Lobstering hurts. Clam digging hurts. In fact, most fishermen, whatever species they harvest, end up in pain, whether it’s their back, shoulders, or knees. Sometimes they seek help from a medical professional, sometimes they don’t, “self-medicating” the injury instead. Findings ways to ensure that Downeast lobstermen and shellfish harvesters get the medical attention that they need when they need it is the subject of an eye-opening study by University of Maine at Machias professor Tora Johnson and members of the Downeast Health Research Collaborative.
The hard work of lobstering causes injuries, some of which may be chronic. Getting proper care is a problem in Downeast Maine. Photo by T. Yoder.
“Injury combined with structural and normative barriers to care are likely a significant contributor to addiction and overdoses among shellfish and lobster harvesters in Downeast Maine,” Johnson said in a preliminary report on the study, “Injuries, Substance Use, and Health among Fisheries Harvesters in Downeast Maine.”
A professor of social sciences and geography and now co-chair of the university’s Environmental and Biological Sciences Division, Johnson has long been interested in community resilience, particularly in fishing communities. In recent years she heard more frequently about the health problems arising from chronic injury among Downeast lobstermen and shellfishermen and the prevalence of opioid addiction.
With funding from the University of Maine, the Elmina Sewall Foundation, and the Maine Shellfish Restoration and Resilience Fund, Johnson, students and collaborators conducted the pilot study in 2021. “We did a survey and interviews to figure out is there an injury problem and what sorts of self-medication is going on and what are the barriers to proper care,” Johnson explained. The survey covered communities from the Blue Hill peninsula to the Canadian border. Surveys were returned by 106 harvesters and 88 health care providers and fisheries advocates; 19 personal interviews were conducted with harvesters and health care providers.
Intervention at the right time can break the cycle of injury and addiction. Photo courtesy of Gloucester Times.
“The survey showed us that many individuals self-medicate after an injury, which was not surprising. What was surprising was that no one was looking at how events unfolded to get the person to that point,” Johnson said.
Not complaining is a point of pride among many lobstermen and shellfish harvesters. As one interviewee said, “Unless it’s sticking out or very, very bloody, we work through it.” Some individuals may not have health insurance coverage under the Affordable Care Act due to the fact that they are not computer-savvy or have poor Internet access. Younger fishermen may rely on being “tough” in all circumstances or simply don’t believe that they ever could truly hurt themselves. Combining that feeling of immortality with a youthful disregard for saving money when times are good leads to a situation Johnson called a “perfect storm.”
“We heard the same story over and over again. Someone hurts himself, he is under-insured or has no insurance, so he goes to the emergency room at the hospital. They patch him up and send him home, often with a pain medicine but no long-term treatment. And then the cycle begins,” she said. Without a primary care provider or a long-term care plan, the person goes back to work and hurts himself again. Now he can’t work, doesn’t have money saved up, and faces high medical expenses. Often that leads to “self-medication” with illegal opioids or other narcotics.
“Some people survive, some don’t. One shellfisherman in Addison we interviewed said that four people in his community had died from overdoses in the past year,” Johnson said.
Her research showed that the distance to reach health care as well as the difficulties of scheduling care around the tides were among the barriers to proper health care in Downeast fishing communities. In addition, there was the more subtle barrier of the feelings fishermen had when going to a health care provider. “We learned that some individuals felt that they were being talked down to because they were shellfishermen, or that they were being judged for self-medicating. So they were hesitant to go in,” Johnson said.
While the data derived from this pilot project is not conclusive, Johnson has some preliminary recommendations for how to improve the situation in Downeast fishing communities. “Preventative care can be made available through a mobile health care unit that goes to where the harvesters are. Transportation should be provided to get people to health care providers. And there are numerous points in the cycle when interventions can be made, where additional care can be given to change the result,” she said.
“We have a lot more to do on this. We need to know how many are experiencing these problems and how often they lead to addiction. How much self-medication is going on and with what? We need more understanding of the cycle to know when to intervene and bring health care people in to prevent the cycle from continuing,” Johnson emphasized.
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