A piece of advice offered when I asked around for how to provision my first boat for cruising was, “Get a good medical kit.” It took years to fully understand what my advisor meant by this. It also took time to realize that for ocean-going cruisers who spend at least as much time in port, medical self-sufficiency is as important in exotic land places as on the high seas.
For a span of 13 years, I acted as ship’s “medic” aboard cruising boats. It made sense to designate one of us, just as it made sense to have one sailing captain. Designating a medic encourages that person to expand their knowledge and to be ready to make decisions at critical times. The choice can but doesn’t have to coincide with the crewmember who is the least squeamish or has the most experience.
“Care of the health impaired sea-goer is a challenge for the health care provider, especially when there are miles separating the ship from shore.” This quote comes from the 2003 edition of The Ship’s Medicine Chest and Medical Aid at Sea, a publication of the US Department of Health and Human Services first printed in 1881 as a reference for crewmembers who treat American merchant seamen on ships required to carry a “medicine chest.”
Especially when just starting out, it’s tempting to buy a pre-packaged kit from a marine supply store. They come in a bewildering array of options and are usually categorized by type of cruise, number of people on board, and time it would take to reach help. Ideally one would know all these conditions and be able to take them into consideration each time one started on a cruise, but in reality, most small boat ocean voyagers are on a multi-month if not multi-year cruise and don’t easily fit a single category.
Keeping it together
It’s actually not bad to invest in a decent kit and keep this for first aid/emergency. Some products come with units already made up for separate emergencies –– such as burns, wounds, fractures –– that contain the tools and supplies needed for initial treatment. In a crisis, the medic can reach for a pack rather than gather supplies from lockers and waste critical time. Bigger kits also contain lots of bandaging supplies; lists for cruisers always have this and acquiring them can be a pain even in your hometown.
But first aid is just what it says. Once an injury is stabilized, you need to provide continuing care. You’ll also need to provide this if a crewmember becomes ill. This can happen at sea, which is not really the sterile place people think it is. Besides, whenever you leave land, you take what you encounter there with you.
For continuing care as well as for day-to-day health situations, you need supplies that don’t come in a kit, especially drugs, which are not included in retail packages. For each crewmember’s unique needs, this is easy; have them prepare reserves from over the counter and their own prescription drugs, plus make a plan for getting refills (sent from home or purchased on the way?). Medicines useful for women should be included, and boats with children on board should know how drug administration differs for them.
How do you start building a boat’s medical kit? “Take a list to your family doctor. Ask for drug prescriptions and maybe they’ll give you some of the fancier equipment,” said my advisor.
Your first real challenge is to come up with a supply list. When we first headed out in the 1990s, I relied on two books that are still standards for cruising sailors and that have both been updated since then: Your Offshore Doctor and Advanced First Aid Afloat. I combined their lists, culling from both to generate my own supplies that included not just drugs but also equipment. You obviously can’t carry everything, but there are many portable objects that can administer the other items in your medical locker.
Useful drugs can be sorted by category: antibiotics, antifungals, antihistamines, antiseptics, painkillers, steroids, heart medications, severe allergic reaction treatments, to name some. My family doctor substituted a pain med that customs officials would be unlikely to confiscate because at the time it had no street value. Nowadays authorities are very concerned about abuse of opioids, so you must balance effectiveness with safety. Relaxants are also important.
Hot climate issues
Tropical places offer special medical woes. Antifungals are useful because the hot, moist environments cruisers generally travel in are great breeding grounds for fungal strains, though I picked up an intractable case of athlete’s foot which ate my toenails until a doctor in Borneo treated me with an American drug that was not approved for use in the States. We encountered food poisoning. Tom got a staph infection from wading in a lagoon where the locals were continuously affected so their shins were permanently scarred. A former American Navy medic living on the atoll treated the infections with a primitive penicillin derivative, opening capsules of powder directly onto the sores. A cruising buddy got malaria falciparum in New Guinea. It’s the kind that will kill you in 48 hours if untreated and the local clinic only had a type of chloroquine that worked on the recurring malaria that locals get and not on first-time Westerners. I talked to an infectious disease doctor back in the States who walked us through how the local pharmacy could supply what we needed to supplement onboard anti-malarials. Any of these medical conditions could have hit us offshore if we left land before they showed up.
In New Guinea, as in many countries throughout the Pacific, medicines are available through local pharmacies without prescription. Even Panadeine, the trade name for Tylenol-Codeine in commonwealth countries, is available over the counter as a mild painkiller. You have to know what to ask for (i.e., requesting Tylenol-Codeine may not get you far in Australia), and in places where you don’t know the language, have someone write out a list. Even if you do speak the local language, knowing the generic/scientific name for a drug can make the difference when you face a puzzled pharmacist. Compound drugs may have to be made up from their ingredients, as was the case with my husband’s blood pressure medication.
Aside from various topical preparations for skin problems and over-the-counter drugs for digestive issues, the most commonplace items in your kit will be NSAIDs or nonsteroidal anti-inflammatory drugs. While a true steroid like prednisone is a definite plus on board, this category is made of the “take two aspirin and call me in the morning” variety. What used to embody aspirin and Tylenol (acetaminophen) now includes ibuprofen in its various brands as well as naproxen and ketorolac, which was fairly new when I set out and was suggested as effective for moderately severe pain, especially for minor surgical procedures, without affecting a crewmember’s performance in a shorthanded crew. Voltaren patches or cream are useful for localized pain.
A way to give back
NSAIDs also offer a chance to give back to local people for all the time we spend in their lands. At least in the Pacific Islands, the simple relief that Tylenol can offer is difficult to come by, so consider carrying a stock of bottles to give away.
Medical equipment is pretty standard, and you won’t likely use it often. Supply lists are useful, and this is another good time to ask your doctor for advice. One thing I would do differently next time is take a surgical stapler. I watched residents staple cuts on family members’ scalps, and while it’s not applicable in all circumstances, it can overcome squeamishness toward stitching and still the qualms of inexperienced people, especially if the medic is the wounded one!
A third distinct category of onboard medical supplies is for the life raft. It’s good to familiarize yourself with the contents of your raft’s first aid kit (by list—you can’t access it without deploying your raft), and be prepared to supplement. Besides any personal drugs or supplies, follow the rule about first aid/continuing care and decide whether the kit is enough for an extended stay afloat. On our Peterson 44, Oddly Enough, we kept our backup medical supplies in a large drybag which was stored handy to grab if we needed to abandon ship. This meant digging into it to renew supplies in the head cabinet and keeping track of what we removed. The drybag was neoprene-coated and more durable than the nylon bags readily available today. AquaQuest and Siberion both offer these heavy-duty drybags. The advantage of a drybag over hard waterproof case is that drybags float and are easier to stow in a boat’s unsquare spaces.
Simply having a good supply of drugs and equipment on board does not guarantee that you can effectively meet medical problems. You also need to know how to use what you have. First aid kits come with instructions, but in a crisis, stopping to read them may be difficult. It’s wise for sailors venturing beyond coastal cruising to set up ahead of time a communication network of referrals and preferably be able to contact a shore-based doctor who can talk you through medical issues.
Carry books on medicine.The Merck Manual which lists drugs and symptoms. The Ship’s Medicine Chest, while not geared to the small boat sailor, is chock-full of information and worth having (it’s free to download).
Satphone communication has evolved tremendously over the years. Though still expensive, it is the most reliable means of obtaining medical help, and you should consider it if you are particularly concerned about health starting out. You can sign up with telemedicine services; we’ve all become more familiar than we’d like on land with telemedicine during the pandemic, and I for one have found it quite useful. Ham and SSB radio nets still exist, though they are limited if you can only reach them at certain times. If you travel with other boats even loosely, there may be a doctor or someone in the group who knows one to contact.
Last but not least, it’s a good idea to cover exigencies if a crewmember needs medical help beyond what the boat can offer. General travel insurance will not do this, but DAN, the divers’ network that also provides coverage to sailors, offers insurance that will get you evacuated by ground, air or sea to the nearest hospital for a reasonable premium. Some insurance companies cover hospital and doctor expenses overseas.
Ann Hoffner and Tom Bailey voyaged for years aboard the Peterson 44 Oddly Enough. They are currently looking for another cruising boat.