By Dr. Emmanuel Ekugo
Diving has been required for almost all of the thousands of wells drilled offshore since the first oil field development in the Gulf of Mexico in 1948 after World War II. This prompted a lot of divers to be employed in the industry. Drilling went deep from 300 metres to 1500 metres engaging the divers and offshore workers in the business. An experimental and epidemiological work was done to ascertain any possible long term effect of repeated exposure to a hyperbaric environment. A hyperbaric environment is that environment which is under high pressure. This poses serious health hazards to the diver. The opposite of this type of pressure is in piloting in the aviation industry called Hypobaric when pilots fly in the altitude.
For any Baseline Study (BSL), to be meaningful in Nigeria, one should start off with epidemiological work like in the UK where in 1941, the first case of Aseptic bone necrosis in a diver was described – that was the worst case of Bends sickness Type (3). The British Medical Research Council recorded 65 cases of BENDS type 3 from 5100 divers who registered at the Newcastle upon Tyne…at that time, because they were serious about it in their Medical Research Council in the UK.
When diving offshore became popular in the North Sea in the early 70s, there was a big rush for diving as a profession. Results were really frightening, diving rapidly became the most dangerous occupation in the whole industry. Many divers were killed in the rush to dive deeper for longer and for good pay. This is a typical occupation health hazard! For this to be remedied in Nigeria, we have to be serious about it. In the UK, they created awareness in Hyperbaric Medical Surveillance with Hyperbaric physicians. We should follow the UK, US, Gulf of Mexico standards and approach to this health problem which the lay man does not know about. Statistics and recording have to be in place if it is properly attended to. The Seven-point Agenda could then be meaningful in the health sector in Nigeria.
Currently in Nigeria, the general concern is more about the old traditional health problem of infectious diseases with emphasis on Roll-back malaria (RBM), HIV/AIDS, malnutrition, high maternal mortality…low life expectancy, very high total fertility rate, imminent starvation and minimisation of trauma of injuries that occur onshore. We are on the right course with this current medical knowledge.
However, we are gradually or silently being engulfed by enormous problems and diseases due to dangers in deep sea activities and its environ. Any area of operations as vast and as dangerous as that of Nigeria’s offshore sector calls for health safety regulation. Such legislation would be designed to protect the worker from illnesses and injuries for more and effective production input and to make his existence as comfortable and safe as possible.
For example, one area where the issue of health is largely ignored is in the hyperbaric medical practice. Deep offshore oil prospecting normally requires the services of divers for underwater activities. The divers carry out a host of underwater functions in challenging environments. Experience shows that the health conditions of the divers are hardly considered both before and after services because of lack of proper facilities. Whereas oil exploration has been going on in Nigeria for decades, this area of medical practice that takes care of divers and associated offshore ailments remains largely underdeveloped and ignored despite the DPR regulations of September 2001 Re: Control of Hyperbaric activities in the Nigerian petroleum industry which states that a person shall not take part in a diving operation as a diver unless he has:
- Undertaken formal training to ensure that he is competent to use the plant and equipment provided for the operation and
- A valid certificate of medical fitness to dive issued by a medical doctor who has trained in hyperbaric and diving medicine.
DPR warns that compliance with the above is necessary. The question is that DPR has not been given the figure of the number of divers/offshore workers in Nigeria yet by oil company operators in the upstream. Our experiences have shown that our Nigerian divers are treated shabbily by some contractors. For example unofficial records show that about seven divers lost their lives in 2003 after diving. One of them died of drug abuse, while 10 workers on the BONGA platform died of food poisoning, these records were given to us unofficially by some divers.
In the present time, if a diver dies after diving session, it is attributed to ‘Water spirits’ because of ignorance, superstition, poverty and neglect, there should be an awareness campaign by medical experts. Almost 90 per cent of our divers are casual divers, there are no welfare packages for them, no health insurance policies for these risky workers nor for their families, whereas their expatriate counterparts are highly rated because they have everything from their home countries, UK or US. We advise that our local divers must go for the business of diving with a pre-employment compulsory medical examination certificate. It is a compulsory requirement. If they are well informed they should know that a potential diver should be 100 per cent fit in the real sense of it.
Health problems like diabetes, traits of sickle cell anaemia, hepatitis, obesity, stammering etc should be ruled out from a potential diver. If he is employed illegally with their so-called black market certificates which is now rampant in Nigeria, the after effects of BENDS sicknesses are enormous and would set in e.g. cardiac arrest, hypothermia, injuries to the skeletal system, poisoning, vertigo, chokes, deafness, dysbarism in all forms, cerebral BENDS, spinal BENDS, neurological problems, aseptic bone necrosis. The health hazards continue with psychological problems like suicidal attempts, news blackout as a result of long stay offshore and many others. These cases can only be addressed by the accredited hyperbaric physicians, the physicians who must have worked in such environment offshore as doctors and are able to treat such cases in a recompression chamber. BENDS sicknesses were first discovered by Prof. Caisson in Norway in the field of Occupational Health Department and Hyperbaric Medicine.
There should be a direct link and understanding between the Six-Joint Venture multinational oil and gas companies, the eight multinational companies in PSC on one side and the hyperbaric physicians with divers and offshore workers on the other side. If the link is not there, the desperate diver gets the job without passing the rigorous medical exams, the middle men who employ them need their services like yesterday, so they don’t bother about how genuine their certificates are. If things are properly done, Nigeria could reduce unemployment by training up to 5000 divers yearly especially from the Niger Delta region, where they are talented from childhood. Our trained healthy divers could get employed in neighbouring countries like Ghana, Equitorial Guinea, Sao Tome, Gabon and Angola etc. The foreign divers who come here to work as divers are properly trained and medically fit with their National Health Insurance Certificates and their workman’s compensation cards which gives them an edge over our local divers who they underestimate.
Our local divers as I said earlier are shabbily treated. We have had the opportunity to interact with our local divers, firstly when our clinic conducted a workshop on a private initiative for the divers in Port Harcourt in 1999 at the Podium building. HRM King Alfred Diete Spiff willingly donated the hall to us where we discussed all the health problems in their profession. The second lecture organised by our clinic was at the Hotel Presidential Port Harcourt on December 17, 2000, also chaired by HRM King Alfred Diete Spiff; he was the first Nigerian diver in the Nigerian Navy, he encouraged us and still feels that things should be alright by now. We try as much as possible via DPR to get information about our Nigerian divers from their employers for them to be assessed medically, psychologically and acquire education and awareness on immunisation, but all these efforts are in vain.
There are no records of our divers in Nigeria’s medical archives today, we do not know how many of them died, but I tell you that the mortality and morbidity rate is high; this medical issue has to be revisited. For your information and record keeping purposes, a Nigerian diver who dived late last year developed signs of BENDS sickness type 1 while working offshore and when his employer contacted a doctor in Aberdeen, Scotland on telephone, the doctor in turn diagnosed and dictated the mode of treatment through his GSM (remote control treatment) which lasted for over six hours. However, the diver made some improvements in a recompression chamber by a chamber supervisor, but not a medical doctor. It was when the company needed the diver badly for him to go back to work immediately that our consultancy was contacted. We continued treatment from where the Aberdeen doctor stopped and carried out all the neurological tests and treatments successfully. This gives you an idea of the neglect some of the foreign contractors have for us qualified professionals which leads to brain drain. The doctor in Aberdeen I am told, was handsomely paid in hard currency, the contractors normally prevent Nigerian professionals from getting such opportunities.
With all these unethical practices meted to Nigerian doctors, it is high time we looked into the health problems of our offshore workers and divers, those brave divers who carry out the most important and risky jobs in obscure areas of upstream in order to get the hydrocarbon from beneath the sea (Crude oil) that places Nigeria as No. 6 in the world today. The saying is always correct that a healthy nation is a wealthy nation. The health of Nigerian workers offshore upstream should be considered in our National Health Insurance Scheme as a priority.
Dr. Ekugo, a hyperbaric physician, practises in Port Harcourt, Rivers State.