A holistic approach to a population's disease management generates the best outcomes. This approach involves studying the socioeconomic, behavioral, physiological, and environmental factors that may predict disease occurrence.

what we do

Together with each fishing community, we design and implement simple sustainable solutions to address some of the most urgent needs. From this collaborative exercise, we take away what works and does not work for interventions at the community level, gauging the model's adaptability for other fishing communities.

Through continuous data collection and examination of the fishermen's health conditions, we identify gaps in our knowledge and determine factors that might predispose the fishermen to DCS. We aim to build a decompression table that allows them to safely ascend even from provocative diving patterns. 

What We've Achieved

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understanding the diving behavior of artisanal fishermen

Since 2008, we have deployed palm-sized dive recorders to individual fishermen to better understand their diving patterns. With running data collection from up to 17 consenting fishermen who wear these recorders on their waists on every dive, we have built the largest data repository of artisanal fishermen divers' diving behavior. Analysis of their dive profiles revealed that about a quarter of all dives exceed the U.S. Navy no-decompression limit. Linear regression showed that harvest volume is correlated with dive depth and bottom time, which is correlated with income. 

Today I just earned US $20, taking three more
divers with me, would reduce my income to US $5 per trip
— Fishermen’s Perceptions and Attitudes toward Risk Diving and Management Issues in Small-Scale Fisheries

Socioeconomic factors such as increasing market demands, scarcity of catch and financial stress may contribute to their high-risk diving behavior and decompression stress. 

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reducing carbon monoxide poisoning and educational intervention

From gas analysis of the fishermen's diving air, we identified carbon monoxide (CO) poisoning as a confounder of DCS. We built a simple and cost-effective model off-site to modify the setup of the existing equipment to reduce CO contamination and held several focus groups with the fishermen to provide insights into concerns regarding the impacts of the proposed intervention. Upon analysis of 7 hookah dive systems, the level of CO contamination in the fishermen's diving air was reduced by 72%. Workshops demonstrating how to set up the intervention, and posters explaining the intervention were hung in 6 fishing cooperatives. After 1 year, the number of boats that had modified the hookah system setup to achieve the gas separation increased from 7 to 120 of 198 total boats in a single fishing village.

The simplicity of the intervention, its efficacy, and the fishermen's collaboration in the design helped with its adoption by other fishermen. Workshops in surrounding communities may help continue spreading this efficacious, simple intervention.

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With the generous support of one of our donors, we were able to gift fishermen with oxygen tanks to keep on their boats, for emergency administration en route to the hospital in the case of DCS. In a series of workshops, we showed the fishermen how to administer oxygen to a fellow diver through an oxygen mask, as well as other first aid procedures, such as CPR.

ongoing work


Sea cucumber (evisceration)


A global market demand drives the fishermen's diving behavior. We are collecting capture data as well to merge onto the diving patterns above. 

Fishing behavior is dictated by the type of species that is being harvested. Lobster and sea cucumber are two examples of high-value target species in Mexico. Lobsters are agile, and fishermen can catch only a handful per dive, conducting a “yo-yo” dive pattern. Meanwhile, sea cucumbers are relatively non-mobile, and fishermen harvest up to 60 kg per dive. The resultant difference in nitrogen load may account for the difference in DCS severity between different seasons targeting one species or the other.

treatment at the local hyperbaric chamber 

A thorough understanding of disease distribution could help target interventions. By analyzing 17 years of fishermen's treatment records for DCS at the local hyperbaric chamber, we aim to establish the true incidence of the bends and their distribution across the fishing villages and individual fishermen. After we locate the hotspots of DCS occurrence, we can start strategizing how to respond.

We also work directly with the medical students and the treating physician on site to study the difference in hyperbaric practice in Mexico from the U.S. We share our experiences and curriculum and train each other on how to fill the gaps in our skills and knowledge.


Students at our collaborating institutions conduct community fieldwork with our principal investigators and doctors to gain hands-on experience and perspective of the research they support. We present and publish our findings regularly at both domestic and international conferences.