Treating people at sea

Sarah is a doctor working on the MV Aquarius, a search and rescue vessel in the Mediterranean Sea. She shares her experience…

“Full body aches” is a complaint that every MSF medical staff has seen. In most instances, it’s the body’s way of manifesting stress in a context where physical suffering may be socially acceptable but where there are limited ways in which to express ongoing devastating emotional distress. In most cases, full body aches respond well to hydration, reassurance, acetaminophen, and listening to people’s stories.

On the MV Aquarius, a search and rescue vessel run jointly by MSF and SOS Mediterranee, I was recently asked to see a man with full body aches who complained of difficulty walking. On a very full boat, we had over 550 people on board, he was deep in the bow and I knew I would have trouble accessing him, so I asked the MSF staff member who found him if he could get to the clinic where I could meet him.

I was interested to find that he walked to the clinic without any significant problem – showing that his ailment was less likely to be a serious physical issue. Through an interpreter, he told me that he had had full body pain for at least one month. He denied a cough, fever, vomiting and diarrhoea. I thoroughly examined him, doing a full set of vitals, listening to his heart and lungs, examining his skin and finding a common fungal infection, and finally checking his joints. His joints, which he complained were sore, had full range of movement and no swelling.

When I told him that he seemed well except for a rash that we could treat, he seemed unsurprised. When I asked him why he thought he was sore, which I should have done before examining him, he told me that he had been kept in a cell by smugglers for two months before getting on a boat the previous day. After over 60 days in a cell, the previous day was the time he had been able to move freely – and even then, his movement was limited by being on a perilously overcrowded wooden boat with approximately 450 people jammed onto it. I was stunned.

In medicine, we say that the history gives us the diagnosis in 80% of the cases, and this case was no exception. I reassured the man that he would now be able to move freely. I suggested he gently start moving again and let him know that his strength would return with time. I gave him a cream for his rash and some ibuprofen for his joint pain. I do not have a cure for the psychological and physical effects of callous captivity, but I now have one more thing to add to my list of differential diagnoses.

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