ome
ow
~~.
*
2
MATE &
~
Fe
~
ey
ePTion
Db
toa
ALL raddacion related disesses in the enyosed and control
populations phys
full
sereenting of
all
faliahltante now
Living dur veheuuled tu be eepatehoted tu) Merlall Gedands cootumbnited ty atomic tablaut
As in Options A, & aad C buc with
added etphasis on earty detection and
Il.
Constrstacy
111.)
Present levels of care
As in Options 4, & and C - This option
treatrent of all significant discusce.
Thia option offera unequivocable
evidence of the true concern of the
u.S. for the comprehensive health care of
the peoples of the tslands contaminated
exceeds the mandates of our present pro-
In vddttion, such a program would
allow us to develop 3 much nore sigalfleant “health prof fie” of the
Marshallese to assist in the detece
aination of potential radiutfon
rebated pathotogieal conditions,
CUE/DOL/DOD meeting on che status of the
peuples of Eadwetok and Bikiel, tc appears
thac this option fa the one favored by
by
the Cesting proyram.
gram and would be
fmpossible withaue
wh apprecduble Increase fn fundiny,
txEseing Policy
An fm Uptions A, B and C - En addition,
in light of
the recent
the Under Secretary of
4c. Joseph.
(Occ.
12,
1978)
the facerduc,
Extyeiny necds and demandy
Thls option mast closely meees che needa
aid demands of the Marshallese peuple aad
(heir luaders,
ref ined
objectives im consddvrat lon
uf
restraincs.
As in Upeions A, 8 and C,
the restatement of objectives
wlll be dependent upon:
I, Tho definictons of the
tole (moral /fiscal) of the
administtators of OO1 and
BOE to carry through on the
statements of prifcipal made
at che Oct, 12, £978 - DOI/DOF/
DOD reeting fn Washington, D.C,
concerning the status of the
peoples uf Oikind and Enlwetok.
2.
TE full health care responwibtlicy 4s assumed - Gprion D
Needs ho restatement.
Projected needa and demands
Sloce this opcion provides adequate
heatth care for all currently and
wetentiaily Invalved Marshallese, ic
stunk meee all projected needs and demands
Fiaoutag at other levely
4s in Opoioas A, #B anil C
‘edsting facilictes
Aw da Opeions A, 8 and C - A major expansion
ot cuisting Faciil(ttes vould be necessary to
tepere a medical progeam moce than twlee the
pteoent ef fure.
3.
Tf Voiced healeh care
responsibili¢y Is the choice ~
Some compromise between Options
C and D is indicated.
tv,
terms of:
Whacs
Full direceed datz base,
screening und Follow-up of
percinent €indings {n population
defined under “Objeceives”
Who: With the expansion of the
patient populatton, it would
be wise to see up (2) Cield
medical teams; (A} the 8NL«
acule exposure study team
{covering peoples of Rongelap Utirik) and (8) the “low level”
sCudy group = under contract +
both supported by adequate~-]° -24
care at Ebcye and Majuro.
Where:
Vv. Selection Criteria
Analyst{s
Develop possible approaches to
ateaining the objectives, with
each approach being atated in
As in Option C,.
When: As in Options A, & and C.
lluw: As in Option C - plus
added manpower to support 2 field
teajma plus ut least 2 U.S,
trained phyyictans at HMajura and
Ebeye = supported by paramedical personnel, Pliywiciau
Agslstants and sure
practitioners.
Sec forth the eritecta for the selection of 20 aporowch:
Performance or_ resulta
Research based upon a sound primary - aecemdary care delivery
ayetem will provide cptisue care for each patient. The total
population of the Marshall tslande ts abowt 22,000 people of these only about 2,000 would be completely covered by
Option D. The remaining 20,000 would benefit greatly by
the general improvement in tho quality of care at the
primary centers, + but thar would be a secomdary goal of
the medical staff - working with the cxistteg Marahal lage
medical officers and theie stalfe.
Total cogt
Really impossible co develop 2 reasonably accwrate figure.
However, based upon our present operating expenses (Opt tuo
€) with a cusulacive budget of about 1 silliem the expansion
to Option D should cuse about 1 to 1 mii tiom extra.
Floxibiltty
This option gives ua the greatest flexibility In scheduling
examinations if the field, due to the increased on-site
meagtcol and transportation resources.
Avoidance of untoward consequences
This option offece the best proof of « aiweeve U.S. commit@ent to tho people, This should help groatty da leproving the
image of U.S, in a1) of the aedia = U.S. as well as tncernational.
In addition, with the new “free association”, the Marshallese
might decide to (111 the primary medical care vacuum with Japanes
physiciane (wlth the good posadbilicy thac left ving = ant{+
nuclear MO's might become enfrenched io the Marshalls).
Risk
“ful
U study would nmced co be inseituced as
‘aouy pusalble to determine the currencg and
Tue sonte af unch a program (please ace
tliow ¥ Selucelon Criteria) - under “Total
te,
Sy ae (13)
‘dn Uptiong A, & and C. - Pivase see Secedon
+ Hsilysaw of “How for manpower requirements.
a, 4
:7 a
* tlae by now opttinum fue DOE in Light of
oh oaad Micshablewe statements of
needs.
sialicPopulation Characterinetes
‘rn ptiona Ay hand € - The area Ca be
reed @lll be much sore chan duubled by this
ous iae., Mijure ‘F
Translation
Hestatement of
Ujelany.
least riwk of all options ~ unluas cosmiteent was mudy and
then not honored,
Cost/effectivenceas
Au in Optiona A,B and Cc.
Timing |
This is che optimum time for implementing Option D ~ for two
reasons; A) The sovemene toward “free associarfon™ has placed
the Marshall Islands in « stace of transition, Thy revisions ia
the health care delivery systems could move along moat smoothly
{n this period of general and economic transition. 6) The peuple
of Bikini and Enivetok are demanding quick and decizive answers
to thele very legitimate requests.
- ~~ oF
ne SRSTE
¥: Yge a -
Fatabliah the beoad vbjectives
t.
t
4