健康上の課題克服：女性船員のがん、子宮内膜症、過活動膀胱

EWD

EveryWoman Dayは、女性の健康問題に対する認識を高めるために設けられました。女性船員が直面する特有の健康上の課題、特に癌や子宮内膜症、過活動膀胱といった疾患の管理に焦点を当てることは、特に厳しい職業における支援と理解を深めるために極めて重要です。
女性船員にとって、特に癌や子宮内膜症、過活動膀胱といった疾患は、過酷な労働環境、医療へのアクセス制限、海上生活による肉体的・精神的負担によって、さらに深刻化する可能性があります。
本稿では、女性船員にとっての健康上の課題とその影響について説明します。

As we recognise EveryWoman Day, a time dedicated to raising awareness of women's health issues, it’s crucial to highlight the unique challenges faced by female seafarers, particularly in managing conditions like cancer, endometriosis, and overactive bladder, underscoring the need for greater support and understanding in this demanding profession. 

The maritime industry, traditionally male-dominated, has seen a rise in female seafarers over the past few decades. Despite this positive shift, women working at sea face unique health challenges that are often overlooked or inadequately addressed. Conditions like cancer, endometriosis, and overactive bladder (OAB) can severely impact their ability to perform their duties and maintain their well-being. For female seafarers, these health issues can be compounded by the demanding nature of their work environment, limited access to medical care, and the often physical and emotional toll of life at sea. This article explores these health challenges and their implications for female seafarers. 

Cancer

Prevalence and Risks: 

Cancer remains a significant health concern for women worldwide, particularly breast, ovarian, and cervical cancers. The UK Health Security Agency (UKHSA) highlights that jobs involving outdoor work, might significantly increase the risk of skin cancers, thus emphasising the importance of preventative measures.  

  • Breast Cancer: As the most common cancer among women, breast cancer poses a potentially significant risk to female seafarers. Regular screening and early detection is vital but often inaccessible at sea. Limited access to mammograms and diagnostic tools, and extended periods away from healthcare facilities, can delay diagnosis and treatment, possibly increasing the risk of severe outcomes.  
  • Ovarian and Cervical Cancer: Ovarian cancer is often diagnosed late due to its subtle symptoms, complicating early intervention. Cervical cancer can be preventable, however this requires consistent healthcare access.  Early access to cervical smears and HPV vaccination is paramount. Enhanced awareness, routine screenings, and access to healthcare can help address these critical health issues among female seafarers. 

The Importance of Regular Screening and Awareness: 

Awareness of signs and symptoms, self-examination and regular screenings are essential to help combat illness onboard. Suggested early interventions such as facilitating remote consultations with healthcare professionals, and ensuring that female crew members have access to necessary screenings promptly are essential supportive strategies.  

Endometriosis: 

Understanding Endometriosis: 

Endometriosis is a chronic condition where tissue similar to the lining of the uterus grows outside it, causing severe pain, irregular bleeding, and in some cases, infertility. According to the World Health Organisation (WHO), endometriosis affects approximately 10% of women of reproductive age, and its impact on female seafarers can be profound due to the physical nature of their work and the limited access to specialised care. 

Challenges Faced by Female Seafarers with Endometriosis: 

  • Severe Pain and Physical Demands: The intense and often unpredictable pain associated with endometriosis can make daily tasks, such as lifting, standing for long periods, and managing stressful situations, extremely challenging. The lack of adequate pain management resources on board may exacerbates these difficulties, inevitably leading to decreased productivity and increased emotional stress. 
  • Limited Access to Treatment: Effective management of endometriosis often requires a combination of medication, hormone therapy, and sometimes surgery. These treatments are difficult to access at sea, and the lack of accessible specialists whilst on board can result in inadequate care. Female seafarers may also face difficulty in obtaining prescription medications, which can lead to lapses in treatment. 
  • Emotional and Psychological Impact: Endometriosis is not only physically debilitating but also mentally taxing. The fluctuating pain levels, the unpredictability of symptoms, and the potential impact on fertility can lead to increased anxiety and depression. The absence of support networks may also intensify emotional challenges. 

Strategies for Better Management: 

Effective management of endometriosis for female seafarers involves fostering a supportive environment and improving healthcare access. Providing crew-wide training on women’s health can increase awareness and reduce stigma around the condition, encouraging more open discussions. Ensuring timely pain management is crucial; appropriate medication, and telemedicine consultations with specialists may be recommended. Flexible work arrangements, such as adjusted duties during flare-ups and protocols for medical leave or evacuations, can also help manage severe symptoms. Partnering with port-side healthcare providers for regular check-ups and access to specialist care during docking periods can further support affected seafarers. 

Overactive Bladder: 

Understanding Overactive Bladder (OAB): 

Overactive Bladder (OAB) is characterised by a frequent, sudden urge to urinate that is difficult to control, often leading to incontinence. Beder reports that OAB has a prevalence of more than 20%, and affects women more commonly than men. While OAB is generally associated with aging, it can affect women of all ages. OAB may be particularly difficult for those working in environments with limited bathroom access, such as ships. 

Impact on Female Seafarers: 

  • Work Disruption: Frequent urination might interfere with a seafarer’s ability to perform their duties, especially in roles that require constant vigilance, such as navigation or machinery operation. Limited access to bathrooms during critical operations can cause significant discomfort and can lead to incontinence.  
  • Social Embarrassment and Isolation: OAB can be socially isolating, as the fear of incontinence or the need for frequent bathroom breaks can lead to embarrassment. This is especially true in a male-dominated environment, where discussing urinary issues can feel stigmatising. 
  • Limited Access to Treatment: Treatments for OAB include medications, pelvic floor exercises, and lifestyle changes. However, accessing these treatments at sea can be challenging. The absence of medical professionals who are knowledgeable about OAB and the lack of privacy for exercises or consultations further hinders effective management. 

Creating a Supportive Environment: 

To support female seafarers with OAB, easy access to clean and private bathroom facilities on ships is key. Education about bladder health, and access to remote consultations with specialists is helpful if medically indicated. Simple measures, such as allowing flexible work shifts and providing discreet incontinence products, can significantly improve the quality of life for affected women. 

Conclusion: Navigating health at sea 

The maritime industry must recognise and address the unique health challenges faced by female seafarers. An environment that prioritises the health and well-being of female crew members to encourage and retain skilled female professionals is desired. 

Key actions include improving access to healthcare services, training on women’s health issues for staff, and fostering a culture of support and understanding. By addressing these challenges, we can ensure that female seafarers are empowered to continue their careers at sea with confidence and without compromising their health. 

Creating awareness and providing adequate support for female-specific health issues at sea is not just about compliance; it’s about ensuring that the women who choose this challenging and rewarding career path have the tools, resources, and support they need to thrive. 

Written by Venetia Lawrence, Director of Operations at Oceans Marine Ltd.  

Independent Marine Surveyors and Consultants - Oceans Marine Ltd

References: 

United Kingdon Health Security Agency (UK HAS) 2023. Health Effects of Climate Change (HECC) report. Chapter 13. Solar radiation and public health. Online (accessed 29/08/24) https://assets.publishing.service.gov.uk/media/65705f3a739135000db03bc3/HECC-report-2023-chapter-13-solar-radiation.pdf.  

World Health Organisation (WHO) 2023. Endometriosis, key facts. Online (accessed 29/08/24) https://www.who.int/news-room/fact-sheets/detail/endometriosis.  

Beder, D (2021). Overactive bladder in women. British Medical Journal (BMJ) 2021;375:e063526.