–
I am here today to speak to you on behalf of Future Care Inc. We are a leading provider of Medical Management Services for the International Seafarer and the Maritime Community. Ironically I am here to speak to you about the advances in technology into the medicine and unlike my colleagues who have sophisticated slides to assist I am afraid you will have to indoor just me but I promise to be relatively brief. I am here to speak to you today about the availability of primary health care for the seafarer while on board ship. Particularly, I wish to bring to your attention how the advances in remote medical diagnosis and treatment or tele medicine as we call it now make this a reality and why it is important for the entire Maritime Community.
Telemedicine or the use of electronic equipment to provide remote medical diagnosis and treatment can trace its roots back to the 1960’s space age when the US National Aeronautics and space administration first put men into space. Beginning from Maryland with the use of electronic signals to simply transfer medical data, it has grown into a sophisticated indeed futuristic system of remote diagnosis and medical treatments. Telemedicine is now used to provide both a cute and a primary health care to the poor and remote geographical areas the elderly, the infirm and other should travel with difficulty and of course now in the workplace. In the Maritime environment, remote medical care is accomplished primarily to the improving of satellite communications allowing to enchant with video stream. Inexpensive and portable storage of medical data also facilitates this, and the remarkable growth in the sophistication of electronic diagnostic tools available to the ship at sea for the use by the physician on land. The proliferation of both electronic medical devices and software is literary mind-boggling. As we all realize by now the smart phone has eclipsed the laptop and even tablet computers combining almost unlimited portability with an application or app for just about everything including medicine. If you believe the so-call futurists the mobile phone might be the last external computer device before we are all implanted with a chip at birth. Personally I can wait for that one for a while.
Regarding medical applications, in addition to remote electro cardiograms and other instrumentation it is now possible to obtain a remote auto sound from a smartphone. Indeed the top ten medical uses of the iPhone include an auto scope which is an ear and canal examination or device to allow such examination, a goo committer for blood sugar pressurement , a dermatoscope for high resolution skin images and a slit lamp IPs digital adaptor to view the retina remotely. All of these devices will allow the user to track, manage and share the data of the individual patient. Why is this important to the Maritime Community? Because this technology can and does bring enhanced medical care to the seafarer while onboard ship. From the human perspective, the quality of life, of the raffle 1,3 million seafarers on the ocean has just become vastly improve, benefiting themselves, their families and their dependence. The longevity of life and medical quality of that longer life for the seafarer is now a reality. The sea’s power to diminish the health of those who ply their trade over her vast distances is weakening as we speak. Technology is bridging the gap in the health care available between the land based and seafaring worker. The benefit to the seafarer is in the provision of the cute and primary medical treatment at sea. A satellite telephone will allow for a land based physician to speak to the crew man onboard the ship and make a remote diagnosis with some possible treatment options.
A video communication via a computer or smartphone will allow that same physician to see the patient crewman and in some instances visualize the complaint thereby affording improved diagnosis and treatment options. An onboard medical kit or a smartphone equipped with the appropriate medical apps will allow that very same physician to measure the majority of vital signs and depending upon an ailment or injury examine the conditions more closely through high resolution microscopes. Obviously the quality of medical treatment improves dramatically in many instances with the level of the technology that is available onboard the ship. At the highest level the physician is about as closed as anyone can come to the seafarer while he or she is at their workplace sort of being physically present on board the ship. Additionally, the highest level of technology now allows us for the type of care almost never available to the seafarer while at sea that is primary or wellness healthcare.
There are many definitions of the term primary health care but the one I like especially is from the University of Canada Medical School which says quote “Primary care refers to the first contact that deals with the majority of health problems, it is the foundation of any health care system and countries with strong primary care seem to have better health care than those without.” I don’t think that I need a medical degree to state truthly that the majority of health issues that affect people, certainly working people are neither a cute nor life threatening until of course the big one.
Most working people seek medical advice through years from minor complaints that are truly minor or for chronic conditions. A third possibility concerns minor complaints certain symptoms of something actually potentially more serious with time. To date the extent of most seafarers primary health care consists of the pre-employment medical examination or PM which is preferably conducted as close to shining on board as practical. The PM has evolved into a wide spread fairly comprehensive medical examination allowing for a basic overview of the crewman’s overall medical health. The PM is an excellent first step in seafarer primary health care and it likely has saved a prolong lives of many seafarers by identifying serious medical conditions before they had SeaWorld. Happily the vast majority of seafarers receive the covered feed for duty standard notification after taking their PM. However this doesn’t mean that the same seafarers are in perfect health or that they are without physical elements. It is just that the condition or the conditions noted are not serious enough to keep them from boarding the ship at the time of the examination. The chronic illnesses that afflict many of us in some form or another hypotension, diabetes, cardiovascular problems etc. are identified by the pre-employment medical examination and then taken on board by the afflicted seafarer when beginning the ocean voyage.
Weather seafarer or employer, I suggest you have to ask yourself this question, now that the PM has identified this chronic conditions, is there a good reason to ignore them while the seafarers onboard ship. I think that all of us can agree on the correct answer to this one. This is the next level of health care for the international seafarer utilizing the available technology to monitor and address these chronic conditions, chronic but manageable while onboard ship. There is literally no persuasive reason not to do so. The medical technology and instrumentation is for the most part inexpensive and available over the Internet. Innovations and satellite bend with usage and encrypted technology make the use of this communication inexpensive, safe and private. The cost in lost time from work is minimal, utilizing video conference appointment with land based physicians schedules every three months to conduct a simple interview, review of vital signs and report on management of any chronic condition need take no longer than 15 minutes. Even the time used for unscheduled physician conference to address a seeming reminder complaint is a better investment than waiting for the condition to deteriorate into an emergency, distracting the ship’s command and in worst case scenario resulting in unscheduled repatriation, deviation, or emergency ship evacuation.
As many of you are aware the combined effect by the Maritime Labor Convention and the IMO standards for training with the Manila amendments mandate that the Community and the Flag States are required to provide seafarers with medical care as nearly as possible equivalent to the care they would receive ashore and to ensure by prearrange system that medical advice by radio and satellite communication to ships is available in the hour of the day or night. In a well-supported article titled “The Business case for telemedicine” published by 2013 by Biomedica International, the five distinguished offers in their own words called make the initial assessment of the economic and business reasons in support of both publicly finance and private telemedicine being implemented onboard commercial vessels.
Their study goes out of the consensus of participants at the International Maritime Health Association Conference held in Malta in 2013. The economic reasons for tele medical assistance is compelling based in part on data obtained from Future Care and health metrics of Manila, the authors estimate that one in five ships will be forced to divert from medical reasons per year for an average statistical annual cost of 32.750 euros per diversion per ship. The authors calculate that the depreciated cost of placing onboard the necessary tele medical equipment is 25.000 euros and annual training cost extra 12.000 euros over and above the free services available. The authors conclude the return on investment per vessel from investing in equipment and training will therefore statistically paying for itself in less than one year. The conclusion, so what is the take away as they say from all of this, talk about futuristic gadgets. Your opinion might be that the crew and the captain will like it and the owner doesn’t want to pay for it.
Well, I respectfully suggest to you that the captain and the crew will indeed like the benefits of improved overall healthcare. Greater control over their chronic conditions and that they will have a piece of mind in knowing that even we are far out of sea there are medically trained personnel available to tent to the moment’s notice. I also suggest you that the ship-owner will consider the minimal investment required while worth the cost refer. In addition to the intangible but nevertheless real benefits of a healthy crew working onboard the vessel the reduction in medical incidents that reach P&I standards in unscheduled repatriation, ship deviation and emergency alone justifies the financial costs. The financial benefits are so predictable and significant that I submit to you that in a few years the P&I Clubs will be insisting in paying for primary health care plans onboard the vessel as a part of the overall ship loss prevention program.
The current technology is reducing the power of the sea to isolate the seafarer from the appropriate medical treatment that he so ritually deserves. Humanitarian, legal and financial forces are combining to break down whatever barriers remain in bringing improved medical care and quality to the seafarer onboard the ship while working at sea. I suggest you that the advances in telemedicine combined with the well managed health care program will revolutionize the life and productivity of the seafarer in a manner similar to the way the shipping container forever altered transportation of cargo. The future of Medicine for the Maritime Community has arrived.
Above article is an edited version of Lawrence Jacobson’s presentation during 2014 SAFETY4SEA Forum
More details may be found by viewing his Presentation video