I was fortunate enough to get to tour the [USNS Mercy](http://www.med.navy.mil/sites/usnsmercy/Pages/default.aspx) in San Diego last week, which I’m interested in because of our [medical services on cruise ships](http://www.seasteading.org/blogs/main/2010/02/03/naama-moran-medical-tourism-ships) business venture. It’s a hospital ship, with ship operations handled by [Marine Sealift Command](http://www.msc.navy.mil/) (a civilian logistics provider for the DoD), and the medical unit run by the US Navy. The ship was in the dock for repairs, before it heads out on its next mission. While the main goal for the ship is to provide medical support for US military missions, and it served in support of Operation Desert Shield, when it is not needed for military missions (which is most of the time), it goes on humanitarian missions instead. Keeps the crew in practice while helping the world – pretty awesome.
(http://www.cpf.navy.mil/subsite/pp08/photos/july.shtml)[Wikipedia’s page on the Mercy](http://www.cpf.navy.mil/subsite/pp08/) summarizes the ship’s most recent humanitarian missions:
> USNS Mercy departed San Diego on January 5, 2005 en route to the tsunami-devastated regions of South East Asia, where she provided medical care to the victims of the disaster as part of Operation Unified Assistance.
> USNS Mercy departed San Diego in 2006 en route to several ports in the South Pacific Ocean including the Philippines, Indonesia and Banda Aceh. The ship’s primary mission was to provide humanitarian assistance to these countries, and its staff included several Non-governmental organizations, doctors from the armed services of several countries, as well as active-duty and reserve military providers from many branches of the US armed forces.
> USNS Mercy, departed San Diego on April 14, 2008 for “Pacific Partnership 2008”, a 4-month humanitarian and civic deployment in Southeast Asia and Oceania. Mercy, with her 900 officers and sailors, included 300 US health and construction experts
(http://www.cpf.navy.mil/subsite/tsunami_relief/tsunami_relief.htm)We asked a lot of questions on the tour, and talked about a lot, but most of the details were not relevant to our main interest here, which is how the Mercy’s experiences can inform seasteading and related business ideas such as medical tourism ships. So my notes focused on that area, although there’s some general stuff too.
* The ship is a retrofitted oil tanker, built in 1976, and stripped down to the hull and main bulkheads in 1984. The hospital was built in one module, they told us, and dropped into place as a single unit (8 decks high!).
* They anchor about a mile out from their mission sites, as the ports they visit usually don’t have harbors and facilities which can handle a ship their size. [They use a couple little launches (bandaid 1 and bandaid 2) for ferries](http://www.msc.navy.mil/sealift/2006/October/band-aids.htm), we were really surprised at how small they were, but they apparently can take 45 people each (or equipment). They setup onshore clinics for most work (dentistry, etc.), only brought the most serious cases onboard.
* The medical module is located at approximately amidships (ie center of gravity from fore to aft) which minimizes pitch, and the OR level is at approximately the center top-to-bottom, minimizing yaw. But they have never had to operate in heavy seas, never had any issues at all with ship motions (Eric, who was on the tour with me, comments: _”the medical staff can make requests of the captain for a smoother course (presumably into the waves instead of in the ditch). I don’t recall if she said that had actually been done in practice, but it seems worth mentioning either way.”_). Much of the equipment has tiedowns, like all the oxygen bottles (only a few rooms are plumbed for O2, mostly they use bottles).(http://www.flickr.com/photos/edoug/2966026940/)
* One idea we’ve had for a medical tourism ship is “stacking the deck” by choosing procedures and patients with a low risk of disaster. The reason being that the reputation of the business and trust of clients is very important, and an accidental death or other issue early on would be very bad PR, which is bad for business and more likely to bring regulatory attention. So we really want to make sure that doesn’t happen. The Mercy screens for healthier patients, not for the PR reason, but because their humanitarian missions only involve a week or two in each port. So anyone who would require substantial pre-op or follow-up care, beyond the capacity of local medical facilities (ie, anyone who is in really bad shape) was screened out. On their last tour ([Pacific Partnership 2008](http://www.navy.mil/search/display.asp?story_id=40027)), they treated 90,000 patients, including 1,300 surgeries, with no deaths. They had one death on the previous tour. Sounds like stacking the deck works pretty well.
* Their two large pieces of equipment are a [CAT Scan](http://www.radiologyinfo.org/en/info.cfm?pg=bodyct), and a machine for [interventional radiology](http://en.wikipedia.org/wiki/Interventional_radiology).
* No MRI because the ship is made of steel – not so good for a magnetic based machine. There are ways they could have dealt with it, but it would have been difficult and expensive and the MRI doesn’t add that much value anyway.
* We asked what the general equipment issues were. Weight, electrical load. Apparently electrical quality is not an issue for the machines (it is generated using an old diesel-powered steam generator). (Eric: _I also got the impression that electrical quality probably was an issue for the fancy stuff, but part of the “GE/Siemans/etc. marine operations people” was that the standard boat install comes with power conditioners for each piece of serious equipment. But it did certainly seem like for all the small stuff they just plug it in._)
* The manufacturers of their equipment (GE, Siemens, etc.) are familiar with ship issues, installation, and maintenance. (Not sure if they are familiar b/c of Navy ships, or other uses). These companies have techs who come do maintenance when the ship is in dock, train the ship’s crew techs, etc.
* (http://www.flickr.com/photos/kabl1992/2780418725/)They have resupply issues sometimes, even with the Navy supply chain. Can’t always predict what stuff they will need.
* Living space is obviously at a premium – officers bunk 4 or 6 to a room, w/ bunk beds, and perhaps 30 ft^2 of storage, and we didn’t even see the non-officer quarters. On the other hand, their trips are rarely at full medical capacity – other factors are the limit, and so many of the hospital wardrooms and ORs are not opened, and just empty. (Just like ResidenSea – non-reconfigurable public space leads to inefficiencies, in this case empty wardrooms and tight crew quarters).
* All the bathrooms in the medical area were male, which was ok for the military 20 years ago, but for humanitarian missions today, is not so good. They were dividing the bathrooms into male and female as part of this maintenance run.
* They had a small negative-pressure isolation ward, which they used mainly to isolate people they were worried might have TB. TB was the main infectious disease they worried about, screened everyone who came on board the ship with a chest x-ray.
* No issues with infectious disease in the crew. We were concerned about doing medicine in such close quarters, but apparently good hygiene takes care of things.
* No major operational or hospital issues they could think of, besides the few mentioned. (Of course, they have the experience and logistical support of the world’s most powerful military backing them).
[Pictures on Flickr tagged USNS Mercy](http://www.flickr.com/photos/tags/usnsmercy/)
Interested in living on the ocean? Read [A Brief Introduction to The Seasteading Institute](http://www.seasteading.org/mission/intro).