It's September 28, 2021, and the waves are calm. Román's plan is to return with good fishing as usual. Before jumping into the water, he performs the ritual learned at a young age; he checks the compressor and adjusts the hoses, but when he leaves the port of San Felipe, Román goes 80 kilometers out to sea with his companions and feels sick. One of his hands goes numb. It is the first symptom of decompression that will leave you without walking for a year and with permanent sequelae.
For Román Antonio Can, the sea combined his passion and his work space. He fished to support his family and freedived in his spare time. His story is part of that of more than five thousand decompressed divers in eastern Yucatán, in southeastern Mexico.
They all have different names, different ages, but they are in the same situation: the evidence is that current preventive measures are not enough to protect fishermen from risking their lives on each dive.
Most fishermen do not have social security. Source: Itzel Chan.
Román, a case that is repeated in southeastern Mexico
Thousands of fishermen dive every season in search of lobster in the Yucatan Sea. They do this with rudimentary compressors that keep them underwater for hours, but these machines also condemn them to a silent consequence: decompression.
“When I hit the boat I walked out, I didn't feel anything. Then I understood that when it's bone marrow you don't feel any pain and those are the dangerous areas. They take me to the hospital, they put me in the hyperbaric chamber. I go out walking on my own foot, but then I stopped walking,” says Román, a member of the Cooperativa Pescadores Unidos de San Felipe and the Federation of the Fishing Industry of the Eastern Zone of Yucatán.
During 23 years of diving, Román Can suffered 14 decompressions until he faced a serious situation that marked him forever. Today his legs don't respond one hundred percent, he needs a cane and double effort to walk.
Román Can when he was a freediver. Source: Courtesy of Román Can.
Risk, a constant
In the last 22 years, at least five thousand cases have been registered in this region, according to data from the Mexican Social Security Institute (IMSS), leaving men with permanent sequelae, exiled from the sea and several others without life. Just this October 7th, José Mendoza, 24, died in the port of Celestún.
To exemplify the problem, Can explains that in the Federation of which he is a member, made up of five cooperatives from San Felipe, Rio Lagartos and El Cuyo, there are nearly 900 members, of whom 800 are divers. It ensures that everyone has entered the hyperbaric chamber at least once due to an episode of decompression.
In part, it is because of the hookah-type semiautonomous diving system (known in Mexico as compressor fishing) that puts those who practice it at risk. This involves the use of a pump or compressor located in the boat, which through long hoses supplies air directly to the divers while they are under water, but when the pressure is not properly regulated or if the equipment is old, it filters oil and increases the risk of decompression.
Insufficient government measures
Decompressions are a historic problem in fishing communities, as considered by Lila Frías, head of the Secretariat of Sustainable Fisheries and Aquaculture of Yucatán (Sepasy). However, it recognizes that actions that promote dependence are insufficient in the face of the magnitude of the risk.
“There are educational campaigns, but it is necessary to reinforce training and control in fishing communities, as well as to expand health and awareness actions about the risks they face; the fight against poaching with more drastic penalties, since they tend to be the most exposed to decompression incidents,” he highlights.
However, according to testimonies from fishermen, so far, Sepasy does not provide theoretical training on risk prevention, since they rely on the empirical knowledge of those who are engaged in fishing. They also don't monitor the condition of the equipment.
Fishermen go out to sea without their equipment being supervised. Source: Itzel Chan.
“Sepasy knows about this problem, and knows that many don't have modern equipment, but have been with them for more than 20 years, but when the lobster season opens, not even their lights, they don't show up here, they never check our equipment. With other programs, they do provide motors or vests, but decompressors don't,” says José Daniel Perera, one of the decompressed fishermen.
Carlos Acevedo, project implementer in the Great Islands Region of the organization Community and Biodiversity (COBI), stresses that injuries, disabilities and deaths due to decompression are a latent reality in many Mexican communities, although they are rarely documented.
It confirms that the lack of supervision of equipment by the authorities multiplies the chances of an accident. In this regard, a decalogue for safe diving prepared by COBI recommends technical training in communities, specific manuals and spaces for the exchange of experiences.
For him, it is not enough to provide technical training because there is an urgent need for a change in mentality and in the perception of risk, otherwise the danger will continue to be part of everyday life.
“If you normalize the risk, you're already prone to it happening to you. It's not enough to know the theory; if the mentality doesn't change, the perception of risk doesn't change either,” he says.
Steps for prevention
For Acevedo, prevention begins with the official recognition of those who dive every day and COBI proposes the creation of a register of commercial divers and divers that allows them to manage and regulate the activity fairly, in addition to formalizing the employment relationship with cooperatives and permit holders through contracts that guarantee basic rights.
Despite the fact that there is the Fishermen's Register, which concentrates 12,700 people engaged in fishing in Yucatán, the data is not disaggregated on who is engaged in diving or not.
In terms of safety, it is proposed to establish official equipment maintenance regulations because to date they do not exist. Many accidents result from compressors in poor condition, whose oils, when evaporating, are inhaled by divers and cause poisoning.
“Compressor oil, when it evaporates, can be inhaled and cause poisoning. A safer compressor can lower the risk, but it's still a risk,” Acevedo emphasizes.
For the specialist, the problem is national and complex, and it will not be solved without the participation of all sectors.
“The involvement of the academy, civil society organizations, the fisheries and health sector, and the Ministry of Labor is urgently needed. Otherwise, it's not going to be solved,” he says.
The ideal proposal, from Lila Frías's view, is for anglers to use certified equipment consisting of wetsuits, oxygen tanks, regulators and depth and time monitoring devices, even though anglers have mentioned that this is not profitable for them because of the high costs.
The state official attributes that the decompressions are due to the lack of specialized resources, the lack of regulation and oversight in the past, as well as the priority that for a long time was given to productivity over safety.
The Tizimín clinic can receive up to 10 decompressed fishermen in one day. Source: Itzel Chan.
Decompression: an occupational hazard
Diego Juárez, Occupational Health operating physician, at the Family Medicine Unit 60 Mérida of the Mexican Social Security Institute (IMSS), confirms that fishermen are exposed to abnormal atmospheric pressures during their dives, so decompressions must be recognized as an occupational hazard.
The NOM-014-STPS-2000 recognizes that commercial diving activities involve exposure to abnormal environmental pressures and, therefore, must be considered occupational hazards.
Therefore, the doctor specifies that the standard requires employers to ensure safe conditions through periodic medical examinations, training, emergency plans with access to oxygen and hyperbaric chambers, as well as equipment in good condition and with documented maintenance.
He adds that the Ministry of Labor has not enforced these guidelines in the fishing sector. Most artisanal divers lack formal contracts, have no social security, medical evaluations, or nearby specialized infrastructure.
“It's a sum of factors that make this a serious problem,” he says.
Factors behind decompression
Dr. Nancy Labastida Mercado, one of the people responsible for the Tizimín hyperbaric chamber, points out that decompression depends on multiple factors, that if taken into account, more cases will be prevented.
Some of these are depth, dive time, ascent speed, number of dives, temperature, currents and distance to the coast. Added to this are personal risks such as obesity, age, heart or lung disease, alcohol or drug use, and even intense physical activities.
“For example, if on Saturday and Sunday they took and also dived all week. Or if they started painting a house, if they played soccer or baseball, or just having sex, that puts them at constant risk because their bodies are subject to constant stress,” he explains.
Of the five thousand cases registered with the IMSS in this area of Yucatán alone, 2014 was the year with the highest incidence, bringing together almost 400 and coinciding with the season when permits were last granted to capture sea cucumbers.
The hyperbaric chamber of Tizimín
In Yucatán there are only three hyperbaric chambers, located in Mérida, Progreso and Tizimín. The latter is the most used because it concentrates the majority of lobster fishermen from the east of the state. Those responsible there are Dr. Juan Carlos Tec Tun and Dr. Nancy Labastida.
The main reason for service is decompression. Labastida explains that it occurs in fishermen who use a compressor or 'hookah' and occurs when, after spending long periods underwater breathing pressurized air, the diver ascends too quickly and gases, mainly nitrogen, which dissolved in the blood and tissues form bubbles inside the body. These bubbles cause anything from severe joint pain and dizziness to paralysis, loss of consciousness or, in severe cases, death.
“It's a big phenomenon. There are acute events that put life at risk, they are emergencies that require urgent admission to the hyperbaric chamber. The sessions last two to six hours, depending on the case,” says Dr. Nancy Labastida.
This is the hyperbaric chamber that has saved thousands of lives in the eastern part of Yucatán. Source: Itzel Chan.
The doctors have activated a “Bubble Code” to attend to emergencies: the partner of the affected person notifies the cooperative, an alert is activated via WhatsApp, first aid is given and the patient is immediately transferred to Tizimín.
In this municipality, the hyperbaric chamber, which provides up to 10 services a day, is located in the General Hospital of the Area with Family Medicine No. 5 of the IMSS. From San Felipe, the transfer takes about an hour; from Rio Lagartos, 47 minutes; and from El Cuyo, up to an hour and a half. These are the times that fishermen must go through in the midst of an emergency.
The Tizimín hyperbaric chamber was installed in 2003 and has since become a lifesaver. In 2015, Ángel José Gamboa Patrón, 55, was admitted for severe decompression. Today, at 66 years old, he remembers that he experienced 12 decompressions throughout his life.
“This last time I decompressed myself, the bubble penetrated my spinal cord, immobilizing half of my body. It took me a while to walk again. Many times I decompressed myself, but sometimes you don't feel anything in the background and it's when you come out that you get pain or purple spots start to appear on your body and that's when you say: I already screwed up. The last time I decompressed myself was the good one, I was forbidden to go to the sea,” he describes.
Ángel José walks with difficulty and has not been out fishing for more than 10 years. Source: Itzel Chan.
In his yard he keeps an upturned boat, a symbol of the life he left behind and from there he describes that for his recovery, fellow fishermen took him daily to Tizimín to have his session in the hyperbaric chamber.
Ángel José is still living with pain in his back, legs and knees. He says that, although the State government knows that cases of decompression increase in lobster season, they do nothing to provide them with better equipment.
Consequences due to the lack of prevention
Meanwhile, fishermen like José Daniel Perera, 58, are still exposed to decompression. He has suffered six incidents; in the last one he was not walking for about a year.
“When I was not walking my wife pawned my van, my motorcycle and all the work equipment to be able to support us all that time. Today I have sequels, I walk as if I were drunk, but I keep diving because I have to work,” he explains.
At 55 years old, José Arsenio Marfil has accumulated four decompressions. The first was at 18 and the last less than five years ago.
“My blood was being poisoned, and I started to get red bumps. I was already turning half purple. I had been breathing really bad all the way. Diving is the most difficult of all types of fishing. It remains for us to entrust ourselves to God. We have a little chapel at the exit and that's where we stopped first. The day I had the last decompression, another colleague dived in the same place and also decompressed himself, but he didn't survive,” he says.
Román is still in the fishing sector, but now in management. Source: Itzel Chan.
Among those who had to retire by force, there is a longing for the sea and the physical and emotional consequences.
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