session 7 15 - dungan d - are international standards ... bergen 2014
DESCRIPTION
The Norwegian Sea Health Conference 2014, Bergen, 27-28th August 2014TRANSCRIPT
International Medical
Examination Standards
Are these enough or do we require additional standards of
the Insurers, Ship-owners and Manning Agencies
Dr Robert David Dungan
NSHC 2014
Bergen
Norway
It used to be so easy: Seafarer Recruitment
FIT DRUNK Brawler
NO PEME
Dead Quite
soon
Strong
Scurvy No ILO, IMO, SFM, ITF
Syphilis
INTERNATIONAL LABOUR ORGANIZATION
INTERNATIONAL MARITIME ORGANIZATION
Sectorial Activities Programme
ILO/IMO/JMS/2011/12
Guidelines on the medical examinations
of seafarers
With national fitness standards for seafarers varying widely,
the set of international guidelines adopted in 1997 (the
Guidelines for Conducting Pre-sea and Periodic Medical
Fitness Examinations for Seafarers) was a first attempt
towards harmonization. The increasing internationalization
of shipping makes such harmonization even more
desirable. Medical practitioners performing such
examinations should have a clear understanding of the
special requirements of seafaring life, as their professional
judgment is often critical to the lives of seafarers. All
concerned should be able to trust a seafarer’s medical
certificate as having been issued in accordance with the
relevant applicable international standards.
ILO and IMO introduced the new guidelines
to medical fitness to work at sea. This was
then backed up by the STCW and the
Manila Convention(2006). These came into
play in October 2013.
Disseminating these Guidelines and ensuring their
implementation should contribute towards harmonizing the
standards for medical examinations of seafarers and
improving the quality and effectiveness of the medical care
provided to seafarers.
Intention of these Guidelines
Purpose and scope of the Guidelines
1. Seafarers are required to undergo medical examinations
to reduce risks to other crew members and for the safe
operation of the ship, as well as to safeguard their personal
health and safety.
2. The MLC, 2006, and the STCW Convention, 1978, as
amended, require a seafarer to hold a medical certificate,
detail the information to be recorded and indicate certain
specific aspects of fitness that need to be assessed.
3. These Guidelines apply to seafarers in accordance with
the requirements of the MLC, 2006, and the STCW
Convention, 1978, as amended. They revise and replace
the Guidelines for Conducting Pre-sea and Periodic
Medical Fitness Examinations for Seafarers, published by
the ILO and WHO in 1997.
4. When implementing and utilizing these Guidelines, it is
essential to ensure that:
(i) the fundamental rights, protections, principles, and employment
and social rights
outlined in Articles III and IV of the MLC, 2006, are respected;
(ii) from the point of view of safety of life and property at sea and
the protection of the marine environment, seafarers on board
ships are qualified and fit for their duties; and
(iii) medical certificates genuinely reflect seafarers’ state of health,
in light of the duties they are to perform, the competent authority
shall, after consultation with the ship owners' and seafarers’
organizations concerned, in giving due consideration to applicable
international guidelines referred to in Guideline B.1.2 of the MLC,
2006, prescribe the nature of the medical examination and
certificate, as outlined in Standard A.1.2.2 of the MLC, 2006.
5. These Guidelines are intended to provide maritime
administrations with an internationally recognized set of criteria
for use by competent authorities either directly or as the basis
for framing national medical examination standards that will be
compatible with international requirements. Valid and consistent
guidelines should assist medical practitioners, ship-owners,
seafarers’ representatives, seafarers and other relevant persons
with the conduct of medical fitness examinations of serving
seafarers and seafarer candidates. Their purpose is to help
administrations establish criteria that will lead to equitable
decisions about who can safely and effectively perform their
routine and emergency duties at sea, provided these are
compatible with their individual health-related capabilities.
6. These Guidelines have been developed in order to
reduce the differences in the application of medical
requirements and examination procedures and to ensure
that the medical certificates which are issued to seafarers
are a valid indicator of their medical fitness for the duties
they will perform. Ultimately, the aim of the Guidelines is to
contribute to health and safety at sea. And avoid the conflict-
------- Competent Authority vs.
1.Insures.
2. P&I clubs.
3.Ship-owners.
4. Manning companies.
IV. Seafarer medical fitness examinations 16. The aim of the medical examination is to ensure that the seafarer being examined is medically
fit to perform his or her routine and emergency duties at sea and is not suffering from any medical
condition likely to be aggravated by service at sea, to render him or her unfit for service or to
endanger the health of other persons on board 17. Medical examination findings are used to decide whether to issue a medical certificate to a
seafarer. Consistent decision-making needs to be based on the application of criteria for fitness that
are applied in a uniform way, both nationally and, because of the global nature of seafaring and
marine transport, internationally. 18. The medical certificate is neither a certificate of general health nor a certification of the absence
of illness. It is a confirmation that the seafarer is expected to be able to meet the minimum
requirements for performing the routine and emergency duties specific to their post at sea safely
and effectively during the period of validity of the medical certificate.
19. The ability to safely and effectively perform routine and emergency duties depends on both a
person’s current degree of fitness and on the likelihood that they will develop an impairing condition
during the validity period of the medical certificate.
Question:
Do you consider the guidelines to be sufficient or do we
need to add tests to avoid unhealthy crew working and
endangering themselves and fellow crew members?
Many of the insurers, ship owners and manning agents
request a number of additional tests, many that are
invasive and may in some cases compromise the
crewmembers employability
Maritime Labour Convention 2006
1.…..prior to beginning work on a ship , seafarers hold a
valid medical certificate attesting that they are medically
To perform their duties they are to carry out at sea
2. The certificate genuinely reflect seafarers state of health
In the light of the duties they are to perform.
3. The certificate will be issued in lines with STCW (Manila Convention)
4.The certificate is issued “Duly qualified medical practitioner”
So what differs between the standards of
the Competent Authorities described and
the standards of the Insurers, ship-owners
and crewing companies ?
The following was requested by a crewing agent recently
Full medical
CXR
Ultrasound Abdomen
HIV
VDRL
CBC
U&E
Liver function test
Glucose and HBA1c
Uric Acid
Hep B sAg.
Hep C.
Lipogram
Malaria Test
TB Test ?
PSA in crew older than 40yrs
Blood type
Drug and Alcohol test
Lung function test
ECG (First time medical and then over 50)
X-ray Lumbar spine
What are your thoughts?
1.These are all defendable ?
2.Do you become unfit if you have a positive result ?
3.Are these ethical?
4.Costs?
1.Situation that we have all faced: Passed National
Medical standards and failed Company/ Insurer/
Crewing medical standards
Are all these additional invasive tests needed?
Are they justifiable?
Are they Evidence Based?
Are they to protect ? And who are they protecting?
Super Crew
HIV
PAP Smears
Sudden incapacitation
Accidents Do these tests make
the crewmember more
employable and do
they determine that the
crewmember will not
get ill?
IS THIS WHAT IS
REQUIRED???
AD Crew member
South African Perspective
South African guidelines based on the ILO/IMO document.
SAMSA has identified that there is a specific disease profile in the country and have
decided to limit the duration of the SAMSA seafarers certificate to 1 year.
The challenge we have is that we are one of the world leaders in the occurrence of
HIV/TB. Whilst HIV does not exclude a crew member from working it is essential to
determine the status of the immune system.
It is however, forbidden to perform pre-employment or annual medical HIV screening
The SAMSA Certificate is needed fro the following
1. Crew members
2. Stevedores
3. Dock workers
1.There is a doctor approval process.
South African Maritime Safety Authority
2. There is a facility approval system.
3. There is an appeal process.
4. There is no QA
So all the boxes are ticked:
Right ? 1. Doctor approval:
a. Registered with HPSCA
b. Diploma in Occupational Health (No Maritime focus)
c. Or “some experience in maritime health”
2. Facility Approval:
a. Performed by a maritime surveyor who is generally a ex ships
Engineer
3. Appeals Process:
a. The appeals process is well established and there were 7 appeals
last year. The weakness of the system however is that there is no
Maritime Physician on the board.
NO Quality Assurance / Peer review Process
DO THESE MEET THE INTENDED
NORM?????
How are the “short falls being addressed?
1. We are developing an additional maritime module that
we hope will be added as an optional module to the
Occupational Health Diploma for students that want to
become AD in SA
2. We are looking at a group of doctors to do the
accreditation. ? The biggest challenge with this?
3. We have motivated to have a maritime specialist
on the appeals board.
4. QA is still an enormous stumbling block
I believe that the international guidelines are complete, self
explanatory and sufficiently evidence based to give all parties a
basic standard to determine a seafarer’s “FITNESS TO WORK”
as laid out in the ILO/IMO. The weakness in the system is the
different “Competent Authorities” determination of an AD
approval and medical facility. The challenge that has been
taken up by the insurers, manning agents and Ship-owners is
their uncertainty at the QA/ Approval of the “Duly qualified
medical practitioners’ and their facilities. I have no doubt that the
guidelines are sufficient and there is no need to add the
demands of the other interested parties if there can be
consensus on the approval of AD’s and an internationally
accepted QA process
QUESTION OR COMMENTS PLEASE
This is an extremely exciting concept and all
comments will be greatly appreciated