I. Purpose This report is intended to provide an assessment of the medical program as conducted by Brookhaven National Laboratory in the Marshal! Islands. Between June 1975 and September 1976 I served as resident physician for the program in the islands. During that time I became acutely aware ofa difference in perception for the purpose of the medical program between Brookhaven and the Marshallese being studied. Since my return to the United States, letters from Utirik and Rongelap have been received indicating the peoples' feelings and desires. This report will attempt to explain where the problems lie and to help explain the basis for the peoples distrust and dissatisfaction for the present program. It is hoped that these views can be used to objectively reassess the program and improve on it in the future. Ii. Background In March, 1954, a thermonuclear device was detonated at Bikini atoll in the Marshall Islands. Through an unfortunate series of events, Marshallese people living on the atolls of Ailingnae, Rongelap, and Utirik were exposed to radioactive fallout within hours of the explosion. These ‘islands lie almost directly east of Bikini at a distance of 80, 100, and 280 miles respectively. A group of U. S. servicemen at Rongerik, 120 miles east, were also exposed to the fallout but are not included in the Marshall Islands medical program. Knowledge of the human exposure to the fallout was reported to authorities within hours when detection equipment at Rongerik began to register the abnormal levels. It required, however, 2-3 days to completely evacuate the populations of the exposed islands. The exposed people were taken to Kwajalein for decontamination and medical evaluation by an assembled group of U. S. physicians. Decontamination procedures consisted primarily of repeated bathing to remove the residual fallout particles from clothes, skin, and hair. The people from Rongelap and Ailingnae were found to have evidence of radiation sickness manifested by skin burns, gastrointestinal disturbances, hair loss, and hematologic changes. resolving within a few weeks. All these problems were transient, The exposed people from Utirik manifested no symptoms of radiation injury and the difference in the two island groups was attributed to the difference in radiation dose received by each population. There were no fatalities from the initial exposure to the fallout. A few people from Rongelap were left with permanent scars from the radiation burns. The exact levels of radiation that each group of people were exposed to have been difficult to ascertain. Much of the difficulty centers on the fact that there were no detection instruments on the islands, except at Rongerik where the Americans were stationed. The initial radiation levels that the People were exposed to were estimated from measurements of residual radiation remaining on each island about one week after the fallout occurred, as well as the known levels actually measured at Rongerik by the monitoring Personnel. 1012200 .