Cruising healthcare
Veteran cruisers share tips for staying healthy at sea
Sailboats today are far safer than in the past, but accidents happen and getting speedy medical assistance can be difficult, especially when bluewater cruising. Prevention of accidents and illnesses aboard a boat requires careful evaluation of onboard hazards as well as provisioning with the necessary medicines and equipment, and having the knowledge at hand to use them all wisely. In other words, be prepared.
A good medical book or CD-ROM should be in every ship’s library. The information should be clear and easily understandable, and should deal with common health problems and emergencies, including information on drug use and interactions.
We asked a group of veteran long-distance cruisers for their input on life outside mainstream healthcare. Their responses provide insight into concepts of prevention and provisioning for responsible and self-sufficient healthcare, including recommendations for additions to standard offshore first aid kits.
Prevention Like most long-distance cruisers, Terry and Janine Plain take responsibility by being prepared for troublesome eventualities and keeping fit. They tout the importance of diet, nutrition and exercise, and agree that knowing the problems you may encounter and how to prevent them is the best defense.
Jim and Ann Cate concur. “Prophylaxis is where it’s at. We try to keep healthy, but accidents happen,” Ann said. They minimize risk by having easy-to-use preventers to control the boom, rigging jack lines, using radar, keeping careful watches and reefing early. Likewise, they maintain a balanced diet and take vitamin supplements to ensure a healthy immune system as well as undergoing preventative dental care.
The cruising boat Repose is equipped with safety features like a galley bum belt, accessible fire extinguishers and a gimbaled stove. Owners Jean and Tom Ness wear shoes when it is prudent, never jump onto docks and use gloves when rope burns might occur. Jean’s advice is to “stay clean, keep all food areas clean and treat dodgy water.”
Provisioning Provisioning a medical kit for going offshore requires careful consideration. Begin by thinking “What if?” and build a “second aid” kit with items and information that will provide the necessary care when there is no doctor, pharmacy or hospital close at hand.
Topping the list of medical kit priorities were regularly used over-the-counter medications, a good antihistamine, wide-spectrum antibiotics, a dry-powder antibiotic, instant ice packs, a serious pain medication, strong anti-inflammatories, spare prescription glasses (or an eyeglass prescription), Epi-pens for anaphylaxis and malaria treatment doses. Amongst those who get seasick, all stressed the importance of finding out, through trial and error, what works best and stocking up. Seasickness not only makes your life miserable, it can be life threatening.
Circumnavigators Sandy and Sidney Van Zandt work on the principal of supplementing what they normally use at home. “There are lists available and medical experts on the radio—or in the cruising fleet—to tell you how to use the medications you carry.”
Aside from meds for common first aid ailments such as colds and headaches, the Nesses always try to have relatively fresh packs of more than one type of antibiotic on board. “In the tropics, I try to get an antibiotic specific for coral cuts and skin problems that can become ulcers and a major life-threatening problem and scare you absolutely silly,” Jean said. Antibiotics need replacing regularly, but you can get them over the counter in many foreign ports.
A doctor with cruising experience recommended the comprehensive medical chest used by the Plains. Janine added to the kit a product called Ural. “Ural is a urinary alkalizer and can be quite a godsend if you’re far from medical aid and you develop a bladder infection. Being able to treat the infection at the first signs usually stops it completely after a few hours,” she said.
Aboard our cruising boat FellowShip, tea tree oil has proved handy for fungal infections as well as minor cuts, burns, abrasions, pimples, boils, bites and stings.
Overseas care Gillian West said it best when she said, “Contrary to North American’s beliefs, there are wonderful doctors and dentists in most countries.” So don’t worry, healthcare in major ports is available, affordable and the quality is often good.
In fact, some places have a reputation for inexpensive specialist work. Dentists in Fiji and Venezuela (Puerto la Cruz) have long been regarded as providers of good dental work. Prices and service are excellent and encourage medical tourism. My crewmate Foster and I had dental work done in Suva. Di Harris aboard Pangolin II underwent dental treatment in Tonga at the hands of a visiting German dentist. In all instances, care was good and the costs negligible. Nowadays, several hospitals in Southeast Asia and India are hailed as centers of low-cost medical care and medical tourism there is becoming popular.
Before going cruising, explain the situation to your family doctor and request a copy of your medical record. Keep any X-rays, MRI scans, mammograms and blood reports, in case they are needed for follow-up care. Sandy Van Zandt aboard Sequel recommends that sailors set up a collect call system with their personal physician so that in an emergency they can be contacted. Sailors should look into getting their doctor’s e-mail address, as well.
Radio help Having an HF radio and the ability to operate on VHF or single sideband radio can save a life. Make sure all crew know radio medical procedures and that a list of likely and available frequencies is kept close at hand.
For a serious medical emergency, ham radio operator Mike Harris’ first choice for advice would be through marine SSB and a coastal radio station. “On the other hand, if faced with a more common medical situation, I’d use one of the amateur marine nets,” he said. “It would have to be one where I knew the operators and could trust them not to escalate the situation into a drama.”
Ted Popham has used ham radio to get medical advice from a doctor friend in Australia. He has also used “radio e-mail” to contact a Canadian doctor who had experience with local health problems in Vanuatu. “Calling on HF distress frequencies is getting less effective,” Popham said. “Maybe we will all have to get satellite phones for these types of emergencies or get DSC radio, both of which are expensive.”
“Winlink has a list of ham radio doctors on call,” noted circumnavigator Paul Mitchell. “Atlantic or Pacific, you can reach a Maritime Mobile Net 24-7. SSB nets probably offer the same kind of assistance.” Although a special radio license is required for amateur frequencies, hams will assist unlicensed operators in an emergency.
Working short-handed Setting up your boat for easy sailing is the key to coping when short-handed. The test for user-friendliness is simple: If it is difficult to maneuver in good conditions, systems need to be redesigned. As for the problem of immobilizing an injured crewmember, Rob and Jo Woollacott aboard Blue Moon have a car seat belt that they can attach, if necessary.
When captain or crew is disabled because of illness or injury, the importance of knowing how to singlehand, use the radio and administer medications becomes evident. Often, crewmembers tend to specialize in certain tasks, so cross training is essential. One suggestion is to write a “users manual” in case the skipper is incapacitated. It should include instructions on how to engage and adjust the wind vane or autopilot, trim the sails, use GPS and radios, plot a position on a chart, reef the main, do a man overboard and troubleshoot common problems, especially those unique to your boat.
Before she went cruising, Gillian West devised and taught courses on sailing singlehanded. “Nowadays, I could singlehand but I am arthritic and would have to severely reduce sail,” she said. The big trick is to plan ahead before doing anything.”
