By IRA ZUNIN
Medical officers selected to care for crews aboard Hokule‘a and Hikianalia during the international portion of the Worldwide Voyage prepare to practice austere, blue-water, wilderness medicine. Traditional Polynesian voyaging, which uses noninstrument navigation on a sailing canoe, is potentially hazardous. Few predictions can be made about the weather more than several days in advance, so it is impossible to fully predict the conditions one will encounter during the projected four-week sail on the first international leg from Honolulu to Tahiti, or any of the future legs. Space for medical supplies is extremely tight, and the working conditions are austere.
The biggest difference between blue-water, wilderness medicine and emergency medicine is that there can be no expectation of timely backup. If a person collapses with chest pain in an urban setting, someone trained in CPR can render aid while awaiting the ambulance. In the deep ocean there is no 911. Instead, we have focused on prevention and preparation.
Hokule‘a recently underwent an extensive dry dock to prepare for the worldwide voyage. The physicians who form the Medical Logistics Committee for the Polynesian Voyaging Society concurrently brought the role of medical officer through its own dry dock, one perhaps less visible. The inventory of medical supplies has been fully revamped, protocols have been developed for a wide array of situations and the medical officer aboard now has a dedicated medical iPad with important reference material. There is also a satellite phone for emergency communications and support from medical specialists.
Medical screening of the crew began many months before the voyage now at hand. For a large portion of the crew, the early screening created an impetus to increase physical activity, improve diet and trim excess weight. Once the bar for health and fitness was set, crew candidates worked hard to meet the mark, and the majority were extraordinarily successful.
After extensive dialogue a decision was made to have only one medical officer charged with the health of crews both on Hokule‘a and Hikianalia, her sister vessel. The challenge is that, especially in rough weather, the transfer either of the medical officer or a sick crew member can be extremely difficult. Even in calm seas, transferring is a chore and time-consuming. To help bridge this gap, the first group of medical liaisons just completed a four-week course. Their primary role is to be the eyes and ears of the medical officer on the second canoe and to communicate efficiently and effectively on the day-to-day health status of the crew. Medical liaisons are also stationed on the canoe with the medical officer, which gives them an opportunity to continue to train. They also can assist the medical officer particularly in the unlikely event of a large accident or epidemic at sea. In addition, medical liaisons may be helpful if the medical officer gets sick or is hurt. Finally, when Wi-Fi is up between the canoes, it is even possible to engage in a basic form of telemedicine using iChat.
“Man overboard” drills are an important part of crew training. As recovery is challenging even in calm seas, the entire crew must be poised to respond quickly by simultaneously establishing a spotter, sending out a rescue ring and stopping the canoe. Rescue swimmers have been trained and can be dispatched by the captain. The medical officers and liaisons also train to interface with the rescue. It must be determined whether illness or injury was associated with the fall overboard and how this may affect the rescue strategy and care following recovery.
While it is impossible to prepare for every eventuality, efforts have been made to prepare for a wide range of scenarios given the inherent limitations of blue-water, wilderness medicine.
Note: At the request of the Polynesian Voyaging Society, Dr. Ira “Kawika” Zunin is serving as medical officer on Hokule‘a and Hikianalia during the first leg of the voyage, to Tahiti.
Ira “Kawika” Zunin, M.D., M.P.H., M.B.A., is a practicing physician. He is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to email@example.com.