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