1 INTRODUCTION Vietnam is a coastal country with over 3260km coast and time-bigger ocean area compared with the land Recently, Vietnam economy has been developing stronger and stronger Our marine and coastal economy was defined to become the leading sector with its contributions getting bigger and bigger Thanks to its rich potentials, the maritime and coastal economy has been attracting more and more labors of which has maritime transport sector All disadvantages of ocean environment and working conditions on the ships have seriously affected health and typical disease rising and finally make the impact on working ability and reduce working age of seafarers Cargo fleets of Vietnam Ocean Shipping Joint Stock Company and Vietnam Sea Transport and Chartering Joint Stock Company The time of continuous voyages are normally from 11 months to 14 months Health care works to crews has had difficultlities due to unavailable medical officers on board or the lack of medicines, medical equipment and even sometimes the impossible support from coastal clinics Thus, what are the aboard working conditions of these companies and how they influence to health and typical diseases rising? What are advantagese and disadvantageses of the medical care to crews? Those considerations pushed us to conduct the study for the following targets: To describe the oceangoing ships working conditions of the two Vietnam Ocean Frieght companies in 2011-2012 To evaluate the situation of crews’ health, disease structure and health change before and after the voyage To propose and adopt some health care solutions to Ocean fleets crews of Vietnam New contributions of the dissertation The dissertation identified disadvantages of aboard working conditions and specified health, disease patterns, long voyage impacts on health, disorders, and diseases of crews Specially, it pointed out the medical care reality to crews, proposed the solutions and applied successfully one key solution of maritime medical care training for deck officers who are responsible for health care on board The dissertation layout The thesis includes 130 pages (Introduction: pages; Chapter 1: Overview 33 pages; Chapter 2: Research subject and method:16 pages; Chapter 3: Research results: 41 pages; Chapter 4: Discussion: 34 pages; Conclusion and recommendation: pages) There are total 50 tables and 12 figures References: 154 (75 Vietnamese ones and 64 English ones) The appendix includes Study template and list of deck officers participating in intervention maritime medicine training Chapter OVERVIEW 1.1 NATURAL ENVIRONMENT AT SEA Natural environment, especially ocean one is regarded as the first factor affecting seafarers’ health They daily face to the tough situations of ocean, including: + Impacts of rainstorm, storm and sea waves The coastal climate in our country belongs to tropical monsoon with many complicated types that affect our maritime and coastal economic activities as well as harm crews’ health and working abilities on board, even threat their life [41] Waves make direct impacts on aboard activities, for example, high waves can make seasikness then affect physiological funtions and their working abilities +Effects of temperature and solar radiation When working on board, people are affected directly by hot weather in summer and coldness in winter Moreover, the temperature between inside and outside of ship are extremely differen that makes difficulty in adjusting temperature for body and finally easy to get a cold [129] 1.2 Working conditions in oceangoing ships 1.2.1 Aboard working environment The crews have to simultaneously suffer from a number of factors’ impacts not only during working time but relaxing or even sleeping time as well These factors are microclimate on board; physical factors such as noise, vibration, lighting, electro-magnetic wave, and ultrahigh-frequency waves; chemical ones; biological ones and the sudden change when passing different climate areas 1.2.2 Social conditions, hygiene and nutrition on board - Aboard microsocial condition: During the voyage, crews are separated from normal life on land, all their activities are limitted in the narrow ship - Nutrition condition on aboard: unbalanced food diets used in the ships cause metabolism disorders of glucose, lipid, and protein which increases the risks of cardiovascular and aterial blood pressure problems 1.3 Health and disease structure of oceangoing freighter crews 1.3.1 Crews’ health description Labor’s health is key factor to the work completion level and performance Under a research conducted to 3.300 workers working for Ocean shipping Companies of Polish Republic, Filikowski J [88] found that only 32.8% of workers checked were healthy; 19.21% were in dysfunctions but not yet in pathological signs; while 42.9% of them were suffering from some chronic diseases This was a very high figure The result was the same as that of Nguyen Van Hoan, Vu Tuyet Minh [25] pointed out when checking 380 crews working in some Vietnam cargo ships 1.3.2 Study on diseases of ocean shipping crews The most popular diseases in crews were circulation, digestion, infection and parasitic, and mentally behavior disorder diseases 1.4 Health care and management to ocean shipping crews 1.4.1 The importance of health care works to ocean shipping crews The international organizations such as ILO, WHO, IMO, and IMHA has enforced many international conventions on crew health protection, care and improvement and simutaneously set up the health standard frame for crews in order that the member nations can build the health standard regulations for crews which helps to choose seafarers healthy enough to fit this typical works [99], [101], [132], [133] 1.4.2 The situation of health care and management to oeangoing freighter crews - The health care to crews of Ocean freight companies still had shortcomings Fleets had been equiped medicine and medical equipment however they were not enough and accordant with Standard of International Maritime Convention [12], [55], [86] Many oceangoing shipping companies had not sent their deck officers to take part in maritime medicine training courses for deck officers - Training and maritime medicine knowledge updating for crews: VOSCOJSC., have paid attention to health care training for deck officers who would undertake as doctor on board for 15 years Chapter RESEARCH SUBJECTS AND METHODOLOGY 2.1 Research subjects, location and time 2.1.1 Research subjects 2.1.1.1 Working condition on the ships 13 cargo fleets of VOSCO and Vitranschart 2.1.1.2 Crews - Group 1: included 600 crews belonged to VOSCO and Vitranschart, among those there were 193 officers and 407 crews at the age of 36.45± 8,34 years and working experience year of 11,56 ± 5,25 years and they were divided into three groups: deck, engine and servers All were male - Group 2: included 300 crews working on 13 fleets of VOSCO and Vitranschart in of them consist of 103 officers and 197 seafarers - Intervene group: choose total 104 deck officers among 600 crews of group - Reference group: included 300 labours in land, all males and same age with the studied groups who were now working in office, interprises located in Hai Phong and had regular health check in Vietnam National Institute of Maritime Medicine in 2012 This group was checked and mesured all items same as the studied group and used to be reference group 2.1.2 Research location: Department of heath management and Examination of seafarers, Maritime medical training center, Vietnam National Institute of Maritime Medicine, 13 cargo fleets of VOSCO and Vitranschart 2.1.5 Research period: From January 2011 to December 2012 2.2 Methodology 2.2.1 Research design and sampling 2.2.1.1.Research design - The cross-sectional descriptive study and analyzed to evaluate the working condition and crews’ health and disease situation of the companies - The study described vertically and compared before and after to evaluate the health and disease change of crews before and after the voyage - Intervene study: proposed and applied health care and protect solutions to crews working on the ships 2.2.1.2 Sampling method and sample size  Sample size of aboard working conditions The fleets of VOSCO included 19 cargo ships, of which 11 large vessels were working in ocean world wide We chose fleets randomly among those 11 The ocean fleets of Vitranschart included 13 cargo ships, of which large vessels were working in ocean world wide We aslo chose randomly ones The 13 ships above of the Two companies would be surveyed the working conditions Method of taking and surveying working condition models - We surveyed microclimate, noise, vibration on the cargo ships in different places such as cabin, deck, engine rooms and crew rooms; models per each place as under the regulation of taking sample in working condition surveying  Sample size of crews’ health status and disease structure At the time of studying, there were total 1,200 crews of both companies, thus, to increse the reliability of research figures, we chose 600 crews (50%) to have regular health check and entry health check before working on board at Health Management and Examination Department of seafarers from January 2011 to December 2012  Sample size of crews’ health and disease change before and after a voyage - We took all members joining the voyage of 13 surveyed fleets counting as 300 people  Sample size for intervention research We chose 104 deck officers among 600 studied crews to conduct intervene method which we trained them knowledge and practice about maritime medicine so that they can undertake medical care work in the fleets 2.2.2 Research content - Study the health and disease situation of crews belonged to VOSCO and Vitranschart - Study crews’ health change before and after a long voyage - Study maritime mecidical training for deck officers who had not participated the course 2.2.3 Study items and technique 2.2.2.1 Survey working condition on board  Survey on working environment on the ship includes: - Microclimate: temperature, humidity, and wind speed - Physical factors: noise, vibration and light  Survey on occupational safety and healthy: Survey method for occupational safety and health is observation and interview (appendix 4)  Survey on living and hygiene conditions on the ship (Appendix 5) + Cultural life condition on the ship, area per crew (m2) 5 + Fresh water used in daiy life per crew (m3/person)  Survey on nutritional conditions on board by direct observation and interview 2.2.2.2.Study on health condition of crews - Physical situation - Physiological funtions such as circulation and respiration; hematological and blood biochemical items; urine components analysis - Clinical diagnosis, test to identify metabolism disorder syndrome - Abdominal ultrasound to detect a number of diseases, record diabetes etc - To study psychophysiological items 2.2.2.3 Study disease structure and typical diseases of crews 2.2.4 Suggest and apply intervene solution to ensure crews’ health + Some solution proposals - To enhance the medial care for seafarers - To train maritime medicine for deck officers of ocean shipping companies - To well equip medical equipments and necessary medicine on board under International Maritime Labor Convention year 2006 - To set up e-Medicine document to manage crews’ health at specialized medical care units + Applying intervention solution Intentionally choosing total 104 deck officers among 600 crews under the study who had not taken part in training course of maritime medicine to join the training programe of maritime medicine for whole deck officers belonged to Ocean shipping companies under IMO’s reguations of STCW/1978 Convention modified in 2010 and Vietnam maritime Administration The target is to replace the title Health Officer (Doctor) on the ship before but now is abrogated when Vietnam changed from administrative and subsidy centralized economy to socialist-oriented market economy Chapter RESEARCH RESULTS 3.1 Working conditions on the ocean freighters of Vietnam 3.1.1 Survey results on board - Microclimate on board: Average temprature in all places were over standard, especially in the engine room - Noise on board at the port and during the voyage: Among all places surveyed, only that in engine room was over standard, in the port was 97 ± dBA and in the voyage was102 ± dBA - Vibration on board at the port and during the voyage: Vibration at the port was under standard but during the voyage vibration in the engine room was over, at 13,10 -3(m/s) 3.1.2 Result of working condition surveying - 100% ships and crews were equiped personal safety things such as gloves, torches but only 40-47% of crews often wore earplugs and safety glasses - Life safety for crews were equiped fully under International Convention ” Safety of life at sea- SOLAS 83” in quantity, content and regular checks - 100% ships were equiped medical cabinets but 15% were not enough in quantity and categories; 90% ships had medical cabinets and regularly checks 3.1.3 Living standard and hygiene condition of crews - There were many items of living condition including accommodation, cultural activities of crews on the ship is inferior to those on land However, waste treatment on the oceangoing ships 100% met the requirements of International Convention 3.1.4 Nutritional condition of crews on board - Their food diets contained higher calorie in comperision with that for heavy labors of Vietnam However, the calorie percentage of foods were imbalanced (lipidie and protein, sweet food were high but vegastable was small) 3.2 Health and disease reality of Vietnam ocean cargo crews 3.2.1 Physical force norm of oceangoing ships crews Table 3.1: BMI classification of crews (n=600) Crew classification Thin (BMI ,18.5) 9.33% Normal (18.5