Fishing industry health Fishing industry health issues: International issues: International

and National and National implications. implications.

Environmental Environmental characteristics and Risk characteristics and Risk

PreventionPreventionM. Luisa CanalsM. 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 Potgraduate URV Course “University Specialist on Maritime Health;Co-ordinator of the Potgraduate URV Course “University Specialist on Maritime Health;Former IMHA President (International Maritime Health Association); Former IMHA President (International Maritime Health Association);

Former SEMM President, Dir. S. Tech. & Scien. Former SEMM President, Dir. S. Tech. & Scien. SEMM (Sociedad Española de Medicina SEMM (Sociedad Española de Medicina Marítima)Marítima)

Other authors: Example of research study, Pedro Nogueroles (UCA, Cadiz)Other authors: Example of research study, Pedro Nogueroles (UCA, Cadiz)

ORP 2008 “VI Congreso Internacional de Prevención de Riesgos LaboralesORP 2008 “VI Congreso Internacional de Prevención de Riesgos LaboralesA Coruña - España, 14-16, Mayo, 2008A Coruña - España, 14-16, Mayo, 2008

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 …- Health & Psychosocial factors [workshop: 15-5-08]- Health & Psychosocial factors [workshop: 15-5-08]

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- Cadiz Univ.Research “- Cadiz Univ.Research “SEGUMAR"SEGUMAR" study in study in SpainSpain

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

OCCUPATIONALMEDICINE

OCCUPATIONALMEDICINE

MARITIMEACTIVITIESMARITIME

ACTIVITIES

ACCIDENTSPROFESSIONAL D.

PATHOLOGIES

ACCIDENTSPROFESSIONAL D.

PATHOLOGIES

FISHINGFISHING MERCHANT M.MERCHANT M. PASSENGERSPASSENGERS

• COASTAL• DEEP SEA

• COASTAL• DEEP SEA

-COASTAL-OCEANIC

-COASTAL-OCEANIC

FERRIES CRUISES

FERRIES CRUISES

PORTPORT

NAVAL M.NAVAL M.

SPORTSPORT

PREVENTIONPREVENTION

INCAPACITYINVALIDITY

INCAPACITYINVALIDITY

•SAILING•SURF•SWIMING•OTHER ….

•SAILING•SURF•SWIMING•OTHER ….DIVINGDIVING

APNEACOMPRESSED AIR

ESPECIAL MIXTURES

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: vibration, ventilation, noisePhysic R: vibration, ventilation, noise

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

•Medical Fitness Exams: Medical Fitness Exams: Health surveillance --- It Health surveillance --- It allows individual and collective epidemiological studies, allows individual and collective epidemiological studies, COMPULSORY in Spain COMPULSORY in Spain (new RD 2007/1696)(new RD 2007/1696)

•Welfare and social aspects: Psychosocial FWelfare and social aspects: Psychosocial F, , personal and occupational relationspersonal and occupational relations ((Stress, fatigueStress, fatigue))

•Safety – Survival: Safety – Survival: Disasters, protection …Disasters, protection …

•Training – risk prevention Training – risk prevention (O. health education)(O. health education)

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 finally approved in 2007 C.188 Recommendation finally approved in 2007 C.188 CONCERNING WORK IN THE FISHING SECTOR, R.199 CONCERNING WORK IN THE FISHING SECTOR, R.199

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, Continuing Education in Maritime Health, Barcelona, Nov. 2003Barcelona, Nov. 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, incertainity, …)variable, unsafe, incertainity, …)

• Overwork, rithm, time preassure, especial Overwork, rithm, time preassure, especial conditions (fatigue, nocturnity, number of conditions (fatigue, nocturnity, 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: lonelyness, Culture & organization: lonelyness,

interpersonal relations, role conflicts, lack of interpersonal relations, role conflicts, lack of safety in work, low salaries, hard work, safety in work, low salaries, hard work, inmigration, interferences with family life, social inmigration, interferences with family life, social value …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, resignation, environmental, lack of environmental, lack of training …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, noise, isolation, fatigue,

hot, cold, nocturnity, stress, bad wether hot, cold, nocturnity, stress, bad wether

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

HEALTH HEALTH SURVEILLANCESURVEILLANCE

REAL DECRETO 1696/2007, de 14 de diciembre,por el que se regulan los reconocimientosmédicos de embarque marítimo (updated in Spain)

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 …

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 A

BOTIQUÍN C

MEDICAL CHESTMEDICAL CHESTR.D. 258/99R.D. 258/99(in Spain)(in Spain)

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 Spanish

Radio-Radio-MedicalMedical

Advice 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 Practitioners?Occupational or General Practitioners?

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.

Número de Accidentes de Número de Accidentes de trabajotrabajo

con baja, sectcon baja, sector pesca y acuicultor pesca y acuiculturaura

931.813

1.005.289 1.024.936 1.016.670954.847 955.744 981.795 10034405.789

4.734 4.655

4.143 4.108

3.687 3.681

5.147

0

200.000

400.000

600.000

800.000

1.000.000

1.200.000

1999 2000 2001 2002 2003 2004 2005 2006

Nº

tota

l ac

cid

en

tes

0

1000

2000

3000

4000

5000

6000

7000

Nº

AT

en

pes

ca

Total Pesca

↓ ↓ 34,5 34,5 %%

http://www.mtas.es/Insht/statistics/mtas.htm

2009

2659

2815

2714

2536

2502 1856

1836

1858

1821

1921

1946

1887

1811

1714

1627

1587

307

474

439

488

547

546

393

473

453

547

578

629

625

628

513

453

430

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 %

VideosVideos

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

research about the research about the general state of the general state of the Andalusian fishing fleetAndalusian fishing fleet from the point of from the point of view of the view of the safety and the prevention of safety and the prevention of occupational risksoccupational risks. As part of this survey . As part of this survey we analyze the health of the fishing we analyze the health of the fishing personnel (morbidity, use of medications personnel (morbidity, use of medications and lifestyles), work related accident and and lifestyles), work related accident and some aspects of the life at sea related with some 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. QuestionnaireQuestionnaire of health and lifestyles were of health and lifestyles were administered to a sample of 247 workers administered to a sample of 247 workers in 20 of the 23 Andalusian ports.in 20 of the 23 Andalusian ports.

• 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 problemsand 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 and a 43% of them had sick 43% of them had sick leaves for injuries on board.leaves for injuries on board.

Conclusions: Conclusions: Coastal fishingCoastal fishing• Working injuries, Working injuries, actinic keratosesactinic keratoses and and

lesions in areas of exposed skin, lesions in areas of exposed skin, rhinosinusitis, bronchitis obstructive rhinosinusitis, bronchitis obstructive and and high consumptions of medicineshigh 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 The injury rateinjury rate in our environment in our environment is is highhigh but similar to the registers in 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 fishermen relate to the labor fatiguefatigue. . The The dietdiet on board should be related to 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.

Dee sea fishingDee sea fishing

The longer The longer the time the time enroled the enroled the worst their worst their quality of quality of lifelife

Quality of Life Quality of Life related to Healthrelated to Health – – Deep sea Deep sea

fishingfishing - - QL repeated measures: holidays, after 2 & 4 QL repeated measures: holidays, after 2 & 4 months on board months on board

EscalasEscalas puntuciones puntuciones en tierraen tierra

puntuaciones a los puntuaciones a los 2 meses de 2 meses de embarqueembarque

puntuaciones a puntuaciones a los los 4 meses de 4 meses de

embarqueembarquemedias DEs medias DEs medias DEs

SíntomasSíntomas 3.78 0.27 3.68 0.45 3.68 0.41I. Capacidad físicaI. Capacidad física 3.05 0.56 2.82 0.71 2.79 0.63II. Función psicológicaII. Función psicológica 2.87 0.54 2.59 0.60 2.52 0.60III. Ánimo positivoIII. Ánimo positivo 2.44 0.68 2.35 0.70 2.24 0.64IV. Ánimo negativoIV. Ánimo negativo 3.25 0.66 3.20 0.70 3.09 0.77V. Función socialV. Función social 2.71 0.61 2.40 0.73 2.24 0.76VI. Bienestar socialVI. Bienestar social 3.10 0.56 2.61 0.74 2.62 0.71

(n=56) (n=56) (n=49)

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 , deep sea and coastal fishermensea and coastal fishermen should not be should not be forgottenforgotten

• More researchMore research on their health has to be on their health has to be implemented, we can implemented, we can share our share our experiences in the next experiences in the next Hispanofrancophone Congres, Cartagena, Hispanofrancophone Congres, Cartagena, Octubre, 2008Octubre, 2008. . http://www.semm.orghttp://www.semm.org