Shortly after beginning to climb the nine-metre pilot ladder, he was seen to stop, retreat and then lose his grip. Despite the efforts of a launch attendant and two crew members who all jumped into the sea and despite attempts at cardiopulmonary resuscitation on the launch, the Chief Engineer was pronounced dead in hospital two hours after the accident.
The autopsy revealed "severe coronary artery disease evidenced by previous myocardial infarction", but while the direct cause of death appeared to be drowning it could not be determined whether this was the result of a heart attack while climbing the ladder or accidental loss of grip.
The accident investigation report by the Hong Kong marine department suggested the Chief Engineer, tired after the long journey and affected by the insulin injection, may have over-estimated his ability to climb the ladder. Pride, perhaps, came before his fall and dissuaded him from requesting an easier way of boarding the ship.
The investigators also pointed up the discrepancy between the clean bill of health given shortly before his death and a report three years earlier noting the need for lifelong medication. If the doctor who issued the "fit to work" certificate had been aware of the previous history, the report said, he may have acted differently. The Chief Engineer may then not have died in the way he did.
In its recommendations the report says seafarers should assess their own health and physical condition when confronted with demanding tasks such as climbing a nine-metre ladder. They should also, it adds, be honest about their health and any prescribed medication when taking medical examinations.
When, however, a medical examination could result in a loss of earnings, the temptation to be reticent may prove too strong for some. A sharp and costly rise in crew claims for illness and injury in the 1990s led, after it became clear many were the result of pre-existing conditions, to the introduction of pre-employment medical examinations (PEMEs) and the saving of hundreds of millions of dollars.
One P&I club recently claimed to have identified 8,300 seafarers as medically unfit for employment in the 15 years since its PEME scheme began. This represented, based on an average claim of USD 12,000, a saving of USD 100 million.
The death of the Chief Engineer (not the first to result from boarding a ship at sea) also revealed he suffered from three of the most common diseases among seafarers and three of the top 10 reasons why seafarers fail to pass PEMEs (others include liver disease and hepatitis).
Medical examinations can be either statutory or, like PEMEs, part of pre-employment screening for insurance purposes. A recent conference in Norway heard claims doctors are sometime unsure which of the two they are performing.
When they are statutory, they can vary from country to country, creating, according to one medical expert, "the wilderness of different health requirements". Achieving common standards could result from guidelines due to be issued later this year by the International Maritime Organization (IMO) and the International Labour Organisation ahead of the pending entry into force of the Maritime Labour Convention (MLC). They are also expected to address concerns about quality assurance and auditing of approved doctors.
Flag-states could also adopt mutual recognition of health certificates and medical examiners based on accreditation of doctors and clinics under a quality assurance programme being developed by the International Maritime Health Association.
Under the MLC requirement for medical certificates, doctors will also have to assess seafarers against minimum physical requirements for duties they are likely to undertake, such as taking part in evacuation procedures and donning lifejackets and immersion suits.
Much of the information that forms the basis of such assessments, however, comes from the developed world and, medical experts have pointed out, may not be relevant for Asian seafarers.
One difference between "western" and Asian seafarers is in levels of obesity, with the former more likely to be overweight. Recent Danish research found 71% of male seafarers were overweight, compared with the national average of 47%. The highest rates of severe obesity were found among officers aged 45 or over, but researchers also found around half of Danish cadets were overweight.
Dealing with obesity and another MLC requirement that seafarers have access to good quality and nutritional food poses a challenge for employers as they now have to cater for a wider range of nationalities and cultures with different tastes and dietary requirements.
The MLC will also require health protection and medical care on board to be "as comparable as possible" to that available to workers ashore. This could see a rise in demand for "telemedicine" services currently available by radio and, increasingly, the internet.
But low funding of dedicated medical services ashore, poor levels of awareness and language problems are seen as potential barriers to greater adoption. Effective use of systems such as video-conferencing will also depend on seafarers being better trained in diagnostic and treatment technologies.
Developments in regulation and technology and better understanding of the factors affecting the physical and mental well-being of seafarers hold the promise that deaths like that of the chief engineer may be more easily preventable.
By Andrew Guest