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Getting Sick at Sea

| March 8, 2004

CruiseMates recently received a letter from a woman who had a problem on a cruise. Her sister had taken ill on board and went to the ship's doctor. A decision was made to run a series of tests to see what was wrong. When she received her bill at the end of the cruise, there was a $1,500 charge for medical services. They complained, but to no avail, and were told they had to pay their bill before anyone on the ship was allowed off. As upset as they were, they paid.

What kind of medical treatment can guests expect to receive during a cruise and what will they have to pay for it? No one wants to get sick during a vacation, especially on a ship out of the country and out on the ocean. But a little preparation can help if the situation does arise.

The most common ailment guests feel at sea is seasickness (or at least the feeling that they are going to be seasick). With today's modern fleet of very stable vessels, this common ailment is less and less of an issue. Besides, most ships dispense anti-seasickness medication free for those who did not bring their own. Taking one or two of these pills (Dramamine, Bonine or something similar) and then a short nap will usually solve the problem.

If a medical problem is more serious, seeing the ship's doctor may be necessary. All of the ships catering to the U.S. market have a facility with medical staff. It might be one doctor and a nurse, it might be one or two, it might be more. They will have different levels of qualifications, and they will certainly have different levels of equipment at their disposal. This may depend on the size of the ship and how many guests it carries: the larger the ship, the more staff and facilities.

In addition, 16 companies are members of the International Council of Cruise Lines, a non-profit trade association that has taken a very proactive stance on medical care and treatment at sea. Specific guidelines have been set to foster the goals of 1) providing emergency medical care for passengers and crew; 2) stabilizing patients and initiating reasonable diagnostic and therapeutic intervention; and 3) facilitating the evacuation of seriously ill or injured patients when deemed necessary by a qualified physician.

General Information There is no industry-wide uniformity on one of the biggest questions: Is the medical staff employed by the cruise line or independent contractors? When you're sick at sea and need a doctor, this is not an issue. But if this is an issue for you before you choose the cruise line, read the line's brochure carefully. Personally, I've never worried about this. Qualified staff is qualified staff. The doctors and nurses may very well be permanently employed on cruise ships or they may be doing this as a break from their land-based positions.

One thing worth checking before you sail is what kind of coverage you have on your insurance policy. Since most ships are registered offshore, regular medical insurance may consider them foreign places and not provide the same -- if any -- levels of coverage at sea. Again, it's not worth a whole lot of worry: If you're sick, you're sick. But it is good to know so you can make educated financial decisions while on board, if necessary.

If you have any medical problems that may impair your cruise, it's best to be upfront with the cruise line and see what their specific conditions are. The cruise line brochure may spell out some specifics, but might not cover all situations. Disabilities are different and also deserve some investigation upfront.

It is always best to take any required medications with you. The ship may not have what you need, even if it's an emergency. And, never pack this medication in your luggage; put it in your carry-on. There's always a possibility that luggage may be lost. It's bad enough to be without clothing and other stuff; it could be really serious to be without medication.

All cruise lines set limits on how far into pregnancy a woman can travel, but there is no hard and fast rule. For Carnival and Celebrity, it's 27 weeks. For Holland America, it's 24 weeks. Some lines draw the demarcation point as the beginning of the third trimester. It's best to check in advance and not take chances.

Treatment Costs An old adage says when you're sick, you don't care how much treatment costs -- you only care about getting well. It's only after you're healthy again that medical costs make you sick all over again. I am not a medical financial expert, but it in looking at what various cruise lines charge for various types of treatment, I find them reasonable. A basic office visit seems to be running about $50-$80. More difficult conditions may incur a higher charge. Follow-up visits naturally are less. House calls (or stateroom call) have a surcharge of about $30. Some minor surgical procedures may be possible on board. Broken limbs or bones are treated appropriately with casts or splints; a finger splint may be $40 while a cast for a broken bone in an arm may get up to $80-$100. If the case is serious enough that evacuation is needed and a ship's escort is required, it's naturally going to be expensive.

Charges for tests and medications will run the gamut. This is where it really pays to check out what the cost of options is going to be. Don't agree to a battery of tests that you may not feel are urgently necessary unless you know the costs up front.

That Nasty Virus Whether it's called NLV (Norwalk-Like Virus) or Noro Virus, it's a medical condition that has generated lots of bad press coverage for the cruise industry. Yes, there have been outbreaks of it and I wouldn't want to have it myself. But I've been on 18 cruises in the last 37 months and haven't had it myself or been on a ship with an outbreak. It's not going to keep me from taking or enjoying a cruise vacation.

Cruise lines all have programs in place to deal with this gastrointestinal problem, depending on the levels of severity. Some cruise lines take a very proactive approach. Crystal Cruises, for example, has a very advanced hand-washing system at the gangway and every one re-entering the ship must use it. It just takes a few seconds and I must say you feel really good about it once you go on board. Most cruise lines, including Carnival and Holland America, are in a more reactive mode and deal with it on a case-by-case basis if any outbreak occurs.

In addition to having guests wash their hands with an anti-viral solution each time they board, Crystal publishes a statement in the daily paper on board encouraging guests to wash hands frequently. Crystal, along with other lines, has eliminated the practice of having guests shake hands with the Captain at receptions and parties. Overly cautious? I don't think so. Outbreaks have been fewer and fewer, and it's great that the industry has stepped up to deal with it quickly and effectively.

A Few Cruise Line Examples In the brochures published by the various cruise lines, there are usually some paragraphs on the subject of medical treatment. They all have a certain amount of information but the general tone is pretty straightforward. A few examples follow:

Holland America Line The Holland America brochure says: "Each of our ships is equipped with limited medical facilities that are staffed by a physician and registered nurses. The physician is an independent contractor. There will be a fee charged for all medical services and medications obtained on board. If you become ill during the voyage and the physician is unable to care for your needs on board, you will be transferred to medical facilities on shore. If your condition will require that you have special medical apparatus or assistance on board, we must be made aware of that at time of booking in order to determine whether we can accommodate your needs. If you are using prescription drugs, please bring an adequate supply with you and keep them in your carry-on luggage."

This is clear and concise, essentially telling cruisers all they need to know. Yet it opens up the door for guests to call and ask questions about such things as wheelchairs, oxygen tanks and dialysis equipment.

Crystal Cruises The medical equipment on Crystal's three ships is extensive. It runs the spectrum from an X-ray machine, to defibrillators, ECGs, cardiac monitoring equipment, ventilators, nebulizers (look it up!), tanks of oxygen, anesthetic machines and much more. Symphony and Serenity each have seven overnight beds (Harmony has five), and these include the emergency trolley beds similar to the advanced U.S. medical ships like Mercy.

Cunard/Queen Mary 2 Much has been written about the grandeur of Queen Mary 2. Certainly a lot has been made of the incredible size and facilities on board. However, less well known is that the ship has the largest medical facility at sea and, without doubt, the most comprehensive levels of treatment available. There are two full-time doctors and four nurses, all registered in the U.K. and three medical attendants to help out. There will also be dentists on certain voyages (although I don't think I'd want to have my teeth drilled while the ship is crossing the Atlantic).

There are two consulting rooms, an emergency room, six wards, and 11 in-patient beds (five are fully equipped Critical Care Units). In addition, there are x-ray facilities, a lab, a pharmacy and a dental suite.

The ship has advanced teleradiology and telemedicine equipment, allowing medical staff to transmit information and films shoreside to get further advice whenever necessary.

Final Word Obviously no one wants to get sick at sea. And, thankfully, I never have. But I am very impressed by the improvements made in this area in recent years and would feel quite comfortable if I needed to consult a physician on board.

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