Center Quality Assurance and Care Committee.
Also included in that review are items such as the
appropriateness of the use ofanti-infective agents.
A certified medical records consultant randomly
reviews approximately 20 percent of our records
for accuracy and completeness.
Staff:
The Marshall Islands Medical Program is
deeply indebted to the many outstanding
physicians who, despite the inevitable personal
inconvenience, participated in the medical team
visits of 1988-1991. It is fair to say that they are
the heart of the program. Drawn from excellent
medical centers through the United States and
from private practices, these physicians provide
the program with a wide range of up-to-date
clinical experience and perspective that contribute
to better patient care. The physicians and other
medical team personnel involved in the 1988-1991
missions are listed in Appendix A. The clinical
role of team physicians is the delivery of primary
and subspecialty care. By selecting subspecialists
who remain active in general medicine for this
role, the medical program benefits from in-depth
knowledge of their specialty. The following
medical specialties and subspecialties were
represented in 1988-1991:
Internal Medicine
Pediatrics
Cardiology
Rheumatology
Radiology
Gastroenterology
Hematology
Endocrinology
Surgery
Ophthalmology
Obstetrics/Gynecology
Pulmonary Medicine
Emergency Medicine
Oncology
MEDICAL FINDINGS
Patient Participation:
The participation of many excellent medical
specialists undoubtedly has been a major factor in
the acceptance of the Marshall Islands Medical
Program by the population it serves, for utilization
of the program is entirely voluntary. The percentof
personsin the exposed and Comparison groups who
appear for examination remains high. For the
current reporting period the annual acceptance rates
(corrected for nonavailability) were:
1988
Rongelap
86%
Utirik
84%
Comparison 68%
1989
82%
91%
62%
1990
88%
85%
65%
1991
85%
87%
60%
The percent of the eligible population examined
on at least one occasion during the last four-year
period was:
Rongelap
Utirik
Comparison
95%
98%
90%
These figures do not include several persons
residing outside the Marshall Islands. Most exposed
persons in this category have medical examinations
arranged through a local physician by the
Department of Energy or the Marshall Islands
Medical Program.
The acceptance rate for mammography among
eligible women was 100%. For sigmoidoscopy,
about 75% of age-eligible persons elected to
undergo this procedure on a regular basis.
Overall Survival:
After 37 years there continues to be litle
difference between the survival curves of either the
high-exposure Rongelap group or the low exposure
Utirik group and the age- and gender-matched
unexposed Rongelap population selected in 1957
(Fig. 1). Estimates of the survival distribution by
the actuarial life table method were analyzed by the
Mantel-Cox and Breslow statistics for testing the
equality of the survival curves. The “p” values for
the two tests were 0.66 and 0.82, respectively, for
the Rongelap and Comparison group, and 0.43 and