orrign BD
AlL tadsathon related discases
in the expesed and control
plus full gerecning of ahh inhabitants now
populations a
Islands contaminated by atomic faliour
ving (or scheduled fo be cepateivted tu) Marshall
livi
l.
Establish che broad objectives
with
As in Uptiuns A, B and © but
on and
added emphasis on earky detecti
diseases,
treatment of atl significance
fis option offers unequivecable
of the
vvidence of the crue cuncern
care of
Wos. for the comprehensive health
contaminated
islands
the
of
peoples
the
by the Cesting prograg.
m would
In addicion, such a proy,ra
more signiallow us to develop 4a much
ficant “health pevltle” of the
Marshallese to assist In the determination of patential radiarion
related pathological conditions.
il.
Constraints
TE,
Present levels of care
“ks in Options A, B and C - This option
exceeds Che mandates of our present proKram and would be impossible without
an appreelable dacreage in fund ng.
Translation
Restatement of refined
objeccives ja consideration
of restraincs.
As in Options A, B and C,
the regcatement of objectives
ExistingPolley
will be dependent upon:
peuples of Enadwetok and Bikini, Lt appears
that this option ts the one favored by
administrators of BOL and
DOE to carry through on the
As tn Options A, B aid C - In addition,
In light of che recene (Occ. 12, 1978)
DIE/DOL/DOD meering on the scatus of the
the Under Secretary of the Interior,
Me. Joveph.
txlating necds and demands
This optlon most closely mcets the needs
and demunds of the Marshallese people and
tietic leaders.
Projected needs and demands
slie thts optlon provides adequare
tealth care for all currentky and
elentiully involved Marshallese, it
eonid meet all projected needa and demands
Flinntny at other levels
Ay in Options A, B and C
trtsting facilirtoes
Aa In Options A, B and C - A major expansion
4 yatsting factiities would be necessary Lo
spurt 2 medical program more chan twice the
prement ef fork,
Tinian dal
A vott study would need to be dasciturced as
son as possible co determine the current and
‘lute costs of such a program (please sce
ac tie ¥ Setection Criteria) ~ under "Total
etm
is
ser (LY)
‘Sot Uptions A, B and C. - Please see Section
sAwilysts of “low for manpower cequirements,
a
I
i
l.
The definicions of the
tole (morol/fiscat) of the
statements of principal owe
at the Occ, 12, 1978 - DOL/DOE/
DOD meeting in Washingron, D.C.
concerning the status of the
peoples of Bikind and Entwecok,
2.
1 Cull health care respongfbility ts assumed - Optidn D
needs no restatement,
3.
Tf limtced beskeh care
responsibility Is the chotce ~some compromise between Ope fons
C and D is indicated,
lV.
V.
Analysis
Develop passible approaches ca
attaining the objectives, with
cach approach being stated La
terms oft
Selection Crireria
Set forth the criteria for che seleerion ot
un ape. et.
Research baacd upon ua sound primary ~ secondary care delivery
system wWlEl provide optimum care for each patient. The total
population of the Marshail Lstands Js about 22,000 people -
What:
Full directed date buse,
screening and follow-up of
pertinent findings in population
of these anly abour 2,000 would be completely covered by
Option D,
The remaining 20,000 would benefit preatly by
Who: With the expansion of che
patient popvlation, if would
the medfeai staff - working with the exincing Marshallese
medical officers and their staffs.
defined under "Objeccives”
be wise fo set up (2) field
medical teams; (A) the BNL-
acute exposure study team
(covering peoples of Rougelap ~
Ucirik) and (8) the "low level”
study group ~ under coatract ~
both supported by adequate-19 +24
care at Ebeye and Majuro.
Where:
As
in Option C.
When: Ag in Opeluns A,
& and C.
How:
As in Option C ~ plus
added munpower to support 2 field
teams plus at least 2 U.S.
trained physicians ac Majuro und
Ebeye -— supported by paramedical personnel, Physician
Assistauty amd mrse
pracctitf{oners,
the generai improvemenc in the quality of care az the
primary ceuters, ~ but thac wuld be a secondary goul of
Tatal cost
Really impossible to develop a reasonably accurate Figure.
However, based upon our present operating expenses (Option
C) wich a cumulative budget of about 1 miJlion the expanaton
tu Opcion B should cust about I te Lt million extra.
Fiowibtltey
This option glyes ua the greatest flexibllliy ia sthedutiny
examinations in the field, due to the increased on-sire
medical and transportation cesvourcesa.
Avoidince of untoward consequences
This opthon offecs the best proof of a sincere U.S. comalt~
ment to the people.
This should help greatly In improving the
{mage of U.S. in all of the media - U.S, as well a5 dutecuucional.
In addition, with the new "free association", the Marshaliese
might decide co £111 the primary medical care vacuum with Jupanes
physictuns (with the good posaibilicy chat tefe wing - wnti-
nucteae MB's might become entrenched ta Che Marshalls).
Risk
Least visk of all opelons - uniess commitment wos mude and
then not honored,
Cost /elfect tvencss
As in Options A,B and C.
Titi |
This is the optimum clme for daplemencing Option P - tor ceo
Yeasony: A) The movement toward “free assuciacion” has placed
the Marshall
Tslands
in a state of transition.
The revistons 11
the health care delivery systems could move along most smoothly
fn thts perdod of general and economic trunsltion,
Ae
+ time Ly now opcimum for DOR In Light of
ml Mirshullese statemencs of needa.
soe stayhle Population Characteristics
{Ja Uptlons A, Bo and C - The area to be
Sd WITi be much more than doubled by this
wor daa, Mijure as
*
Ujelany.
B) The people
of Bikint and Entwetok are demanding quick and decisive answers
to thele very iepitimate requests.