Generally speaking the number of people served by each clinic is small, thus the patient load per health assistant is low. The number of people served per day at the clinics vary between none to 2-3 per day (unless a flu epidemic is being fought). The low numbers of births and deaths per month further confirm this fact. homes by house call. In fact, most care is delivered at Many clinics have a total population to be served of less than 200, few attain 500 or more. The most frequent types of problems seen by the health assistants are those problems common to children and mothers, plus some chronic problems of older people (among which diabetes and hypertension are the most common). It is not surprising then that health assistants list as most common symptoms the following: flu (upper respiratory), headache, stomach, fever, diarrhea, skin problems, toothache, and diabetic problems (insulin shots). Though from the patient loads it would appear there are too many clinics for number of people served, remoteness, bad weather, lack of transport, and poor supervision are all commonly a problem making effective access to health care, even to another island clinic on the same atoll, not always possible. Real medical emergencies needing immediate evacuation to a secondary care facility are uncommon. in three years. For some clinics it has been as low as once Waiting times and access in such cases has been extremely variable but usually lengthy and costly, if at all possible. The frequency of visits by supervisory staff for continuing education, resupply of medicines, atoll to atoll. and special clinics varies tremendously from It has been totally dependent on the "field ship" schedule (see transportation-communication section). Medical records at clinics vary between none at some, poor to fair at the majority, and good at very few. The forms are generally too complicated and the system has broken down due to lack of supervisory support and encouragement. Most of the health assistants visited in the survey are middle age to old. Most received their training in Majuro from navy corpsmen shortly after World War II. Their educational elementary Some school). of the newer level is recruits low (3-5 years of have high school education and have been trained in a nine-month health assistant program 18