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To Your Health: Understanding the Roadblocks to Healthcare Downeast

First published in Landings, September 2023

“A lot of it was due to the injuries… and the doctors prescribing the pain medications, and I got addicted to it. And it took off from there. It’s just stupid… It started with my back and just escalated.”

Finding ways to help Downeast lobstermen and shellfish harvesters get the health services they need is one of the goals of the Downeast Health Research Collaborative. Tora Johnson, a professor of social sciences and geography at the University of Maine in Machias, led the Collaborative’s recent study on injury, pain, and substance use among fishermen in Washington and Hancock Counties. The Collaborative’s report on the subject calls for “a better understanding of prevalence, risk and structural factors in injury, pain management and substance use among lobster and shellfish harvesters.”

To compile data on health and injuries, the Collaborative sent out surveys to licensed lobstermen and shellfish harvesters in the two counties as well as local health care providers and fisheries advocates. Surveys were returned by 106 harvesters and 88 providers and advocates. In addition, 19 personal interviews were conducted.

Whether it's clamming or lobstering, many Downeast fishermen find themselves injured and in pain. WGME photo.

What they found was not surprising. Lobstermen and shellfish harvesters hurt themselves often. The injuries may be to the back or elbow, shoulder or neck. They create pain, enough to cause 43% of respondents to stop work. But a self-employed fisherman can’t stop work for long; his or her income is dependent on being on the water or catching the tide to go clamming.

So what do the injured harvesters do? Some try over-the-counter pain relief, visit a doctor or other medical professional, go to a chiropractor, or attempt to relieve the pain by stretching or exercise. For a significant number, they self-medicate with opioids, marijuana, heroin, and alcohol.

“If you’re asking if I’d seek medical advice, that’s kind of almost the last alternative,” said one lobsterman.

A majority of respondents (70%) admitted they had avoided going to the doctor or seeking other medical care. They don’t seek medical care because of difficulties related to insurance, time lost to get to a medical office, or the cost. In addition, fishermen choose not to go to the doctor because of apprehension about how they will be treated. Some felt they were talked down to in previous visits; others believed they would be in trouble because of opioid use. Such hesitancy is also complicated by the unique sense of self that fishermen have – singularly independent and opinionated. Medical practitioners and fishermen may find it hard to communicate.

“There’s no value given to education and to somebody who is an expert, they think their opinion is just as good. I don’t need anyone to kiss my feet, but you came into my door. If you don’t respect my opinion, then why did you come here?” commented one physician.

And then there’s the issue of insurance. Of the 106 surveys returned, 27% of respondents said that they do not have any insurance. Of the rest, 48% were either on MaineCare or Medicare. Those interviewed said that acquiring insurance was a bureaucratic nightmare, made worse by lack of access to a computer or to the Internet. Changes due to the Affordable Care Act, which erased many cheap catastrophic care health plans, made any type of insurance unaffordable for some.

“The catastrophic plans they have now are not affordable. A real true catastrophic plan, my catastrophic plan was my life insurance. That’s 40 bucks a month,” said one fisherman.

Downeast Maine is a tough corner of the coast. Distances between towns are long, the weather is always a factor, and the economy is fragile at best. Dealing with health issues is made difficult not only by these factors but by a mindset that praises those who just “work through it.” Unfortunately, that path leads too often to permanent disability or serious drug addiction.

The Downeast Heath Research Collaborative report makes clear recommendations on how to improve health outcomes in Washington and Hancock Counties, from injury prevention and an insurance program specifically tailored to fishermen to mobile health units that travel to the docks. Other suggestions include health interventions at emergency rooms and clinics and trainings for healthcare providers on fishing culture.

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