seafarer's diet and colon/ colorectal cancer

The interplay of dietary factors, age and  working environment  while at sea contribute to the development of    colon cancer among seafarers.

The Supreme Court ruled in the case of Skippers vs. Lagne ( G.R. No. 217036 August 20, 2018 ) that  rectal illness is compensable for permanent and total disability due to his dietary provisions.

Colon cancer, also known as colorectal cancer or large bowel cancer, includes cancerous growths in the colon, rectum and appendix. Colorectal cancer can invade and damage adjacent tissues and organs. Cancer cells can also break away and spread to other parts of the body (such as liver and lung) where new tumors form.

Companies usually deny liability for payment of disability or death benefits since there only three  types of cancers  listed as occupational diseases under the POEA Standard Employment Contract– (1) Cancer of the epithelial lining of the bladder (papilloma of the bladder); (2) cancer, epithellematous or ulceration of the skin or of the corneal surface of the eye due to tar, pitch, bitumen, mineral oil or paraffin, or compound products or residues of these substances and (3) acute myeloid leukemia and chronic lymphocytic leukemia.  

 Jurisprudence provides that to establish compensability of a non-occupational disease, reasonable proof of work-connection and not direct causal relation is required. Probability, not the ultimate degree of certainty, is the test of proof in compensation proceedings.

Settled is the rule that for illness to be compensable, it is not necessary that the nature of the employment be the sole and only reason for the illness suffered by the seafarer. It is sufficient that there is a reasonable linkage between the disease suffered by the employee and his work to lead a rational mind to conclude that his work may have contributed to the establishment or, at the very least, aggravation of any pre-existing condition he might have had.

The  Supreme Court stressed that the seafarer  acquired or developed his illness during the term of his contract due to the  strenuous nature of his  job, his advanced age at the time of hiring combined with his poor diet which consists of mostly carbohydrates, high-fat, high­ cholesterol, and low-fiber foods.

His dietary provisions while at sea increased his risk of contracting colon cancer because he had no choice of what to eat on board.

Being a seafarer, the food provisions on a ship  are designed for long journeys across the oceans and seas. The food provided are mostly frozen or processed meat, and  canned goods. Seldom are there vegetables which easily rot and wilt and, therefore, impracticable for long trips.

These provisions undoubtedly contribute to the aggravation of the seafarer's rectal illness.

While there is no specific cause of colorectal cancer, the Supreme Court noted that  certain factors can increase risk of developing the disease, including diet, age and health. Diets high  in fat, red meat, total calories, and alcohol are significantly associated with the formation of cancer-causing chemicals known as carcinogens which predisposes humans to contracting the disease.

 

The compensability of colorectal cancer has also been ruled upon in the case of Leonis Navigation v. Heirs of the late Catalina V. Villamater  (G.R. No. 179169               March 3, 2010) wherein the Supreme Court noted that factors that increase a person's risk of colorectal cancer include high fat intake.  

Diets high in fat are believed to predispose humans to colorectal cancer. It is believed that the breakdown products  of fat metabolism lead to the formation of cancer-causing chemicals (carcinogens). Diets high in vegetables and high-fiber foods may rid the bowel of these carcinogens and help reduce the risk of cancer.

Living in typically confined environments on board vessels for prolonged periods of time leaves seafarers exposed to various ongoing health problems including obesity and vitamin deficiency, as they choose convenience foods heavy in sugar and salt and low in protein.  Poor diet has even been found to be a key factor in altering physiological and psychological functions, which can have a devastating impact not only on the individual but also on the smooth running of daily operations.

Seafarers are exposed to occupational risk factors, as well as environmental risk factors, as part of their normal everyday activities since they spend a large part of their lives at sea. Most seafarers live and work under extremely hazardous conditions that can cause serious short-term and long-term damage to their health. In some cases, they are exposed to conditions that can even be fatal.

 Atty. Gorecho heads the seafarers’ division of the Sapalo Velez Bundang Bulilan  law offices. For comments, email info@sapalovelez.com, or call 09175025808 or 09088665786

psychosis, severe depression or schizophrenia

A seafarer’s psychosis, severe depression  or schizophrenia may be  considered  compensable due to the work-related  stressful environment  on board the vessel.

Seafarers are susceptible to mental health issues due to  harassment and bullying  that can take a wide variety of forms, ranging from physical or verbal aggression, ill-treatment, cyber-bullying or sexual discrimination. There is even a high risk of suicide for seafarers with psychosis.  

While the physical effect of harassment and bullying is fairly easy to identify on account of the obvious external signs, the same cannot be said of their  emotional effects  which are often denied or distorted.

In Cabuyoc vs. Inter-Orient Navigation   (G.R. No. 166649,              November 24, 2006) , the Supreme Court ruled that  the seafarer’s illness was the direct result of the demands of his shipboard employment contract and the  hostile treatment and mental trauma in the hands of German ship officers . This led to his nervous breakdown and untimely repatriation to the Philippines.

The  Court disregarded the company’s argument that  psychosis or schizophrenia is not compensable under the POEA contract as his illness  is not caused by a  traumatic head injury which contemplates accidents involving physical or head contacts.

The Court noted the trauma  under the POEA contract  is not limited to  physical in nature but the same may involve mental or emotional hurt, damage or loss sustained. The word "trauma"  is defined as "a bodily injury caused by a physical force applied from without or  a disordered psychic or behavioral state resulting from stress or injury."

The seafarer's disability is not only physical but mental as well because of the severe depression, mental torture, anguish, embarrassment, anger, sleepless nights and anxiety that befell him.

In Leonis Navigation vs. Obrero (G.R. No. 192754, September 07, 2016), the Court ruled that  work-related stress may precipitate the disorder noting that the seafarer’s prolonged stint at sea eventually taxed his coping abilities which rendered him incapable of handling the stress.

The Court pointed out that  Schizophrenia is the most common form of psychotic disorder which involves a complex set of disturbances of thinking, perception, and social behavior and whose causes are still largely unknown, primarily associated with stressful life events.

In NFD International. v. NLRC (G.R. No. 107131, March 13, 1997),  schizophrenia was declared  to be work-related after the employer failed to negate the causal confluence between the epilepsy suffered by the seafarer after a mauling incident while on-board the vessel and his subsequent affliction of schizophrenia.

In Career Phils. vs Godinez, (G.R. No. 206826, October 2, 2017), the neophyte young seafarer's grave illness was directly caused by the unprofessional and inhumane treatment, as well as the physical, psychological, and mental abuse inflicted upon him by his superiors, aggravated by their failure and refusal to provide timely medical and/or professional intervention, and their neglect and indifference to his condition even as it was deteriorating before their very eyes.

 In C.F. Sharp vs. Perez (G.R. No. 194885,                January 26, 2015)  psychotic disorder was not considered  an injury as a result of an accident from any cause whatsoever which would entitle the seafarer  to higher disability benefits under the CBA.

Accident is one  which happens by chance or fortuitously, without intention and design, that does not occur in the usual course of events or that could not be reasonably anticipated, and  not attributable to mistake, negligence, neglect or misconduct.

There is no proof that seafarer  met an accident or an unintended and unforeseen injurious occurrence while on board the vessel. But his  disability was deemed  permanent and total, citing the company doctor’s  findings that recurrence of the same psychotic disorder is possible if the seafarer  is placed in the same situation.

In disability compensation, it is not the injury which is compensated, but rather it is the incapacity to work resulting in the impairment of one's earning capacity.  Permanent total disability means disablement  to earn wages in the same kind of work, or work of similar nature that he was trained for or accustomed to perform, or any kind of work which a person of his  mentality and attainment could do. It does not mean absolute helplessness.

Probability and not the ultimate degree of certainty is the test of proof. The precise medical causation of the illness is not significant, as long as the illness supervened in the course of employment and is reasonably shown to have been either precipitated or aggravated by work condition.

Atty. Gorecho heads the seafarers’ division of the Sapalo Velez Bundang Bulilan  law offices. For comments, email info@sapalovelez.com, or call 09175025808 or 09088665786

Changing of the guards in seafarer’s cause

 With two seats as party-list representatives ,  the  major challenge of  MARINO   is to confront the questions raised on the qualification  of its first three   nominees who are not seafarers.

The results of the recent  party-list election  saw  the changing of the guards for the Filipino seafaring industry  as  Marino  replaced  incumbent Angkla.

In previous elections, several sea-based groups  attempted to gain slots in  Congress through the party-list system. 

Two parties run twice but failed to reach the required votes:  Maritime Party  in 2001 and 2004 while  Seaman’s Party run  in 2004 and 2007.

In 2010, three parties campaigned but also failed: Adhikaing Alay ng Marino sa Sambayanan (ALON)  with 49,893 votes , Ang Kapisanan ng mga Seaman (AKSI) with  26,805 votes, and United Filipino Seafarers (UFS)   with  6,121 votes.  

Angkla entered the political scene in 2013 competing with another group, Association of Marine Officer and Ratings (Amor Seaman). DIWA also carried the seafarers’ issues.  Angkla , won a seat ranking 26^th with  360,138 votes while  Amor  lost ranking  111^th for 40,849 votes. 

The 2016  election witnessed again  the race  between Angkla and Amor. As an incumbent, Angkla retained its seat but   dropped to 32^nd  place with 337, 245  votes which is 22,893 votes lower than that in 2013.  Marino made a debut  ranking 79^th place with 102,430 votes.  Amor ranked    87^th place with 68,226 votes.  

During this year’s midterm election, Angkla’s popularity continued to slide  down after occupying  the  53^rd slot  with  179,531 votes.  This is lower by 157,714 votes in 2016. As a consequence,  Angkla  came short of almost 12,000 votes to retain its  seat in Congress for a third term.

The problem besetting the Standards of Training, Certification, and Watchkeeping (STCW) for seafarers affected Angkla’s candidacy. Seafarers complained that the process for obtaining and renewing their license became more difficult when the functions of Professional Regulation Commission (PRC) were transferred to the Maritime Industry Authority (Marina) by virtue of Angkla’s R.A. 10635.  MARINA was designated as the Single Maritime Administration to implement the  STCW.

Angkla’s decline could likewise  be attributed to the impression that it   prioritize   business matters rather than the basic seafarers’ issues. As Angkla was born in the boardroom with corporate genes, it    is heavily supported by the groups of manning agencies as well as shipowners.

It echoed the manning agencies in depicting  lawyers assisting seafarers for their legal claims as ambulance chasers when it authored  R. A.  No. 10706 (Seafarers Protection Act).

It even filed H.B. No. 5430 on February 2015  aimed to delay the execution of  NLRC/NCMB award  for cases involving monetary claims.

The  negative perception on  Angkla led to the shift of  seafarers’ support to Marino for this year’s election.

Marino  waves a Five-Point priority: cadet scholarships, family centers, trainings, free legal services and decentralization.

Despite  the fact that its  first  three  nominees are not seafarers, Marino placed seventh in ranking for its 677,378 votes.  It is  backed by big-time Davao-based businesses  and has  close ties with the Dutertes.  

Several groups have earlier  called for the repeal or amendment of the party-list law as political dynasties and businessmen have “hijacked” the system, supposed to be a platform for representation of marginalized sectors. The rosters of party-list representatives in previous Congresses had been hit for being recycled lists of people already in power and those with business interest.

Poll watchdog Kontra Daya  earlier raised red flags on party-list groups that have nominees that do not belong to the marginalized sectors they are supposed to represent.  Its    true intent   should be upheld  so that “only those that champion the marginalized and under-represented would emerge victorious”.

It is the group  as a whole that should be  evaluated  but  it cannot be denied that the identity of the nominees remains a significant reference for voters. Oftentimes, a party-list is voted based on political ads without actually knowing it or its platform.

Preliminary  reports noted  that seafarer deployment hit  337,502 in 2018 with remittance reaching US$6,139,512,000.

As the incoming congressmen are not seafarers, MARINO must prove that it is worthy of the Filipino  seafarers’   vote as their party-list representatives  that will genuinely protect their interest and not that of capital  to the prejudice of their labor rights. Otherwise, they will face the   2022 election with a bitter pill and suffer the same fate of Angkla.

Atty. Gorecho heads the seafarers’ division of the Sapalo Velez Bundang Bulilan  law offices. For comments, email info@sapalovelez.com, or call 09175025808 or 09088665786

Tuberculosis among seafarers

Seafarers by nature of their work are exposed to a variety of occupational hazards making exposure to biological agents and the concomitant risk of communicable diseases extremely  high.

Because of their nature of work, seafarers are bound to visit many ports in different parts of the world and are thus exposed to various pandemic and epidemic diseases such as tuberculosis.

In Inter-Orient Maritime  vs. Creer (G.R. No. 181921 September 17, 2014) , the Supreme Court pointed out that pulmonary tuberculosis is airborne and easily transmissible by infected patients. The risk of being infected, or acquiring, the tuberculosis infection is mainly determined by exogenous factors. 

The probability of contact with a case of tuberculosis, the intimacy and duration of that contact, the degree of infectiousness of the case, and the shared environment of the contact are all important determinants of transmission.

On the other hand, the risk of developing the disease after being infected is largely dependent on endogenous factors. The tuberculosis bacteria may lie dormant in the infected person’s immune system for years before it becomes reactivated, or he may ultimately develop the disease within the first year or two after infection, depending on the innate susceptibility to disease of the person and level of immunity.

In ruling for the compensability of tuberculosis, the Supreme Court held in the case of BARKO vs. Alcayno (G.R. No. 188190               April 21, 2014) that  a certification declaring the seafarer  as fit to work contrary to a prior finding of tuberculosis can be considered as a ploy to circumvent the law intended to defeat the seafarer’s  right to be compensated for a disability which the law considers as permanent and total.

The Supreme Court  explained that tuberculosis is a contagious infection caused by the airborne bacterium Mycobacterium tuberculosis. It is usually transmitted by inhaling air contaminated by the bacterium. Active tuberculosis usually begins in the lungs (pulmonary tuberculosis). Tuberculosis that affects other part of the body (extrapulmonary tuberculosis) usually comes from pulmonary tuberculosis that has spread through the blood. Tuberculosis adenitis is a form of tuberculosis which affects the lymph nodes. 

The court noted that under the  POEA contract, "Pulmonary Tuberculosis" shall be considered as an occupational disease in "any occupation involving constant exposure to harmful substances in the working environment in the form of gases, fumes, vapors and dust."

The seafarer’s daily tasks as an able bodied seaman were to paint and chip rust on deck or superstructure of ship and to give directions to crew engaged in cleaning wheelhouse and quarterdeck, which constantly exposed him to different types of hazardous chemicals, such as paints, thinners, and other forms of cleaning agents and harmful substances, that may have invariably contributed to the aggravation of his illness.

The Supreme Court noted the suspicious  gesture of the company in having a medical certification declaring him as "fit to work" despite apparent clear knowledge that he has been subjected to a long period of medical treatment.

For a sick  seafarer to be entitled to medical benefits under the  POEA Contract,  it is not sufficient to simply establish that the seafarer’s illness or injury has rendered him permanently or partially disabled; it must also be shown that there is a causal connection between the seafarer’s illness or injury and the work for which he had been contracted .

TB bacteria most commonly grow in the lungs, and can cause symptoms such as a bad cough that lasts three  weeks or longer, pain in the chest and coughing up blood or sputum (mucus from deep inside the lungs). Other symptoms of TB disease may include weakness or fatigue, weight loss, no appetite, chills, fever, and sweating at night.

Since one of the requirement for an illness to be compensable is that the seafarer suffered said illness during the effectivity of the POEA contract, it is imperative that his condition or symptoms  must be documented while he is on board the vessel.

Otherwise, his claim for disability benefits might be denied due to failure to prove that said illness occurred while his contract is still in force.

(Atty. Gorecho heads the seafarers’ division of the  Sapalo Velez Bundang Bulilan  law offices. For comments, email info@sapalovelez.com, or call 09175025808 or 09088665786)