Utirik patients at the hospitals at Ebeye and Majuro; and for the TT health services to furnish personnel to help with the examinations on Rongelap and Utirik. In order to determine the possible association of thyroid tumors with radiation exposure in the Utirik group, more data were needed on the incidence of thyroid abnormalities in unexposed Marshallese populations. Thyroid surveys (neck palpations) were conducted in 1973 on 192 people at Likiep Atoll and in 1976 on 162 people at Wotje. In addition, during the past 6 years, nearly all the unexposed Rongelap and Utirik people living on various atolls (more than 900 people) have been included in these examinations. As part of the expanded medical program certain other diseases not found to be associated with radiation exposure have been given Special attention. Diabetes is one of the most common diseases in the Marshall Islands; it is being studied (see Section VII) in the hope that helpful advice will be pro- vided to the Marshall Islands medical service group on its nature and treatment. Intestinal parasitism is widespread in the Marshall Islands. Since 1977 a program of diagnosis and treatment has been carried on at Rongelap and Utirik Atolls (see Section VI). Other special studies (possibly associated with radiation exposure) include those on growth and development in exposed children (see Section IV); on detection of mutant proteins as a possible index of genetic effects in children of exposed parents; and on the frequency of isoleucine substitution in hemoglobin as a possible index of somatic mutation (see Section V.C.2). Since low levels of residual radiation persist on Rongelap, Utirik, and Bikini, radiological monitoring of personnel on these islands has continued. Urine samples have been radiochemically analyzed on about an annual basis for the radionuclides 137cs and 90sr, and more recently for the isotopes of Pu. In addition, gamma spectrographic analysis (whole-body counting) for 137¢s has been done at intervals. These examinations, formerly the responsibility of the BNL medical team, have been carried out since 1975 under the Safety and Environmental Protection Division of BNL. the direction of The 20-year report (1) outlined a number of problems affecting the medi- cal program in the Marshall Islands. Some of these problems relate to carrying out the examinations, such as the language barrier, cultural differences, scarcity of demographic data, and inadequacy of follow-up medical care in patients seen by the medical team. Criticisms of the BNL medical progran, voiced by some, stem largely from lack of understanding of the limited mandate for the program. Other problems relate to the accident, to misconceptions and fears of the people about radiation effects, and to objections to needed con- tinued medical examinations. In the past 5 to 6 years increased efforts to correct misunderstandings among the people have involved expansion of the educational program by discussions at village meetings and special lectures. One member of the team spent several weeks on Rongelap and Utirik for this purpose, and this was greatly appreciated. The necessity of again removing the Bikinl people from their home island in 1979 because of unexpectedly high radioactivity levels in the food crops was unfortunate. Misunderstandings have arisen concerning bills for compensation and hospital benefits (travel payments, etc.) for the exposed people. The Burton Bill passed by Congress charges the Department of the Interior with development of a plan for delivery of health care to Marshallese affected by fallout. vi -