-ll- (e) Current cractice Annual_costs for the medical monitoring, follow up care, and envirenmental monitoring program of the Desarcment of Enersy for the secple of Rongelap and Otirik currently are in the range of $3-4 million. In contrast, in FY 80, the entire health budget of the Marshall tsi anés_Govermment was_ Sa.imillisn. This amount had to provide curative and preventive medical Care and programs for a pogulation of over 30,000 people, many scattered om outer islands. This amount supported the major hespital at Majuro, which serves as the only major in-patient facility in the Marshalls. The current hospital facility in Majuro has 90 beds and is in very poer condition, but fumessoranew hospitalhavebeen apprcsriated. In addition to the Majuro hospital and an Ebeve sub-hospital, the Marshalls Health Deparsment supports some 56 out-isiand dissensaries. these are under-manned and ill-equipped. Some of Administrative and professicnal staffing of the health services of the Marshalls met—-minimimacceptable health standards in the sass. In an attempt to improve health care, the Marshall Islands Government recently concluded _anagreementwith "medical care_adimmes” of the Seventh-DayAdventistMission_inGuam totakecover the controland Management_of -health services from the Ministry of HeaithServices. This new health care_service agency should be brousht_intoanyplanning exercise_bythe.contractor-at. an earlystage. (f) Special Problems Related to Diversity of Residence Monitoring and special health care for the people of Roncelap, OUtirik, Bikini, and Enewetax mistprovidednotonly_in their_home_atolis but. inotherparts of the Marshall Islands where considerable numbers of these individuals now resideeizher_on_a temporaryorpermanent basis. Por example, there often ars as many Rongelagese and Otirikese iiving on Ebeye and/or Majuro as are in residence on Fongelap and Ctirik Atolls. The pest and current medical program under the auspices of the Deparment of Energy has had to be tailored to the placeswhereame she resicents are living. at thetimeofthe quarterly or-_annual-_surveys. This pattern ean be expected to continue inthe_futire andmst be_an_intecral_partof proposedcare Large numbers of Bikinians also are scattered throughout the Marshalls and these individuals also will be entitled to aedical cara. Although the people of Fnewetak, Raving iived on tue isolatedatoll of Ujeiang for the past 34 years, are the =ost cohesive group, under the current return program to the atoll of mmewetak, four commmities will be in existence. ‘There will be new communities on (1) Enewetak island, on (2) Medren Island, and on (3) Saptan Tsland in the southern part of Znewetak Atoll. Distance between these islands is too great to permit cone cantralized local health facility. For the foresseable future also, thare very likely will be an Enewetak community of varying size on (4) Ujelang Atell, which is 124 miles southaast of Enawetak, and this community also must be provided with nedical care.