Dear Colleagues,

for all those who missed it at the first occasion: this is the second issue of your journal’s magazine section! Our intention with this new product is to extend the journal’s impact factor beyond the scientific community into maritime medical practice
(See: Nix T, Smith J, Song J. Measuring impact. In: Markovac J, Kleinmann M, Englesbe M (eds). Medical and Scientific Publishing, Author Editor and Reviewer Perspectives, Academic Press, Elsevier, London, 2018). We want to be a point of contact for those responsible for health in the maritime environment, to raise existing problems or questions to the attention of applied research and to be a marketplace of information from all areas of maritime health for the frontline practitioners.

When International Maritime Health Foundation conducted its workshop on the development of the International Maritime Health journal in October 2021, the experts assembled identified the following list of topics to constitute a structure of a future magazine part: reports from practice; chronicles; reflections on state of art; book reviews; obituaries; news from regulatory bodies; reports on research and development projects (communication on state, call for cooperation); news of the industry; reports from courses/seminars/congresses/symposia; papers of educational character/lessons learned; presentation of dissertations; case reports; International Maritime Health Foundation news; debates/commentaries; journal club… the list may be extended.

Why am I giving you this enumeration? It is because we want to encourage participation from your side. If there is any question or problem you would like to be addressed, let us know. If there is any piece you would like to contribute or share with the community, please submit. Any comment on the content of our journal? Please mail your opinion.

Looking forward to a vivid dialogue!

Klaus Seidenstücker
Temporary magazine editor
International Maritime Health Foundation’s Expert Panel

News

Contributed by Nebojsa Nikolic

SEAFARER’S CHARITY

The Seafarers’ Charity funds new charity to support women who have experienced sexual trauma at sea.

On April 19th, 2023, the Seafarers’ Charity has announced funding for a new service aimed at supporting women seafarers who have experienced sexual trauma while working at sea. Salute Her UK which operates internationally, is set to receive funding over a 2-year period to deliver their women-centric therapy and trauma counselling to women seafarers and women working in fishing.

Salute Her is a relatively new charity which emerged as a gender specific response to support female veterans who had experienced sexual trauma during their military service. The Seafarers’ Charity funding will enable Salute Her to expand their therapy services to women working at sea. At Salute Her, women can choose from a range of therapeutic activities — workshops, courses, group and individual counselling or mental health therapy delivered either face to face or virtually. The service can be accessed by women in the UK or internationally. As well as offering therapeutic services, Salute Her actively campaign for ‘gender specific’ physical and mental health support services and trauma-informed care for women who have lived experience of bullying, harassment, discrimination, and sexual abuse.

The funding announcement from The Seafarers’ Charity of this new service for women seafarers is in response of evidence revealed in a recent research report on the ‘Port-Based Welfare Needs of Women Seafarers’ by International Maritime Health Foundation Expert Panel member, Professor Helen Sampson and Dr. Iris Ajeco at Cardiff University’s Seafarers International Research Centre. The research, funded by Seafarers’ Charity, revealed female seafarers’ experience of isolation and fear of sexual assault within the male-dominated environment of cargo ships.

WHO/ILO

In its 15th meeting on May 4th, 2023 the World Health Organization (WHO) IHR (2005) Emergency Committee highlighted the decreasing trend in COVID-19 related deaths, hospitalization, intensive care unit admissions and the high levels of population immunity. Committee members advised to transition to a long-term management of the pandemic.

The WHO Director General determined that COVID-19 is now an ongoing health issue and no longer constitutes a public health emergency of international concern.

In April 2023 International Labour Office (ILO) published an Independent High-Level Evaluation of the office’s COVID-19 response. The evaluation focused on two dimensions: institutional and policy. ILO was forced to develop new policies to address this new world, under a four-pillar framework:

A report can be accessed at: https://www.ilo.org/digitalguides/en-gb/story/evaluation-covid19.

Announcement

16TH INTERNATIONAL SYMPOSIUM ON MARITIME HEALTH

Dear Colleagues!

As you know in light of the COVID-19, the 16th International Symposium on Maritime Health (ISMH16) was postponed. Now, when the pandemic is over on behalf of the organizing committee I would like to invite you to join us at the ISMH16 “Maritime Medicine-from the Antiquity to the Present Day” which will be held in Athens 5–8 October 2023 with the Pre-Symposium Research meeting on 4 October. The Symposium welcomes all physicians, scientists, trainers, legislators and stakeholders of the international shipping industry involved in maritime health, safety and welfare of seafarers worldwide.

The planning of the ISMH16 is taking a step forward. The Symposium registration and abstract submissions are open. As with previous conferences, the event will consist of oral paper presentations, keynote speeches, and chaired poster presentations.

Please, visit ISMH16 Webpage: www.ismh16.gr.

If you have any questions, please contact: maritimedoctor@gmail.com or dr_denisenko@yahoo.com.

Hope to see you in Athens soon!

Dr. Ilona Denisenko
Chair ISMH16

Reports

MARINERS MEDICO GUIDE — RIGHT IN THE POCKET OF SEAFARERS

By Jon Magnus Haga and Lise Skogstad Loftsgaard

You never know when you will face a medical emergency. What happens when it occurs at sea — far from land and with limited support?

The Mariner’s Medico Guide is a new app, designed to improve medical treatment on board ships. The guide is tailored for seafarers and the equipment available on board. The guide has been developed by Gard and the Norwegian Centre for Maritime and Diving Medicine and provides step-by-step guidance for assessment and treatment of medical issues faced on board.

The Mariner’s Medico Guide is free to use for all seafarers. Fully downloadable, it can be used mid-ocean and in remote parts of a ship — even without a signal.

Symptom-based approach

The guide differs from other ship medical guides in several ways. As it is digital, it provides new ways of accessing the information, both through search and interactive navigation. It covers both physical and mental health issues, using a symptom-based approach, and is easily updated in accordance with future medical developments and technological advances.

Designed and written by doctors specialised in maritime medicine, guidance is set out in simple steps and language, for users with limited medical experience and reduced accessibility to medications and medical equipment.

The guide has been developed to facilitate better use of the available resources and access to basic health care for all seafarers. It includes advice on when and how to contact public telemedical services worldwide, how to evaluate warning signs and how to treat a sick person in dialogue with the telemedical doctor.

Flag State approval

The Mariner’s Medico Guide was presented to the Sub-Committee on Human Element, Training and Watchkeeping (HTW) of the International Maritime Organization (IMO) at its 9th session in February 2023. All Flag States were invited to endorse and promote the guide.

The guide has received Flag State approval from the Norwegian Maritime Authority as its national equivalent medical guide to the 2007 World Health Organization (WHO) International Medical Guide for Ships and been endorsed by the Marshall Islands and a number of international non-governmental organizations, including the International Transport Workers Federation (ITF). More flag states are currently assessing the guide in view of similar recognition.

Previously, the guide has been presented to the WHO.

For more information, please visit www.medicoguide.com.

Dr. Haga and Dr. Loftsgaard presenting Mariners Medico Guide to the Sub-Committee on Human Element, Training and Watchkeeping (HTW) of the International Maritime Organization (IMO) in London together with partners from GARD and the Norwegian Maritime Authority.

The 3rd IMHF workshop “MANAGEMENT OF MEDICAL INCIDENTS AT SEA”

29–30 September 2022, Hamburg, Germany1

Professor Volker Harth, Organizer; Lukas Belz and Thomas von Münster, Rapporteurs
Report by Klaus Seidenstücker and Nebojsa Nikolic

Introduction

Following its statutory objectives, the International Maritime Health Foundation (IMHF) decided to conduct a series of expert workshops following the proposals of its Expert Panel (EP). In parallel to IMHF’s primary project, the journal International Maritime Health (IMH), these workshops shall collect relevant expertise and knowledge to provide state of art guidance for maritime health practice.

The International Labour Office’s (ILO) Convention 2006 (as amended)2 states that seafarers’ medical care should be “as comparable as possible to that which is generally available to workers ashore”. While this may leave room for interpretation the IMHF-EP held the opinion that the implementation of this rule would need specific definition and that in the end medical guidelines should be established that would reflect the conditions of the maritime environment as well as those of actual best medical practice.

A workshop conducted by the International Maritime Health Association (IMHA) in 2015 had already addressed the issue. However, its conclusions had not yet arrived at the relevant working structures of ILO and International Maritime Organization (IMO).

The IMHF-Management Board’s (IMHF-MB) request to the workshop therefore was to analyse the IMHA workshop’s consensus statement for necessary update and complementation and provide IMHF governing bodies with a recommendation for follow up activities towards above UN Organizations.

Materials and methods

The 3rd IMHF workshop was held in Hamburg, Germany, September 29–30, 2022. Altogether, fourteen expert participants from international maritime medicine institutes, universities, legislative bodies and industry, actively participated in the workshop, namely: Lukas Belz (Hamburg Institute for Occupational and Maritime Medicine [ZfAM]), Jon Magnus Haga (Norwegian Centre for Maritime and Diving Medicine [NCMDM]; IMHF-EP), Marie Hamming (TMAS Denmark), Volker Harth (Hamburg University Medical Centre [UKE]; ZfAM; German Association of Maritime Medicine [DGMM], IMHF-EP), Alf Magne Horneland (IMHF-MB), Alison Kay (Trinity College Dublin; IMHF-EP), Thomas von Münster (ZfAM; DGMM), Nebojsa Nikolic (IMHF-EP), Marcus Oldenburg (ZfAM; DGMM; IMHF-EP), Klaus Seidenstuecker (IMHF-EP), Beate Stelzer (Master of container vessels; Maersk; DGMM), Markus Stuhr (Occupational Trauma Clinic Hamburg; DGMM), Jens Tuelsner (Marine Medical Solutions; IMHF-EP; DGMM), Nils Wagner (German Navy Medical Service).

Discussions on the matter were based on the report and consensus statement from the above mentioned IMHA workshop on ‘The Management of Medical Emergencies at Sea’3 and were preceded by the following six presentations:

The round table then discussed along the structure of the 2015 IMHA Consensus Statement Management of Medical Emergencies at Sea and addressed training, medical chest and equipment, medical guides, Telemedical Maritime Assistance Service (TMAS) and treatment pathways especially, and produced the following consensus statement.

Results

The result of the workshop is a set of recommendations to the IMHF governing bodies for a follow up activity.

RESEARCH

International Maritime Health Foundation should encourage relevant institutions to conduct research on available databases at shipping companies (medical logbooks), TMAS centres, insurance companies and national health registries. IMHF should review research results that could provide information on the occurrence of medical incidents at sea. IMHF should encourage assessment of priority according to these data.

International Maritime Health Foundation should establish a network between research institutes and create an electronic database on medical incidents at sea.4

TRAINING

The workshop concludes that shortening of training intervals in between medical courses is essential to establish reliable outcomes.

The workshop suggests additional onboard medical refreshment training (drills, exercises) and the use of tele-teaching, including simulation training and augmented reality training. It is recommended, that exercises and drills are conducted under supervision preferably of TMAS-centres or other professional maritime medical institutions. (TMAS-centres should be encouraged to adapt their structures according to this new task.)5

Institutions or organizations providing such AR/VR simulation training for seafarers should record and debrief training drills and make outcomes/lessons learned to supervisory/regulatory bodies on an anonymized basis, if possible. Whilst challenges to the sharing of such data may exist and were acknowledged by the participants, the benefits of shared training outcomes, e.g., for the purpose of certification, potential risk and hazard identification with a wider Maritime Community should not be underestimated.

Training curriculum should be developed in concordance with the course curriculum under IMO responsibility. These should be evaluated and certified at regular intervals by relevant inspection/certification authorities6.

MEDICAL EQUIPMENT

Changes and amendments for the medical equipment on board should follow requirements derived from the data mentioned above and they should support skills and knowledge according to defined learning outcomes referenced in the second IHMF Workshop on Medical Training on Board, to be updated according to actual state of art.

International Maritime Health Foundation sees a necessity to ensure direct telecommunication from the sick bay or any likely place for a medical incident to onshore assistance.

MEDICAL GUIDE

Medical guides should be up to date with the best medical practice at any time. The IHMF prefers an online version, that allows ships to download updates regularly for offline use. We recommend that ships have medical guidance available wherever an emergency occurs.

Further recommendation is that a physical guide should be kept on board for reference during such times as when there is no power available to access electronic versions (for instance: abandon ship situations).

PATHWAYS

Pathways reflecting the special situation at sea should be developed and then included in the medical guides. To develop such pathways existing medical guides should be analysed for suitable solutions (research effort).

The IHMF recommends a permanent expert group be established to consider state of the art guidelines or pathways.

A further workshop is recommended with a 4-step approach:

1. Look at databases.

2. Determine what is a relevant priority?

3. Consider what to expect from the seafarer and how this can be achieved?

4. Develop pathways suitable for inclusion in the medical guides.

We proposed to use a similar methodical approach for the pathways as was applied for the development of training outcomes at 2. IMHF workshop in Bergen, Norway. Possible interrelations between both subjects need to be kept under consideration.

Summary

The result of the workshop is a set of recommendations on the management of medical incidents at sea. This consensus statement was drafted by an editorial group and then circulated to the workshop participants for further tuning. Comments, add-ins, or changes were communicated with all participants in several rounds of tuning. A final draft was then produced by the editorial group and submitted to the IMHF-EP for comment.

The final document was submitted to IMHF governing bodies for approval and to decide on the further steps. Such steps had already been suggested in the IMHA workshop report (see appendix). Eight years have passed since the London workshop. We feel that it is more than overdue to have a viable solution for the demands of the Maritime Labour Convention of 2006 (!) regarding the level of healthcare available to seafarers!

Appendix (cited from the IMHA London workshop report)

“The next steps

This consensus statement is to be agreed by all those present. A full report will be compiled, agreed by all and published within two months.

After wider discussion a working group will need to be established with clear guidelines and timelines. A reference group will also need to be established with representatives from the relevant international agencies, social partners and national maritime authorities in an appropriate timeline.

Research is necessary to establish the numbers and types of cases that the seafarer encounters. This can guide the priorities for pathway development and for training.

Any new system of medical incident handling must be reviewed on a regular basis with appropriate audit, feedback and research. Quality assurance and enforcement is key to the success of any system.”

Reflections of State of Art

BEST PRACTICE AND PERFORMANCE INDICATORS FOR SEAFARER HEALTH

By Professor Tim Carter

How can the quality of healthcare provided for seafarers be measured? Why does this matter? Who cares?

Right now, there is a lack of accountability for good maritime health practice in the shipping industry and probably only a minority of ship operators have even thought about this beyond meeting the minimum requirements of the Maritime Labour (MLC) and other relevant Conventions.7 However, there are established key performance indicators for other aspects of ship and crew management, and these are becoming an important way for those who have cargoes to transport to assess which ship operators to charter from, at least in certain industry sectors such as oil and chemical transport and container shipping.

The Seafarers Hospital Society in the United Kingdom recently commissioned research on the barriers to improving health care for seafarers, both in terms of physical illness and the psychosocial determinants of wellbeing.8 One of the key conclusions was that a new concept of a ‘caring culture’ needed to be framed and that the development of markers for best practice in maritime health and for the effectiveness of interventions to improve health and wellbeing were an essential tool in taking this concept forward.9

That said, these ideals are confronted by the reality of an industry that prides itself on being global, flexible, and cost-effective, so how can they best be developed. One route would be by means of an internationally agreed legal instrument. In principle this already exists in the form of the MLC. However, this is limited by the inertia inherent in international agencies where action is only taken following a high level of public concern as well as a lack of consistent international implementation and compliance, and perhaps by an attitude to legal requirement where just enough is done to stay out of trouble rather than looking at how benefits from its requirements and recommendations can be maximised. Most MLC provisions relate to inputs and facilities and the convention does not major on measurement of outputs or outcomes in terms of health benefits. There may be greater scope for improvement by inclusion of crew health in other instruments that have legal backing such as the International Safety Management code or by means of guidelines from international agencies, such as those produced on medical examinations or health and safety management.

Voluntary measures are a simpler and speedier option, at least for those parts of the industry where the reputation of a ship operator matters, either in terms of customer chartering decisions or because of the need to recruit and retain seafarers who are competent and committed. The key performance indicators originally developed by Intermanager, the ship managers trade association, and now promoted by Baltic and International Maritime Council, a ship owners’ service and support organization, have gained currency in some sectors and could be developed to include criteria for crew healthcare.

The Seafarers Hospital Society is exploring these options and considering how best it can form partnerships to develop a set of best practice and performance standards for seafarer health and wellbeing. This is an ambitious and probable a long-term project but one that, if successful, could do much to help create the ‘caring culture’ that is often lacking in the industry as well as encouraging practicable ways in which ship operators can be accountable for health and wellbeing and improve the quality of crew health for the future.

Maritime health professionals are important partners in this work, but at this stage the key challenge is to look at how best to influence industry cultures. To this end the Society is working with those who have practical experience of ship management, insurance and maritime decision taking. Workshops involving maritime health professionals will be held once the boundaries of what is practicable have been better defined.

Particulars/IMHF News

CHANGE OF COMMAND ON THE BRIDGE OF THE INTERNATIONAL MARITIME HEALTH FOUNDATION

By Klaus Seidenstücker10

Since 2018 this journal is owned and published by the International Maritime Health Foundation (IMHF). The foundation then took over from the Polish Society of Maritime, Tropical and Travel Medicine that still is a founding member of the IMHF.

Statutory objectives of the foundation are:

Founders of IMHF are:

These three entities constitute the IMHF “cooperating institutions” and were joined in 2022 by the International Transport Worker Federation’s Seafarers’ Trust (ITF-ST).

Governing bodies of the IMHF are:

President of the Management Board since the establishment of the IMHF was Alf Magne Horneland, formerly director of the Norwegian Centre for Maritime Medicine.

Alf Magne completed medical school at the University of Bergen in 1977 and specialized in general practice and family medicine. For 20 years he worked as district medical officer in municipalities along the Norwegian coast, 8 years as advisor to the national social insurance.

From 1998 to 2008 he was Surgeon Commander in the Royal Norwegian Navy and chief medical instructor for the Norwegian Navy Schools.

Alf Magne is head of the appellate body of the Norwegian Maritime Authority and the Norwegian Coastal Administration.

He held membership of the International Maritime Health Association (IMHA) from 2001, was member of the IMHA board of directors since 2009, IMHA vice president from 2011 to 2013 and president from 2013 to 2015. In that position he organized the 13. International Symposium on Maritime Health (ISMH) in Bergen, Norway, which many of us will have in good memory.

Alf Magne was the main inspirator and driver in the establishment of the IMHF when the International Maritime Health journal was in a severe financial situation from 2016 to 2018. It is his merit that maritime medical professionals can still read and rely on a source of information specializing in maritime health. From 2018 to 2022 Alf Magne was president of the IMHF’s Management Board. And it is fair to say that he took almost all responsibility on his shoulders to keep the ship afloat in these years.

Alf Magne devoted his life and his professional career to maritime medicine in an exemplary way. He stepped down from the IMHF Management Board’s (IMHF-MB) presidency by the end of 2022 and we owe to thank him for his dedication to the cause as well as for the diligence, methodical approach and expertise he invested in every obligation he accepted — even in times when his health was at stake.

By the end of 2022 Alf Magne handed over IMHF-MB presidency to Nebojsa Nikolic. He still lends his expertise to the IMHF Expert Panel as advisory member. We are happy to have him alongside for the many challenges ahead and wish to thank him for his outstanding contribution to our common cause in the past!

Nebojsa is a founding member of IMHF’s Expert Panel. Many of our readers will know him as IMHA member and IMHA president from 2008–2009 and chair of the 8th International Symposium on Maritime Health, held in Rijeka, Croatia in 2005.

He was the chair of Maritime Medicine at the Faculty of Maritime Studies and lecturer on maritime medicine at the faculty of medicine at Rijeka and the University of Cadiz, Spain. Nebojsa was awarded a medal of the Institute of Tropical and Maritime Medicine at Gdynia, Poland. He is honorary professor at the Institute of Transport in Odessa, Ukraine, court expert of maritime medicine and medical advisor of ITF and the Ministry of Transport in Croatia.

Nebojsa has a legend as invited speaker at international conferences and is author of 70 scientific papers and 3 books. He is author of the chapter on maritime medicine in World Health Organization International Travel and Health annual editions. He is member of this journal’s editorial board and past board member of the Journal of Travel Medicine and of Medicina Marittima.

He is vice president of the medical commission of the World Sailing, president of the medical committee of the Croatian Sailing Association and member of the Association of Summer Olympic Games Medical and Science Consultative Group within the International Olympic Committee. He was chief medical officer for the sailing events at the Olympic Games in Rio 2016 and Tokyo 2020.

With Nebojsa not only do we have an expert contributing a new set of views on maritime health but also someone who will provide continuity as well as lay out the path for a next generation to carry IMHF into the future.

We wish him always fair winds and following seas at the helm of our foundation!

Presentations

CENTRE FOR OCCUPATIONAL AND MARITIME MEDICINE, HAMBURG

Provided by Professor Volker Harth

The Hamburg Centre for Occupational and Maritime Medicine (Zentrum für Arbeitsmedizin und Maritime Medizin [ZfAM]) is an institution of the ministry of Justice and Consumer Protection (BJV) of the Free and Hanseatic City of Hamburg, connected with the Medical Faculty of the Hamburg University through the university professorship for occupational medicine and maritime medicine. The combination of occupational medicine polyclinic and 6 research working groups (Clinical Occupational Medicine, Epidemiology, Maritime Medicine, Mental Health, Public Health, Toxicology) offer ideal prerequisites for a successful interdisciplinary cooperation in research, teaching and patient care. The Institute is located in the St. Pauli Health Centre.

Responsibilities

The remit of the Institute is the performance of occupational scientific and medical investigations in order to increase knowledge about work-related adverse effects on human health. The Institute is responsible for basic and applied research, communicating health care methods and further training, academic lectures, the assessment of safety at work and hygiene, as well as the counselling of physicians, ministries, authorities, accident insurance claimants, local employees (including seafarers) and employer organizations.

In close cooperation with its clinical-experimental working groups, current research topics are taken up that arise from the constant change in the working world “on land and at sea”. Thematically, the focus is on the development of workplace-related and at the same time public health-related prevention strategies, e.g. on the increasing absenteeism and early retirement due to mental stress and diseases or on health burdens caused by the increasing work intensification, the globalized commodity trade and new industries and technologies. In this context, the ZfAM draws on extensive expertise, but at the same time sets thematic priorities in newly established research projects, e.g. on the health effects of night and shift work and on quality-assured methods in the early diagnosis of occupational respiratory and lung diseases.

The Institute continues to deal in particular with research topics that have a Hamburg-specific connection, an example of which is the complex of topics “Psychomental stress in shipping”. For the coastal states, the emerging technology sector of “offshore wind energy” poses a challenge to employee and workplace-related prevention, to which the institute contributes its expertise. The diagnostics of the “classical” chemical-irritative, toxic, carcinogenic and biological stresses also continue to be a focus at ZfAM. Cooperation with the UKE takes place within the framework of the Hamburg City Health Study (HCHS), for which ZfAM developed questions of occupational and environmental medicine in particular; involvement in the Centre for Health Care Research (CHCR), the UKE association for health care research, was also expanded.

History

In 1968, the Senate of the Free and Hanseatic City of Hamburg converted the Extraordinariate into a full Chair of Occupational Medicine and created the Central Institute of Occupational Medicine (ZfA). Shipping Medicine was founded in 1966 as a department of the Bernhard Nocht Institute but was integrated into the ZfA in 2000 which was manifested with the renaming to the Central Institute for Occupational Medicine and Maritime Medicine (ZfAM) in 2007. In 2019, Prof. Harth‘s professorship was reassigned to occupational medicine and maritime medicine.

Current externally funded projects

Institute for Occupational and Maritime Medicine (ZfAM)

University Medical Centre Hamburg-Eppendorf (UKE)

Seewartenstraße 10 | Haus 1 | 20459 Hamburg

Tel.: +49 40 428 37 4201 | Fax: +49 40 427 31 3393

E-Mail: zfam-sekretariat@justiz.hamburg.de; Homepage: www.uke.de/arbeitsmedizin

The ZfAM in house 1 of the St. Pauli Health Centre, formerly known as the harbour hospital

1 The workshop was sponsored by the TK Foundation, the German Association of Maritime Medicine (Deutsche Gesellschaft für Maritime Medizin eV.; DGMM) and the Hamburg University, Medical Faculty.

2 International Labour Office: Maritime Labour Convention 2006: https://www.ilo.org/global/standards/maritime-labour-convention/lang--en/index.htm.

3 The workshop was held in London, February 2nd to 3rd, 2015. A report was drafted but is unpublished yet. We intend to have an article on that workshop in one of our next journal issues.

4 An expert conference maybe the way to start this process.

5 See remarks on “experiential learning” in the report of 2nd IMHF workshop on medical training (Nikolic N, Haga JM, Tuelsner J, et al. Medical training of seafarers: International Maritime Health Foundation (IMHF) Expert Panel Consensus Statement. Int Marit Health 2023; 74(1): 15–23).

6 Suggestion was to consider a follow up workshop on this.

7 Guillot-Wright S. The changing economic structure of the maritime industry and its adverse effects on seafarers’ health care rights. Int Marit Health 2017; 68(2): 77–82.

8 Slade MD. Seafarer health: research to date and current priorities. Seafarers Hospital Society and Yale University, August 2022. https://seahospital.org.uk/yale-university-report-seafarer-health-research-to-date-and-current-practice/.

9 On course for a Culture of Care. Seafarers Hospital Society, 2023. https://seahospital.org.uk/seafarers-health-on-course-for-a-culture-of-care/.

10 CVs based on contributions from Alf Magne Horneland and Nebojsa Nikolic