals who work one of the most hazardous jobs in the world.
Access to reliable primary care services is limited during months at sea. Between 2005 and 2012 the Australian Transport Safety Bureau recorded 245 incidents resulting in seafarers being seriously injured or dying. Furthermore, language barriers and limited finances make it less likely for these patients to seek appropriate care early.
Information provided regarding previous international ports visited and past medical history is commonly scant, and patients may present with more severe illness than previously communicated. Occasionally, cases such as meningitis, which may provide chemoprophylaxis of crew members, a difficult task if a berthed vessel has departed.
Practitioners witness instances of inappropriate self-care or symptom minimisation as patients may feel workplace pressures regarding the implications of accessing health care via their employers. Often these individuals support several family members and without access to sick leave have little or no financial surety.
West Australians reap great benefit from our minerals and resources sector, which relies heavily on these contractors to carry exports offshore. It might come as a surprise to know they are still not recognised as essential workers by the Australian Maritime Safety Authority.
Crew are isolated and operate in small teams away at sea together for prolonged periods. Seeing the psychological impact that an unexpected death and illness has on colleagues, has led to some charitable organisations providing support for those in crisis.
Despite this, medical care remains fragmented enroute to Australia and there have been instances of delayed presentation of malignancy and serious preventable illnesses. With stopovers commonly lasting less than 24 hours, rural clinicians are troubled with the dilemma of how to provide treatment according to Australian standards of care as the follow-up of investigations is difficult.
Increasing the awareness of the challenges faced when assessing and treating these vulnerable patients will help us work together to treat these individuals with respect and dignity. They are vital to our economy and greater resources could be provided by corporations alongside structured recommendations for care by health-care regulators.
Some suggestions that could help include:
- Mandatory information collected for patient encounters including ports visited, immunisations, occupational screening, correct contact details and a best possible medication history.
- Digital live video translation services to improve history taking and communication when non-English speaking patients are in our hospitals.
- Nominating a contact within each shipping agency for the communication of medical results and the safe transmission of personal information compliant with privacy legislation.
- A national ‘seafarer safety net’ using private industry funds to assist with the costs of sight, life or limb threatening interventions within the Australian health system.
- Open-access electronic medical record software that can be easily utilised by vessels with limited internet connection interfacing with Australian digital services. This may allow an Individual Healthcare Identifier to create non-resident MyHealthRecord data for patients who frequent various Australian health care facilities.