Book Review Cruise Ship Blues
The Underside of The Cruise Industry
By: Ross A. Klein

I was eager to read this book about the Cruise Ship Industry as most of the articles I have read written by Cruise Ship physicians, travel agencies, and the Cruise Companies have been overwhelmingly only positive and do not meet with my own previous experiences working as a Chief Medical Officer and physician for a Cruise Line.

Ross Klein is perhaps the best person to evaluate the experience of the modern cruise inclusive trip, writes this book from the dual perspective of a sociologist and as a self confessed 'cruise junkie'.

Most of us have the Titanic, Queen Mary, or Loveboat to use a popular reference for cruising all of which are different from the modern voyage.

Mr. Klein focuses on his own experiences from being a cruise enthusiast (although he distinguishes that under present condition he will not cruise) as well as anecdotes from other passengers, cruise insiders and other reference sources including guidelines and statements from various organizations (medical, legal, and others).
The discussions are often qualitative with anecdotes supporting each point. Some sources are anonymous to protect the individual while others are clearly cited references. I do not find this a methodological weakness since my own experience with patients returning from cruises and my own observations clearly support the widespread concern over passenger safety, hygiene, and proper running of a vessel in international waters even if this is rarely mentioned in the media.

Mr. Klein has given a balanced perspective of the good and bad parts of cruising, and documents that many significant problems still occur- assaults, rapes, epidemics, and fatalities in the modern cruise age.

It is not important how often they occur (which is difficult to ascertain given the way complaints are handled by the cruise industry) but that they do happen and that every passenger should have some awareness of their own possible risk for illness, accident, assault, and fatality however small it may be while cruising and not accept to idyllic picture that is marketed by the Cruise Industry.
This book is organized into sections that stratify the problems at different levels. The first few chapters deal with an explanation of the Cruise Industry and how it is set up including extra costs and deceptive costs claims. Much of this is understandable since everything promoted by the Cruise Industry has been marked up for a captive audience.
This section will benefit those who have never cruised before and will understand the extra costs before they go.
The safety section includes maritime and medical hazards abroad. These are prepared with many interesting and concerning anecdotes. I was surprised that one of my own voyages with the MS Tropicale was mentioned when we narrowly avoided hitting a fishing boat. Our ship had to veer at the last moment when a fishing boat was in our lane causing every shelf aboard to topple that night.

A chapter is devoted to the environmental impact of cruising and Klein's statistics give sobering realization that pollution generated by cruise ships can be enormous, not including unlawful dumping. Clearly tighter legislation can improve this. He uses examples how Caribbean and Alaskan Ports have tried to minimize impact by placing limitations on the cruise industry's rapid growth.
Perhaps the most relevant chapter deals with the employees: Cruise department (entertainers), support staff, deck hands, stewards, officers and others. He gives a brief overview of many of the problems facing many of these people - overworked, underpaid, and often unable to speak to other people. It is very clear that the cruise industry is able to make vacation trips affordable based on the low sub minimal wages paid to the employees.
My own interaction with the crew as their occupational medicine physician gave me a slightly different perspective. I found that many of the crew was glad to be making sub minimal wages because they were still making more than they would in their home country and these crewmen did not always seem to resent the system as much as one would suppose. Crewmembers from more developed countries that had more pay and freedom than deck hands were more resentful because of their higher expectations and previous accustomed lifestyle.

Mr. Klein's perspective is more from a passenger but I had noticed from working with the staff and crew that despite many of the edicts from above management that many of the managers and supervisors actually cared a great deal for their employees and that many of the complaints that arose from poor service, accidents were more from poor training, ignorance rather than malevolence. The system I had worked with had many individuals in positions that may have been promoted above their capabilities and were poor with working with people often letting their departments down; but also many very capable individuals were present that took pride in getting their departments on track.

Unfortunately consistency with all departments was a problem. I felt that the longer a member was aboard the more likely they were to assume a 'crew culture' no matter what country they were in. Locked into a weekly routine many members would get into alcoholism, drugs, and unsafe sex practices, for lack of something to do. The exotic location quickly lost their luster after 6-9 months of seeing the same part every Friday. Mr. Klein suggests developing on independent counsel or Ombudsman to help both passengers and crew work through difficulties would be very progressive in anticipating these problems instead of shipping problem crewmen home if they give too much difficulty. Such an outlet would be a very positive step towards eliminating much of the steps of living and working with the same people for months.

There are many other health issues to explore in criticism of the cruise industry including long-term crew health : proper medical care, vaccinations, adequate rest , HIV from very risky behavior, and even protecting crew from assaulting passengers which is something I had seen several instances of.
This book does great job at identifying many important issues to consider. Mr. Klein remains an enthusiast of cruising and states many times that he would like conditions to improve and then he would resume cruising.
He has offered suggestions for how the industry might be improved for the benefit of all including disabling flags of convenience (that is ship registration in countries like Panama or Liberia that specifically allow lower standards), stricter central dumping, standardized medical training for doctors and nurses, and increased public awareness of all the problems that cruising creates.

I agree with his points especially that the Cruise industry will not change by its self but needs to be prodded. I did see some progressive ideas while I worked for aboard. We were having repeated fights where groups of men would be fighting over young women during college Spring break. One episode ended in a riot where blood was smeared over the Lido deck. It was observed that these particularly aggressive men in their mid 20s and over specifically came onboard to meet these groups of girls traveling together who were about 18-21. Carnival made it a requirement that anyone under the age of 21 had to have a chaperone older than 25. This eliminated a lot of single girls who were just under 21 traveling with a friend only a year or so older. The results were that this did decrease the incidence of fights aboard ship.
The Medical team had also been revised in a different way. Previously overzealous doctors and nurses were given a commission for the passengers that presented to the infirmary with seasickness and whom were then given unnecessary injections and then billed. After the commission was dropped and staff were solely paid with a salary this medical harassment had stopped.
A lot more needs to be done. At present Carnival has a policy that any employee found in a passenger's room outside of a legitimate purpose will be fired. This policy is a defense for rape charges against the company. It is permissible though to bring a passenger back to the crewman's quarters and engage in what is presumed consensual sex. I have personally heard from one 19 year woman had been grabbed by the hand by one of the middle aged engineers to be led to his cabin. She only told me as a physician and refused to report this to security as she didn't t want the crewman to be in trouble. Little that she knew that this was a weekly occurrence onboard. There are clearly different levels of tolerance for rule breaking among the sharply caste like divisions aboard. The rules for liaisons with passengers exist yet ways around them are quickly found. The rules should clearly be for the protection of the passenger and not merely a legal formality that is improperly enforced.
I believe well demarcated rules of conduct for crew should be made more clearer and available to all levels of crew as well as the passengers.
Cruise ship Blues is a good introduction to the microcosm of the Cruising industry and is very sincere in its efforts to improve conditions by opening a forum on the author's website: www.cruisejunkie.com.

I would recommend this book for casual readers, prospective employees, and medical professionals or travel agents who advise travelers. It is very well referenced for readers wishing more background on the topics introduced. The comments I have made do not reflect any deficiency of the book but relate more to my own observations from a longitudinal relationship with the crewmen as opposed to the episodic vacationer. I would like to recognize that most of the staff of the ships I have served with did their best to help and assist passengers but poorly defined rules, high expectations and remote resources had caused many problems.
Cruise ship Blues concludes that with better guidelines and training; stricter supervision by outside agencies; and appropriate sanctions when violations occur the Cruise ship Industry may be able to reform itself and even become an environmental leader if it can first be forced to recognize its deficiencies by public pressure.