1.  Aspects of seafaring life which are relevant to medical examination of seafarers
The medical examiner should bear in mind the following aspects of shipboard life:

• As ships often operate far offshore or inaccessible areas it is often difficult to replace seafarers who become injured or ill.  Many ships have only the only the minimal number of persons on board  ncecessary to operate the ship, thus the incapacitation of even one seafarer may place a substantial additional burden on his or her shipmates.
• Ship's officers genearlly receive basic first-aid and other medical training, and ships are usually equipped with basic medical supplies.  Nevertheless, it is often quite difficult to transport sick or injured seafarers ashore where they can be treated by licensed physicians.  In some geographical area, the closest medical care facilities ashore may be well below the standard of the seafarers' home country.  It is therefore unadvisable and often unsafe to allow persons with certain medical conditions to become seafarers or to return to seagoing employment.
• Seafarers live close to each other at sea, often for long periods.  Contagious diseases therefore may be a serious threat, endangering not only the health of other seafarers but also the safety of the ship and, where carried, passengers.  It is particularly important that seafarers concerned with the preparation of food not suffer from conditions which may be transmitted to others through this work.
• Seafarers must be physically and psychologically fit to perform their normal duties correctly and to be able to respond to emergency situations (e.g., fighting fires, lowering lifeboats, assisting passengers, etc.)They should be able to adjust to continual vibration and the often violent motions of the ship, to be able to live and work in sometimes crampled spaces, to be able to climb ladders and to lift heavy weights amd be able to withstand exposure to harsh weather conditions on deck or excessive heat in the machinery spaces.  As they often travel by air to reach and return from their ships, they must not suffer from conditions which prohibit air travel.
• Seafarers should be able to live and work closely with the same people for weeks and perhaps months on end and under often stressful conditions.  They must be capable of dealing effectively with isolation from family and friends and, in some cases, from persons of their own cultural background.

There are two types of medical examinations.
-  Pre-sea medical examinations, those conducted before a person embarks upon a seafaring career; and
-  Periodic medical examinations, those conducted either before a seafarer reports to a ship or at periodic intervals during the seafarer's career.

A medical certificate, signed by the medical examiner, is issued to seafarers who pass the examination.  Without such a certificate seafarers are often prohibited from working on board ships.

A Pre-Sea medical examination provides an oppurtunity to prevent a person who should not, for health reasons apparent at the time, from embarking on a seafaring career.  It is therefore more stregenth in nature than a periodic exanination, bearing in mind that the objective is to head-off an unhealthy or unwise career choice.  By its very nature, this examination may occur only once, and it is very important that the medical examiner conducts it thoroughly.

A Periodic medical examination provides an opportunity to ensure that a seafarer remains fit for sea service by identifying medical conditions which may have developed since the seafarer entered the profession.  It should be more flexible than the Pre-Sea examination, yet not so flexible as to permit unfit seafarers from returning to work at sea.  Seafarers should be examined at least every two years and those above 40 years of age should be examined at least every year. If a seafarer has been incapacitated by illness or injury for 30 or more days, the medical examination should be repeated.

The following suggested procedures do not aim to replace the judgement or experience of the medical examiner.  They will, however, serve as a tool to assist in the conduct of examinations.  A Medical Examination Form (Form Mex) has been developed for this purpose.  (Annexure E)

1.  The medical examiner should determine if the purpose of the examination is for a seafaring career (Pre-Sea examination) or to determine if the person is fit to return to sea (Periodic examination) and conduct the examination accordingly.
2.   The identity of the person to be examined should be verified.  The number of his or her discharge book, passport or other relevant identity document should be entered on the examination form.
3.  The examinee's intended position on board ship, and, as far as practicable, the physical and pshychological requirements of this work, should be determined.  The type of shipping operation (e.g., foreign, coastal or harbor service) and cargo type (container ship, chemical tanker, etc.) should also be considered as this information may lead to closer scrutiny or to less stringency in certain aspects of the examination.
4.  The examinee's previous medical records, if available, should be reviewed.
5.  Informationshould be collected directly from the examinee on his or her previous medical history.  Point-by-point questions on the details of previous diseases and injuries should be asked and the results recorded.  Details on other diseases or injuries not covered should aslo be recorded.  After the information is collected, the examinee should sign the form to cetify that it is a true statement. (An individual should not, however, bear the burden of proof concerning the consequences of physical or mental illness, past or present, on his her fitness for work.) (Annexure E)
6.  The examinee's weight, height, pulse rate and blood presure should be measured and recorded.  The results of laboratory tests, ECG, chest X-ray and (if necessary) other examination should be checked and recorded. (If drug and alcohol testing is required, reference should be given to the Griding Principles on Drug and Alcohol Testing Procedures for Worldwide Application in the Maritime Industry adopted by the Joint ILO/WHO committee on the Health of Seafarers (Geneva, 10-14 May, 1993).
7.  Hearing, eyesight and colour vision should be checked and recorded.  Eyesight should be in compliance with the eyesight standards given in (item 16- Annexure B)
8.  The examinee's vaccination record should be examined.  Advice should be given on immunisations.  If new vaccinations are given they should be recorded on the International Certificate of Vaccination (See also paragraph 4 below).
9.  The results of the examination should be recorded and assessed to determine if the seafarer is fit for the work envisioned to be undertaken.  Annex I contains information on medical conditions which should be taken into account when considering whether a person is fit or currently unfit for work at sea, the age and experience of the person to be examined, the nature of the duties to be performed and the type of shipping operations and cargo should also be considered.
10.  If the examinee is found fit for the work to be performed the medical certificate should be issued.  Any restrictions concerning work should be reflected in the description of the work he or she is fit to undertake.
11.  If the examine is found temporarily "unfit" for service, and therefore is not to be granted a medical certificate, he or she should be given an explanation of reasons.
Advice should be given on the need to make additional tests, to obtain opinions from specialists, to complete dental or other treatment, to undergo rehabilitation, etc.  The examinee should be informed when to return for another examination.  He or she should be advised on the right to appeal and how an appeal can be made.
12.  As appropriate, and if time permits, the seafarer should be counselled on lifestyle (to limit alcohol intake, stop smoking, modify diet, lose weight, etc.), on the dangers and methods of prevention of HIV/AIDS and other venereal diseases.  Printed health educational materials on drug and alcohol abuse prevention, smoking cessation, diet, HIV/AIDS prevention, etc. should also be provided, if available.(If the tests for HIV which may have been carried out in connection with the examination reveal a positive result, the seafarer should always been informed.)
13.  The Medical Examination Form should be clearly marked "CONFIDENTIAL" and be retained for atleast 10 years in the health establishment where the health certificate was issued.  The file should only be made available for medical purposes related to the performance of duties or the provision of medical care.
14.  A copy of the Medical Examination Form should be given to the seafarer and the seafarer should be advised to bring it to the next medical examination or when he or she is treated for an illness or injury.  If possible, a card indicating blood-type and other vital information may also be given to the seafarer to facilitate emergency treatment.
15.  The serial number of the medical certificate should be recorded and the signed cetificate should be given to the seafarer.

1. International Certificate of Vaccination

Seafarers should carry an International Vaccination Certificate indicating the type, and place and time given, of all vaccinations.

Some countries require a valid International Certificate of Vaccination for yellow fever.  This requirement is often strictly enforced for persons arriving from Asia, Africa or South America.  It is therefore recommend not only for health purposes but also to facilitate travel to, from and through countries from these regions.  The vaccination certificate is only valid if it conforms with the WHO model, if the vaccine has been approved by the WHO, and if it is administered by an approval Yellow Fever Vaccination Centre.  The period of validity of the certificate against yellow fever is 10 years, beginning 10 days after vaccination.  If the person is revaccinated before the end of this period, the validity is extended for a further 10 years from the date of vaccination.  If the vaccination is recorded on a new certificate, the seafarer should be advised to retain the old cetificate for 10 days while the new certificate becomes valid.

These are immunizations that are not required for seafarers according to the International Health Regulations of the World Health Organization.  Such immunizations are, however, recommended for seafarers and should be given on request.  The following are recommended:
-  Viral Hepatitis Type A (infectious hepatitis, epidemic hepatitis)
-  Viral Hepatitis Type B (Serum hepatitis) - When scheduling inoculation, medical examiners will need to bear in mind that doses are recommended at either 0, 1 and 6 month intervals or 0, 1 and 2 month intervals, with a booster at 12 months.  Consideration must therefore be given to when the seafarer will be at sea and thus unable to receive the vaccine.
-  Tetanus - Most seafarers will have immunized, however booster doses are required every 8-10 years.  It is preferred that this vaccine be administered before the seafarer is on board ship, as the alternative (administering the antitetenus immune serum after an injury) may in some persons result in a dramatic and dangerous allergic reaction which could present a serious health risk at sea.
-  Poliomyelitis - Reimmunization, by a booster dose of the oral polio vaccine, is recommended every five years.  Persons not previously immunizes should be vaccinated with the full course of killed or inactivated (Salk) polio vaccine (IPV) prior to taking employment on ship.  Medical examiners should bear in mind that the doses should be made in two, one-month intervals, plus one dose after 6-12 months.  This may affect the scheduling of the seafarer's embarkment.