PRATT, HUGH S. 125-14-6535 ~ Support problems are complex. been slow and uncertain.* : Communication, by radio, training of support personnel. logistics of the program. D. Personnel Travel between the islands by a variety of .ships has ee is also uncertain due to inadequate equipment and Both of thesé problems have a serious impact on the . : ‘ . : Over the past 5 years, BNL has established a staff in the Marshalls, headed . by a resident physician. This position, in particular, has been difficult to fill with competent professionals willing to make a significant time commitment (2 or more years). It is anticipated this problem will continue. A’ strong support system must be established, due to high physician turnover, or “there will be little or no con— tinuity of patient care. _. , ta oe Because of the unique nature of the study group and the communications problems which have evolved, it is felt that, asmuch as possible, these support personnel should be Marshallese. The present Marshallese nurse-practitioner has provided valuable insight into Marshallese customs and attitudes to the scientific team. She has also been an effective educator/change agent for the study group. Since one goal of this project is to place the radiation accident in perspective with other factors impinging .anindividual.health and well-being, a- credible, resident staff is-essentia _The staff must be able -to communicate freely from a commoncultural base for maxinun effectiveness. The BNL team should be prepared to support them with technical expertise, supplies and equipment, but the Marshallese must accept responsibility for changing their own life styles and maintaining their own health, as much as possibleE. . BNL. Financial 1) Funding for the program.is split between the DOE office in Honolulu and This division makes it difficult for the P.I. to maintain close chronologic surveillance on the expenditures (i.e., actual vs. predicted) to allow him to re~" establish priorities in light of unexpected changes in available funds. sO F. cussed. Cultural/Sociologic 1) ee oo, . Many of the cultural/sociologic limitations have been previously dis— In addition, the Marshallese are not "time-oriented” people. This orienta— tion has presented significant problems in generating a chronologic narrative con— cerniag history of morbidity, etc. The medical team must re-orient their schedules to the Marshallese concepts. . 2) There is a large cultural (communication) gap between the Marshallese and the scientific group. This gap must be kept in mind constantly to reduce nis- ~ understanding and to ensure the credibility of the study. The study should place as many qualified M } arshallese as possible in key field positions to enhance communication G. Tentative Schedule ; my May-June,1979 Field Trip - concentrating on a full pediatric survey (Dr. M. P. Sullivan, Professor of Pediatrics, University of Texas Graduate School of Biomedical Sctences, 4D. Autersoa Hospital and Tuuer Instltute). In addition, Dr. J. Robbias, Ciiet of PnGot sinolovy, NIE, will accompany; Des. Peate and Conard to review the elevea naw nodules Lowad on thes January-February 1979 survey’and to check a number of suspicious