There is difficulty in communication with the people on ~~! ° the purpose of the annual examination for the detection of radiation-induced disease. The facilities available on both Rongelap and Utirik do not afford the opportunity for a good physician-patient relationship and, until this situation is improved, misunderstanding and mistrust by the people will continue. This was more evident when I visited the Marshall Islands with members of the Special Joint Committee in July 1972. The language barrier - increases the difficulty for both patient and examining physician as the physical examination is conducted. “4 , — .—s t+ fo bo, 4 | OBSERVATIONS RELATIVE TO THE TREATMENT OF PAST AND PRESENT DISEASES , In regard to the diagnosis and treatment of disease endemic to the Marshall Islands visited and not related to radiation, the methods for delivery of good health care are totally inadequate. The difficulty in transporting heavy diagnostic medical equipment ashore at Rongelap and Utirik precludes examination using, for example, modern x-ray machines. In view of this, consideration should be given to the procurement of a "hospital" ship with such equipment permanently installed. This method would also allow additional clinical examinations to be performed as well as treatment of surgical problems. Such a facility would afford visiting medical personnel clean living accomodations not now available. This method of delivery of good health care has been adopted and proven highly successful in other developing countries. 7 The medical record system observed is totally unsatisfactory. A medical record should be established for all persons, both exposed and non-exposed. That information pertinent to the - available for the visiting Medical Officers of the Trust Territory. An upgraded record of immunizations should be 7 | 2. 7 exposed population should be part of such a record and maintained to prevent outbreaks of diseases which could be prevented by early childhood immunizations. The tragic poliomyelitis epidemic of 1963-64 is an example of the necessity of such a program. Consideration should be given to the preparation of a document in Marshallese on the purpose of the annual — examination by the Brookhaven National Laboratory Medical 199 ml