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