a EU el, we a ey) oe oe oe lo 5 i -- - dee over ce vanes A25ATS6535 ee ee 9. Establish better communication and transportation between islands to enhance health care delivery and facilitate movement of medicel staff, e.g., in case of need Methods of Procedure: ' A. History and physical examination. On each periodic examination (every 4 months), an interval history is obtained. The history is directed toward the signs and symptoms of those pathologic conditions most often associated with the specific radiation characteristics of this accident, e.g., thyroid enlargement, hypofunction, etc., or evidence of other neoplasia (breast, GI, GU, dermatologic). In addition, -demographic data is obtained to establish periods of residence on specific atolls and pedigrees. The history is obtained by a group of Marshallese from the Trust - Territory health care system, who have been an integral part of the _study for a ‘number of years. r 4 eePea Leerekee eeaae C. *APMP ea ty for medical evacuation from or medical care on remote islands.~ The physical examination is conducted by the professional staff of BNL and guest ; consultants. It-is a thorough, general physical examination with special attentio2z to palpation of the thyroid and careful screening examination of other areas at in-— creased risk, e.g., careful breast examination, henoceult exanination of stools, etc. A year ago, a female OB-Gyn specialist began to accompany the team. Her presence has “greatly strengthened the acceptance of the program by the Marshallese (a matriarchal society) and has uncovered a significant emount of pathology. These patients have been referred to the TT health care system or treated and/or referred by the BNL team to other referral sites. Yearly electrocardiograms are obtained on individuals ¢are 40 or older and on selected younger patients. A 14xl7 P-A x ray of the chest is obtained about every two years on individuals age 40 and older and on younger indivi- . duals as indicated by-smoking history and/or signs and symptoms of pulmonary pathology Thyroid palpation is performed by recognized thyroidologists. Im the event of any questionable findings on thyroid examination, at least one other confirmatory exanin— ation is performed by another qualified member of the team. If a mass is discovered, the patient is requested to assemble at a central point and our surgeon (consultant, currently Dr. Brown Dobyns, Case Western Reserve) examines all pathologic findings prior to referral to BNL for work-up and to Cleveland for surgery. B. Biochemical and Hematological xamination. The biochemical samples are collected by experienced laboratory personnel. Four smears are made for differential and a WBC, RBC, Hct, and platelets are obtained. Utilizing a J.T. Baker Instrumentation Division MK-40 for the WBC, RBC, Hgb and Het, About 15 ml of whole blood is dram for an MK-4-HC is used for. platelet counting. determination by Dr. P. R. Larsen of Peter Bent Brigham Hospital and for isolucine studies by Dr. Popp. TSH oe Periodic 2-hour PC blood sugars are drawn annually from known diabetics and A dip-stick urinalysis is performed, using periodically from the entire study group. the Labstik (Ames) C. (pH, sugar, acetone, blood and protein). Health/Patient Education A program of primary preventive medicine has been introduced by the This program Marshallese nurse practitioner working with the rest of the staff. diabetes, obesity, for programs includes basic nutritional counselling and special request) (on information alcoholism, hypertension, smoking cessation, birth control These programs are in early developaent and continuous evaluntioa of and child cere. SO. | . :