tugh S. Pract, M.D. September 6, 1979 Page 5 for followup observat ton or casts without therapy and without the opportunity s least, continua is not acceptable medical practice. AC the vety ; siasm of partictpan’s an restrictions could adversely affect the enthu program. (3) The P yee ee a such of eritically impair the effectiveness are currently i eq are ment treat factlitics available for diagnosis and rn relatively smal the to to deliver comprehensive medical care even be the critica of individuals we are now serving. These might well The trae oe am. progr the deterrant to a significant expansion of Lighted ore ed d, dimly tione Majuro and Ebeye are inappropriately parti equipped for their purposes. They, as well as the shipboard | ac ficient currently availablefor outer island tours, are simply insuf present or anticipated needs. tenes ive Perhaps serious consideration should ° ser e given 4 aine to a consolidation: the marginal or inadequate facilities currently maint e mobil ged enlar an by ced repla be well on several different islands could . facility that could be used at all the islands, including Majuro and Ebeye d be shoul ied ship ely modif priat appro The initial financial outlay for an balanced eventually by savings in transportation and maintenance costs, more e efficient use of personnel, and by obviating the need to transport Marshalles make ). would It iable means n unrel by n patients to examinatio centers (ofte virtually every atoll and island accessible to the biomedical team and would provide an identity not necessarily comparable to the S.S. HOPE but nonetheless effective. Currently, there is an extensive reduplication of fragmentary medical efforts in Micronesia. Facilities of varying capabilities are staffed by personnel to the dual missions of biomedical teams; i.e., the provision of continuous general medical care and the detection and scientific investigation of radiation related clinical problems as they may emerge. This duality of purpose should be emphasized both in the planning and staffing of future surveys. Finally, I would like to address a point that, as physicians concerned with the health of welfare of people, we cannot ignore. Recently, Rissa Bernstein, the Peace Corp health representative on Ebeye, passed through Los Angeles on leave - and discussed some of the problems she had encountered. In the two weeks prior to her departure, she was aware of four suicide attempts on Ebeye, all in teenagers, two of which were successful. The primary medical problems in the Marshallese are clearly not radiation related; they are dental, alcoholism and suicide, the latter constituting the leading cource of death in young Micronesian. men. COMSE The sociological effects of outside influences (not necessarily American , but in large part) on the Micronesian cultures have been profound . They Should be recognized and, if possible, remedied - not by pouring in more a VU . nO with how much more effective these efforts would be if consolidated toward their common purposes. A serious shipboard facility could serve as a focal point for such a consolidation, and personnel who currently provide individual medical care in one form or another could be more effective if incorporated into the team. It will become progressively mcre important, however, to define clearly the roles of participants and how they are expected to contribute ae from Trust Territories, Peace Corps, military, Micronesian, medical evangelist organizations and others besides our own. One cannot help but be impressed