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
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.
(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.)
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’
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, with sound-proofing such that you never hear any other activities onboard.
Minor surgery or procedures that do not require general anaesthetic can also be performed on board – from stitches and draining abscesses, to removing cysts and benign growths.
The most common conditions seen onboard – in addition to tummy bugs (if there’s an outbreak of something like norovirus, passengers are isolated and treated in their cabins) – are chest infections in winter; and accidents or mobility problems in summer.
There is also the occasional emergency – and Dr Teru tells me about a recent example.
‘A woman had a heart attack near Madeira and we were too far away for a helicopter to come and winch her off the ship – which happens in serious cases – and so we kept her in the intensive care unit for five days until we got back to the UK,’ he says. She is apparently now recovering well.
Christian Marshall, 78, from Clacton-on-Sea, reflects on the 24/7 care with huge relief.
He and his wife, Carol, were three days into a two-week cruise around the coast of Britain and Ireland last summer when Christian woke in the night, coughing violently, with a sore throat, throbbing headache and, what he didn’t know at the time, sky-high blood pressure.
‘I felt dangerously ill, worse than anything I had ever experienced before,’ he says. ‘I was admitted to the ICU room and underwent every kind of test, culminating in a diagnosis of acute bronchopneumonia.’
This is a serious infection which can affect breathing – and is sometimes fatal. Christian, an ex-station officer with Hampshire Fire & Rescue Service in Southampton, believes it started with an infection that he picked up on the ship.
‘For the next few days I was put on a nebuliser (which converts medication into a breathable mist) to widen my airways and counter the infection directly in the lungs,’ he says.
‘The care I received was outstanding from start to finish.’
So outstanding that Christian, who is now back to good health apart from the fact that his voice has not fully recovered, believes he would have died if the same thing had happened to him at home.
‘My wife would have taken me to Colchester Hospital, which is 30 miles away, and no doubt there would have been a long delay in A&E,’ he says.
‘As it was, it took three attempts once we got back from the cruise for me to see a doctor.’
Almost all cruise ships insist on passengers having travel insurance before boarding. Any charges are sent direct to the insurance companies.
On Ambassador ships, these amount to £90 for a consultation with a doctor and £50 for intravenous treatment.
In Christian’s case, he was insured with Nationwide Worldwide Travel, which picked up the whole bill apart from a £50 excess charge. His total claim came to nearly £2,300.
Michael Barnett, 72, had a similar experience some years ago on board Royal Caribbean’s Brilliance of the Seas during a Mediterranean cruise.
‘We docked in Livorno in Italy and were offered a trip to Pisa,’ he recalls.
‘I started to climb the steps at the foot of the Leaning Tower, but became short of breath and then could hardly move.’
After being helped back on to the ship, he went straight to the medical centre.
One patient described their care aboard the cruise ship as ‘outstanding from start to finish’
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.
