MMI September 2010 - mmi home

16 Service Sector Tropical & Infectious Diseases
Dr Ford also noted the importance of
choosing the correct drugs, since a number
of different chemoprophylaxis are available,
though some anti-malarial drugs such as
chloroquine have seen a decline in
effectiveness as resistant parasites become
more common. However, in recent years a
new form of antimalarials called artemisininbased
combination therapies have proven
effective in fighting these resistant strains of
the disease. It is recommended that different
treatments are used in combination in order
to combat malarial drug-resistance.
Despite all good intentions, seafarers may
be unaware of the importance of taking these
kinds of medicines while operating in malarial
regions and this can lead to costly incidents
for shipping companies and their insurers. Ian
Barr, director with the London P&I Club said:
“We have written loss prevention advice in
the past saying to members that there are a
lot of simple things that they need to be
careful of and one of them is that if they’re
going to a malarial region, they should take
anti-malaria tablets. It’s a timeless message, its
always going to be valid.”
“We have had malaria cases” he added. “It’s
a problem in certain parts of the world. I can
remember we had one ship where three
different crew members got malaria just
because the route that the charterer had put
the ship on was entirely within malarial
regions and it was an increased risk for them.”
Mr Barr noted that shipping companies
should adhere to the International Safety
Management code and inform crew of
appropriate preventative measures prior to
travel but added: “The ship owner would not
be prejudicing his cover if we discovered that
they had not been giving out anti-malaria
tablets or were not making sure that the crew
were taking them. With personnel cases, we’re
here to help not to say “you’ve compromised
your cover”; we get them where they need to
go for appropriate treatment.”
Despite all good intentions,
seafarers may be unaware
of the importance of taking
these kinds of medicines
while operating in malarial
regions and this can lead
to costly incidents for
shipping companies and
their insurers
However, Mr Barr stressed that malaria can
be a costly disease: “From the P&I Club’s point
of view, anyone who is sick onboard with
malaria requires professional help. It is
expensive. If you have a malaria case and
you’re somewhere where medical help isn’t
present, its not beyond the realms of
possibility that you’ll end up having to
transfer them from one country to another for
medical help. It depends where the ship is
bound when the seafarer is diagnosed. If the
vessel happens to be going to Singapore,
where there’s world class medical treatment,
then they will get treated but an issue is that
it will be expensive. If there is someone who
is really quite ill onboard ship and the ship is
bound for somewhere in the developing
world, available treatment locally is not good
so from time to time we do have to transfer
sick and injured crewmen to get them
somewhere where the medical standards are
higher. It’s expensive but it’s what the owners
pay their P&I Club to do.”
Also commenting on time as a vital factor
in the treatment of malaria, Dr Verbist said:
“Nowadays we have the principal of stand-by
emergency treatment, which can be done
onboard ship and starts when fever or flu-like
symptoms occur, after a seafarer has been in a
malaria region and where it is not possible to
obtain medical attention within 24 hours. It’s
the responsibility of the master to assess the
risk and to make sure that if a crew member is
suspected of having malaria, not to wait
longer than 24 hours before giving treatment.
“The treatment is based on the same
medication as given in prevention but in
higher doses. It is important to refer to
information that is readily available, including
advice regarding what anti-malaria drugs are
effective at that moment and in the specific
area where the ship is.” He concluded: “The
resistance of the parasite against drugs
changes and different combinations of the
drugs must be used. Ships should always
have standby emergency treatment onboard
when they go to malaria areas.” ❤
maritime medical international ________________________________________________________________________________________________________ september 2010