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Reprinted from CLINICAL PEDIATRICS, Vol. 23, No. 1, January 1984






Pediatrics in the Marshall Islands

Claibourne |. Dungy, MD, MPH, Beverly C. Morgan, MD, William H. Adams, MD

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The delivery of health care to children living on isolated island communities presents unique
challengesto health professionals. An evolved method ofproviding longitudinalservices to infants
and children residing on islands of the Marshall Island chain—a central Pacific portion of the
Micronesian archipelago—is presented. Thedifficulties associated with provision of comprehensive

Tne DELIVERYof health care to children living
on isolated island communities, where accessibility is
often impossible rather than merely difficult, presents
unique challenges to diagnosis, treatment, and health
maintenance that are not found in most other remote
areas. A health care team, directed by physicians at
Brookhaven National Laboratory working under contract with the United States Department of Energy,
has been involved in the delivery of health care to
several atolls in the Marshall Islands. The Marshall
Islands are comprised of 29 coralatolls and five mountain top islands located in the central Pacific ocean
From the Department of Pediatrics, University of California,

Irvine, Irvine, California and the Medicine Department, Brookhaven National Laboratory, Upton, Long Island, New York.
The research for this article has been carried out under the
auspices of the U.S. Departmentof Energy under contract no. DEAC02-76CH00016.
Correspondence to: Claibourne I. Dungy, MD, MPH, Department of Pediatrics, University of California, Irvine Medical Center,

101 The City Drive, Orange, CA 92668.
Received for publication June 1983, revised July 1983, and
accepted September 1983.

January 1984

approximately 2,500 miles southwest of Honolulu,
Hawaii (Fig. 1). The 35,000 inhabitants of the Marshall
Islands live on small islands that total only 70 square
miles of land scattered over a vast ocean area of
300,000 square miles (Fig. 2). The two major population centers are located on Kwajalein and Majuro
atolls. Approximately 8,000 Marshallese live on the
island of Ebeye on Kwajalein atoll and 15,000 live on
Majuroatoll. Majuro also serves as the seat of governmentfor the Marshall Islands. The MarshallIslands,
together with the Caroline and Mariana Islands, comprise the Pacific archipelago of Micronesia.
In this tropical setting, a combination of mobile and
stationary health units has evolved that provides a
medical infrastructure for someisland inhabitants. The
current strategy incorporates day-to-day medical care
by resident health aides (provided by the Government
of the Marshall Islands Health Services), supplemented
by more in-depth interval medical care provided by
physicians of Brookhaven National Laboratory and
the Government of the Marshall Islands.

On March 1, 1954, 259 Marshallese living on Rongelap and Utirik atolls were accidentally exposed to
radioactive fallout as a result of a nuclear device exploded at Bikini atoll. The medical consequences of
exposure to radioactive fallout, which was estimated
at 175 rads of whole body gammaradiation of Ron-


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Editors’ Note: One of our reviewers commentsasfollows: “Although
this article may not seem exactly relevant to the average practitioner,
most pediatricians knowlittle about this part of the world and are
poorly informed about the people, the poverty and neglect, and
the medical-socioeconomic problems. Physicians should be concerned and wish to be informed aboutall children and their health

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health care in a vast ocean area are discussed.

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