分类: health

  • Column: Verruiming bewegingsaanbod gewenst

    Column: Verruiming bewegingsaanbod gewenst

    Across Suriname, organized sports clubs offer a wide range of athletic activities for residents, but a growing share of the population is adopting increasingly sedentary routines that threaten long-term public health. Today, even for short trips, most Surinamese opt for private cars, motorbikes, or the increasingly popular electric bikes instead of walking or cycling. While this shift is partially driven by rising public safety concerns that make many people avoid walking outdoors, the trend has put meeting the recommended daily minimum physical activity guidelines out of reach for a large portion of the population.

    This growing inactivity comes at the same time that fast food options are rapidly expanding across the country, creating a dangerous combination that sharply increases residents’ risk of developing cardiovascular disease. To reverse this trend and encourage more Surinamese to incorporate regular activity into their daily lives, public health advocates are pushing for expanded, more accessible recreational infrastructure that meets communities where they are.

    A core proposal calls for every residential neighborhood to maintain at least one public sports ground, where local residents can organize low-threshold physical activities with no barriers to access. Unemployed residents and those not attending school should have free, open access to these spaces, while existing sports clubs are encouraged to open their underused facilities to community members looking for casual activity opportunities. For working adults, advocates suggest redesigning workplace routines to give employees 15 minutes of group physical activity per day, a small change that not only produces fitter workers but also reduces long-term healthcare costs for employers while giving staff a chance to recharge mid-workday.

    Nowhere is expanded daily physical activity more urgently needed than in Suriname’s schools, experts say. On top of the long-term benefit of building healthy habits that persist into adulthood — a well-documented effect of early active routines — children and adolescents in Suriname are regularly exposed to unhealthy dietary environments. School canteens overwhelmingly stock salty, sugary, high-fat snacks, with no options for fresh fruit or low-calorie alternatives, and the existing physical education curriculum is far too limited to create lasting healthy lifestyle changes. Advocates say adding just 15 minutes of structured daily activity for students could reverse these harmful trends. Without action, the combination of inactivity and poor diet among young people will create long-term burdens for Suriname’s entire public health system.

    The policy and cultural changes proposed are intentionally designed to be accessible to all, require minimal upfront investment, and deliver substantial long-term social and health benefits. Regular daily movement is a fundamental biological need, and embedding small, consistent activity into daily routines across communities will create a far healthier population over time. For this approach to succeed, however, widespread public outreach and education will be critical to help all residents understand why regular movement matters and how easy it is to participate.

    Outreach sessions should be held for employers, workers, college students, and schoolchildren to build buy-in for the new approach. Experienced local sports leaders can also be deployed to workplaces to lead casual activity sessions, keeping routines light and focused on consistent participation rather than exhausting, high-intensity workouts. No participant should be left behind due to overly fast paces or overly difficult exercises, and consistent, regular participation is the core requirement to achieve the intended public health gains.

  • QEH digital records rollout ‘set for July’

    QEH digital records rollout ‘set for July’

    Barbados’ largest public healthcare facility, Queen Elizabeth Hospital (QEH), is on schedule to launch the first phase of its transformative digital patient record initiative by this July, senior officials confirmed Wednesday, marking a major milestone in the island nation’s multi-year healthcare system modernization drive.

    The project, developed in partnership with digital management service provider Abergower, aims to convert a total of 170,000 existing paper-based patient medical records into standardized, secure, and readily accessible digital data. Since work kicked off in August last year, the team has already completed digitization for 75,000 patient records, corresponding to roughly four million scanned pages of clinical documentation, with thousands of additional files processed every month.

    QEH Chief Executive Officer Neil Clark framed the digitization effort as a long-overdue fix for systemic inefficiencies that have plagued paper-reliant healthcare operations for decades. “We’re not just scanning pieces of paper – we’re transforming static physical records into dynamic, usable digital information that will upend how care is delivered here,” Clark explained during the official launch of Abergower’s Barbados operations in Wildey.

    Beyond basic digitization, the overhaul integrates a suite of interconnected upgrades to support the new system. Parallel work streams already underway include infrastructure overhauls, cybersecurity hardening, equipment updates, and staff upskilling. The hospital has identified 60 “super users” across different clinical and administrative departments to lead a train-the-trainer model, ensuring all personnel can adapt to the new software workflow. Wards and outpatient clinics are also being fitted with new end-user devices and a purpose-built, medical-grade Wi-Fi network to enable uninterrupted, on-the-go access for clinical staff. To address growing concerns over patient data privacy, an external cybersecurity team has been brought in, working alongside the Ministry of Innovation, Science and Technology to conduct rigorous penetration testing and strengthen the system’s resilience against cyber threats.

    Per the current timeline, the first phase of the digital system will go live in hospital wards and primary care clinics around July. Clark projects full hospital-wide deployment will take an additional two to three months after the initial rollout, with full system implementation across QEH targeted for the end of 2026. Once fully operational at QEH, the digital network will be expanded to connect with public polyclinics and eventually private healthcare facilities across Barbados, creating a unified national patient health record ecosystem.

    Clark emphasized that the shift to digital records will deliver tangible improvements to both clinical safety and patient experience. At present, patients seeking emergency care often face repeated testing and long delays because clinicians cannot quickly locate their existing paper records. With the new system, emergency department teams will have instant, full access to a patient’s complete medical history, eliminating redundant testing and cutting wait times. Faster information access also enables clinicians to make more informed, safer care decisions, and gives patients greater confidence that their health data is reliably accessible when needed.

    “Digitization is the critical foundation that makes our entire future health information system work,” Clark noted. “A system is only as strong as the data it holds, and this project turns decades of scattered paper records into the reliable core of that system. It will transform how we manage patients, track ongoing care, and run our daily services.”

    While technical work has progressed steadily, Clark acknowledged that the greatest challenge to successful implementation will not be infrastructure or technology, but changing decades-old work habits among staff. “The biggest hurdle isn’t the equipment or the cybersecurity – it’s behavioural change. People naturally default to the processes they’ve used for years, and even with new digital tools in place, many still try to force old manual workflows into the new system, steps that no longer need to exist,” he said.

    QEH has operated with paper-based records for 62 years, and Clark noted that the digital overhaul will not just update record-keeping, but re-engineer the entire patient journey to eliminate unnecessary steps built around outdated paper systems. Even as the hospital continues to grapple with broader systemic challenges such as patient surges, Clark expressed confidence that the new digital system will deliver meaningful, long-lasting improvements to care quality and operational efficiency. “Digitization won’t solve every challenge we face, but it will make accessing the data that drives all care much faster – and in healthcare, data is king,” he added.

  • Hantavirus Cruise Ship Heads for Canary Islands as Global Contact Tracing Expands

    Hantavirus Cruise Ship Heads for Canary Islands as Global Contact Tracing Expands

    In an ongoing public health incident that has triggered international response coordination, a cruise ship linked to a deadly hantavirus outbreak is making its way to Spain’s Canary Islands, as health agencies across multiple nations work around the clock to trace and monitor potentially exposed contacts.

    The expedition vessel MV Hondius departed Cape Verde on Wednesday, carrying close to 150 remaining passengers and crew members. All people onboard are currently held under strict isolation protocols, with continuous medical monitoring to track any emerging signs of infection. The vessel is projected to dock at the island of Tenerife within three days of its departure.

    As of the latest update from public health officials, the outbreak has been connected to at least eight confirmed and suspected cases, with three deaths already recorded. The fatalities include a Dutch couple and a German passenger, while a British national who was hospitalized in intensive care in South Africa is now showing signs of improvement.

    The World Health Organization has confirmed that the outbreak involves the Andes strain of hantavirus, a pathogen that can spread between people through close, prolonged contact in rare instances. Even with ongoing transmission on the vessel, global health leaders have emphasized that the overall risk of widespread infection to the general public remains very low.

    Health authorities in a dozen countries across Europe and Africa, including Switzerland, South Africa and the Netherlands, have launched full contact tracing operations to locate and test passengers who developed symptoms either during the cruise or after disembarking at previous ports of call. The process of identifying all potentially exposed contacts has been complicated by the international makeup of the ship’s passenger roster, with travelers from more than 15 countries originally on the voyage.

    Discussions around the vessel’s planned docking at Tenerife have been ongoing between regional and national Spanish health officials, with Spanish authorities confirming that the arrival can be managed safely under rigorous, established public health protocols. All passengers and crew will undergo comprehensive testing and extended quarantine protocols once the ship docks, per regional health requirements.

    Investigations into the origin of the outbreak are still ongoing, with preliminary epidemiological findings pointing to possible exposure to the virus before passengers boarded the vessel in Buenos Aires, Argentina. Public health teams in Argentina have also launched preliminary checks at ports and departure points to identify any potential sources of the initial infection.

  • Volksgezondheid start landelijke hiv-campagne na stijging besmettingen

    Volksgezondheid start landelijke hiv-campagne na stijging besmettingen

    Public health authorities in Suriname have launched a nationwide awareness campaign aimed at boosting HIV testing rates, responding to a documented increase in new infections and the persistent gap in public awareness of personal HIV status. Spearheaded by the country’s Ministry of Public Health, Welfare and Labor, the campaign officially kicked off on May 4 under the core slogan: “Know your status, get tested.”

    Public health officials have flagged a growing, worrying trend: a large share of people living with HIV in the country remain unaware of their infection, putting them at greater risk of unknowingly transmitting the virus to sexual partners and delaying life-saving care. In line with this concern, the campaign prioritizes outreach to sexually active people and those planning to become sexually active, urging couples to get tested together as a shared health responsibility.

    To remove barriers to testing, the campaign has added dozens of new testing sites across the country that offer free, confidential HIV testing administered by licensed healthcare professionals. These new accessible locations join existing testing hubs, including the Dermatology Department at Tourtonnelaan, the Trop Clinic in Geyersvlijt, multiple RGD polyclinics, and Medische Zending care centers. A number of local community organizations are also participating in the initiative, including the Stichting Liefdevolle Handen, Suriname Men United, and the Foundation He&HIV/Pluspunt, to expand reach to underserved groups.

    The Ministry emphasized critical context about HIV care today: while untreated HIV can progress to AIDS and cause life-threatening complications, early detection through regular testing paired with modern treatment can stop further transmission of the virus and drastically improve long-term quality of life for people living with HIV. The campaign closes with a clear public call to action: all community members must take responsibility for their own health and the health of those around them by getting tested and knowing their status.

  • WHO warns of more hantavirus cases in ‘limited’ outbreak

    WHO warns of more hantavirus cases in ‘limited’ outbreak

    GENEVA, Switzerland – The World Health Organization issued an update Thursday on a rare hantavirus outbreak linked to the expedition cruise vessel MV Hondius, which has already claimed three lives. Officials have cautioned that additional cases may surface in the coming weeks, but expressed confidence that targeted public health precautions will keep the outbreak contained.\n\nThe incident has sparked global concern after three passengers tested positive for the Andes strain of hantavirus — a rare, human-to-human transmissible variant — and subsequently died. Early Thursday morning, a fourth ailing passenger from the ship disembarked in Europe, and the vessel is now en route to Spain’s Canary Islands, where all remaining crew and passengers will be evacuated upon its scheduled arrival Sunday in Tenerife. As of Thursday, the ship’s operator, Netherlands-based Oceanwide Expeditions, confirmed no currently symptomatic people remain on board.\n\nDuring a press briefing in Geneva, WHO Director-General Tedros Adhanom Ghebreyesus confirmed that the outbreak has so far produced five confirmed cases and three suspected cases, counting the three fatalities. “Given the incubation period of the Andes virus, which can be up to six weeks, it’s possible that more cases may be reported,” he explained. Shortly after the briefing, the Leiden University Medical Centre in the Netherlands confirmed that the recently disembarked sick passenger had returned a positive hantavirus test.\n\nDespite the possibility of new cases, WHO Emergency Alert and Response Director Abdi Rahman Mahamud struck a measured tone, noting: “We believe this will be a limited outbreak if the public health measures are implemented and solidarity shown across all countries.” Currently, people linked to the outbreak are receiving treatment or in isolation across five countries: Britain, Germany, the Netherlands, Switzerland, and South Africa.\n\nUnlike COVID-19, hantavirus is primarily spread by infected rodents, though the Andes variant can spread between humans. The rare respiratory illness can trigger severe complications including respiratory failure, cardiac impairment, and hemorrhagic fever, and no vaccine or targeted cure exists for the disease. Epidemiologists trace the origin of the outbreak to an initial passenger who contracted the virus before boarding the MV Hondius in the Argentine coastal city of Ushuaia, where the ship departed on its voyage on April 1. The virus then spread to other passengers during the Atlantic crossing.\n\nThe timeline of the outbreak unfolded steadily over the past month. A Dutch man who boarded the ship in Ushuaia with his wife became the first fatality, dying aboard the vessel on April 11. His body was removed on April 24 at Saint Helena, a South Atlantic island where 29 other passengers also disembarked. His wife, who disembarked to accompany his body to South Africa, developed symptoms and died 15 days later; hantavirus was confirmed as her cause of death on May 4. A third fatality, a German passenger, died on May 2, and her body remains on the ship as it continues to Tenerife.\n\nInternational contact tracing efforts are now underway across more than a dozen countries. The WHO has notified 12 nations whose citizens disembarked at Saint Helena. The Dutch woman who died flew from Saint Helena to Johannesburg on a commercial Airlink flight while symptomatic, and health officials are currently working to identify and monitor all 82 passengers and six crew who were on that flight. Argentina’s health authorities are also planning to test wild rodent populations in Ushuaia to confirm the initial source of exposure, while Chilean health officials have ruled out local transmission for the two deceased Dutch passengers, noting their travel window did not align with the virus’s incubation period.\n\nThe UK Health Security Agency confirmed two passengers who returned to the United Kingdom from the cruise have been advised to self-isolate, adding that both remain asymptomatic and the overall risk to the general UK public remains “very low.” Oceanwide Expeditions added that there were 149 people total on board the vessel, including 88 passengers, and the company is working to trace every passenger and crew member who has boarded or disembarked the ship since March 20.

  • Cruise ship caution

    Cruise ship caution

    Against the backdrop of a recent hantavirus outbreak linked to a cruise ship off West Africa that has left three people dead, Jamaica’s Ministry of Health has moved quickly to reassure the public that robust precautionary measures are in place to block the virus from reaching the country’s borders.

    With Jamaica long established as a major regional hub for international cruise shipping, authorities have identified vessel arrivals as the highest priority point of entry for enhanced monitoring. Speaking at a post-Cabinet media briefing Wednesday, Chief Medical Officer Dr. Jacquiline Bisasor-McKenzie outlined the government’s stepped-up vigilance, noting that while the World Health Organization (WHO) currently assesses the risk of global hantavirus spread as low, the island nation is leaving no room for complacency.

    “WHO’s current assessment pegs global transmission risk at low, but we are taking every possible step to stop the virus from entering Jamaica, especially through our cruise ports,” Bisasor-McKenzie said. “Given our status as a core cruise shipping hub, boosting our vigilance is a logical, necessary precaution.”

    Public health protocols for incoming cruise vessels have been strengthened around three core pillars: early detection, rapid clinical intervention, and minimizing public exposure risk. All cruise ships bound for Jamaican ports are already required to submit a full maritime declaration of health before docking, which lists any cases of illness on board during the voyage. Under the new enhanced protocols, local health officials will conduct more rigorous reviews of these pre-arrival reports, followed by on-board inspections to verify the information provided before clearance is granted.

    Bisasor-McKenzie also confirmed that all port health and environmental teams have completed updated sensitization training on hantavirus identification and response protocols, shifting the country’s response from reactive monitoring to proactive inspection.

    To address potential risks from the virus’s natural reservoir, Jamaican veterinary and environmental health authorities have already completed nationwide surveys of rodent populations, the primary reservoir for hantavirus, and found no evidence of the virus circulating among local rodent communities.
    Bisasor-McKenzie further explained key clinical facts about hantavirus to inform the public: the virus causes two life-threatening syndromes in humans, hantavirus pulmonary syndrome and hemorrhagic fever with renal syndrome. Initial infection presents with fever, before progressing to severe pneumonia, acute respiratory distress syndrome and potentially fatal shock. Symptoms develop between one and eight weeks after exposure, most commonly within a two-to-four-week window. The virus is primarily spread to humans through contact with infected rodents’ urine, feces or saliva. While human-to-human transmission is extremely rare, the Andes virus strain circulating in South America has been documented to spread between people through close contact with infected respiratory droplets or saliva.

    On testing capacity, Bisasor-McKenzie confirmed that Jamaica does not currently have on-island facilities to process hantavirus tests, but has established a reliable testing pathway through the Caribbean Public Health Agency (CARPHA), headquartered in Trinidad and Tobago. Recent upgrades to CARPHA’s sample transport network have cut delivery times and improved reliability for Jamaican samples, and the ministry is also in ongoing discussions with the Pan American Health Organization (PAHO) to secure additional testing partnerships with global collaborating centers.

    The heightened precautions come as eight cases of hantavirus – three confirmed, five suspected – have been reported on the cruise ship MV Hondius, currently anchored off the coast of West Africa, with three fatalities already recorded.

  • Virus-hit cruise ship heads for Spain as evacuees land in Europe

    Virus-hit cruise ship heads for Spain as evacuees land in Europe

    MADRID, Spain — Spanish authorities announced Wednesday that the MV Hondius, a cruise ship affected by a fatal hantavirus outbreak that has claimed three lives, is on track to dock at the Canary Islands’ Tenerife within three days, with mass passenger evacuation operations set to begin on May 11. The outbreak has triggered international concern over potential spread, though top global health officials have moved quickly to reassure the public that the situation does not mirror the scale of the COVID-19 pandemic.

    Earlier on Wednesday, emergency response teams completed the evacuation of three individuals from the vessel: two symptomatic crew members and one close contact of a confirmed infection case. The ship had previously been anchored off the coast of Cape Verde, and after the evacuation operation was completed, it set sail for the Spanish archipelago. Medical personnel clad in full hazmat suits transferred the three evacuees from the cruise ship to a specialized ambulance boat, before the group was transported to Praia International Airport, Cape Verde’s main air hub in its capital, for onward travel.

    According to on-site AFP correspondents, a medical aircraft carrying two of the evacuated passengers touched down at Amsterdam Airport Schiphol in the Netherlands at 17:47 GMT. German emergency services confirmed they subsequently took custody of the third evacuee — the individual who had been exposed to an infected passenger on board — and transported the person to a specialized hospital in Dusseldorf for monitoring and treatment.

    Virology experts have confirmed that the strain of hantavirus detected on the MV Hondius is the Andes virus, an uncommon subtype that is the only known hantavirus capable of spreading from person to person. World Health Organization (WHO) expert Anais Legand explained to AFP that based on the virus’s 1- to 6-week incubation period, the initial index case on the cruise could not have contracted the virus during the voyage itself. The ship departed Ushuaia, Argentina on April 1, and the first fatality linked to the outbreak was recorded just 10 days later on April 11.

    Argentine health officials confirmed that the first couple killed by the virus had completed travel through Chile, Uruguay and Argentina before boarding the cruise in Ushuaia. In response to the outbreak, experts will travel to the southern Argentine port city to conduct testing on local rodent populations — the natural reservoir for hantavirus — to trace the origin of the infection.

    Global and national health authorities have actively sought to calm widespread public anxiety over a potential large-scale global outbreak, noting that hantavirus is significantly less transmissible than the SARS-CoV-2 virus that caused the COVID-19 pandemic. WHO Director-General Tedros Adhanom Ghebreyesus told AFP that the current situation is not comparable to the COVID-19 pandemic, emphasizing: “The risk to the rest of the world is low.”

  • Darville pledges to pass laws for families abandoning patients

    Darville pledges to pass laws for families abandoning patients

    The persistent crisis of family members abandoning elderly and long-term care patients in Bahamian public hospitals has spurred the incumbent Davis administration to announce plans for targeted accountability legislation if voters return the party to power for a second term, Health and Wellness Minister Dr. Michael Darville confirmed in a press briefing this week.

    Dr. Darville, who has repeatedly highlighted the growing problem of so-called “hospital boarders” — patients who no longer require acute medical intervention but remain occupying hospital beds — told reporters the vast majority of these boarders are elderly patients whose families have refused to remove them from public care facilities. The issue is most acute at two of the nation’s leading public hospitals, Princess Margaret Hospital and Rand Memorial Hospital, where constrained bed capacity has already created widespread care delays.

    According to Dr. Darville, the ongoing occupation of acute care beds by non-acute patients creates cascading disruptions across the entire public health system. It directly slows patient turnover in accident and emergency departments, and blocks timely transfers of stable patients from admission and assessment units to inpatient wards, leaving patients with urgent medical needs waiting longer for critical care. To mitigate existing strain, health officials have already partnered with private sector organizations to source alternative care placements and supportive housing for abandoned patients, but the burden on the public system remains unacceptably high.

    While the Ministry of Health maintains a compassionate approach to the vulnerable elderly patients caught in this situation, Dr. Darville emphasized that the systemic cost of inaction is too great to ignore. If re-elected, the proposed legislation will explicitly codify legal responsibility for family caregivers, with swift enforcement action targeted at households that collect National Insurance benefits to cover their relative’s care but still abandon them in public hospitals.

    This is not the administration’s first step to address the crisis. Back in October 2024, Dr. Darville announced the government was advancing serious regulatory and coordination reforms to improve long-term elderly care, amid a steady rise in the number of patients being left in public hospitals. At that time, officials confirmed cross-agency collaborations with the Department of Social Services and Sandilands Geriatric Facility to develop long-term strategies that both reduce pressure on acute care facilities and uphold the safety and dignity of abandoned elderly patients.

    Notably, the issue is not unique to The Bahamas. Neighboring Jamaica has grappled with the same problem for years, with local outlet The Jamaica Observer previously reporting that patient abandonment continues to restrict bed access and strain public health resources across Jamaican facilities, mirroring the challenges now facing Bahamian health officials.

  • Five confirmed hantavirus cases from cruise ship, three suspected — WHO

    Five confirmed hantavirus cases from cruise ship, three suspected — WHO

    GENEVA, Switzerland – In an official briefing held Thursday, the World Health Organization (WHO) has updated the public on an emerging hantavirus outbreak linked to the Atlantic cruise vessel MV Hondius, confirming five positive cases of the disease, with three additional suspected infections still under investigation. Three deaths have already been connected to the incident, and global health officials have cautioned that further cases may emerge as the outbreak continues to unfold.

    The Dutch-flagged exploration ship departed Ushuaia, Argentina on April 1 for a northbound Atlantic voyage that was scheduled to end in Cape Verde. After wrapping up its stop in Cape Verde, the vessel set a new course for Tenerife, Spain this Wednesday, carrying its remaining passengers and crew after multiple passengers disembarked earlier in the journey.

    WHO Director-General Tedros Adhanom Ghebreyesus confirmed to journalists in Geneva that the specific strain involved in the outbreak is the Andes hantavirus, a variant endemic to parts of South America. This particular strain is unique among hantaviruses because it is the only variant with confirmed evidence of person-to-person transmission. Most hantaviruses spread to humans exclusively from infected rodents, typically through contact with contaminated urine, fecal matter, or saliva.

    “Andes virus has an incubation period that can extend up to six full weeks, which means we cannot rule out additional cases being detected in the coming weeks,” Tedros explained. He added that he has maintained consistent communication with the captain of the MV Hondius, who reported that passenger and crew morale has improved dramatically since the vessel resumed its journey. “I want to recognize the captain and the entire ship crew for their ongoing efforts to protect everyone on board,” he said.

    Tedros confirmed that during a stop at the British overseas territory of Saint Helena between April 22 and 24, 30 passengers disembarked the vessel. The first recorded fatality from the outbreak, a Dutch national, died on April 11 before the stop. To date, 12 countries have been notified by WHO that their citizens were among those who left the ship at Saint Helena: the United Kingdom, Canada, Denmark, Germany, the Netherlands, New Zealand, Saint Kitts and Nevis, Singapore, Sweden, Switzerland, Turkey, and the United States.

    In a promising update, global health leaders expressed cautious confidence that the outbreak can be contained. Abdi Rahman Mahamud, Director of WHO’s Emergency Alert and Response, stated that the outbreak will remain limited if appropriate public health protocols are implemented consistently across all affected countries and regions. To support ongoing testing efforts, Argentina is preparing to ship 2,500 diagnostic testing kits to laboratories across five countries that are handling contact tracing and case confirmation for the incident.

  • Three people evacuated from hantavirus-hit cruise ship as local opposition mounts over vessel’s destination

    Three people evacuated from hantavirus-hit cruise ship as local opposition mounts over vessel’s destination

    A hantavirus outbreak on a commercial cruise ship has triggered an emergency response that has spilled into public controversy, as three passengers have been evacuated for medical care while local communities push back against the vessel’s planned itinerary. The incident unfolded after the virus was detected aboard the ship, prompting health authorities to order the immediate evacuation of the three affected individuals to onshore medical facilities for monitoring and treatment.