ORP 2008 VI Congreso Internacional de Prevencin de

ORP 2008 “VI Congreso Internacional de Prevención de Riesgos Laborales A Coruña - España, 14 -16, Mayo, 2008 Fishing industry health issues: International and National implications. Environmental characteristics and Risk Prevention M. Luisa Canals Ph. D, MD. E-mail: lcanals@comt. es Maritime Health Occupational MD, ISM Tarragona - Spain; Co-ordinator of the Potgraduate URV Course “University Specialist on Maritime Health; Former IMHA President (International Maritime Health Association); Former SEMM President, Dir. S. Tech. & Scien. SEMM (Sociedad Española de Medicina Marítima) Other authors: Example of research study, Pedro Nogueroles (UCA, Cadiz)

Main contents of the presentation: 1. Global vision of fishing as an occupational activity and its health relations. - International implications: ILO Conventions, IMO STCW-F … , Scientific societies IMHA … - Health & Psychosocial factors [workshop: 15 -5 -08] 2. Occupational risk prevention - Related to fishing tasks, environmental conditions … - National implications: Organization in Spain - Cadiz Univ. Research “SEGUMAR" study in Spain

OCCUPATIONAL MARITIME MEDICINE - Maritime Med. MARITIME ACTIVITIES OCCUPATIONAL MEDICINE FISHING MERCHANT M. PASSENGERS SPORT NAVAL M. PREVENTION ACCIDENTS PROFESSIONAL D. PATHOLOGIES INCAPACITY INVALIDITY § FERRIES § CRUISES -COASTAL -OCEANIC • COASTAL • DEEP SEA DIVING APNEA COMPRESSED AIR ESPECIAL MIXTURES • SAILING • SURF • SWIMING • OTHER ….

Global vision of fishing as an occupational activity and its health relations • Ergonomics: Physic R: vibration, ventilation, noise • Hygiene on Board: Biological R: sanitation, water, food • Medical Fitness Exams: Health surveillance --- It allows individual and collective epidemiological studies, COMPULSORY in Spain (new RD 2007/1696) • Welfare and social aspects: Psychosocial F, personal and occupational relations (Stress, fatigue) • Safety – Survival: Disasters, protection … • Training – risk prevention (O. health education)

Internacional Labour Organization: Conventions OIT/ILO/BIT - Fishing Ind. • • • C 112. Minimum age (1959) C 113. Medical Fitness Examination of fishermen C 114. Fishermen enrolment C 125. Competence certificates (1966) C 126. Accommodation ----R 7. Hours of work (1920) R 126. Professional training (1966) ----Tripartite Meetings of Experts – 1999 – 2003 – 2004 -2005 Superconvention + a complementary Recommendation finally approved in 2007 C. 188 CONCERNING WORK IN THE FISHING SECTOR, R. 199 Internacional Maritime Organization: STCW-f

I M H A W O R K S H O P S 1. 2. 3. 4. 5. Infectious Diseases, Antwerp 1999 Cruise Medicine I, Miami 2000 Practical Guide on Maritime Medicine, Vigo Cruise Medicine II, Philadelphia Health & Occup. Risk Prevention in Harbours, Barcelona, 2002 6. Telemedicine, Rome 7. Health in the Fishing Industry, Cádiz, 2002 8. 7 th ISMH: 4 Seminars (G. B. Aspects, Med. Exam. Standards, Occupational accidents & Diseases, Maritime Activities), Tarragona, April 2003 9. Continuing Education in Maritime Health, Barcelona, Nov. 2003 10. Working at Sea, Psychological Health Problems, Riga, May, 2004 11. Collection and Validation of Data in Maritime Medicine, Brest, July 2004 12. Drug and Alcohol Policies, Odessa, Sept 2005

IMHA WS: Gral. : S. Fdo (Cádiz-Spain), 2002 & Psychosocial Aspects: Riga (Latvia), 2004 • Directly related to fishing tasks (monotonous, variable, • • unsafe, incertainity, …) Overwork, rithm, time preassure, especial conditions (fatigue, nocturnity, number of crewmembers …) Sensation of control (stress, no decision …) Environmental conditions, work equipment, multiple risks and expositions: accidents Culture & organization: lonelyness, interpersonal relations, role conflicts, lack of safety in work, low salaries, hard work, inmigration, interferences with family life, social value …

Psychosocial factors characteristics – A work culture in the fishing industry – Difficulties in risk prevention: 1. Personal, attitud: fatality 2. 3. resignation, environmental, lack of training … Organizacional: group relation, salary based on the catch, lack of rest, insuficient crew, family, multicultural, rights? ? ? Institucional: inspection, ergonomics, competence conflicts, rules and regulations, small ships ? ? ?

Fishermen: work related exposures • Access: risk different levels - to jump

Fishermen: work related exposures • to walk on board: risk of slipping, strings, cables and other things like fish … on deck, water, grease, narrow spaces ….

Fishermen: work related exposures • While fishing: trawling doors, pulleys, cables , nets. . . falls, bruises, contusions, smashed, crushed. . .

Fishermen: work related exposures • Different risks according to the type of fishing and tasks

Fishermen: work related exposures • Environment: noise, isolation, fatigue, hot, cold, nocturnity, stress, bad wether

PREVENTION: recommendations E. g. Knees and back pain • Change position while working, • balanced weight, feet position, to facilitate movements. Adapt ergonomics till find the height to the efforts needed ----- • Relax muscles: exercises • Suitable equipment: clothes, shoes, … • Combine ergonomics of the ship and psycho-sociology of fishing work tasks HEALTH SURVEILLANCE REAL DECRETO 1696/2007, de 14 de diciembre, por el que se regulan los reconocimientos médicos de embarque marítimo (updated in Spain)

Training (first-aid and medical care on board) l IMO: STCW Convention [Ch. VI: sections A-VI/4. 1 minimum for all seafarers (pre-sea training) and 4. 2 for persons in charge of medical care on board ships] (1978, 1995) … Directive 92/29/EEC [health, medical chest, medical assistance, safety, training] RD 258/1999. . . in Spain. l 31/1995 Occupational Risk Prevention Law, special RD for fishing ships > 15 -18 GT … l

Health Education

Campaigns BOTIQUÍN C BOTIQUÍN A MEDICAL CHEST R. D. 258/99 (in Spain) B. O. E. 24/02/1999

The system of health care for seafarers and fishermen in Spain An integrated system on board and ashore Hospital Ships The Spanish Radio-Medical Advice Center

l l Coordination Data base

The maritime health programme combines Health care & Prevention (A common computerised data base of medical examinations, hospitalizations , rediomedical consultations, repatriations…) • On board: - Hospital ships taking care of the fishing fleet - Telemedicine RMA … by Radio (from 1979 in Spain) • In the port of call: and even abroad • Occupational or General Practitioners?

Spanish doctors abroad (because of the fishing fleet) • St. Pierre et Miquelon (1968) - St John’s (1970 -1998) / • Beira (Mozambique 1989 -1994) • Nouadhibou (Mauritania - 1970) * • Dakar (Senegal - 1972) • Luanda (Angola - 1973) * • Walbis Bay (Namibia - 1973) * • Seychelles 1987 - Mahe …. • -Madagascar – Monbasa (Kenia) • - Ship • Abidjan (Ivory Coast - 1992) (*) some few years interrupted activities because of war, logistics.

Número de Accidentes de trabajo con baja, sector pesca y acuicultura ↓ 34, 5 % http: //www. mtas. es/Insht/statistics/mtas. htm

The Spanish Radio-Medical Advice Center

Centro Radio-Médico Español Proportion calls: 1 merchant /13 fishemen Diseases: reumathology-MS, digestive, neurology, dermatology, bad defined. ØSatellite, 1. 5 consultations /case Accidents: Deck 76. 8%, Engine 8. 7%

Videos

Research: e. g SEGUMAR project Introduction: the SEGUMAR project is a research about the general state of the Andalusian fishing fleet from the point of view of the safety and the prevention of occupational risks. As part of this survey we analyze the health of the fishing personnel (morbidity, use of medications and lifestyles), work related accident and some aspects of the life at sea related with fatigue. Methods: Cross-sectional study with proportional sampling by conglomerates. Questionnaire of health and lifestyles were administered to a sample of 247 workers in 20 of the 23 Andalusian ports.

• Health status damage is due in most cases to the worsening of previous medical pathologies, and less to incident problems , emphasizing the musculoskeletal, digestive and mental health problems. • A 76% of the fishermen have had some accident on board during their labor life, and a 43% of them had sick leaves for injuries on board.

Conclusions: Coastal fishing • Working injuries, actinic keratoses and lesions in areas of exposed skin, rhinosinusitis, bronchitis obstructive and high consumptions of medicines, and tobacco were associated with fishing. • The recognized pattern of illicit drugs consumption doesn't show excessive differences regarding the values registered in Spanish adult population. • The injury rate in our environment is high Dee sea fishing but similar to the registers in other studies on fishing population. • The concern about the fishing, and the long work shifts are factors that the fishermen relate to the labor fatigue. The diet on board should be related to the digestive illnesses and with the work shifts to the labor fatigue. The longer the time enroled the worst their quality of life

Quality of Life related to Health – Deep sea fishing - QL repeated measures: holidays, after 2 & 4 months on board Escalas puntuciones en tierra puntuaciones a los 2 meses de embarque puntuaciones a los 4 meses de embarque medias DEs 3. 78 0. 27 3. 68 0. 45 3. 68 0. 41 3. 05 II. Función psicológica 2. 87 III. Ánimo positivo 2. 44 IV. Ánimo negativo 3. 25 V. Función social 2. 71 VI. Bienestar social 3. 10 0. 56 0. 54 0. 68 0. 66 0. 61 0. 56 2. 82 2. 59 2. 35 3. 20 2. 40 2. 61 0. 71 0. 60 0. 70 0. 73 0. 74 2. 79 2. 52 2. 24 3. 09 2. 24 2. 62 0. 63 0. 60 0. 64 0. 77 0. 76 0. 71 Síntomas I. Capacidad física (n=56) (n=49)

CONCLUSIONS • In any country • we have to make an effort to adapt health services to seafarer’s needs, deep sea and coastal fishermen should not be forgotten More research on their health has to be implemented, we can share our experiences in the next Hispanofrancophone Congres, Cartagena, Octubre, 2008. http: //www. semm. org