can come to their island and say he is only interested in radiation problems and that anything else is the concern of another doctor hundreds of miles away in the district center who they probably never see. It is no wonder that the people say that the survey team has a lack of interest in their general health care needs when the research effort is what the program emphasizes. The people have no strong association with the Trust Territory health system because they never see it. It is the Brookhaven doctors that appear on a regular basis and are the doctors that the people expect and want to provide their total care. The peor can also appreciate the vastly better care that the Brookhaven doctors provide compared to what is available in the local system. Even when Trust Territory medical officers accompany the survey, the people still know that it is Brookhaven and ERDA who have the responsibility, money, and control. It is the research profile of the program that has created other misunderstanding with the people. Several years ago, the charge was made by many Marshallese that the people examined in the program were being used as guinea pigs in an experiment on radiation effects. This charge touched off a bitter controversy and vigorous denials on the part of the program directors. Yet, even now the people feel an intense awareness of being subjects of a research project rather than willing participants of a general health care program. It is not hard to understand the people's point of view if you can drop all your American ideas and bias about medicine and try to see things through the eyes of someone living on a relatively isolated primitive outer island. Consider - each March a large white ship arrives at your island. Doctors step ashore, lists in hand of things to do, and people to see. Each day a jeep goes out to collect people for examinations, totally interrupting the normal daily activities. Each person is given a routing slip which is checked off when things are done. They are interviewed by a Marshallese, then examined by a white doctor who does not speak their language and usually without the benefit of a Marshallese man or woman interpretor. Their blood is taken, they are measured, and at times, subjected to body scans. In the end, people say they are sent on their way with little or no explanation or medicines despite many complaints. People indicated that they have complained of certain problems for years and the doctors always do nothing or tell them nothing. Now if an American was to go through this process each year for twenty years, would he also not consider himself a research subject - a type of guinea pig if you will? The people feel that they have no input into decisions about their examinations and care. The doctors always appear with a predetermined plan of what will be done, who will be seen, and what will be achieved. The people are not consulted beforehand and are essentially ordered to do things the way the American doctors have established the plan. Such plans are usually formulated on American cultural guidelines and neglect the local traditions. When the prople raise any hint of an objection or seek to question some point, the doctors think they are only trying to cause trouble. What seems to be forgotten is the patient's right to decide how, when, where, or by whom he/she is treated. It is easy for a research project to neglect such patient's rights and feelings in the interest of the outcome of the program. 5 [012204