o- ‘effective. | To’ supplement the program, a comprehensive companion effort by the Medical Division will be put into effect. This program will be directed towards education requested by the Marshallese to explain the most common pathologic conditions,e.g., Giabetes, high blood pressure, malnutrition and dental problems. their own priorities for these health education programs. Each island will set This will help the Marshal- lese understand the relative risk of exposure to radioactive material in perspective to their overall health status. Both programs will be carried out initially by Brookhaven National Laboratory personnel, the effects of radiation program will be taught by a member of the health physics team while the medical program will be carried out by a RN in conjunction with a MD. To be successful, however, the program must involve Marshallese as mich as possible, from the beginning. In fact, the program should eventually be run entirely by Marshallese, with BNL personnel serving only dn an advisory capacity. In essence, it must be a synthesis of two worlds and two frames of understanding. To bridge this cross cultural gap, Marshaliese with the required qualifications, a degree of science for the environmental aspect and for the medical programs local residents will be hired. In the latter case, the BNL Marshallese nurse practitioner will be available to avoid any cultural bias. The key liaison on each island will be the president of the women's club, the queen, the health aide and minister and the school teacher. Asthe medical program progresses, a health educator/RN or Medex (trained either in the US or Fiji) will be recruited for each island te work with the local resident to maintain the continuity of the program. Both programs will be constantly evaluated to ensure that they are culturally sound and realistic. Ultimately, the goal is to have a full-time Marshallese on each island responsible for the medical program who will be in touch with the environmental program as well. The primary importance of the health education program is realistic because medical problems are usually the first ones to be recognized with environmental problems being less clearly defined. Therefore, the environmental monitoring educator could restrict his/her presence tothe field visits while the health educator can cover for the environmental monitoring educator during the interim.