poor jco of managing hypertension.
inservice @uucac.cn for health workers
as well as community education and screening programs would appear to be
high priority items.
The final
chronic
disease of
increasing
significance
is
diabetes.
Though incidence figures are difficult to ascertain, anecdotal] reports show
it to be of real concern among both the health workers and the community.
"Insulin clinics" operate on both Ebeye and Majuro where diabetics come
daily for their injections.
the outer
closed
islands,
because
of
These also operate intermittently on some of
but evidently all
insufficient
of these clinics
supplies
of
one
are periodically
kind
or
another.
Fortunately, most patients must not be ketogenic, as they tolerate this
intermittent schedule surprisingly well.
insulin
allergy/resistance
must
be
The impact on the development of
considerable
approach to diabetic care must be developed.
and
a
more
rational
Oral agents, e.g. Diabenese,
are widely used for obvious reasons, and education regarding proper dietary
patterns and urine checking are not adequately promoted.
Recommendations
1.
Develop cancer, hypertension and diabetes educational materials within
the health education unit and promote these among both health workers
and the general population.
2.
Develop
specific
screening
protocols
for
selected
cancers,
hypertension and diabetes that will be taught to the medex (medical
assistants) and health assistants through inservice education and then
be integrated into the primary health care system.
3.
Identify a referral system for persons with selected types of cancer
and communicate this to be primary care workers.
4,
Develop treatment protocols for hypertension and diabetes, along with
appropriate equipment and supplies, for the outer island clinics.
5.
Start a research project to adequately ascertain the true relevance of
the disease and its etiology (which seems to differ here from other
high
diabetes
populations).
A
cost
estimate
epidemiological study is included in Appendix L.
for
such
an