What you need to know about medical care on cruise ships

From aqua parks to Michelin star chefs, cruise lines aren’t shy about advertising their high-end amenities. But what the ads don’t reveal is that the medical facilities on board are likely to be far less grand. “People assume that they will have access to the same medical care on a cruise that they do on land, but this is hardly the case,” says Natalie Newman, M.D., who has served as a ship doctor on several cruises. And cruise-ships pose some unique health risks, too, from infections that can spread quickly in the boats close quarters to insect-borne diseases at ports-of-call.

Understanding the realities of medicine at sea can help keep your “Love Boat” dream trip from turning into a “Poseidon Adventure” medical disaster.

1. Infections spread easily

A cruise can be just what the doctor ordered to beat the winter doldrums. But it can also expose you to some nasty infections. Norovirus, which is so common on boats that it’s called the cruise-ship virus, causes vomiting and diarrhea. Scrupulous hygiene is key to containing this highly conta­gious disease, which is not limited to ships. Wash hands after every trip to the bathroom and before every meal. Soap and water is best, though a hand sanitiz­er that’s at least 60 percent alcohol is OK. The good news: Most people get better in a day or two.

2. Mosquitoes can come aboard

The Caribbean and Central America, two popular cruise-ship destinations, are now home to dengue fever and chikungunya (ChikV), diseases once found almost only in Africa and Asia. Both can cause high fever, headaches, and joint pain that last about a week. Mosquitoes carrying both have also been found in Florida. To avoid bites, when on shore cover up as much as possible and avoid tight clothes, dark colors, and perfume. Natural repellents with 20 percent picaridin worked well in our tests. Deet-based products also work, but we recommend avoiding those that are more than 30 percent deet.

3. Cruise ships aren't hospitals

Many ships have a doctor on board who, like Newman, is trained in emergency medicine—but not all of them. According to international maritime law, they aren't required to; a crew member with medical training is sufficient, says Ross Klein, Ph.D., author of "Paradise Lost at Sea: Rethinking Cruise Vacations." The medical facilities are generally more like an infirmary or walk-in care clinic than a “floating” hospital. You might find a ventilator and a small X-ray machine and the doctor may be able to perform simple laboratory tests to check for infection or electrolyte or blood sugar levels. But there's no MRI or CT scanner, intensive care unit, or blood bank (although the crew has usually been blood-typed and may be asked to serve as donors if a passenger needs a transfusion).

4. In an emergency, you may be on your own

“We’re all used to getting medical care where and when we need it, but that’s not the case mid-sea,” Klein said. You probably could get basic treatment, such as stitches or IV fluids, but for anything serious, there’s a very good chance that you will have to disembark at the next port of call—whether you want to or not. It’s up to the ship’s medical personnel, not you, to decide, Newman says. You’d be treated at a local hospital, and the ones in more remote areas may not have the same standards of medical care or facilities available in the U.S. And once you recovered, you’d have to arrange another way to get back home.

What if you have a heart attack or develop appendicitis miles from dry land? Don’t assume the Coast Guard will airlift you out. Bad weather can make flying a helicopter dangerous, and the Coast Guard isn’t obligated to take that risk. Even in calm waters, if the ship is 500 miles or more away from shore, it’s unlikely that the Coast Guard will respond, Klein said.

Read about your consumer rights on cruise ships.

5. Get ready for sticker shock

Check with your health insurance company before you set sail to be sure, but most plans don’t cover medical services you get on board, according to Newman. (In fact, this is usually the case anytime you receive medical treatment from a doctor or hospital outside the U.S.) This means you pay out-of-pocket. The bill can range from a few hundred to several thousand dollars “People don’t realize the extra expense they will incur for each medical service received,” Newman says.

Travel health insurance is your best protection. Consumer Reports recommends avoiding commission-driven policies sold by tour operators, cruise-line representatives, and travel agents. Instead check out an online broker, such as insuremytrip.com, that sells coverage from multiple companies and allows you to tailor a plan to your needs. Ask for quotes, but be sure you’re comparing apples to apples. What’s covered under policies can vary. For example, some may not include emergency evacuation.

6. Your ship does not have a CVS

Most ships do have common prescription drugs on board, but you can’t count on it. What’s more, if you needed one, you’d be charged full price—not just your insurance co-pay—for each drug dispensed on the ship. That also goes for over-the-counter medications, such as aspirin and sea-sickness pills, as well as bandages. Be sure to pack enough of any prescription medication you take to last the entire trip—and a little extra in case you are waylaid for any reason. Write down the brand and generic names of the drugs, the dosage, and the dosage frequency, too, and keep the list with you in case you need to get a refill in a foreign port. You might want to bring along any over-the-counter drugs (painkillers, antacids, etc.) you think you might need, too, as you’ll pay far less for them at your local supermarket or drug store than you will on board.

7. A cruise is no place to convalesce

Taking the time to rest and pamper yourself after surgery or a major illness is a good idea—as long as you stay on terra firma. About one out of five people who are hospitalized are readmitted within 30 days of discharge and you don’t want to be in the middle of the Caribbean if you are one of them. The same goes for people who have a long-term condition that requires strict medical management. Even if your doctor clears you for travel, consider the type of monitoring or treatment you need to receive regularly, such as dialysis or checking for blood thinner levels. According to Newman, doctors often give their patients their blessing, assuming that the ship’s doctor will do whatever needs to be done. “On one trip, I had five passengers who were taking blood thinners and they needed regulation in order to avoid a stroke or a blood clot,” she says. “Only one of them was within an acceptable therapeutic range. One physician sent along a note, expecting me to stabilize the patient’s blood levels.”

8. The cruise itself may put your health at risk

Norovirus and motion sickness aren’t the only health concerns to think about when you’re on a cruise. Falls and cardiac problems are also quite common. The CDC estimates that injuries, typically from slips, trips, or falls, account for 12 to 18 percent of shipboard medical visits. Obviously anyone can fall, but for people who use a cane, walker, or wheelchair, wet decks, rough waters, and the occasional cocktail can be a formula for disaster.

Studies have identified that the highest likelihood of sudden cardiac death occurs on holidays associated with overindulgence—Christmas, New Year’s, Thanksgiving, and the Fourth of July. Given the rich food, 24/7 buffets, and copious amounts of alcohol available, you can put a cruise vacation in the same category. While the mechanism is not clear, triglycerides—a type of fat that’s present in your bloodstream after a large meal—can cause coronary artery inflammation, a common prelude to a heart attack. Large amounts of food and alcohol can set off adrenalinelike substances that can cause a fatal abnormal heart rhythm. Most deaths aboard ships are from heart problems, and most liners are equipped with a dedicated morgue.

9. You can sue the cruise line, but you will lose

Courts have ruled that a cruise line may not be held vicariously liable for the negligence of a ship’s doctor, and that “a cruise ship is not a floating hospital.” To the surprise of many disgruntled passengers, there’s no medical malpractice for care rendered aboard a ship. “The physician is a private contractor,” Klein says, “and don’t think that the cruise line will accept liability—that’s been tested all the way up to the Supreme Court of Florida.”

—Orly Avitzur, M.D

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