OPTION B
n-relsted diseases plus the care
Theu deteetion and treatment of radtactio
found to
and tvilow-up of patients fn the Ixposed and Control Groups
have non+radyaucion relaced dlovdous
lL.
Establish the ideal objectives.
A.
Screening for rad{ation-related
A
pathologic conditions as in Option
- plus additional screening for age
diseases.
apd sex correlated high risk
BR
Treatment as in Gption A for
ridiation-related diseases.
LLL. Translation
Ti Constraints
For all
ry
other diseases change "tertia
ry
care ceater to primary oF seconda
caré center, as available.
Follow-up (as {on Option A)
Cc.
primary or
~ Change tertiary care to
le.
secondary cure, gs avallab
Present levels of care
~"Slyceaing:
a8 In Option A - plus, need co develop
“rok cables" (age and sex specific) to expand tie
gcrceulng data base.
The relative improvement in
recent health “statistics” should be of some
asutatance. Treatwenc: (1)(7)(9)(10)(11) plus
tnereosed logistic requiremenra of added care.
in consideration of restraints.
each approach being stated in
As in Option A - The increased
patience care demanded by Option B
What:
terms of:
Ag lu Option A = plug
selected "risk hazard appraisal"
acreening, care and follow-up.
a
Selection Critecta
Set forth the criterta for the selection of am appeeach:
Performunce or reaults
As in Option A - However, Lhe section on radiation related diseases will amesct
to be expanded co include chose age and sex specific general mdical problems
hoc currently assocfated with radiacion.
The methodology of KoLbins and Hall
will be used co determine what specific historical, physical, und Jeboratory
Findings would be most sensitive and specifte co detect the mest prevalence
diseawes (age and sua-determined, c.g., we wild not luok Cor Lorem y
Fo) lue-up: As in Option A - plus increased
Yoylutic wand manpower required for care.
Since the lacrease ia directly
related to primary patient care
Who;
Euleting Policy
As in Option A - plus current operacing proceduras already includes thia added group and
athena.
ponsibllity, perhaps some Inter
agency agreemeot with DOT could
be reached to provide thia supplement.
In addition, if, under the
active commitment.
atherosclerosis ln young fewules, evidence for alcoholisa will be songhe in
young und old mates, etc,),
Where;
Total
kadeting needs and demands
Kwajalein toxea are to paid directly
cure Jaavident to many Marahallese.
They are
surceutly and have biscorically, demanded
ether cite,
portion might be diverted co grimary medical care under a DUU/Kwa)-
Au in Uption A - The need for better primary
Propectid needs and demands
Au ja Uption A > plug an ever increasing base
popul-tlen - erude geoweh rare 3% ~ better pri-
mary sedicul cape will probably reduce mortality
reoutitag fu increasing population.
Many Marshallese
arg wting for birch control education,
Plansiay at other Levels
Aa sa Option A = Plus significant decrease in
abesegp maper T.T. support of medical care due
tu vote tor “free association”.
Pedeeing Pacdiicies
Aw 1. Uption A - plus the increased load of
futttor patlent care would strain the existing
facbbitivs resulting in severely diminishing returns
[ue +sh beslih dollar (below minimum “eritical Mase").
bh + cots (ECS) C6) {7)€8)
The added screening costs
will %s 2sanl) inctement in the existing screening
plectss The added pelmary and secondary cure and
{olla - both short/long term may be a aignifificant
(See facilities cost
the dis wasn atte tol and chere prevlance).
anount (dependent upon
as well).
ett f cugperation wil) hopefully improve compl tance
dia
~
A
n
Optio
in
Manpower: (13) As
alos: requirements cun be handted by better
The iu Cra bue t #
Tang quality of dateay.
Fees (ar Ajst, og nurse praccitioner.
wer, add fay ome
utilization of manpo
tie tool oon cage should raise credibilicy of DOE/DOI.
er,
Ilowev
~
A
AS in Option
Timing:
teh oe procedures!
w
This option 4s stil} belo
dath‘elu Uptiva A - but with « reduction in covert
Pemopraphic Popu Locion Chart t
Y ,oedenumler care, scfiil below, currear
tion.
hoseLbity + increased coopera
operating palictes.
mt
attaining the objectives, with
will require a slight increase in
manpower and logistics (Funding).
V.
Analysis
iv.
Develop possible approaches tu
Restatement of refined objectives
and {s, therefore, nat DOE's res-
“Cros association” agreemenc che DODto the Marshall Islands, some fixed
Marshall tsland Government agreement -
As in Option A - BNL is
currently excceding Option B in its
Screening, care and
follow-up of exposed and control
groups wherever ve can locate
then.
When: Ags in Option A ~ plus
regulac intermittene visits
{every 2'5 months) Eor follow
up Of nun-radiaclon related
problems (already being done).
How:
We would, uctually, need
to cuc back on our present
commitments to comply with
Option 8, e.g., we have aiready
puc almost oll of the people
formerly on BLlkini through che
entire scresuing procedure.
As in Option A -but we cun cancel out che specific education program
(explaining che cut in services).
The various cost trade-offs have been
discussed in che previous sections of thls option. We mur keep in mind
That this option is acil) below our present commitment.
Flexibility
There is Increased fleathility with this opefon,
We feel che #NL team
Stationed at Ebeye could handle thts additonal Josd without prubtemsy in Fact, it would enrich their practice and provide some vetcome warloty.
Avatdance of untoward consequences
The added flexibiiley and commitment of the DOE/BNL cess shauld enhance ar
shaky credibilicy and yenerace true gratitude among sume ot the Murtnalles
The critical point ia never to promise more chan you can
dviiver.
The
ceedibility pap may be partially putched by saying "To dun'c knaw” more
feequentky and by forwarding all pertinence daca on to facsrested Marshalle
as soon as if 1s avalluble.
Risk
The riska to DOE/BNL are Lesa than with Option A - However, Lhis level on
effore is below the current program and will cause some adverse reaction
(publicity, cooperation, erc.}.
The ciska co the Marshallese are thac a great deal of potentially treatabl-
disease will be excluded From our atteatlun by this optiay,
Costfeffectiveness
As in Option A
Timing
As in Option A - The increased population would nor appeectably change our
existing schedyle.