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.