REPOSITORY BNL RECOROS ISLANDS | Coutection LZARSHALL Box No LEDICAL DEPT sf 6f fe PV8LICAT IONS FOLDER Se AOIT 212! St? 35/0% \ ' esearch Center Brookhaven National Laboratory Upton, L. L, New York Reprinted from CLINICAL PEDIATRICS, Vol. 23, No. 1, January 1984 fe | 4 ! 401852 r t Pediatrics in the Marshall Islands Claibourne |. Dungy, MD, MPH, Beverly C. Morgan, MD, William H. Adams, MD eae ™ ay 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. CLINICAL PEDIATRICS 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. Background 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- 29 TO AM eM Tete yt acTWRS en ye nL 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 problems.” we wy ame pais oe health care in a vast ocean area are discussed.