Hospitals on Cruise Ships

Design and location of hospitals on cruise ships *We have seen a certain degree of evolution in the last years, but it must be recognized that a fully satisfying solution has not been reached yet* Dr. Antonio E. M. Attanasio (September 20, 2005) Cruise ships' hospitals are not the same as doctors' clinics on land The design and location of hospitals on cruise ships have undergone a certain degree of evolution in the last years, but it must be recognized that a fully satisfying solution has not been reached yet. No doubt, many ship infirmaries meet the basic requirements for an on-board hospital, but when looking at some of the solutions that have been implemented, one cannot help wondering where on earth (in the sense of land, as well) some naval architects have looked for expert advice. Managing the ship's infirmary is not the same thing as managing a small clinic on land. Basic requirements In a widespread community spending much time in deciding the location of a clinic is unnecessary, besides being pointless due to the hard rules of the real estate market. On a ship, where space is at a premium but every square inch of it can be designed without "market" constraints, careful planning of the hospital location is both mandatory and possible. First of all, it should be very easy to reach the hospital, and it should be very easy to get out of it, and that must be true for both patients on one hand and doctors and nurses on the other. Doctors as well as nurses must have their cabins within the hospital As far as doctors and nurses are concerned, every effort should be made so that all of them actually live in the hospital, which means having their cabins within the hospital enclosed area. It looks like this aim has been reached almost universally for nurses ("almost"), but in many ships doctors still have their cabins either in the officers' section, or in the passengers' area, or even on the crew decks. And this brings us to the design of doctor's cabins. Ship's doctors are not just emergency surgeons Most higher officers have large, comfortable cabins consisting of a private sleeping room and an up-front office to receive and entertain no one knows whom. Doctors' cabins usually are of a more frugal design, with very little room (if any) dedicated to reception purposes, as if all doctors' consultations could be carried out in a busy hospital treatment room with nurses freely coming and going, as if doctors had no need ever to talk with their patients privately. That assigns more importance to doctors' privacy than to patients' privacy, and reverses the way things are done on land, thus failing to meet what patients are used to expect from doctors. The actual experience of most doctors show that indeed a casual talk in a private setting can solve many problems, particularly those of exhausted, uptight or depressed crew members (let us not forget that ship's doctors do not treat passengers only, and that quite often they are to some crew members what chaplains should but cannot always be). If naval architects were able to set doctors' cabins within the hospital, with the reception part of the cabin opening onto the hospital common space, that would probably be almost perfect. The hospital is not the morgue And then of course there is the question of where to set the hospital within the ship. Most squeamish commissioners require the naval architects to hide the hospital away from passengers' eyes, as if it wasn't the hospital, but the morgue. The obvious result is that when passengers really need the hospital, they cannot find it. Another result is that, when passengers happen to find it by chance, they readily realize that, so well hidden away as it is, it must be the morgue or the leprosarium. Yes, we all know that passengers pay handsome money to be happy and enjoy themselves, and we all know that thinking of accidents and illnesses is not conducing to happiness and enjoyment, but we also know that very rarely do screams of pain and suffering flow out of ship hospitals' doors. What good does it do to hide hospitals between the engine room and the garbage collecting area ? People see their doctors for health improvement, too The most logical place for the hospital is by the spa or fitness centre, for mutual utility. Passengers attending the fitness centre will certainly appreciate the proximity of preventive advice and occasional intervention, while a close cooperation between the doctors and the fitness centre will enhance both the doctors' treatment options and the centre's revenues. Also, putting the hospital in a more central position on the ship will shorten the time for passengers to get there and for doctors and nurses to get to where they are needed for emergencies. Of course, to achieve a more central position for the hospital without relegating other important services under the galley will require some hard thinking and clever designing, but after all that's what naval architects are paid for. Left: a well-equipped cruise-ship surgery. Good for treating life-threatening conditions - less so for solving psychological problems. Right: waiting-room-reception. Let the Spa lure customers - we don't want to have more than absolutely necessary. (Photo courtesy of Dr. Bob Wheeler, Voyager Medical Seminars, www.vms4csm.com)