Dockside Medicine

A medical student from a lobstering family takes on the challenge of bringing effective health care to the community that raised her

two medical students on lobster pier

The morning was hushed and cold. I wore the grubbiest clothes I could get my hands on—the kind of clothes that had cycled through the wash and still stank of bait juice and mud. The boots were way too big for me. At that point in my life I had yet to be introduced to coffee, and sometimes it took a few hours aboard the boat before I would really wake up.

The sky and the sea often mirrored each other, and today was one of the good days, the type of June day when the clouds were small, the swells were minimal and the boat smoothly rocked in the waves. The burly sternman paced the deck, tending the rope and traps. My father stood silently at the wheel, guiding the bow of the boat into the wind.

As a 14-year-old, all I was thinking about was how cold I was, the smell of bait rankling my nose and the time that had to pass before we would be done hauling traps for the day. I would count the strings of traps as we went, banding lobsters tossed in my direction and adding bait to the long, metal needles that allowed the sternman to change the bait as each trap was pulled aboard.

The bait needles would click, and one by one a new tray of bait would replace the one I’d emptied. Sometimes the conversation aboard the boat would be ribald—a free academy of expletives, attendance mandatory—and at other times it would be a mix of silence, the protesting slap of lobster tails and the occasional shout as a school of tuna caught the crew’s attention.

How different my life attending medical school is from when I was a kid back on Orr’s Island, Maine. Growing up the oldest daughter of a lobsterman and the niece of three lobstering uncles in many ways made me who I am.

No question, lobstering can be a hard way to make a living. The income is seasonal and often unpredictable.

Beyond the financial insecurities inherent to the industry, these fishermen (and a handful of women) spend year after year facing one of the harshest working environments imaginable. The ocean may be tolerant, but it is not welcoming of people. Routinely, my father drives his boat into a blinding fog bank to get to work, and with the prices of lobster dropping precipitously, he now fishes through the icy Maine winter months in addition to his regular summer rounds.

No Outsider Here 

My own world consists of well-lit Boston classrooms. I spend my days collaborating with some of the most intelligent people I have ever met. Still, I can never forget that knowledge comes in many forms. The fishing community in which I was raised is home to some of the most savvy and quick-witted outdoorsmen you could ever meet. These people spend their lives harvesting what they can from the ocean—making a living using the tools and faculties available to them. Their knowledge of the open water is unparalleled. They are stoic, self-preserving and self-sufficient. 

These same qualities cause many lobstermen to view health care as a choice of last resort. Lobstermen consistently cancel appointments with doctors; from their perspective, missing a day of decent fishing weather to sit in a doctor’s waiting room makes little sense. 

Small injuries—ones that would send you or me screaming to the doctor—are pushed aside or ignored. Even chronic ailments, such as skin cancer from constant sun exposure and repetitive-use injuries from years of hard physical labor, are addressed only when they become debilitating. Whole families and communities live without health insurance because they can’t afford it. 

These are the types of public health issues that I’ve been thinking about in a new way, now that I’m training to be a doctor. I’ve been weighing all the community and individual concerns plaguing a hardworking industry that is essential to the Maine way of life. But my observations so far are anecdotal. More information is needed to address the problem.

Over the next three years, my goal is to serve as a conduit between the medical and fishing communities. This past summer, I launched a project that I plan to continue throughout medical school. The initial phase is focused on gathering data. In collaboration with Tania D. Strout, the lively and compassionate director of research in the emergency department at Maine Medical Center in Portland, I have come up with a survey that will explore various health issues among Maine’s commercial fishermen.

Strout’s experience in clinical research and her boundless energy have proven invaluable. Our 15-page survey includes topics such as chronic disease, addiction, injuries and attitudes toward health providers and will give us the most recent needs assessment of the state’s commercial fishing population.

One of the most challenging elements of this project involves successfully reaching out to the fishermen. Outsiders are not always welcomed with open arms, but I’m no outsider here. When the project began in June, the Portland Press Herald covered the story. The response I received to that newspaper article was heartwarming. Doctors, nurses, social workers and chiropractors volunteered their time; advocates from the wider fishing community in Maine reached out with interest, and nonprofit organizations offered to support the effort. 

I have collaborated closely with the Maine Lobstermen’s Association (MLA) to reach fishermen through its monthly newsletter and email communications. The MLA is one of the largest voices representing Maine lobstermen, and the monthly newsletters are scattered on countertops in the homes of most lobstermen. My father regularly flips through it, keeping up with an industry that seems to be perpetually changing.

We’ve made a decent start, I think, but the most difficult work lies ahead. During late summer, I drove around to various fishing neighborhoods to meet with as many fishermen and their families as I could. Maine has approximately 6,000 licensed lobstermen living in cooperatives and small communities dotting the coast and coastal islands. Meeting and shaking hands with these people will be more than half the battle, I believe. Hopefully, the fishing community and the medical community can learn from each other and evolve together as my project continues. 

This article first appeared in the Winter 2014 issue of Tufts Medicine magazine.

Miranda Rogers is a second-year student in the Tufts School of Medicine’s Maine Track program. This is the first in a series of articles in Tufts Medicine about her efforts to bring more effective health care to Maine’s commercial fishing population.

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