Asian-Pacific Newsletter
O N O C C U PAT I O N A L H E A LT H A N D S A F E T Y
Volume 18, number 2, September 2011
Maritime sector
Asian-Pacific Newsletter
on Occupational Health and Safety
Volume 18, number 2, September 2011
Maritime sector
Published by
Finnish Institute of Occupational Health
Topeliuksenkatu 41 a A
FI-00250 Helsinki, Finland
Editor-in-Chief
Suvi Lehtinen
Editor
Inkeri Haataja
Linguistic Editing
Sheryl Hinkkanen, Alice Lehtinen
Layout
Liisa Surakka, Kirjapaino Uusimaa, Studio
The Editorial Board is listed (as of 1 December 2008)
on the back page.
This publication enjoys copyright under Protocol 2 of
the Universal Copyright Convention. Nevertheless,
short excerpts of the articles may be reproduced
without authorization, on condition that the source
is indicated. For rights of reproduction or translation,
application should be made to the Finnish Institute of
Occupational Health, International Affairs, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland.
The electronic version of the Asian-Pacific Newsletter on Occupational Health and Safety on the Internet can be accessed at the following address:
http://www.ttl.fi/Asian-PacificNewsletter
Contents
31 Editorial
Occupational health and safety in the maritime sector
Suresh N. Idnani, India
32 Seafaring and health with emphasis on Asian seafarers
Wickramatillake Hemantha, Brunei
35 Strategy for maritime health services
Vietnam National Institute of Maritime Medicine
(VINIMAM)
Nguyen Truong Son, Tran Thi Quynh Chi, Vietnam
38 Occupational safety in a mechanical ship building
industry
Nguyen Bich Diep, Vietnam
41 Fitness for work at sea
Heikki Saarni, Finland
43 Occupational health services in Brunei Darussalam
N.B.P. Balalla, Brunei
47 Policies, profiles and services in OH&S
Suvi Lehtinen, Finland
The issue 3/2011 of the Asian-Pacific Newsletter deals
with occupational health and safety profiles.
Asian-Pacific Newsletter is financially supported by
the Finnish Institute of Occupational Health and the
International Labour Office.
Photograph on the cover page:
© ILO, Mirza A.
Printed publication:
ISSN 1237-0843
On-line publication:
ISSN 1458-5944
© Finnish Institute of Occupational Health, 2011
The responsibility for opinions expressed in signed articles, studies and other contributions rests solely with their authors, and
publication does not constitute an endorsement by the International Labour Office, the World Health Organization or the Finnish Institute of Occupational Health of the opinions expressed
in them.
Occupational health and
safety in the maritime sector
I
n this editorial, I would like to take the opportunity to look at the changing patterns
in the global seafaring sector and to consider its implications for the health and safety of those at sea.
More than a third of the world’s 1.2 million seafarers are Asians. The boom in
containerized shipping and the increased activity in Asia have created a shortage of
officers and skilled seafarers. Accordingly, the focus of the labour market for seafarers has continued to shift from Western Europe, Japan and North America to the rest of East
Asia and the Indian subcontinent. This has meant that while 72.1% of all ship crew still come
from South and South-East Asian countries, these regions are now also providing 81.2% of the
total supply of officers. This marked increase has come about because European and Japanese
shipowners, faced with severe shortages of seafarers, have established training centres in various Asian countries in order to recruit and train seafarers to man their vessels.
With the increase in recruitment from Asia we have also seen a change from the traditional
permanent contract towards single contracts. While this does provide shipping companies and
seafarers with flexibility, the consequences for the employment, security and general welfare of
seafarers need to be considered. When seafarers become unfit to continue in line with the single contract model, they will return to their home nations. In effect, there is ‘social dumping’
of the costs of long-term care from the global shipping operators to the poor crewing nations
throughout Asia. If the increased provision of Asian seafarers is to remain sustainable, then
this issue needs to be discussed and solutions found.
The implication of this expansion in the provision of seafarers is the need to build on the
associated infrastructure. Clinic services, welfare resources and systems for repatriation all need
to be provided and these need to be able to deal with sufficient capacity, proper quality and assurance that will translate into ethical operations.
When planning the provision of services for seafarers, attention should be paid to the specific problems encountered by those working in the maritime sector in terms of the pattern of
diseases and how they can be managed. The prevention of diseases plays a very important part
in the practice of medicine, and nowhere is this more important than onboard ship. Broadly,
occupational health injuries and diseases can be classified into two categories of origin: morbid (relevant to internal causes) or accidental (external causes). These two have a different impact on the indexes of morbidity and mortality among seafarers in different fleets, being influenced by demographic factors, the standard of living and security of work onboard, the accuracy of pre-employment medical examinations, the region of seafaring, statistics, credibility,
etc. Some causes can be modified and might be reversed by primary or secondary preventive
means while others are irrelevant to medical intervention, depending more on the use of technical or legal tools.
If we consider the problem of loss of life at sea relevant to morbid causes, cardiovascular
diseases (CVD) – myocardial infarct accounting for two out of three and stroke for one out of
four cases, sometimes other cardiac reasons – rank at the top, with diabetes and obesity as the
most frequently present concomitant factors. Among priorities, suicide and mental illness are
current challenges. The main interest is, are they preventable in the maritime work environment, and by what means.
The risk of some contagious diseases in the maritime environment is still topical and challenging. The loss of life, the cost and efficacy of prophylaxis and treatment, and absenteeism
caused by malaria, dengue, sexually transmitted disease and HIV, tuberculosis, legionellosis,
other viral gastrointestinal and pulmonary infections are urgent.
It seems also that acute stress and post-traumatic stress disorder syndromes (including that
related to terrorism) are important and rising considerations as potential factors contributing
to mortality and morbidity in seafaring. The list may be longer, but the ones mentioned have
the most impact on life and occupational health.
From another angle, we should remember that external causes (maritime catastrophes,
collisions, sinking, etc.) are currently the predominating reasons for loss of human life at sea;
especially in fishing. Unfortunately, medical prevention has a rather minimal influence on this
problem.
Asian-Pacific Newslett on Occup Health and Safety 2011;18:31–2 •
31
Photo by the International Transport Federation
Conditions at sea may not be as conducive to healthy living as conditions ashore.
Opportunities for recreation, exercise and
hygienic lifestyle are necessarily restricted; living quarters maybe less commodious and obtaining fresh food becomes more
difficult. Seafarers are separated from their
families for long periods of time; they spend
months in the restricted areas of their ship,
with a small number of fellow crew members around them. Such conditions create
boredom and stress, which may contribute
to some of the ailments and diseases that occur among seafarers.
Welfare centres at trans-shipment ports
provide an excellent means of helping with
the psychological problems encountered at
sea. The relatively recent establishment of the
International Drop-In Centres for Seafarers
located at Keppel Terminal, Jurong Port and
Pasir Panjang Terminals ought to serve internationally as a model of what can be done
to reach out to the crews of container ships,
which stay in port only for very short calls.
These centres, equipped with International
Direct Dialling (IDD) facilities, access to the
Internet and lounge areas for relaxation, provide respite for seafarers who find it difficult
to leave the port area when they are off duty.
While a number of challenges still remain, the recent changes in the Maritime
Labour Convention, ILO MLC 2006, present
a golden opportunity for the Asian maritime
sector to grow and to maintain its increased
importance. Compliance with the standards of international maritime health programmes through a global health care association such as the International Maritime
Health Association (IMHA), and in consultation with International organizations
such as the International Labour Organization (ILO), the International Maritime Organization (IMO), shipowner organizations
and seafarer organizations, can take place
only if the seafarer is valued and seen as an
asset by the international shipping industry.
Suresh N. Idnani
President, International Maritime Health
Association (IMHA)
Trustee, International Committee on
Seafarers Welfare (ICSW)
President, Seafarers Welfare Association
of India (SWAI)
Convenor, National Seafarers Welfare
Board - India (NSWB-India)
Director, Indus Medical Center
S 2/2, Nova Cidade, NH 17, Bardez, Goa
INDIA
www.dridnani.com
32
• Asian-Pacific Newslett on Occup Health and Safety 2011;18:32–4
Seafaring and health with emphasis
on Asian seafarers
Wickramatillake Hemantha, Brunei
Around 90% of world trade is carried by the
international shipping industry. (1) There are
around 50,000 merchant ships trading internationally, transporting every kind of cargo.
The world fleet is registered in over 150 nations and manned by over a million seafarers
of virtually every nationality. The worldwide
population of seafarers serving on internationally trading merchant ships is estimated to be
in the order of 466,000 officers and 721,000
ratings. (2) Seafaring, ideally, includes the
fishing industry, cruise ships, ships that carry
dangerous cargo (e.g. nuclear waste) and research ships. This article focuses mainly on
commercial shipping. However, the health issues of those who work on vessels of all categories are more or less the same.
With reference to manning, the OECD
countries (North America, Western Europe,
Japan etc.) remain an important source for
officers. However, a large percentage of ‘officers’ for the shipping industry is currently recruited from Far Eastern and Eastern European countries, while the majority of the ‘ratings’ are recruited from developing countries;
especially from the Far East and South East
Asia. The Philippines and India are significant suppliers of maritime labour, with many
of their seafarers securing employment opportunities on foreign flag ships operated by
international shipping companies. One publication (3) revealed that foreign seafarers, especially from the Philippines, account for about
97% of those serving on board the merchant
ships under the control of Japanese shipping
companies. Studies have also looked at the age
profiles of seafarers. There were fewer seafarers
above 50 years of age in some of the SouthEast Asian countries. For instance, some recruiting agencies in the Philippines primarily
hire the youngest candidates as seafarers. (4)
The world trading fleet as 1 January 2008 was
made up of 50,525 ships, with a combined tonnage of 728,225,000 gross tonnes. The number
of general cargo ships was 18,982, with 6,890
bulk carriers, 4,170 container ships, 12,583
tankers, 5,957 passenger ships and 1,943 ships
of other types.
Health and safety of seafarers
Seafaring has been recognized as a high-risk
occupation, and safety and health aspects of
work on board ships are a major concern for
ship owners and seafarers. (5) The world merchant fleet comprises around 1.2 million seafarers, two-thirds of whom work within a multiethnic crew structure. Seafarers have a second home on board ships during tours of duty
which can last for several months. Their health
and living conditions are influenced by the
working conditions in a global industry that
is still increasing in size and importance. The
increasing need for effective and fast transport
of goods requires a continuous change in technology and work organization on board, with
new exposures related to health and safety. Although merchant seafaring is a highly international industry, the epidemiological studies done on safety and occupational health
in seafaring thus far have focused mainly on
national studies. Yet, the relevance of international studies has been recognized for many
years. (6, 7) Studies of the health-related aspects of seafaring have primarily been concerned with mortality and morbidity, while
studies related to the health, per se, of seafarers are sparse. Seafarers are expected to be at
least as healthy as or healthier than the general population, owing to the minimum health
status required for passing the regular health
examinations (8). However, what is important
is to examine the issues related to seafarers’
contracting of illness, because of the nature
and location of their work.
Accidents
Much attention has been paid to accidents on
board ships. Despite recent advances in injury
prevention, accidents remain the main cause
of injury and death. This is mainly due to the
hazardous working and living conditions at
sea and non-observance of safety rules. Bad
weather continues to be a factor contributing
to the cause of accidents.
Stress
Many factors are responsible for stress among
seafarers. A German study cited that separation from the family, time pressure, long working days and fatigue, heat in workplaces and
insufficient qualification of subordinate crew
members were the most significant stressors
on board. (9) Furthermore, harassment and
bullying, anxiety, disruptive thinking and behaviour, job insecurity, loneliness, short (ship)
turn around times, unfriendly bunk/cabin
mates, sexual abuse, lack of shore leave and
addiction to alcohol and drugs were acknowledged as contributory factors for stress.
Health issues
Seafarers are among the most isolated demographic working groups in the world, in relation to access to medical care; both in emergency situations and for primary health care
on board a large, slow-moving vessel in the
middle of the ocean. Thus, a seafarer may be
several days away from quality medical services. Health issues that are of general concern
on land become a serious issue when a seafarer requires medical attention for the same
health problem when on board a vessel. In the
seafaring world, ‘Not Fit for Duty’ status and
repatriations caused by illnesses are increasing
and far exceed the number of injuries that occur at sea each year. (10) It has been observed
that the most common causes of illness-related
repatriations among Filipino seafarers were appendicitis, urinary tract stones, hypertension,
inguinal hernia, gastritis, gallstones, haemorrhoids, and cardiac disease. (11) Mortality from
cardiovascular diseases (CVD) among seafarers
is mainly caused by the increased risks and impaired treatment options of CVD at sea.
Asian-Pacific Newslett on Occup Health and Safety 2011;18:32–4 •
33
Communicable diseases in seafaring continue to remain an occupational health problem. Of these, sexually transmitted infections
(STI) are of concern. Effective campaigns on
casual sex and risk reduction methods are
conducted by the shipping industry and the
seafarer unions. Despite such awareness programmes, seafarers indulge in casual sex at
ports of call for many reasons, such as, being
away from home and the regular sexual partner, monotony of life on board and the lack
of opportunity to relieve sexual desires. Thus,
the increased risk of STI is of much concern.
Other diseases are contracted through impure
water (e.g. dysentery, cholera) and at ports of
call (e.g. malaria, dengue).
Exposures to hazardous chemical substances and UV-light are also important
health risks on board ships. Seafarers work
under harsh and stressful conditions on board,
including harsh environmental conditions.
Thus, they must have sufficient recreational
activities both on board and ashore. However,
in reality there is often a lack of leisure time
possibilities.
Terrorism and attacks by pirates
This issue is becoming a matter of concern to
the seafaring occupation. Terrorist attacks by
extremist groups and attacks by pirates lead
to high anxiety and tension among seafarers.
Some issues of concern to Asian
seafarers
Pre recruitment medical examinations
Although the shipping companies and seafarer
unions are much concerned about that medical examinations should be of high standards,
the quality of medical examinations is not up
to standard. For instance, poor quality chest
X-rays can lead to incorrect diagnoses of chest
conditions, especially the presence of tuberculosis (TB); this means the risk that TB can
be transmitted to colleagues on board. Further, new recruits may not divulge illnesses
such as asthma and psychiatric illness, or may
provide false information about such illnesses. Provision of bogus medical certificates is
also of concern.
Health services on board
WHO and ILO have specified standards for
health services on board, which national maritime authorities are required to follow. However, there is little evidence on the status of health
services provided on board Asian ships. It is
uncertain whether trained persons and listed medical items are available at an expected
standard aboard Asian ships. Telemedicine
is being practised now on many of Western
ships, giving a significant boost to healthcare provision on board. However, whether
telemedicine facilities are available on board
Asian ships is not known. Asian shipping companies may be reluctant to implement telemedicine services due to its high initial cost.
Chronic illnesses
Seafarers who work continuously for long periods but avoid medical examinations could
suffer from chronic illnesses (e.g. diabetes
mellitus, hypertension, ischemic heart disease, musculoskeletal disorders, etc.) while
on board. This is a serious issue. Such seafar-
Photo by the International Transport Federation
ers should not conceal their illness from authorities.
Insurance, health cover, claims, and pensions
Many shipping lines work on a “hire and fire’
basis, with health insurance cover valid only for on board accidents, emergency medical
problems and a maximum of repatriation back
home. Seafarers have to bear the cost of medical expenses once they return home after leaving the ship. Most contractual agreements are
silent on the provision of medical care when on
leave. As for pensions, apart from Singapore,
most seafarers from Asian countries have no
retirement pension contribution from their employer and this is also rare for those from Indian
Ocean and Eastern European countries. (12)
Family welfare
Compared to Scandinavian and Nordic countries, family welfare provision is at a minimal
level in almost all Asian countries. The International Transport Federation (ITF) and many
other unions are striving hard to address this
issue, with improved achievements. However,
shipping companies and governments could
provide more support in this area.
References
1. http://www.marisec.org/shippingfacts//
worldtrade/index.php?SID=a5f34978b6bd2be71a
3ff5bd413d9300
2. http://www.facebook.com/group.
php?gid=60732853893
3. http://www.maritime-forum.jp/asia/objectives.
html
4. Knudsen F. If You Are a Good Leader I Am a Good
Follower. Arbejds- og fritidsrelationer mellem
danskere og filippinere om bord på danske skibe,
Arbejds- og Maritimmedicinsk Publikationsserie, 8. Esbjerg: Forskningsenheden for Maritim
Medicin, 2004
5. ILO. Accident Prevention on Board Ship at Sea
and in Port, 2nd edn. Geneva: International Labour
Organization, 1996
6. Goethe H, Vuksanovic P. Distribution of diagnoses,
diseases, unfitness for duty and accidents among
seamen and fishermen. Bull Inst Marit Trop Med
Gdynia 1975;26:133–151.
7. Schilling RSF. Section of Occupational Medicine.
Proc R Soc Med 1966;59:405–410.
8. http://occmed.oxfordjournals.org/content/56/6/393.full
9. Oldenburg M, Jensen HJ, Latza U, Baur X. Seafaring stressors aboard merchant and passenger
ships. Int J Public Health. 2009;54(2):96–105.
10. http://maritimemedicalinternational.com/mmi_issue1_0610.pdf
11. http://www.futurecareinc.com/news/dare-tocare/
12. http://www.itfseafarers.org/happier-ship.cfm
Prof. Hemantha D. Wickramatillake
Occupational Medicine and Health
Institute of Health Sciences
University of Brunei Darussalam
E-mail: Hemantha.wickramatillake@ubd.edu.bn
34
• Asian-Pacific Newslett on Occup Health and Safety 2011;18:32–4
Photo by ILO, Deloshe P.
Strategy for maritime health services
Vietnam National Institute of Maritime Medicine (VINIMAM)
Nguyen Truong Son, Tran Thi Quynh Chi, Vietnam
Introduction
Vietnam comprises 63 provinces and cities
with a total population of 86 million. Of these,
28 provinces and cities with a population of
about 41,866,900 million are on the coast. The
length of Vietnam’s coastline is about 3,260
km.
At present, our maritime economy is developing strongly. The offshore gas and oil industry, both exploration and crude oil production, has also been developing very fast.
Agricultural and industrial products are
exported and imported mainly by shipping
The maritime transport sector consists of shipping companies, maritime insurance companies, shipyards and shipbuilding groups, and
ten large seaports.
The fisheries industry, both deep sea and
coastal fishing, is well developed. There are
about 100,000 fishing ships and boats. In addition, the seafood farming and processing
sectors are developing very vigorously in all
coastal provinces and cities.
Thus the maritime sector in Vietnam encompasses maritime transport (shipping companies, maritime port systems, and shipbuilding), the fisheries industry (including 80,000
fishing boats and ships, seafood farming and
processing industry); and the offshore petroleum industry.
Maritime health system of Vietnam
Since 1990, when the country’s economy underwent transition from a subsidized economy
to a market economy, all maritime health services provided in local general hospitals have
been free. The Ministry of Health established
the National Center for Maritime Medicine
at Haiphong Medical University to conduct
research in maritime medicine and to train
doctors for maritime medicine. This Center
has evolved to become the Vietnam National
Insitute of Maritime Medicine, or VINIMAM,
established in 2001. In addition, there are two
other medical centres, in the ports of Da Nang
and Saigon. At present, however, Vietnam’s
maritime health care system focuses only on
parts of the maritime sector – seafarers, petroleum workers, dockers, shipbuilding and shipyard workers. Most fishermen trust in God to
provide full health care for them.
Maritime health services
of VINIMAM
The first organization focusing on maritime
medicine was the National Center for Maritime Medicine of Vietnam, or the NACEMME,
Asian-Pacific Newslett on Occup Health and Safety 2011;18:35–7 •
35
which was founded in September 1995 by the
Ministry of Health, directly under Haiphong
Medical University. In March 2001, the Government of Vietnam decided to upgrade the
NACEMME to the Vietnam National Institute of Maritime Medicine (VINIMAM) with
its head office in Haiphong City. VINIMAM
has the functions listed below:
• To conduct research in the fields of maritime medicine and the maritime environment, including the effects of the sea climate and the living environment on ships
on seafarers’ health and diseases; underwater and hyperbaric medicine, seafarers’
psychophysiology and maritime occupational medicine.
• Training and issuing a certificate in maritime medicine for deck officers and a certificate of primary health care and first aid
at sea for all seafarers and other maritime
workers.
• Training postgraduates in maritime medicine to be doctors and developing programmes at Haiphong Medical University
to provide training in maritime medicine
for medical students at university and to
Master’s Degree training (MSc in Maritime
Medicine).
• Care for and protection of the health of seafarers, fishermen, divers and other maritime workers.
Table 1. The approximate numbers of maritime workers in Vietnam
Type of maritime worker
36
850,000
Other fishery industry workers
4,000,000
Petroleum workers on offshore installations
24,000
Other maritime workers
61,000
Total
5,150,175
Table 2. The number of Vietnamese seafarers and fishermen employed on ships
under foreign flags
Type of maritime worker
Number
Percentage (%)
Seaman
3,000
75
Fisherman
1,000
25
Total
4,000
100
At present,
there are many
difficulties
involving the
organization and
management of
health services
for all of these
maritime
workers.
Activities in the maritime economy have been
attracting large numbers of workers. Table 1,
based on statistical data provided by the Office of the Vietnam Maritime Department, the
Ministry of Fisheries, the general company Vietnam Petroleum, and the Ministry of Communication and Transport, shows the numbers of maritime workers as at December 2010.
Statistical data provided by the Vietnamese
shipowners’ association indicate that in December 2010, a total of 3,000 Vietnamese seafarers were working on ships under foreign
flags (Table 2).
• Most of the 30,090 Vietnamese seafarers
have been working in State companies and
shipping stock companies.
• All fishermen have been working in stock
and privately-owned companies or are selfemployed.
• Petroleum workers are employed in joint
venture companies that are under joint government and international ownership.
At present, there are many difficulties involving the organization and management of
health services for all of these maritime work-
30,090
Fishermen
Maritime manpower of Vietnam
Vietnamese seafarers at work on
ships under foreign flags
Number
Seamen
ers. In the past, their health services were implemented by State health offices. However,
after 1990, this system disintegrated following
the transition from a concentrated economic
model to free market economy. A new health
care system is now being developed.
The situation of maritime health
services in Vietnam
Before 1990, the Vietnamese government
managed all maritime economic activities and
maritime health care system was well organized. Every company and enterprise had medical stations for employees. There were doctors
to work on the merchant ships and fishing vessels or factories with large crews. These services were provided free of charge to all workers, and they included hospital treatment and
• Asian-Pacific Newslett on Occup Health and Safety 2011;18:35–7
prevention. With the transition from a subsidized economic system to market economy,
government provision of health care services
for maritime workers became very difficult.
The situation led to the gradual introduction of a new model of maritime health services. First came the establishment in 1995 of
the National Center for Maritime Medicine
and Environment (NACEMME) at Haiphong
Medical University and its upgrading in 2001
to the Vietnam National Institute of Maritime
Medicine (VINIMAM). At the same time, the
Maritime Medicine Department of Haiphong
Medical University was founded, to train doctors in maritime medicine. The health offices in
seaports were expanded and their work in the
ports of Haiphong, Da Nang, Ho Chi Minh City
and other ports were rearranged and improved.
Despite this, maritime health care services in
Vietnam should be expanded further, and their
mission should also be improved.
At present, VINIMAM and some other maritime health offices are caring for the
health of seafarers, petroleum industry workers and only some of the dockers and shipyard
workers. Fishermen working at sea still look
after themselves.
Medical examination of seafarers at
VINIMAM and in Vietnam
Periodic medical examinations for maritime
workers in Vietnam are conducted only for
seafarers and workers employed in government companies and enterprises. The medical examinations for seamen, both pre-sea
and periodic, are compulsory according to
the rules and national regulations. They are
based on the Guidelines for Conducting Presea and Periodic Medical Fitness Examinations for Seafarers issued by the ILO/WHO
(ILO, Geneva 1997). Only doctors at government hospitals in three areas – North, Central
and South Vietnam – are authorized to conduct them and to issue certificates of health.
This practice does not apply to fishermen.
Shipowner regulations may apply in the case
of seafarers employed on ships under foreign
flags. Vietnamese seafarers working on international ships can have health examinations
only at VINIMAM in Haiphong and Ho Chi
Minh City.
The scope of the health examinations performed is as follows:
- Physical examination
- Vision acuity and colour vision
- X-Ray of the lungs
- Laboratory tests: Urine, blood, HIV, VDRL,
HBV etc.
- Psychological tests
- Additional tests if necessary, for particular
jobs on board ship, or at the request of the examining doctor.
- The test to determine the seawave withstanding capacity of seafarers is obligatory for all
seafarers undergoing pre-sea medical fitness
examinations.
The medical examiner will reach a conclusion on each seafarer’s health situation as
follows:
- Fit for duty at sea
- Fit for duty with some restrictions
- Temporarily unfit for work on ships
- Permanently unfit for work on ships.
The health certificate is issued for service at sea with a maximum validity of two
years and a mean validity of from 12 to 18
months.
Training in maritime medicine at
VINIMAM
1. Maritime medical training for seafarers
and other maritime workers
Training in first aid at sea and in primary
health care on the ship (40 hours of instruction) is given at VINIMAM. The training programme is based on internationally accepted
standards (STCW-1995).
A maritime medical training programme
is implemented for deck officers who will undertake a position as a medical officer on the
ship in future. They have to participate in a
6-week course which includes 100 hours of
lectures and 100 hours of practice, given at
the Vietnam National Institute of Maritime
Medicine in Haiphong.
2. Training for doctors in maritime
medicine
Training for doctors in maritime medicine has
been given at the Maritime Medicine Department of Haiphong Medical University since
2001. This training is implemented by medical staff from VINIMAM.
3. Postgraduate training in maritime
medicine
A Master of Science programme on maritime
medicine will begin in 2011. It will be implemented by Haiphong Medical University and
VINIMAM.
• Department of Functional Diagnosis and
Seawave Withstanding Capacity Testing
• General Laboratory
• Department of Maritime Environmental
Medicine
• Pharmaceutical Supply Department
• Department of International Seafaring
The units directly under VINIMAM
• Training Center for Maritime Medicine
• General hospital of maritime medicine.
Research in maritime medicine
Research activities in maritime medicine began at Haiphong in the 1980s. The results obtained have been published in national and international medical journals. The health problems of seafarers and fishermen have been the
topics of interest.
Some hundred scientific research works
on maritime medicine and related fields were
implemented from the 1980s to now. Their results have been reported during seven national
symposia on maritime medicine, in the years
1985, 1992, 1996, 1999, 2004, 2007, 2010, and
at some international symposia.
Based on research, ten medical doctors
have completed a PhD thesis and 20 medical doctors have completed a Master’s thesis
on subjects related to maritime occupational
health, work-related diseases and accidents/
injuries among seafarers, medical emergencies at sea and psycho-physiological problems
of work on ships.
The staff of VINIMAM
There are now 100 medical staff members employed at VINIMAM, including:
- 2 Professors (Scientific advisor)
- 1 Professor (MD, PhD)
- 3 doctors (MD) with a PhD degree
- 20 doctors (MD) with an MSc degrees
- 18 doctors (MD)
- 12 BA degree holders
Most doctors have been trained in maritime medicine, for example, at VINIMAM,
Haiphong Medical University, the Institute of
Maritime and Tropical Medicine in Gdynia,
Poland, and at the UBO of France, in Australia, etc.
The specialty departments of VINIMAM
• Department of Maritime Emergency and
Disaster Prevention
• Department of Underwater and Hyperbaric Medicine
• Department of Maritime Occupational Disease
• Department of Polyclinic and Seafarers’
Health Management
• Department of Traditional Medicine and
Maritime Workers’ Functional Rehabilitation
Strategy for the future of VINIMAM
The maritime industry will further develop in
Vietnam, and the number of maritime workers will continue to increase. They will require
efficient health services, both curative and preventive. These will be provided by the National
Institute of Maritime Medicine in Haiphong
and by the network of branch health institutions in the country’s ports. A branch of the
Institute will be opened in the coming years in
the central provinces and in Southern Vietnam.
The training of doctors in maritime medicine will continue in Haiphong. Training
courses on medical matters for seafarers will
be conducted regularly.
In future, tele-medical services for crews
of Vietnam ships will continue, and these
services will be provided with more advanced
technology. VINIMAM would like to cooperate with all countries of the region in order both to develop maritime medicine and
to enhance the health of seafarers and other
maritime workers.
Literature
1. Nguyen Truong Son, Tran Thi Quynh Chi. Maritime health services in Vietnam, International
Maritime Health, 2001;52(1/4):129–34.
2. Nguyen Truong Son et al. Establish the training
program of health care for Vietnam seafarers.
Ministry level research, 1997.
3. Nguyen Truong Son. Research some biological
characteristics of Vietnamese seafarers. Ministry
level research, 1998.
4. Nguyen Truong Son. Establish the healthcare
models for offshore fishermen in Hai Phong.
Ministry level research, 2009.
5. Proceedings of Vietnam National Symposium 3rd
on Maritime Health in Vietnam, 2010.
Nguyen Truong Son
Tran Thi Quynh Chi
Vietnam National Institute of Maritime Medicine
E-mail: yhb@hn.vnn.vn
Asian-Pacific Newslett on Occup Health and Safety 2011;18:35–7 •
37
Working postures among shipbuilders
Working outdoors
Occupational safety in a mechanical
shipbuilding industry
Nguyen Bich Diep, Vietnam
Introduction
The shipbuilding industry is a dynamic and
competitive sector on the global scale. It has
great importance from both an economic and
a social perspective. Many countries promote
its development and address the competitiveness issues the sector is facing. The shipbuilding industry is considered to be an important
and strategic industry for economic development in many countries of the world, including Vietnam (1).
Vietnam has a high potential for development of this industry as it has 3,200 km
of beach and cheap labour costs. As a result,
this industry is making a great contribution to
economic development during the industrializing and modernizing period. However, this
38
industry is still at the beginning of its development, with a poor infrastructure and outdated technology. Nowadays, Vietnam has more
than 60 shipyards for building and repairing
ships. They employ more than 36,000 workers.
The shipbuilding industry entails many
occupational safety and health risks, as has
been mentioned in some studies (2,3,4). Some
studies on the shipbuilding industry have been
carried out in Vietnam, but they have focused
mainly on occupational diseases such as silicosis and deafness. Very few studies have been
done on occupational safety in this industry,
both throughout the world and in Vietnam.
The aim of this study is to describe the
situation of occupational safety and potential
risk factors of occupational injuries in a me-
• Asian-Pacific Newslett on Occup Health and Safety 2011;18:38–41
chanical shipbuilding industry. Moreover, the
aim is to suggest preventive measures based
on the results.
Study materials and methodologies
A cross-sectional descriptive study was conducted. In all, 300 workers were interviewed
by questionnaire about their working conditions (work environment, working hours,
working postures, etc.), risk factors and occupational injuries sustained in the two previous
years. Some environmental factors were measured. The data collected were fed into the computer, and the SPSS 10.0 and Microsoft Excel
software programs were used for descriptive
and analytical epidemiological analyses.
Results
Information about the study subjects
The majority of the workers interviewed were male (97.3%). Their average age was 28±7.4 years, and the age
range was from 19 to 58 years. More
than two out of three workers surveyed were under 30 years old (73.5%
of the study subjects). It was therefore
a young and healthy working-aged
group.
The average working experience
was 5.1±6.2 years, and the range was
from 0.5 to 32 years. The majority of
workers (66.7%) had under 5 years of
working experience . Workers with
from 5 to 10 years of experience accounted for 16.1%, those with over 10
years to 15 years for 9.4% and those
with from over 15 years to 32 years for
7.8% of the study subjects.
Among the workers investigated,
iron makers and welders accounted
for the majority (69.2%). In fact, the
number of workers performing these
jobs in this company was also high.
The remaining workers were engaged
in steel processing (9.9%), machine assembling (6.8%), mechanical and fitting (2.6%), sand blasting, repair and
electricity work (1–1.6%) and others
(4.6%). Over two-thirds (68.3%) belonged to the regular workforce, while
during the 3-year period, fixed-term
contract workers accounted for 29.3%
and temporary workers for 2.3%.
Working conditions
The workers’ schedule followed office hours, from 7:00 to 11:30 in the
morning and from 13:30 to 17:30 in
the afternoon. A standard 15-minute
break was taken by workers in every
working session. In addition, workers
can adjust their work in order to have
a short break. The number of working days per week was 5 days. However, workers can volunteer to work on
Saturday and Sunday if there is a lot
of work and their income is based on
piecework. Workers receive double pay
for work done on Saturday and Sunday.
Work environment
The measured work environment data
showed that the average air temperature was 32.1±1.4 (range 30.9–370C). In
some workplaces such as welding, aircutting, grinding, and curving, where
workers worked in open air or in con-
34.7
Exposure to toxic gases/
chemicals
22.7
Exposure to silica dust
89.7
Exposure to dust
94.7
Exposure to noise
12.3
Dark/glare
31.3
Stuffy
62.7
Hot/cold
0
10
20
30
40
50
60
70
80
90
100
Percentage (%)
Figure 1. The workers’ complaints about their work environment
Table 1. Working postures
No.
Postures
1
Standing
2
Sitting on a chair
3
Number of workers
(n=300)
Percentage (%)
Average working time
(% of total working time)
254
84.7
42.3±21.5
7
2.3
45±40.4
Squatting
271
90.3
50±23
4
Bending
133
44.3
18.8±13.6
5
Twisting or turning
78
26
13.4±10.8
6
Others (walking, laying on
the back…)
16
5.3
36.9±28.3
fined spaces, the temperature was usually high, especially in summer. The
dust concentration in welding and in
hatches was also many times higher than threshold limit values (TLV).
The carbon monoxide concentration
in welding smoke in tight underground
spaces was higher than the TLV. The average noise level was 89.9±5.9 (range
85–109.7 dBA), and in many workplaces was higher than the TLV, especially
in areas where grinding or work with
gas compressing machines was done.
These data were in line with the results from the workers’ interviews. A
large number of workers complained
about exposure to noise (94.7%) and
exposure to dust (89.7%). Because the
majority of workers worked outdoors
around the year, 62.7% complained
about heat in summer and cold in
winter. In addition, 22.7% reported
exposure to silica dust when working
in the sand blasting workshop. A total of 34.7% of the workers, including,
for instance, welders, lathers, and drillers, were exposed to welding fumes.
Some workplaces were stuffy and not
well ventilated; in consequence, one-
third of workers (31.3%) complained
about that.
A large
number of
workers
complained
about
exposure
to noise
(94.7%)
and
exposure
to dust
(89.7%).
Working postures
Standing and squatting on the ground
were common working postures in this
industry (84.7% and 90.3%, respectively) The average working time in these
postures was from 42.3% to 50% of total working time. Many workers had
to work in these postures for about 8
working hours. Bending and twisting
or turning were also common postures
(accounting for 26%–44.3%), and the
time spent in these postures ranged approximately from 13.4% to 18% of total
working time. Working for a long time
in these postures places workers at high
risk of musculoskeletal disorders and
back injuries.
Manual lifting heavy loads
Lifting heavy loads was found to be
one characteristic of the work in the
mechanical shipbuilding industry, as
workers had to work with large steel/
corrugated iron sheets and heavy, long
iron bars. Although this work was
mechanized, e.g. the use of cranes and
Asian-Pacific Newslett on Occup Health and Safety 2011;18:38–41 •
39
100
97.4
97.7
98.3 97.3
98.3
80
97.4
90.3
88.3
76
82.3
Provided
64.7
60
55.3
Actually using
40
20
0
Masks
Gloves
Protective
Safety glass
Safety boots
clothes
Safety
helmets
Figure 2. Comparison between the provision and actual use of personal protective equipment
derricks to lift heavy objects and loads, sometimes workers still have to do manual lifting
(42.3%). 27.7% of the workers had to move
heavy loads by hands frequently. The average weight of the heavy objects was 38 kg, the
range from 5 to 100 kg. The average transporting time was 1.2 hours; the minimum being 5
hours per day, and the maximum 8 hours per
day. To perform mechanical work, the company consumes tens of oxygen tanks for welding
each day. This means that transporting oxygen
tanks was a workload for workers.
Working in the open air
Working in the open air was also a specific characteristic of mechanical shipbuilding
works. Most workers were working outdoors
(86.7%); few workers worked inside. The average working time outdoors was 7.1 (range
1 to 12) hours per day. Some workers have to
work outdoors year round, while others only
have to work in the open air about 1 month
a year. It was a risk factor for accidents, especially on hot days, as having to work outdoors
for 12 hours can cause fatigue that easily leads
to accidents.
Providing and using personal protective
equipments (PPEs)
Figure 2 shows that the company provided
workers with almost all the necessary PPEs,
such as masks, gloves, protective clothes, safety glasses, safety boots, and safety helmets.
Comparison between the provision and use of
PPEs by workers showed that the rate of use
was lower than that of provision. The rate of
use for masks, gloves, safety glasses, safety helmets during work was in fact very low, from 15
to 30% of provision. This means that workers
were not aware of the importance of wearing
PPEs with regard to protecting their health.
Although the noise level was high (85–109.7
dBA) and a large number of workers com40
plained about exposure to noise (94.7%), most
workers were not provided with ear plugs. In
addition, they were also exposed to dust, especially silica dusts in the sand blasting workshop, but they were not provided special respirators protecting against dusts.
Implementation of OSH regulations and policies for workers
All of the workers had had a health examination before they began working in this company. Periodic health examination was also
organized every year; 93.4% of workers had
a periodic health examination. Almost all of
the workers (96.7%) were trained in OSH. The
average duration of training courses was 1 day.
The content of the training courses focused
on occupational safety in specific tasks, such
as safety in welding, lathing, steel processing,
working with compressed gas, etc. Prevention
of fire and explosions, occupational accidents
and occupational diseases were not mentioned
during OSH training courses.
The situation of occupational injuries
Among 300 interviewed workers, 106 (35.3%)
had had occupational injuries during a 2-year
period. Most occupational injuries (60–81.2%)
occurred among young workers 18–30 years
old, among inexperienced workers with 1–5
years of working experiences (50–68.8%), and
among male workers (95–97.9%). The tasks
causing the most occupational injuries were
iron making (37.1%), welding (32.4%), and
steel structure processing (10.5%). The main
causes of occupational injuries were hitting
against the things (75.3%), hot objects (welding and sand blasting machines), electricity
(7.5%), and falling from heights (9.4%). The
majority of injuries were collisions, bruises
and muscle injuries (35–66.7%), fractured and
crushed bones (10.4–35%) and burns (8.3–
10%). The number of workers who suffered
• Asian-Pacific Newslett on Occup Health and Safety 2011;18:38–41
from occupational injuries was much higher
when working outdoors and when tasks involved lifting heavy objects manually.
These results for occupational injuries
were similar to those found in other studies. According to the study done in HyundaiVinashin shipbuilding company in Khanh
Hoa province in Vietnam (3), 47% of workers working in the ship hull had got occupational injuries during a 5-year period. 75% of
injured workers were young, aged 18–29 years
old and with under 5 years of working experience. Similarly, Andi Zulkifly and Isra Isra
(1) studied the decisive factors of occupational
injuries among shipbuilding workers in Makassar, South Sulawesi, Indonesia and found
that workers with under 5 years of working
experience were at higher risk of getting occupational injuries, the occurrence being 3.6
times in comparison to those with more than
5 years of working experiences.
Injury is becoming recognized as a serious problem and a great burden to societies
throughout the world. Annually, there are at
least 5.5 million deaths from accidents, and almost 100 million disabling injuries. Injury is
ranked the fourth leading cause of death. Injury accounts for 9% of global deaths in 2000
and for 12% of the global disease burden. Annually it is expected that the number of people
injured will increase significantly each year
through 2020 (5). In Vietnam, on average,
every day about 30 deaths due to injury and
70 disabling injuries are recorded (6). Occupational injuries are one of the biggest occupational safety and health issues, and they are
the leading cause of disabilities among workers. According to a report on occupational
accidents and injuries in Vietnam, published
by the Ministry of Labour, Invalid and Social
Affairs (MOLISA), in Vietnam, in 2010 there
were 5,125 occupational accidents involving
5,307 people, and 601 deaths (7). The esti-
Photo by Heikki Saarni
mated costs due to occupational accidents
were more than 133.6 billion Vietnamese
dong. The total number of sick leave days
was 75,454 (4).
Conclusions
This study found that workers working
in the mechanical shipbuilding industry
were exposed to many risk factors causing occupational injuries. These risk factors are present in the work environment
and working conditions of this industry:
for instance, high noise levels, high silica dust concentration and toxic gases in
some workplaces; working in the open air;
manual lifting of heavy loads; working in
uncomfortable postures; etc. The findings
of this study indicate the need to provide
information and trainings to workers, especially young and inexperienced workers,
about the risks of occupational injuries and
preventive measures. Working condition
improvements to reduce the risks of injuries are also needed.
References
1. http://ec.europa.eu/enterprise/sectors/maritime/shipbuilding/index_en.htm.
2. Andi Zulkifly, Isra Isra. The decisive factors of
occupational injuries in shipbuilding workers
in Makassar, South Sulawesi, Indonesia. The
Second Asian-Pacific Conference on Prevention of Accidents and Injuries. Hanoi 4–6
November 2008, The Book of Abstracts,
p. 98–9.
3. Diep NB, Hai NK. Burden of Occupational
Injuries in Mechanical Shipyard Building
Workers. The International Conference on
Accident Prevention, 20–22 October 2010
Busan, Korea (ICAP2010). The Book of Proceedings. p. 16–20.
4. Hai NV, Binh DX. et al. Some comments on
occupational injuries at Hyundai-Vinashin
Shipbuilding Factory in Khanh Hoa province
from 1999 to 2004. The first National Conference on Prevention of Accidents and Injuries.
Hanoi 14–15 November 2005, The Book of
Abstracts, p. 66–7.
5. WHO. The Injury Chart Book. A graphical
overview of the global burden of injuries.
2002.
6. Trong LN. Program on Injury prevention and
safe community development in Vietnam.
Proceedings of the 1st International Scientific
Conference on Injury Prevention and Development of Safe Community. Hanoi 26–27
October 2006, p. 7–15.
7. MOLISA. Annual report on occupational
accidents and injuries in 2010. http://www.
antoanlaodong.gov.vn/Desktop.aspx/NghienCuu-Thongke/Bao_cao_thong_ke/
Nguyen Bich Diep
National Institute of Occupational &
Environmental Health
57 Le Qui Don Sreet, Hanoi, Vietnam
diepyhld@yahoo.com
Fitness for work at sea
Heikki Saarni, Finland
The most important
convention concerning
seafarers’ medical
examinations and health is the
Maritime Labour Convention
(MLC) (1) adopted by the ILO
in 2006. Detailed information
on conducting these
examinations is found in the
ILO/WHO guidelines (2).
Prior to beginning work on a ship, a seafarer
must hold a valid medical certificate attesting
that he is medically fit to perform the duty he
is to carry out at sea. Such certificates are issued by a qualified medical practitioner who
must be authorized by the competent authority. The validity of these medical certificates is
at most two years, but only one year in the case
of persons under 18 years of age.
The International Maritime organization
(IMO) has also adopted regulations concerning the medical fitness of seafarers in its Seafarers’ Training, Certification and Watchkeeping (STCW) Code in 2010 (2). Part A of the
Asian-Pacific Newslett on Occup Health and Safety 2011;18:41–3 •
41
Photo by Heikki Saarni
STCW Code, which is mandatory, states the
criteria that each seafarer must meet (Table 1).
The STCW Code also sets mandatory
minimum in-service demands for eyesight.
The hearing capacity necessary to enable effective communication is sufficient for the STCW
Code, whereas the WHO/ILO guidelines recommend audiometric values.
As guidance, Part B of the STCW Code
presents the shipboard tasks, function events
or conditions which every seafarer must be
able to handle (Table 2).
There are a total of 1.2 million seafarers in
the world; their mean age is about 36 years.
Their mean age at retirement is about 49–52
years. However, these mean ages are about
ten years higher among Western European
seafarers. The mean age is rising constantly;
this will have an increasing effect on work capability. Do experience and skills compensate
for youth and beauty?
The physical abilities listed above should
be considered necessary for safety: for the
safety of each individual seafarer, other crew
members and the ship, bearing in mind the
different duties of seafarers and the nature
of the shipboard work they carry out. This
means that every seafarer’s physical capacity must be good enough not only to perform
normal work duties, but also to do their safety
duties on board ship.
Fitness examinations for seafarers present
medical doctors with a real challenge. How
can the doctor be satisfied that the candidate
–– has no disturbance in his/her sense of balance;
–– is able to climb vertical ladders and stairways, step over high sills and manipulate
door closing systems;
–– has no diagnosed medical condition that
reduces the ability to perform routine duties essential to the safe operation of the vessel?
The seafarer must also be able to do the following: work with the arms raised; stand and
walk for an extended period; enter confined
spaces; meet the requirements set for eyesight
and hearing; and hold a normal conversation.
Many of the fitness points listed above can
be verified by observing and discussing with
the seafarer. In occupational health services
(OHS), cooperation with the ship and shipping company may provide important information about how a seafarer manages his tasks
on board ship, e.g. rescue and fire fighting together with life boat launching drills. In many
cases, the drills can be avoided by a seafarer or
the drills are less physically demanding than
these activities could be in a real situation.
There seems to be a clear need for additional
tests to measure fitness for work at sea.
Good communication between a seafar42
Table 1. Health demands made of seafarers (3)
1. The physical capability must meet all the requirements of the basic safety training;
2. Hearing and speech must be adequate to communicate effectively and detect any audible
alarms;
3. The seafarer’s medical condition, disorder or impairment must not prevent the effective and safe
conduct of his/her routine and or emergency duties on board during the validity period of the
medical certificate;
4. The seafarer’s medical condition must be unlikely to be aggravated by service at sea, nor may it
render the seafarer unfit for such service or endanger the the health and safety of other persons
on board; and
5. The side effects of the seafarer’s medication must not impair judgment, balance, or any other
requirements for effective and safe performance of routine and/or emergency duties on board.
Table 2. Obligatory tasks on board ship (3)
Routine movement around the vessel
Maintain balance and move with agility
Climb up and down vertical ladders and stairways
Step over coamings
Open and close watertight doors
Routine tasks on board
Strength, dexterity and stamina to manipulate mechanical devices
Lift, pull and carry a load
Reach upwards
Stand, walk and remain alert for an extended period
Work in constricted spaces and move through restricted openings Visually distinguish objects, shapes and signals
Hear warnings and instructions
Give clear spoken descriptions
Emergency duties on board
Don a lifejacket or immersion suit
Escape from smoke-filled spaces
Take part in fire-fighting duties, including the use of breathing apparatus
Take part in vessel evacuation procedures
er and a medical doctor lays the foundation
for a successful examination. The anamnesis
steers the clinical examination and laboratory tests. A questionnaire makes it possible
to collect structured information about the
seafarer’s physical performance, earlier and
current medical conditions, symptoms and
signs. Management of exceptional situations
• Asian-Pacific Newslett on Occup Health and Safety 2011;18:41–3
on board can also be asked. A clinical exercise test, by bicycle or a walking test, gives important information about cardiovascular and
pulmonary capacities. The clinical examination is based on the above information; further tests can be done to verify sea fitness, if
this is considered necessary.
One major problem today is obesity and fitness
for work at sea. Obesity is an increasing global
epidemic which affects seafaring, too. Obesity is
more than a health problem that can complicate
diseases and lead to death; it is also a factor that
impairs physical function in terms of reduced mobility and working capacity.
What is the basis for judging whether a seafarer is fit or unfit? Should the judgement be based
on overweight per se, on impaired physical function, on the risk for complicating diseases, or on
established complicating disease?
A body mass index (BMI) of 30 or 35 has often
been suggested as the value signalling a need for
more thorough examinations; it may even be the
limit for unfitness for work at sea. A high BMI as
such is not a good screening value, since the physical performance and work ability of an obese person can be very good. A very obese person with a
large waist may not be able to pass through hatches
60 cm x 60 cm in size, or s/he may be too big to
enter the life boat. The seats of free-falling rescue
boards are especially cramped. Very large survival
suits are available, however.
Even if overweight and obesity are clearly related to an increased risk of cardiovascular disease
among the population, the BMI itself is not a good
predictor of the likelihood to develop cardiovascular disease at the individual level. It has also been
shown that moderate overweight is not very risky
as long as the physical condition is good. The highest risk factors for sudden illness while serving on
board stem from cardiovascular disease and diabetes. The medical certificate is granted for two years,
which is too short a time span for obesity as such
to lead to serious consequences or dramatic effects.
The medical examination of a seafarer is a
challenging and demanding task for doctors. Even
though there are international rules, regulations
and guidelines on how to carry out these examinations, the medical examiner should bear in mind
that these international documents cannot totally
replace sound medical judgement.
References
1. Maritime Labour Convention (MLC), Geneva: International Labour Organisation, 2006.
2. Guidelines for Conducting Pre-sea and Periodic
Medical Fitness Examinations for Seafarers. Geneva:
International Labour Organisation/World Health
Organization, 1997.
3. International Convention on Standards of Training, Certification and Watchkeeping for Seafarers
(STCW), Manila Amendments, London: International
Maritime Organization, 2010.
Heikki Saarni MD, PhD, Adjunct Professor
Finnish Institute of Occupational Health
Lemminkäisenkatu 14–18 B
20520 Turku
Finland
Email: heikki.saarni@ttl.fi
Photo by Ministry of Health, Brunei
Obesity and fitness
Performing a spirometric test
Occupational health services
in Brunei Darussalam
N.B.P. Balalla, Brunei
Background information
Country profile
Brunei is a sultanate situated in the northwest of the island of Borneo, with a total
area of 5,765 sq km. It has a population of
(estimated) of 392,000 (2008). (1) Brunei
is a multiethnic country, the majority being the Malay community (67%) and the
remainder comprising Chinese (11%), Indians, indigenous people and other nationals (2.) It has a GDP per capita income of
USD 37,048 (2008), which is higher than
most of the ASEAN and Western Pacific
countries. (1)
Crude oil and national gas production
provide most of revenue for the country. In
addition, other income generating activities of the country are the construction industry, fishing, agriculture, and small-scale
industries.
The total worker population of the
country is 173,501 (2008), with the private sector accounting for 127,410, the remaining 46,091 workers being employed
in the government sector (3). The majority (68.7%) of private-sector employees are
foreign workers (4). A greater number of
workers (28%) is employed in the construction industry, whereas 4% of workers are
employed in the oil and gas sector. (3)
Agencies involved in occupational health
and safety
The Department of Health Services of the
Ministry of Health, the Department of Labour of the Ministry of Home Affairs and
the Public Works Department of the Ministry of Development are held responsible
for occupational health and safety matters
in the country. The Occupational Health
Division of the Department of Health Services provides its services at national level,
whereas the Workplace Safety and Health
Division of the Department of Labour is
responsible for enforcement activities. The
Safety Unit of the Public Works Department monitors the safety of construction
sites.
In addition, the Occupational Health
Department of Brunei Shell Petroleum
Company, being a private organization,
provides occupational health services for
its employees at enterprise level.
Asian-Pacific Newslett on Occup Health and Safety 2011;18:43–6 •
43
8%
8%
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Relevant occupational health and safety
Agriculture, Forestry and Fishing
Agriculture,Agriculture,
Forestry and
Fishingand Fishinglegislations
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Agriculture,
and Fishing
Oil
and Gas Forestry
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Oil and GasOil
1. Employment Order (2009)
and Gas
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and Gas and Timber Processing
Sawmilling
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Oil
and Gas and Timber Processing
Sawmilling
Sawmilling and Timber Processing
Industries
the previous Labour Laws in 2009, covSawmilling
and
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Industries
Mining,
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and Manufacturing
Industries
Sawmilling
and Timber
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Mining, Quarrying
Manufacturing
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Mining,and
Quarrying
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Construction
health and safety, i.e. mandatory preMining,
Quarrying and Manufacturing
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placement
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and Retail Trade
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and
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83), maternity leave(Section 91), etc.(5).
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and Business
Communications
Transport, Storage and
Financial,
Business
Communications
Financial,and
Insurance
and Business
Services Insurance
Financial,
Insurance
and Business
Communications
2. Workplace Safety and Health Order
Services
Other
Community,
Social
and
Services
Financial,
Insurance
and
Business
Services
Other
Community,
Social
and
Other
Community,
Social
and
(2009)
Personal Service Activities
Services
Other
Community,
Social and
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Personal
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Other
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Personal Service Activities
relevant government agencies – i.e. the
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10 %
16 %
16 %
16 %
16 %
16 %
28 %
28 %
28 %
28 %
28 %
Figure 1. Workforce – Private sector (3)
OH&S Agencies
Ministry of Health
Ministry of Home
Affairs
Ministry of
Development
Department of
Health Services
Department of
Labour
Public Works
Department
Occupational
Health Division
Workplace Safety
and Health Division
Safety Unit
Provision of OHS
services
Enforcement of
OHS legislation
Monitoring of
construction safety
Figure 2. Government agencies responsible for occupational health and
safety (OH&S)
Department of Labour, the Department
of Health Services, and the Public Works
Department – and gazetted in November
2009. The Workplace Safety and Health
Order is the main act for health and safety at the workplace in the country and it
covers: the general duties of persons at
workplaces (Part IV); the reporting of
accidents, dangerous occurrences and
occupational diseases (Section 27); and
arrangements for safety and health management (Part VII).
The third schedule of the Order lists
the notifiable occupational diseases. The
preparation of relevant regulations is currently underway. It is hoped that this Order will be enforced in the near future. (6)
3. Workmen’s’ Compensation Act
(1957) (revised in 1984)
The Workmen’ Compensation Act provides a legal background for the compensation of work-related injuries and
occupational diseases in the country. (7)
Occupational health service providers
Occupational Health Division (OHD)
The Occupational Health Division
(OHD) of the Ministry of Health is the
main provider of occupational health and
safety services in the country at national
level. The coverage includes both government and private sectors. The OHD was
Table 1. Manpower (8)
Staff Category
Occupational Health Physicians
Number
8
Qualifications & Training
Seven doctors have received specialist training in Occupational Medicine
Occupational Health Nurses
5
Three nurses trained in Occupational Health Nursing
Health Inspectors (Occupational Health
and Safety)
4
Two health inspectors have undergone training in Health , Safety and
Environment Management
Support staff
5
TOTAL
44
• Asian-Pacific Newslett on Occup Health and Safety 2011;18:44–6
22
Table 2. Employment Related Medical Examinations (2006–2009) (8)
Type of Medical Examination
2009
2008
2007
2006
Pre-placement
5,806
6,122
4,974
4,705
Periodic
1,356
501
2,433
2,147
Others (review, referrals, walk-in)
1,142
1,190
1,418
1,164
8,304
7,813
8,825
8,016
2007
2008
2009
2010
40
31
48
50
Industrial Dermatitis
3
4
3
4
Occupational Asthma
3
1
-
1
Mesothelioma
-
-
-
1
2006
2007
2008
2009
OHS inspection (comprehensive)
117
87
93
51
Workplace Survey
37
307#
365#
37
5
6
7
34
159
400
465
122
Total
Table 3. Occupational and work-related diseases in Brunei (2007–2010)
Occupational and Work-related Diseases
Noise-induced Hearing Loss
Table 4. Workplace OH&S inspection, audits and risk assessments (8)
Purpose
No. of workplaces visited
Others – complaints, follow- up, accident at workplace,
occupational / work-related disease investigation
TOTAL
# includes surveys and preliminary inspections
established in 1993 as a unit under the Department of Health Services of Ministry of Health,
and was upgraded to a division in 2004. Currently it has a total of 22 staff members.
Services provided by the Occupational Health
Division
The services provided by the Division are
based on the Occupational Health Services
Convention No. 161 and Recommendation
No. 171 (1985), of the International Labour
Organization (ILO).
1. Workers’ health surveillance
The Division conducts all types of medical
surveillance examinations, including pre-employment and periodic medical evaluations of
both government and private sector employees. Special worker categories, such as seafarers, spraymen and air traffic controllers, are
also examined at the Division on regular basis.
2. Occupational health clinical service
In addition, the Division is responsible for
management of occupational and work-related diseases and injuries, which are referred by
other physicians. Occupational physicians of
the Division are involved in medical board assessment for early retirement and workmen’s
compensation assessment.
The Division has facilities for conduct-
ing special investigations, such as audiometry, spirometry, ECG and clinical blood
cholinesterase tests for clients.
The majority of occupational and workrelated diseases (see Table 3) were diagnosed at
the Occupational Health Division. As in many
other countries, however, underreporting is a
major constraint in obtaining accurate data.
3. Surveillance of the work environment
Surveillance of the work environment is extremely important as medical surveillance for
the prevention of occupational and work-related diseases. The Division conducts regular
worksite inspections, audits, and risk assessments in both government and private-sector
establishments. The inspectorate team comprises an occupational health physician, an
occupational health nurse and occupational
health and safety inspectors. Following the
inspections, important issues are immediately
brought to the attention of the management,
and advised accordingly. In addition, detailed
reports are sent to the employers, giving them
recommendations with regard to occupational
health and safety at the workplace. Follow-up
visits are conducted at workplaces that have
been assessed to have poor health and safety
conditions.
The Division is fully equipped with the required industrial hygiene instruments, such as
sound level meters, lux meters, dust samplers,
thermo-hygrometers, gas detectors, and heat
stress monitors, to enable assessment of the
work environment.
3. Investigation of complaints and workplace accidents
The Division conducts investigations and
workplace assessments in order to follow complaints relating to workplace health and safety
matters, workplace accidents (depending on
their nature), and work-related diseases.
4. Health education and health promotion
The Division provides health education and
health promotion to employers, employees
and the general public. Activities include
workplace health talks and seminars, discussions on health and safety issues during workplace visits, the production of pamphlets, fact
sheets, quizzes, interactive audiovisual media
and guides.
The Division also promotes its activities
through an exhibition booth at the Health Promotion Centre and the Ministry of Health’s
website, which includes downloadable guides
and pamphlets.
In addition, the Division conducts consultation sessions for employers who seek advice
and guidance on OHS matters in their respective workplaces.
Asian-Pacific Newslett on Occup Health and Safety 2011;18:44–6 •
45
Photo by Ministry of Health ,Brunei
The Division
plays a key
role in the
training of
doctors,
nurses
and health
inspectors in
occupational
health.
Training is
delivered
through
means of
lectures,
seminars,
workshops
and work
assignments.
Conducting a workplace OSH inspection by staff
5. Training activities
The Division plays a key role in the
training of doctors, nurses and health
inspectors in occupational health.
Training is delivered through means
of lectures, seminars, workshops and
work attachments.
The Division has also initiated a student exchange programme
in collaboration with the University
of Washington, where three trainees
from that university have completed a
month-long occupational health residency training at the Division since
2010.
6. Collaborative activities with other agencies
With regard to occupational health
and safety issues, the Division works
very closely with the other occupational health and safety stakeholders,
i.e. the Department of Labour, the
Public Works Department and other government and private agencies.
7. Research and studies on occupational health and safety
In addition to its daily activities, the
Occupational Health Division under-
46
• Asian-Pacific Newslett on Occup Health and Safety 2011;18:44–6
takes research and studies related to
OHS. Several research areas have been
identified so far and will be investigated
in due course.
Future plans of the Occupational
Health Division
The Division expects to strengthen and
increases the coverage of occupational health services through a primary
health care approach. In this context,
the Division has prepared its “Occupational Health Strategic Plan (2008–
2017)”, where it anticipates OSH coverage for 51% of the worker population
in the country in future.
Acknowledgement
I would like to extend my sincere
thanks to Dr Pg Hj Md Khalifah bin
Pg Hj Ismail, Director of Environmental Health Services, Ministry of Health
Brunei Darussalam, for his valuable advice and support given in preparation
of this article.
References
1. Brunei Darussalam, Country Profile
at http://data.un.org/CountryProfile.
aspx?crName=Brunei%20Darussalam
accessed on 19/08/2011
2. Brunei Darussalam Country Profile at
http://www.wpro.who.int/countries/bru/
accessed on 19/08/2011
3. Brunei Darussalam Statistical Year Book
2008, Department of Statistics, Department of Economic Planning and Development, Prime Ministers’ Office, pages 3,39
4. Labor Department Annual Census on
Employers and Employees for 2008,
Brunei Darussalam
5. Employment Order 2009, Brunei Darussalam
6. Workplace Safety and Health Order
2009, Brunei Darussalam
7. Workmen’s Compensation Act 1957
(revised 1984), Brunei Darussalam
8. Annual Report 2009, Occupational
Health Division, Department of Health
Services, Ministry of Health, Brunei
Darussalam
Dr N.B.P. Balalla, MBBS, M.Med
(Occup. Med)
Head
Occupational Health Division
Ministry of Health
Brunei Darussalam
Fax: 673-2230037
E-mail: occuphealth@moh.gov.bn
Photos by Emma Grönqvist
In addition to traditional key issues of occupational health and safety, new topics were also dealt with, such as climate change and its impact on
occupational health.
Policies, profiles and services in OH&S
Suvi Lehtinen, Finland
A group of 154 experts from a total of over
40 countries convened in Espoo, Finland for
the International Forum on 19–22 June 2011.
The topics on the agenda were occupational
safety and health policies, profiles, and services. The Forum was organized by the Finnish
Institute of Occupational Health in collaboration with the Finnish Ministry of Social Affairs
and Health and the WHO Regional office for
Europe. In addition, the WHO Headquarters,
the ILO, the International Commission on Occupational Health ICOH, Bilbao’s European
Agency on Safety and Health at Work, and
Dublin’s European Foundation for Development of Living and Working Conditions were
also involved in the planning of the Forum
programme.
On Sunday, 19 June 2011, the ICOH Scientific Committee on Occupational Health
and Development organized a workshop on
Basic Occupational Health Services for Vulnerable Groups – Current Status and Future
Challenges. The workshop gathered a total of
36 experts who discussed the status of occupational health service provision in different
parts of the world. While some successes were
ings. Both publications will also contribute
described, e.g. India and Vietnam, the need for
to the reporting of the achievements made in
the implementation of the WHO Global Plan
providing basic services for all workers was
of Action on Workers’ Health (WHA60.26).
emphasized. On the global level, we still need
to work hard in order to achieve our goals. A
great deal remains to be done, despite good
Suvi Lehtinen
Finnish Institute of Occupational Health
guidance from international organizations
suvi.lehtinen@ttl.fi
WHO and the ILO, which can be utilized in
the development of basic occupational health
and safety services.
New innovative ways
for service provision
were called for.
The aim of the
organizers is to publish both the materials of the workshop
and the International Forum in order
to enable those who
did not have the opportunity to attend
to make use of the Three Working Groups discuss the various challenges of service provigood practices pre- sion in different countries. The discussions were then reported
sented in the meet- in the Workshop plenary.
Asian-Pacific Newslett on Occup Health and Safety 2011;18:47 •
47
Editorial Board
as of 1 December 2008
Ruhul Quddus
Deputy Chief (Medical)
Department of Inspection for Factories and
Establishments
4, Rajuk Avenue
Dhaka-1000
BANGLADESH
Chimi Dorji
Licencing/Monitoring
Industries Division
Ministry of Trade and Industry
Thimphu
BHUTAN
Yang Nailian
National ILO/CIS Centre for China
China Academy of Safety Sciences and
Technology
17 Huixin Xijie
Chaoyang District
Beijing 100029
PEOPLE’S REPUBLIC OF CHINA
Leung Chun-ho
Deputy Chief Occupational Safety Officer
Development Unit
Occupational Safety and Health Branch
Labour Department
25/F, Western Harbour Centre
181 Connaught Road West
Hong Kong, CHINA
K. Chandramouli
Joint Secretary
Ministry of Labour
Room No. 115
Shram Shakti Bhawan
Rafi Marg
New Delhi-110001
INDIA
Tsoggerel Enkhtaivan
Chief of Inspection Agency
Ministry of Health and Social Welfare
Labour and Social Welfare Inspection Agency
National ILO/CIS Centre
Ulaanbaatar 210648
Baga Toirog 10
MONGOLIA
Lee Hock Siang
Director
OSH Specialist Department
Occupational Safety and Health Division
Ministry of Manpower
18 Havelock Road
Singapore 059764
SINGAPORE
John Foteliwale
Deputy Commissioner of Labour (Ag)
Labour Division
P.O. Box G26
Honiara
SOLOMON ISLANDS
Le Van Trinh
Director
National Institute of Labour Protection
99 Tran Quoc Toan Str.
Hoankiem, Hanoi
VIETNAM
Evelyn Kortum
Technical Officer, Occupational Health
Interventions for Healthy Environments
Department of Public Health and
Environment
World Health Organization
20, avenue Appia
CH-1211 Geneva 27
SWITZERLAND
Jorma Rantanen
ICOH, Past President
FINLAND
Harri Vainio
Director General
Finnish Institute of Occupational Health
Topeliuksenkatu 41 a A
FI-00250 Helsinki
FINLAND