Medical Needs Aboard Hokule`a
"Kauka" Pat Aiu, M.D.
Awapuhi / Ginger: the dried root is a traditional medicine for
preventing seasickness (Illustration by Susan G. Monden, in
Kahuna La'a Lapa'au (Honolulu: Island Heritage, 1976). Today
modern medicines are also used to treat illnesses and injuries on
hints and thoughts from the medical side of long canoe voyages: It
is very important to be in good health, in good shape and to be in
good physical condition before embarking on any open ocean voyage.
The reason being that, although we wish all voyag es were smooth
without inclement weather, viral and bacterial onslaught, the
reality is, that these adversities do exist. The healthier and in
shape you are, the better able you will be able to cope and recover
from any ill that may come upon you. Being s o, you'll better be
able to stand your watch, cook, wash dishes, etc. etc. In all
honesty, aside from jesting, the trip becomes fun and a joy instead
of being a total drag. This is for every one on the crew.
Now this part pertains
more to specific medical issues and is appropriate to and for the
Doc on board. I'll discuss first the medical needs from the past
voyages, then the medical kit, some preventive measures and helpful
hints learned over time, and fina lly some emergency procedures.
Folliculitis; Fungal rashes; Sunburn�first degree and second degree;
Carbuncles; Paronychia; Lacerations; Splinters; Non-specific rashes;
Cracked skin; Dry skin; Abscess.
particularly on hairy guys, is the most encountered complaint.
Fortunately it is a minor problem and is easily treated with Mycolog
Sunburn is prominent
the first week at sea. First degree burns are common, but second
degree blistering is not uncommon. Sun screen helps prevent burn if
the crew will use it.
Tinea of every variety
show up with surprising frequency and Lotrimin works well. Dry,
cracked skin occurs often enough to be a problem. Any of the dermal
creams and lip balms work well. The other problems listed above do
occur and other docs and I have e ncountered them but infrequently.
Cardiovascular-Respiratory Ailments: Upper respiratory infections
are by far the most common ailment. Any of the
decongestant/expectorant and analgesic/antipyretics can be used.
These meds get used up very fast, so be well stocked. I never
encountered any of the crew with suspicious signs of Strept, so I
never had the occasion to use injectable penicillin. I did see a lot
of suspicious Strept. in the islands and treated a number
empirically with oral antibiotics. Cultures, as you would suspect,
were unava ilable. I think a Strept screen kit would be useful
infrequent. Saw 4 cases between 1980 and 1987.
Hypertension: six (6)
people were on antihypertensive medication and needed to be
monitored. I feel that because of the possibility of water rationing
during protracted voyages, individuals who must be on diuretics
should not be on board.
Pneumonia: no acute
pneumonia seen so far.
status should disqualify a person from becoming a crew member.
Ailments: (a) Motion Sickness - Common. Most cases resolve after
twelve (12) to twenty-four (24) hours. Dermal patch would probably
help but most actually say, "Nah! I don't get sea sick." End quote!
One individual required IV solutions to counter dehydration; (b)
Gastro-enteritis - This is usually seen on land or soon after
leaving land. All were short termed, twelve (12) to twenty-four (24)
hours. Imodium, Donnatal tabs or Lomotil all worked. Some preferred
taking their own Pouchai pil ls; (c) The scariest case was one of
acute Gastro-intestinal bleeding. By all means of rough estimation,
individual dropped 5 - 6 grams of hemoglobin. His conjunctiva and
other mucous membranes showed a distinct pallor. He also had all the
signs and sympt oms of acute severe blood loss except shock which
spoke well for his good physical condition.
Ailments: (a) Urinary tract infection was seen in only one female;
(b) Individuals with history of gout, those on allopurinal, those
with history of kidney stones all should be on special precaution
for dehydration and water intake should b e monitored. Don't want a
kidney stone out there. Water rationing on a long voyage would
definitely exacerbate this condition and the placement of a person
with this condition on such a voyage should be carefully considered.
Ailments: One incidence of dislocated shoulder. One dislocated
finger. One broken toe. Remember to stress safety, safety, safety
and be prepared for whatevers.
No real psychoses appeared but three (3) individuals needed "talking
out" sessions and psychological support to help maintain
equilibrium. Just be on the look out, observe and talk to and most
important, listen a lot.
The Medical Kit
(Packed in one to four coolers!)
Antibiotic--creams, ointment; (b) Cortisone/antibiotic/anti-fungal
combinations Mycolog, Mycelex--these go out like no nuff; (c)
Emollients--dermal creams, moisteners, sun screens, tanning oils,
mono'i, etc. Most guys have their private stoc k.
Doxycyline; Penicillin; Amoxicillin; Cephalosporin; Cipro or Floxin;
Septra (for the one wahine!); Vag cream for monilia; Erythromycin;
Indocin (for the gout guys).
Medicines: Imodium and or Lomotil; Donnatal; Tagamet;
Decongestants - I would suggest Seldane to avoid drowsiness;
Tylenol; Tylenol 3; NSAID - Motrin, Clinoril, Naprosyn, whatevers.
504 - lOmg size - (2); Demerol - 50mg - (4); Epinephrine 1:1000 -
(4); Benadryl 25 mg - (4); Valium lO mg - (2); Vistaril or Compazine
- (2) Would suggest using tubex mode for uniformity.
plenty!): 4 x 4 lots and lots; kling; telfa; Xeroform gauze (1/2
inch, one bottle for packing); Cloth tape - 1, 2 and 3 inch size;
Micropore tape - 1, 2 and 3 inch; Ace bandages - 3" and 4" - dozen
Splints: Air splints
only, otherwise can improvise a board
Scrubs: Betadine scrub
- 250 cc size; Betadine solution - 500 cc - this doubles as a water
purifier; Hibiclens or Phisohex; some sterile scrub brushes
Cuts and Bruises
Department: Suture sets (2) - set up sterile, if more needed can
re-use soaking in betadine or hibiclens, unless you can bring along
some cidex. Set to include a needle holder, pair of pick-ups (Brown-Adsens
or toothed) two(2) crile or mo squito clamps, scissors. Keep the set
small. Space is tight. Stick to one size of suture, i.e., 4-0. Use
monofilament nylon for skin, vicryl for subcutaneous or muscle.
Because of the incessant moisture, all the casting material I
brought turned to concre te before Tahiti. I think a Colles fracture
can be splinted to a formed board with ace bandage and worked to
good apposition over time with gentle lomi. All other large bone
fractures should be air evacuated.
Eye and Ear Tray (keep
it small, mark it well): fluorescein strips; topical ophthalmic
analgesic; topical ophthalmic antibiotic; Irrigation solution,
option use IV sol'n but waste a lot usually; Can substitute 4 x 4
gauze for eye patches; brew hot tea, th en use the tea bag for a
warm compress, works well; otic solution - Cortisporin; bulb
Dental Kit: temporary
filling kit (these come prepacked, I've used them in the field with
soldiers); tooth puller plier - if gotta - numb it first; one or two
foley catheters - some guys are over 50 and their prostates might
obstruct! Foley can double as a posterior nasal pack for the high
OCP: The wahine member
IV solutions: LR - 4
liters - intracaths, tubing, and those things.
Spirits: I prefer
cognac or brandy - medicinal; We all needed some after Kimo came
back on board.
and Helpful Hints
Skin ailments and
upper respiratory gunk are the most common problems, so, topicals,
decongestants and expectorants along with the aspirins and tylenols
go really fast. A surprising amount of antibiotics get used up,
primarily for dirty or infected cuts, abscesses, bronchitis, tooth
and gum abscesses, enteritis and urinary tract infection. They also
get used up on land when you treat the natives. Next most used stuff
are the GI ones, imodium, lomotil, donnatal and doxycycline,
particularly when on an isla nd and the crew is eating everything
under the sun.
Expect Islanders to
seek aid when Hokule'a is in port and they discover a doctor is on
board. Supplies get use up fast in this situation. Occasionally
other ships in port will seek medical aid and this was always
It was surprising how
many gouty and / or bursitis flareups occurred. Indocin worked well
in these cases. Lots of Tagamet was used but only on two (2)
landfall it is imperative to check the on board water supply and
then to check the local water supply. Definitely check it's source,
treatment if any, and testing facility for water potability. Then
use your judgment whether further treatm ent is needed. I used
halogenation to purify water. Two cc of betadine solution was added
to a gallon of water (or 10 cc to a five gallon container) and let
stand for an hour. The water did have a faint yellow color but did
not have a bad taste. Most on b oard did not know I treated much of
our water supply in this manner and did not complain of any taste to
the water. We did not have a problem with water borne disease. Water
caught off of the sails tastes yucky, but in a pinch is o.k. to
drink after treat ment. When on island, advise some inquisitiveness
(niele ) and check out the food sources. We always found food well
prepared except in one area. Pig cooked in an umu in Samoa sometimes
tends to be under cooked, raw actually. But looking at the plethora
o f Samoan physical specimen, guess it doesn't hurt them! Pig cooked
in Umu/Imu elsewhere was excellent.
When at sea, check the
galley all the time to keep it clean, the utensils washed and air
dried properly and check the status of all left overs. Use your
judgment, sense of taste, and your nose.
Some people will
become constipated and will not tell, so again be nosey but not
irritating. When the guys trust you, they'll usually tell you
everything. Crew members as a whole are a tough minded, independent,
"macho" lot and generally don't tell the Do c their problems until
very late. This I noted early on in 1980. However if you communicate
to them your competence and concern and they take you for one of
them rather as the "doc" over there, then everything works out very
Make a strong pitch
for tooth and gum care. Pass out floss or stimudents after each
meal. A dental emergency is a bad problem at sea.
A fun thing to do if
you can and have the time, is to weigh and tape every crew member
prior to sailing. Generally on any trip lasting twelve (12) to
twenty-four (24) days, there will be a marked weight loss and the
addition of real muscle mass. Weight lo ss can be as high as
thirty-five (35) pounds for a large man. Trips shorter than nine (9)
days generally don't have much change and those twenty-four (24) to
thirty-five (35) days have the effect of compensation and regaining
of lost weight if eating habi ts remain the same. The Rangiroa to
Hawai'i sail in 1987, the crew ate an average of 3500 calories per
person per day, with a range of 2700 to 5200 calories per person per
day. So it is easy to see that sailing on Hokule'a causes a
tremendous caloric expe nditure with concomitant weight loss in
spite of such high caloric intakes. With this in mind, watch for the
individual not eating for any reason because he'll go down fast.
During a crisis
emergency, the doc will have to use the radio. I have an advantage
in that I know how to run radios from my military experiences. If
you don't already know how to operate a radio, I would advise you to
learn. In an emergency, the call is y ours and you must speak one on
one to the Coast Guard or Navy Doc in charge, who will then decide
if a ship or plane should be sent out, particularly if the distress
is farther than 500 miles from land.
Our Coast Guard is
good for 600 miles plus or minus a few and the Navy may go further,
but generally they like you to be inside of 500 miles. At sea you
get help from any source you can. On every island group we visited,
I met, talked to and learned the c all sign of every radio operator
who came forth. Then at sea, I would call all of them to stay in
contact. Since I was the radio operator on board, I felt it was
within my job to be able to contact any one
IF YOU HAVE AN
EMERGENCY AT SEA, DO THE FOLLOWING:
1. Turn on your
Inmarsat-C/GPS unit to get the canoe's position.[Holding down the
emergency button for 5 + seconds sends out a distress signal with
the position of the canoe.]
2. Contact your escort
boat on channel 16 VHF and describe the emergency and the help you
are requesting. Ask the escort boat for help in calling for help
from any boat or ship in the area. Watch the voltage of the
batteries. If the voltages are below 12 .5, let the escort boat try
to call for help on its single-side band radio and save your power
for communicating with the escort boat. If the voltages are above
12.5, try 3 and 4.
3. Use the single
side-band to contact the US Coast Guard on channels A9-A13 or
through KMI on channels B1-B9. Break into any conversation by
saying: "MAYDAY! MAYDAY! MAYDAY! This is WBJ3292, Sailing Vessel
Hokule'a, Position [Give longitude and latitude in degrees and
minutes from GPS unit]," then describe the emergency and the kind of
help you are requesting.
4. If you are unable
to raise the Coast Guard for some reason, try Peace-Sat at UH Manoa
during working hours on Channels C1-C7 (One of these channels will
be designated as the priority channel.)
5. If numbers 2, 3,
and 4 fail, go to general SOS to any ship in the area.
Six hundred to a
thousand miles out from Hawai'i where no one is close or in range,
the decision is yours; to turn around, or push for our Coast Guard
or Navy safety net, and obviously the condition of your patient
would dictate what you decide.
If you are in the
vicinity of an island group, then you can if you have kept in touch,
call a local radio ham and they can patch to Hawai'i or a facility
by phone. You must let someone know if you have an emergency. Often
the escort vessel will not have a ny more luck than you on their
radio. If you happen to be in an inversion zone and can not send or
receive, the escort will probably be in it too. Just keep trying,
don't give up�ever.
Recruit other crew
members to help care for the injured or sick. Our guys are sharp and
willing to help. It's also a good teaching opportunity and they like
to be involved. Snake and Stanley were able assistants when we did
skin and ulcer debridement ever y two days the last long trip out.
They were really top notch.
Keep yourself fit
physically and mentally so you won't go down with anything. Be
available on sea and on land, ready to listen, help, treat and
comfort. And even if those "Macho" buggers won't usually admit to
you, they feel comfortable with their "Doc" a round.