Fitness Standards In Maritime Industry

Kuwait Oil Tanker Company (S.A.K.) A subsidiary of Kuwait Petroleum Corporation Fitness Standards In Maritime Industry OHKWGCC 2017 Conference May 16 th ~18 th 2017 Kuwait Dr. Fahad Al Obaid Medical Advisor KOTC

Maritime Sector Understanding where each fits into the complex shipping chain can be a tough task 2

Regulatory Requirement 3

Regulatory Requirement Seafaring is, by its nature, international National laws and recommendations alone will do little to ensure health and safety on the seas of the world There is now a framework of international conventions which form the basis for common global standards of safety and, to an extent, for maritime health provision Maritime medical practice plays a major part in meeting international and national requirements 4

Maritime Labour Convention 2006 MLC Kuwait Oil Tanker Company S.A.K Fleet Personnel Group

Background The Maritime Labour Convention (MLC 2006) was adopted by ILO in February 2006 participation from 106 Countries Entry into Force & Status 20 th August 2013 MLC 2006 provides comprehensive rights and protection at work for more than 1.2 million seafarers. Kuwait Oil Tanker Company S.A.K Fleet Personnel Group

Certification The working and living conditions that must be inspected and approved before certifying a ship : 1. Minimum age 2. Medical certification 3. Qualifications of seafarers 4. Use of any licensed or certified or regulated private recruitment and placement service 5. Hours of work or rest 6. Manning levels for the ship 7. Accommodation 8. On-board recreational facilities 9. Food and catering 10. Health and safety and accident prevention 11. On-board medical care 12. On-board complaint procedures 13. Payment of wages 14. Seafarers employment agreements It must be noted that requirements within each of these areas are very detailed and compliance must be with the details! Kuwait Oil Tanker Company S.A.K Fleet Personnel Group

Regulatory Requirement The requirement for seafarers to have a certificate of medical fitness is stipulated on both ILO and International Maritime Organisation (IMO) conventions. Most of the major maritime countries have medical fitness standards that cover broadly the same range of conditions (minimum requirements) but they differ in the line that is drawn between who is fit and who is either restricted or unfit. 8

KOTC Medical Advisor Fleet Telemedicine consultation 24/7 Medical Evacuation Updating the onboard medical chest PEME program D & A Program Health Promotion (General & Specific) Travel Medicine advise Medical Database & EHR Systems Medical Clinic (HO) LPG & Minatank Medical consultation Deal with medical Emergencies Center For Health Promotion Programs ( Group & Individual) Liaise with LPG HSE (Health Promotion) 9

KIHSE Conference February 16 th ~17 th 2015 - Kuwait KOTC Fleet operations At KOTC we operate 30 modern vessels that carry crude oil / products and liquefied petroleum gas. There are a total of 1250 Officers and Ratings manning these vessels. The officers are multinational, and the rating are all from the Philippines. 10

Different classes of Tankers 11

A Year of Global Shipping Routes Mapped by GPS

KOTC sea staff KOTC fleet is staffed by multinational crew Seafarers are away from their homeland for extended periods of time The ability to communicate in a common language is the crucial factor determining the success of a multinational crew 13

KIHSE Conference February 16 th ~17 th 2015 - Kuwait Social Pressures In some countries seafarers are considered as one of the driving forces to the economy The average seafarer will do anything to conceal existing medical conditions during his Pre-Employment Medical Examination to protect his livelihood as failure to do so will result in the seafarer and his family facing economic ruin, especially in countries where there are no social security schemes that cover the citizens during unemployment nor the access to medical treatment in the absence of medical insurance. A consequent culture of being declared Fit For Duty develops Concealment of pre existing medical conditions. 15

KIHSE Conference February 16 th ~17 th 2015 - Kuwait The Mindset The Macho culture The Macho culture is an integral part of the Seafarers mindset Seafarers not taking good care of his physical and mental well being We used to do thing in certain ways If you breath and walk then you are fit for duty 16

KIHSE Conference February 16 th ~17 th 2015 - Kuwait Impact of Culture on Health The average seafarer will do anything to conceal existing medical conditions during his Pre- Employment Medical Examination to protect his livelihood 17

KIHSE Conference February 16 th ~17 th 2015 - Kuwait Remedial Actions As a result KOTC has taken the following initiatives to mitigate and reduce the health risks: Pre-Employment and Periodic Medical Examinations for all seafarers to UKMCA guidelines in Liaison with P&I Clubs (Protection and Indemnity Clubs) Health Campaigns onboard the vessel and in the company premises Adopting a healthy cuisine onboard the vessels Onboard training for health and safety Onboard training for food, hygiene and sanitation 18

KOTC Loss Prevention Initiatives

Pre-Employment Medical Examination Program (PEME) Our assessment revealed inconsistencies in standards used by the clinics all around the world for pre-employment medical examinations. Most clinics adhered to the minimum standard required by the local authority and there was no accountability by the clinics to a shipowner. Action Plan: KOTC and the P & I Club created an enhanced medical examination based on a recognized maritime standard (UK MCA) The standard medical examination is implemented by an approved clinic network established within the major areas of crew recruitment Currently there are 43 clinics in 14 countries 20

Why New PEME scheme? To meet MLC 2006 requirement Screening crew before embarkation to ensure healthy crew on board Reduced frequency and volume of crew illness onboard our vessels Less medical claims To meet industry standards and best practice (Oil Majors) 21

PEME Expectations By adopting a higher examination standard we aim to Screening crew before embarkation to ensure healthy crew on board 22

Pre Employment Medical Exam (contd.) KOTC PEME program contains more medical tests and higher standards e.g. Stress Test > 45 Abdominal U/S Virology screening Back x-ray Vaccination 24

KOTC PEME INITIATIVE We started the PEME scheme in the Philippines in 7/2012 We started a pilot project with one approved clinic in the Philippines The initial results were encouraging and meet our expectations The direct and indirect cost-benefits expected to be favorable How much it costs to divert a vessel? How much does it cost to pay one claim? 25

UK P & I Club PEME Clinic Locations The system has now been expanded to the UK, Poland, Bulgaria, Egypt, India, and others thereby covering 98% of our sea staff Clinics are contracted and are accountable to the P & I club to uphold high standards The accredited clinics audited and reviewed regularly 26

PEME Risk Matrix 27

PEME Examinations 2013-2014 TOTAL EXAMINED = 795 TOTAL FIT = 733 UNFIT = 63 (8%) Number of medical claims reduced in 2012-2013 (15%) 28

PEME Examinations 2015-2016 TOTAL EXAMINED = 1250 TOTAL FIT = 1214 UNFIT = 39 (3%) Number of medical claims reduced in 2015-2016 (45%) Currently there are 25 clinics in 14 countries 29

Statistics Unfit Seafarers KOTC - Unfit list 2014-2014 Diabetes 3 Gallbladder Disease 5 Hepatitis B 10 Hypertension 3 Kidney Disease 4 Lumbo Sacral X-ray findings 27 Sight Defect 1 VDRL 1 PTB 1 Heart Disease 1 Chest X-ray Findings 2 Did Not Return Back 5 Total 63 KOTC - Unfit list 2015-2016 Diabetes 6 Gallbladder Disease 2 Hepatitis B 1 Abnormal Audiometry 8 Cancer 1 Lumbo Sacral X-ray findings 2 Sight Defect 4 Spina Bifida 1 PTB 12 Haematuria 1 Heart Disease 1 Total 39 30 25 20 15 10 5 0 6 3 2014 & 2016 Unfit Status 27 10 12 8 5 2 1 3 4 1 2 4 1 1 1 1 1 1 1 2 5 32

KOTC Sea Staff Medical cases 2012-2016 33

2013/14 2014/15 2015/16 Manpower Manpower Manpower 946 1213 1250 34

Fitness Categories Seafarers are people who live and work in surroundings that are very different from those ashore Ship Considered as a small self-sufficient community 35

Challenging Factors to Implementing Health Management system in KOTC Multi-National Employees Geographic Locations (Logistic nightmare) Influencing Cultures (Local / Regional Culture) Employee turnover (Rotations i.e. onboard marine vessels) Health & Safety Awareness Patient best interest?? Aging workforce NCD Vs Experience 36

Health & Safety Awareness Gap

Thank You 39

Travelers' Health 4

KIHSE Conference February 16 th ~17 th 2015 - Kuwait Prevention is better than cure. Desiderius Erasmus Health Management A successful organization shall adopt the latest and most advanced health care system for the employees welfare. 41

Fleet Health Promotion Programs General Health Promotion Topics: Diet & Exercise Smoking Mental health Flu Travel health issues Specific OHS Topics Noise & Vibration Dehydration & Heat disorders Injury prevention PPE 42

Travelers' Health 43

Inspections in ports Port State Inspection Onshore Seafarer complaint handling procedure The certificates under the authority of a ratifying state shall, if there are no grounds to doubt the basis of them, be accepted as proof of compliance Ships from non ratifying states shall be met by the No more favourable treatment ensuring inspections for compliance on such ships Kuwait Oil Tanker Company S.A.K Fleet Personnel Group

Maritime industries Include all enterprises engaged in the business of : Designing Constructing Manufacturing Acquiring Brokerage Services Shipyards, Dry Docks Marine Repair Shops Shipping Operating Supplying Maintaining Vessels, Or Component Parts 46

Thank You Kuwait Oil Tanker Company S.A.K Fleet Personnel Group

Kuwait Oil Tanker Company - Unfit crew by reason Diabetes 6 Gallbladder Disease 2 Hepatitis B 1 Abnormal Audiometry 8 Cancer 1 Lumbo Sacral X-ray findings 2 Sight Defect 4 Spina Bifida 1 PTB 12 Haematuria 1 Heart Disease 1 total 39 48

The main aspects of maritime medicine on policies and in day to day practice are: Decisions on who can safely and effectively work at sea without risk to their health or to that of others. Responding to medical emergencies at sea: Training, provision of on medical equipment telemetrically advice, evacuation. Advice on working and living conditions Recommendations on preventative measures that can help seafarers maintain good health The collection and analysis of data and use it to improve the quality of care in future. The care and rehabilitation of seafarers who have become ill or been injured 50

What is meant by maritime industry? Parties whose activities involve supplying products and services related to the traditional maritime sector 51

Statistics Unfit Seafarers 52

Maritime Medicine Maritime medicine is not a well-established field The field of Maritime medicine overlaps with occupational medicine, tropical medicine, diving medicine, and travel medicine One general definition of maritime medicine could be any medical activity related to questions concerning the employment, working conditions, living conditions, health and safety of workers at sea Norwegian Centre for Maritime Medicine 53