All hands on deck

A small rust-hued fishing boat slices through the sea, a flock of gulls flapping greedily at its tail. Surveying the Mauritanian-flagged vessel through a pair of binoculars, Captain Carlos García Rodríguez checks the sonar signal on the monitor behind him. Seven similar-sized boats lurk nearby. Some 90 nautical miles south of the fishing port of Nouadhibou in Mauritania, from the bridge of the much larger Spanish hospital ship Esperanza del Mar, García Rodríguez’s crew are scanning the horizon for further signs of danger or distress.

“Chinese fisherman,” he confirms to his first mate after identifying the distinct chatter of Mandarin over the radio. “These guys never call us for help,” he says, later telling Monocle that while Chinese crews have become increasingly prevalent on African-flagged vessels, “we can’t do much because we just don’t understand each other”.

Ever since he joined the Esperanza’s maritime mission as third mate in 1985, the captain and his fellow crew of doctors, nurses and specialist rescue divers have been susceptible to their fair share of geopolitical shifts. From invasions and insurgencies to spikes of sea-faring immigration and the ever-fluctuating regulations of the EU fishing sector, decisions made on terra firma have a tendency to ripple out across the ocean.

“In the 1980s there was a lot more work,” he says from his office on the upper deck. This ship, said to be the world’s largest non-military custom-built hospital vessel, was launched in 2001. The original Esperanza del Mar was a retrofitted ship dispatched in 1982 to back up Spain’s national fishing fleet. After Franco died, Spain gave up its colony known as the Spanish Sahara, which suddenly deprived its fishermen of a friendly port and nearby health facilities.

“Back then there were more Spanish boats in the area and we were treating about 300 patients per month,” he says, recalling the threat of attack on boats from the Algerian-backed Polisario Front rebels who were fighting Moroccan forces. “During the tenser moments, the fiery glow of the Moroccan bombardments lit up the horizon at night.”

Despite a history of skirting the edge of occasional conflict, the Esperanza is no military vessel. Operated by Spain’s monolithic Social Security Ministry, the ship is a crucial part of a much wider maritime safety net supporting one of the country’s biggest industries. Covering a vast swathe of ocean that spans the coastal waters of Guinea-Bissau to the Azores in the mid-Atlantic, and stretching all the way up to the British Isles, the ship has its home port in Las Palmas in Spain’s Canary Islands. We visit the Esperanza when it and its crew of 32 (as well as five work experience students from nautical schools in Las Palmas) have been stationed off the coast of Mauritania, providing medical attention to about 50 nearby Spanish vessels – and anyone else who happens to solicit their help.

“Thankfully things are a lot calmer these days,” says the captain. “There are no civil wars and the rickety migrant boats seem to have been stemmed at the source.” Up until 2014 a steady stream of overloaded cayucos (large fishing canoes) was embarking from Nouadhibou’s port to make the perilous 800km journey to the Eurozone territory of the Canary Islands. After establishing a permanent Spanish police presence in the African port (and a network of informants) the boats stopped but the memories of rescuing sinking crowded vessels are still fresh in the minds of the medical staff.

“When you are confronted with a chaotic situation like that you think, ‘Where do I begin?’” says nurse Lorella Rodríguez Hernández as she walks along the hospital deck. She recounts the time the ship’s four-person medical team was faced with treating more than 150 rescued African migrants, saying it “was definitely one of the toughest days”.

With a background in humanitarian aid work, the Gran Canaria native says fishermen have unique patient profiles. “Many haven’t been to a doctor in years,” she says, while showing us a new X-ray machine, the ultrasound and 17 beds sitting inside several spotless wards. “Imagine working five months on a boat and sleeping only four hours per day; people arrive onboard exhausted.”

Her last patient, a young Indian worker from a passing oil tanker, suffered a heart attack. “We’re not cardiologists and even though we have a fully equipped operating theatre, we don’t have surgeons on board,” she says. “After talking to our partner hospital in Las Palmas, we injected water into his bloodstream to buy time, then set course for Nouakchott [in Mauritania] where he was evacuated by military transport to Gran Canaria.”

The stresses of the sea also take their toll on mental health. The ship includes a one-bed psych ward, which is monitored by closed-circuit cameras and dubbed the “panic room”. “Alcohol consumption is rampant in the fishing sector and sometimes people take to the seas in order to escape substance abuse,” says Rodríguez Hernández. “Sometimes we get radio calls from captains who can’t make sense of their crew members’ behaviour – but we are prepared for anything.”

“The worst day for me was having to amputate 23 fingers mangled by the fishing nets,” says veteran doctor Jaime Medal. “Fishing boats can be a hostile place to work,” he says, recalling the grisliest case he’s seen: a Russian sailor whose hand got stuck in a propeller.

“This month we’ve only attended to seven patients – five Mauritanians with minor complaints and two Spaniards – one of whom only had a tummy ache,” he says, with a slight hint of exasperation. “Lately we seem to operate more like an ambulance taxi: picking people up, giving them an inspection, a good feed and then ferrying them to a bigger facility on land.”

Medal’s colleague, doctor José Luis Cristóbal, offers up a more prosaic diagnosis. “The purpose of this ship is not just about saving lives, it’s also about saving time and money for the fishing industry,” he says. “If a crew member falls ill and the captain has to head back to shore, days of potential revenue are lost and salaries still need to be paid.” Having a floating hospital patrolling the nearby seas ensures such interruptions to the industry are minimal. A smaller sister vessel, Juan de la Cosa, provides a similar fast-track medical service to fishermen in Spain’s northern seas.

“We don’t operate out here alone,” says the softly spoken doctor. The Madrid-based Centro Radio Médico is called upon to supply patients’ medical records. The Spanish defence department’s Hospital Central can be dialled up for specialist advice via video conference and the Social Security Ministry’s Instituto Social de la Marina (which also runs this ship) has made great strides in training crews in first aid and dispensing medical kits onto small boats.

“The greatest challenge is the fact that we don’t have any formal agreements with any of the African countries we operate near,” says Cristóbal. This has led to complications such as the time he was evacuating a patient by plane out of Mauritania and the police withheld his passport. “I told them to keep it and boarded anyway – my priority was my patient.” His passport turned up later, passed on to the pilot at the last minute, but frustrating bureaucratic hurdles like these highlight the importance of the Centros en Extranjero – small clinics that have been set up in Nouadhibou, Senegal, Namibia and as far as Port Victoria in the Seychelles. “We realised that having a local contact on the ground saves us plenty of logistical headaches,” says Cristóbal.

It’s 11.30 down in the kitchen and head chef José Manuel Canose tumbles a tray of mussels and crabs into a simmering pot of paella. “We’re like the stand-in psychologists for the crew,” he says with a laugh. “There’s usually always someone in the kitchen, which gives people a reliable place to come and offload.”

The Galician chef has been working these same stoves for 17 years, and was taught by his predecessor to keep the energy positive by playing high-tempo music and always lending an ear when crewmembers stroll in for a grumble. “We usually plonk them down over there and tell them to peel garlic or potatoes,” he says, gesturing to a stool next to the sink.

With not many leisure activities available on board and limited contact with families, meal times are marinated with extra importance. This is a Spanish ship: the benchmark of food quality is understandably high. The menu, which often features lentils, octopus and fresh fish, is closely monitored when it is printed off and hung up in the mess halls each morning. Using the same monthly stockpile of ingredients (which includes 1,560 eggs, 55kg of steak and 500kg of potatoes), the chef strives to concoct surprising new recipes to keep things fresh and morale high.

The rough sea conditions may add an extra dimension of difficulty to his daily food-prep but there’s an upside to having your kitchen so close to the food source. Fishermen – many of whom feel indebted to the ship for providing treatment and a welcome dose of R&R – often translate their gratitude into gifts of seafood. “We once had the swimming pool full of fresh lobsters,” says Canose.

Daily rituals are also an important part of preserving the esprit de corps. The treasured pincho de la mañana or “second breakfast” sees chorizo, tortilla and coffee laid out on the library table for the hungry machinists and rescue team. The captain can be seen doing post-lunch laps around the helipad while listening to classical music. At 16.00 the small gym fills with crewmembers hoping to burn the consumed calories from chef Canose’s standard four-course lunches. Today, a small interruption to the daily order: the mess hall’s malfunctioning coffee machine quickly becomes a hot news item among the crew. The disruptive incident highlights how much small flourishes within the daily routine – even the pleasure of a simple coffee – can play a big part in keeping the crew happy and healthy.

Back on the bridge, the captain is busy co-ordinating a rescue drill. As the ship heaves through choppy waters, the horizon bounces between the top and bottom of the front windows. A mechanical arm extends the small fast-speed rescue boat over the water, lowering First Diver Kilian López down into the Atlantic where he zips out to meet his team on the second speedboat a few knots ahead. Between the muffled voices on the walkie-talkies, the captain takes a moment to appraise the simulated action. “These days it’s more of a challenge navigating through the public administration,” he says with a wry smile. “Yet out here the situation can change quite suddenly and before you know it, you are inundated with calls, requests for information and opinions. The best thing you can do,” he says, “is hang up the phone, stop answering questions, set a course ahead – and take action.”