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Liaw doteetiuga und Creatmat of
’
radtachon-refoted diseases plus the care
and follew-up of patients in the Exposed and Conteul Croups found te
related diseases
pathologic conditions as in Option A
+ plus udditdcaal screening for age
and sex correlated high risk diseases.
B,
Treatment aa in Option A for
radiation-related cisectacs.
For ail
other diseases change “terctlary”
H Constr sints
Scregalny:
43 in Opctton A - plus, aged
te develop
“Tisk tables” (age and acx specific) co expand
sercening daca base.
The relative improvement
recene ticalth “statisttes" should be of some
assistance. Treatrent; (1)¢72(9) (10) (10) ptus
tucrewsed logistic requirements of added care.
Follow-up:
As in Oprdun A - plus
logiutic and manpower required for care.
CC.Falloweup (as
Existing Polley *
As in Option A - plus current operating procedures alecady iachudus this added group and
tn Uptian A}
= Change tergiaucy care ta primary of
Seuondary wate, as uvaslable.
.
the
in
Increased
fare avnter to peisary or secondacy
Care center, us availible.
TLE, Translation
q
Prevent of
be reached to provide this supplement.
in addition, LL, under che
"Cece assoctation™ agreement the DODKwafaledn caxcs are to paid directly
to the Marshall [yJands, some Cixed
portion might be diverted to primary medical cace under a 0OU/KwajMarshall Iskand Cavernzent agreement.
Ag In Uption A - The need for better primary
cure Is evident to many Marshallese, They are
cucreotly und have historteally, demanded
better care.
Projected needa and demands
5
Many Marshallese
are asning for birth control education.
Hanning at other levels
A ba Uption A - Plus sdynifdcane deereuse In
alcuudy weaper T.T. suppoce of medical care due
ro vite for “Erce asseckation’.
An Hh Uptfon A = plus Che inereased load of
furtins patient care would strain the cmtscing
factlllies cosuledng in severely diminishing returns
Car uh boalth dollar (below minimum “critical Mass").
wilt be a emokl increment
W.
V. Selection Criteria
Analyuts
Develop possible approaches tu
attaining the objectives, wlth
each approach being stated in
tecna of:
Whats As in Option A - plus
selected "risk hazard appraisal”
screening, care and folljow-up,
Who: As in Option A = BNL ly
currently exceeding Option B io Its
active commitment.
Where: Serecning, cure aad
follow-up of exposed and contrel
Broups whecever we cun
them.
lucaty
When: As In Opcion A - plus
Teguiar intermittent visita
(every 24) monchse) for followep of nen-radiution related
problema (already being done).
Mow: We would, actually, need
to cue back on ovr presence
conmituents to comply with
Option 8, e.g., we have already
put aimose all of the people
formerly on Olkind through the
Catire screening procedure.
Sut_ forth the ertterta for the selectivn vf an
appronch:
The added screening costs
in the existing screening
prograa. The added primacy and yccondary care and
meen!
follow-up - Boch shore/long term may be a significant
(See facthities cose
apounc (dependent upon the diseases selected and their prevlance),
as well).
Mansower: (13) AS fm Option A = but better cooperacion will hopefully improve compliance
fand quality of data). The fmercasad dcrecning requirements can be handled by better
utilization of manpower, adding voy Phy-iclan Asst. or aurse praccktbuncr,
As in Option A - Ilowever, inetiied coverage should raise credibility of DOE /LOT,
Tiaine:
This opclon is seth} below current operating Procedures:
ds in Uption A - but with a reduction in covert
Deroyrashfe Pooulation Characteristle
j
hostility + tnersased cooperation. Popslation under care, still below, current
;
upetatiag pobicies.
..
Performance or results
Aa in Option A - However, the seccion on radiation related disvawes vill need
fo be cxpanded to fuctude those age aad sex apecific general eedical problems
not currently associated vith radiatton. The methodology wf Rubblus and Halt
will be used co determine vhac specific historical, physical, and labucactory
findings would be eost senaitive aod specific to detect tae most prevalent
diseaves (age aad sex-deteraiogd, @.g-5 we wil) sot look fur corunary
atherosclerosis in young females, avidence fur sicoboliss wHlt be soughe in
young and old males, etc.).
Total Conc
Aa in Option A -but wu cun cancel out the specific education program
(explaining the cut in eervicos), The varioun cost teadeewffs hava buun
discussed In the previous sections of this option. We aust kucp la mtad
that this option is still below our presence commitucnt,
-
os
4
ne
Sep
ik
ie
« Ug
Flexibllicy
.
There is increased fluxibility with this option. We fevl the SKL teow.
stationed at Ebaye could handla thie additional load withewt problues =
in fact, 1¢ woutd ewrich their practice and provide some welcome vuriuty.
v
a
Be
if
f
The added Clexibility and coamitsaentof the DUE/BNL team should enhance ov
shaky credibility and genceate true gratitude among some of tho Harshalles:
The critical paint is never te promise more than you cas deliver. ‘The
ist
be.
he
frequently and by forwarding all pertiment Jota on to isterested Marshaile
as soon oa it ia available.
i
zh
credibility gap may be partially patched by saying "I don't keaow” nore
Risk
:
The risks to DOE/BNL are leas than with Option A - Huwever, this level o.
effort ie below the current program and will couse some averse tyactive
jatocdag Cactlit tes
Fino tats €1)(5)(6207)(8))
the tncrease is direcrly
related to prinacy pacient care
and fa, therefore, not DOE's responsibilicy, pechapy sone interagency agreement with DOT could
Existing needs ond demands
regulding in increasing population.
As in Option A - The inereaged
patient cure demanded by Opcion B
wilh require a slighe ncrease ta
manpower and logistics (funding),
Since
others
As ia Opcion A - plus an ever increasing base
population ~ crude growth rate 32 - better primory cedical care will probably reduce rortality
Heatatement of refined objectives
in consideration of restralata.
ies
tar radlation-related
“™ "Tablet
Exuimiien the teva object tyes:
Sceeening
oo
1,
A.
~~
(publicity, cooperation, etc.).
The ciske to the Marshallese are chat a great deal of potenttaily treatabl:
dfsuase will be cackuded from our attcacion by this option,
Cost/effectivenesa
Aa in Option A
Tiaing
Aw in
Option A - The (nerecased population would out aparertably change our
existing schedule.
:
:
ee
aae
Nave non-radtation