rr
reports to the Health Services of the Govern-

ment of the Republic of the Marshall Islands on
public health matters identified by the Brookhaven medical teams. In 1983-1984 these public
health reports included information concerning
the prevalence of hepatitis B, the growth of
Marshallese children, tuberculin skin-test positivity, a survey forsyphilisin young adults, and
the prevalence of anemia in Marshallese children. It was a related investigation, which
identified high levels of fecal contamination of
well water on Rongelap and Utirik, that led to
the construction of a large concrete cistern on
each of the twoatolls. This was a joint effort of
the Departmentof Energy Pacific Area Support
Office and the Government of the Republic of
the Marshall Islands. The contents of the public
health reports are always presented to the
Marshallese communities at the time of the
“town meetings” which precede each medical
examination session on the atolls visited by the
medical team.

Exposure Groups
As in recent years, the medical program
continues to examine and treat some 1200 to
1400 persons annually, half of whom are children. For purposes of comparison, however, the
exposure groups defined in the last Brookhaven
National Laboratory report are the same as
those from whichthe statistics herein have been
collected (Adams et al. 1984b). They are de
scribed below:
Rongelap

Now numbering 50, this group received an

estimated 190 rads of absorbed external gamma
radiation. Of the 67 persons originally exposed
in 1954, 3 were in utero.
Ailingnae
Nineteen persons, including 1 in utero,
received an estimated 110 rads of absorbed
external gamma radiation. Twelve persons are
now in this group.

Utirik
One hundred twelve persons are currently
alive in this group. The original 167 individuals
who were exposed, including 8 in utero, received

an estimated absorbed external gamma radiation dose of 11 rads.

Comparison
In 1957, 86 unexposed Rongelap persons were
individually matched by age and sex with the
combined exposed Rongelap and Ailingnae
groups (Conard et al. 1958). Sixty persons
remain in this matched group, against which
the overall survival of the exposed population is
compared (Figure 1).
A second, larger unexposed group continues
to be followed. Currently numbering 135, the
age and sex distributions of its members are
statistically similar to those of the combined
Rongelap-Ailingnae groups and the Utirik
group (Adams et al. 1984b). It is this larger
unexposed population that is used for the
statistical comparison of year-by-year medical
events and that provides baseline prevalences
from which unexpected consequences of the
radiation exposure of persons from Rongelap
and Utirik can be identified. .
Unless otherwise specified, the term Rongelap, when referring to the high-exposure group,
combines those who were on Rongelap and
those who were on Ailingnae at the time of
exposure.

The Brookhaven Medical Program
Under Public Law 95-134, the Departmentof
Energy has a contract with the Brookhaven

National Laboratory Medical Department to

provide for diagnosis and treatment of radiation-related disease among the exposed populations of Rongelap and Utirik. Although
considerable effort is spent on the care of acute
and chronic illnessesof any etiology, a program
is in place which is oriented toward the problems posed by their 1954 radiation exposure.

The exposed population must be considered at
increased risk for malignant disease (Wakabayashi et al. 1983), and chief among the
responsibilities of an ongoing program is a
cancer-related evaluation. There may be
additional risks unrelated to malignancy. The
current strategy of the medical program is
outlined below.
1. Acancer-related examinationis provided,
using as a guide the current recommendations

we

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