Doctors and Nurses: Partners in Public Health
By David Best, Director of Public Health
In an earlier article, I compared the role of a Public Health Officer (PHO) as similar to that of the Mandalorian—the protagonist from the Disney+ Star Wars franchise television series—due to the often-solitary nature of the position. However, nobody, not even someone as dedicated to a cause as the Mandalorian, can succeed on their own. As the renowned Japanese poet, Ryunosuke Satoro, so elegantly expressed, “Individually, we are one drop. Together, we are an ocean.”
When sailing on that ocean as a PHO, you don't have to look far to find your natural allies. Conventionally, tucked away from the bright lights of the casinos, shopping facilities, bars, restaurants, and all the other amenities commonly found on board a cruise ship, is the medical center. Inside that medical center you will find the real heroes of the COVID-19 pandemic: the doctors, nurses, and all the medical professionals, who have worked tirelessly to save lives and prevent further illness, while, in essence, keeping the cruise industry afloat during these challenging times.
When Disease Prevention Fails
Outbreak investigation is a crucial part of a PHO's role onboard. When public health prevention measures fail, communicable disease outbreaks can occur. Potential outbreaks will, likely, first come to your attention through the medical diagnosis of an infectious disease or an elevated number of cases of a particular illness. There are several components to an outbreak investigation with the primary step in the process always being the detection of a possible outbreak.
On a cruise ship, infectious disease cases are generally discovered through public health surveillance conducted principally by onboard medical staff. Through routine case management and documentation, doctors, nurses, Infection Control Officers, and PHOs, can instantly recognize when increased numbers of a particular illness materialize within a given time frame, usually characterized by the length of the voyage. These groups of cases are known as a cluster. If an investigation uncovers a link between infected individuals to explain why they caught the same illness—and the numbers of persons infected reach or exceed designated threshold levels and criteria for a particular disease—the definition of an outbreak is met.
Examining the descriptive epidemiologic features of the cases by describing a disease in terms of the person (who), the place (where), and time (when), provides support in generating hypotheses. Reviewing trends in symptom onset may indicate the period of exposure which can lead to insights into what caused the outbreak. Collecting patient data is a critical element to any outbreak investigation.
During large-scale outbreaks the overriding need for doctors and nurses to provide sufficient patient care takes precedence, but the continued importance of consistent and accurate public health surveillance must be appreciated. The onboard medical department should be given additional administrative support during larger outbreaks where necessary, to ensure data surveillance is appropriately maintained, especially as it becomes even more crucial when the doctor’s clinical diagnosis is unconfirmed.
The Role of Doctors and Nurses in Public Health
It's difficult to imagine that any crew member's life onboard has become easier since the onset of the pandemic. With all the additional protocols that have been implemented to mitigate the risk of COVID-19, the consequences of sailing during a pandemic have been predominantly transferred onto the shoulders of the very crew employed on their ships. Perhaps this is no different to any other moment in time when change has been required throughout the industry, however the right thing to do and the hardest thing to do, tend to be the same.
The burden that medical staff have been encumbered with has been significant. A partial list must include: COVID-19 surveillance measures such as health screening and testing; isolation and quarantine management of passengers, crew and their close contacts; and the actual treatment of, and caring for, infected individuals. These are but a few of the responsibilities doctors, nurses, medical assistants, and Infection Control Officers assume. While symbolic gestures, such as the “Doorstep Applause Campaign” in the UK for National Health Service employees may have faded, our global and complex maritime industry would do well to remember that medical professionals deserve the entire industry's continued respect and appreciation.
For PHOs, these everyday heroes in the form of doctors and nurses are real partners in public health. Working together, the very real sense of collaboration and collegiality saves lives. Without the medical team, Public Health Officers cannot hope to succeed in their role which is why it's important to foster a real sense of collaboration with colleagues. Teamwork is essential in realizing public health goals; it is virtually impossible to reach your highest capabilities unless you become good at creating critical relationships. Together with the onboard medical and public health teams, management can empower its crew to accomplish shared objectives. Cooperation, encouragement, commitment, and consistency are just some of the tools needed to achieve this.
As Malcolm X is attributed to saying, “When ‘I’ is replaced by “we” even ‘illness’ becomes ‘wellness’.”