Crew Welfare: Proper preparation key to avoiding spiralling repatriation costs

Seafaring is among the most hazardous occupations in the world and should a crew member get seriously sick or injured at sea, repatriation can be very expensive.

However, Rowland Raikes, Director at Medical Rescue International, based near Southampton, UK says that proper preparation can help keep costs from spiralling out of control.

“With some ingenuity and planning, and using the right assistance, repatriations need not be so expensive in the end,” he explained.

Mr Raikes retired from the Royal Navy in 1988 after 22 years as a seaman officer including ship command and joined two retired army officers who had created a company providing security consultancy to the cruise sector, and assistance to the general maritime industry in the repatriation of stowaways. After a couple of years, a claims director at a P&I association asked if they could repatriate sick or injured seafarers, as a member had asked for this and thus MRI was born.

“The business has survived beyond the security company and there are now very few places in the world from where we have not assisted a sick or injured seafarer to return to their home or to a better medical facility,” said Mr Raikes.

He added: “As a maritime medical consultancy we have, over the years, had some interesting and challenging cases. No case is ever the same in medicine, nor in the rescue and repatriation business, but after 28 years of experience in this field, we recognise themes that recur or situations which we have seen before.”

Mr Raikes said seafarers sadly do still die in service but the risk of this is no higher than in many professions. The most common causes are strokes, heart attacks and cancer but, as Mr Raikes pointed out, Pre Employment Examination (PEME) Schemes are starting to cause a significant reduction in the incidences of these conditions at sea.

“We have seen some interesting and less likely terminal events, however, such as murder and attempted murder – two shootings (one fatal) and two stabbings (also one fatal) and a suicide,” said Mr Raikes.

Speaking about the attempted murder, he said a ship was proceeding through a group of Caribbean islands on a voyage to a US port when the Master invited his 3rd Engineer Officer to his cabin one evening, to play cards and have a drink. One drink too many led to a political argument and this became violent with the Master stabbing the officer in the throat.

The Master assumed he had killed the man, fled the cabin and rushed to the upper deck, where he jumped over the side. He was never found. However, the wounded Engineer was not dead but severely wounded and was landed to the nearest clinic which was not able to cope with the severity of his injury.

“MRI were alerted and we arranged immediately for the patient to be airlifted to the nearest hospital, in Kingston, Jamaica which we knew had probably more experience in this sort of injury than any other in the Caribbean,” explained Mr Raikes.

“The happy result was that the patient underwent difficult surgery to repair his throat and vocal chords but recovered, returned home for recuperation and was able to resume his duties at sea six months later.”

Another, more unusual, case was that of a fatal poisoning in Lome, West Africa where the local facilities were not sufficient to establish this was the actual cause of death. Local doctors retained the relevant body parts – mostly fluids, stomach contents etc – but the ship owners could not find a way of getting these samples out of the country to a recognised laboratory.

“We were consulted because we have considerable experience of how to do this and where to take the samples.  It is not easy. Courier companies will not carry such things out of Africa,” explained Mr Raikes.

“The samples must be kept frozen or as cold as possible. A medical escort carrying a very special and expensive cold box has to be despatched to the country in question having obtained the necessary visa, and we have been to Cote D’Ivoire, Togo, Guinea and both Congos to do this.”

While the least expensive way of repatriating a seafarer is always explored, sometimes because of the medical condition involved, an air ambulance transfer is unavoidable.

Mr Raikes said this year they have had to organise both long and short haul transfers, with the longest and most expensive one being from the Eastern seaboard of the US to Manila.

“There was not much change from $200,000 for that,” said Mr Raikes.

He said that MRI had found that medical authorities and doctors in the US tended to ‘prescribe’ an air ambulance quite readily, and this is because it is impossible to get a stretcher on an internal US flight.

“There are many air ambulances waiting for some trade and they are cheaper in the US than anywhere else in the world. When it comes to long distance overseas travel, the US aircraft are more reluctant, however. The smaller aircraft we always use have to stop three or four times en route to Manila and must change aircrews at least once as they cannot fly more than eight hours without a rest.”

He said MRI had recently had a case in a port of the Mexican Gulf coast where an air ambulance was called for by the treating hospital.

“We recommended a ground ambulance transfer for six hours to a major airport where we could pick up a KLM flight equipped with a stretcher, a flight to Amsterdam and then on to Manila from there. Savings achieved were in the region of $100,000.”

MRI also administers PEME schemes for various P&I Clubs and ship owners and he says the success of these, and of those administered by others, have resulted in a significant reduction in the number of disembarkations and repatriations due to avoidable illnesses in crew members over the last few years.

Mr Raikes said MRI’s schemes all satisfy MLC and IMO requirements but involved some aspects which he believes strengthens their effectiveness: “Not least of these is the system of referral of borderline cases to our very experienced doctor.”

He added: “We are seeing that recent improvements to medical examinations, backed by robust compliance, are proving beneficial to the overall health of seafarers.”