To meet legal requirements a competent authority responsible for issues of public health functions in most ports. These services differ substantially globally in terms of qualification, scope and services provided. Some Port Health Authorities offer full medical services; others do not have medical doctors in their team but mainly deal with issues of environmental health and ship sanitation. Frequently the local health department covers the responsibility for the port area alongside their duties in the municipality. Sometimes, private port health practices are mandated to perform governmental duties, such as yellow fever vaccinations. Generally speaking the port medical doctor needs to familiarize him/herself with the duties and services of the local port health authority. Also he /she needs to be aware of legal obligations, such as notification requirements and foster good working relations with the port health authority.
Depending on national legal requirements and local arrangements Port Health Authorities provide public health services such as:
Notification of disease by shipmasters (Maritime Declaration of Health), granting of “free practice”
The International Health Regulations 2005 apply to ships and ports, the port health authority ensures/enforces the application of the rules. Every port maritime physician should know them as well and assist the authorities in applying these important rules.
Sanitary inspection of Ships
Port Health Authorities have the duty to inspect the ships and port area as regards hygiene and the presence of infections or vermin and to take measures to control public health risks. If the port medical doctor suspects the presence of a disease that may be caused by unsanitary conditions on board he may contact the port health authority for investigation. This may also include conditions such as insufficient protection from vectors while sailing in malaria areas.
Assessment and control of communicable disease and outbreaks
The shipmaster is legally obliged to notify the port health authority of any non-traumatic disease and death aboard. The port health services will assess the occurrence of disease that has been notifiec and specify all the necessary measure to prevent the spread of the disease. This may include outbreak investigations, contact tracing, isolation and vaccination. The port clinic is an important partner of the port health authority. Often the port medical doctor is the first to detect an infectious disease on board, e.g. open pulmonary tuberculosis. It is the port medical doctors’ obligation to notify the public health service of any notifyable disease so that control measures to protect the public health can be initiated.
The port health authority also handles vaccinations and controls the vaccination cards where necessary. In some ports vaccinations are given by port maritime physicians and therefore a close relation with the port health authorities is necessary.
Health counselling, diagnosis and treatment of sexually transmitted diseases
Some port health authorities offer free and confidential services for the prevention of disease. The port medical doctor needs to work closely with these services.
Disaster and contingency planning
Disasters in ports may be very complicated due to the variety of goods and chemicals stored and handled in a small area. In the case of a fire or an explosion, the port health authority is at the core of the rescue planning. Also, port health authorities will have more or less developed plans to cope with disease outbreaks on board and scenarios such as an influenza pandemic.
Contact with other Organizations
Of 1,549 complaints by seafarers to the ministers of the Mission to Seamen in five years (1994-1999) 123 or 7.6 percent were about illness (1). It may be assumed that these complaints did not go to a port clinic through the normal procedure on board the ship or did not get properly solved or dealt with. In a personal communication a welfare worker declared that very often seafarers are reluctant to trust the port maritime physician because they think he might have links to the captain, the agency or the company and therefore a seafarer sometimes does not report personal and more delicate problems like STD that need treatment. Good contact with the welfare organizations is important so that any patients who report themselves to the ship visitors receive proper treatment and do not lose their rights (1). Chapter 5, Shipboard life and work II, SIRC, Cardiff. Welfare[jc1] organizations also play a very important part in visiting hospitalized seafarers. There should be a system to report hospitalizations to them and team work with volunteers regularly visiting seafarers who are in hospital, to offer them newspapers or telephone cards. Sports activities in ports are organized by welfare centres and seamen’s clubs, medical support for these activities is important and should be provided by the port physician, for instance by supplying guidance on emergency treatment and access to medical services and a small medical chest for first aid.
Because port maritime physicians also operate in their area the port authorities should be aware of the activities in the port clinic. Permission may be needed to enter port areas, to go on board ships and to enter specific installations like locks and terminals. Even if the port clinic is a private enterprise the port authority should know about the activities and services given. In case of a major health problem in the port, the port clinic may be asked to help and assist in a specific task. It is important to be prepared to meet such needs.
Emergency medical services in or around the port area should be informed and instructed on how to cooperate with the maritime physician. Procedures and protocols should be developed that allow good communications between these services and the port clinic. Should a seafarer be brought to such service directly, the port physicians have to be informed about it and contacted to organize follow-up and further care. A system could be that the emergency centre is responsible in such cases for the diagnosis and treatment, but that the port physician is involved in making up a report for the patient and ship and provides expert advice on duty status and on disembarkation or repatriation of the patient when needed. In addition to medical emergency centres the fire brigades in many ports, also taking care of the ambulance transport and so they are important partners for locating, evacuating and transporting injured seafarers. The port maritime physician needs good relations with these services to trace any seafarer who has been urgently evacuated to a hospital.
Port coordination centres
If a ship has identified a medical problem before arriving in the port, and asks for immediate assistance of a doctor on arrival, it is very important that the port coordination centre is aware of this. They can give the ship priority to enter the port and can arrange to let the ship go alongside at a special quay for easy access. The centre can advise the doctor and emergency service on the exact time and place to go on board. Also in case of a departure with a medical case where onshore care has not been finished or if it is necessary to put the seaman back on board at the last minute, the coordination centre may provide information about the exact time of departure or the possibility of bringing the seaman back on board at exit locks etc.
Not many ports have a special harbour hospital or a hospital service for seafarers only. The coordinating role of the port maritime physician in the absence of a dedicated hospital. The port maritime physician needs to carefully select the hospitals and departments that can best manage each hospitalization: in one hospital the surgery section may be very cooperative about the care of seafarers but another department is not. This often depends on the personality of the head of department or on a personal relationship. Also for hospitals the geographic position of the hospital may be important not only in respect of the port or the ship but also in relation to the agencies and the welfare centres that will regularly visit hospitalized seamen.
Some departments in a university hospital may be of importance for port maritime physicians. The department of tropical medicine for example is very important and a special interest of the specialists in tropical medicine in seafarer’s pathology is helpful. The department of the university hospital where the seafarer is eventually hospitalized should be briefed about the special procedures for seafarers by the port maritime physician.
Ship supplying pharmacies
In most ports there are specialized pharmacies which supply ships. These pharmacies will be able to deliver any drugs needed to ships at short notice.
Port Clinics in other ports
The port maritime physician is working in an international industry. He should look further than his own port. Every time a seafarer is sent back to a ship he should carry a report, all results and technical documents concerning his examination and treatment and a clear instruction to contact a port physician with these results in hand if necessary. All printed material from a port clinic should include a statement like: “In case you consult a doctor in another port about the same problem, show him all results you have got from us”…
An informal meeting between maritime physicians of an area or country can be helpful in establishing a network. It is very helpful if a report coming from another port is signed by a person who is known to doctors in other ports.