Consequently, the BNL medical team has become the de facto primary health care provider to an ever-expanding group of Marshallese. The rationale of the Marshallese in the BNL program for their claim to the "right for all medical care" is their association of practically all illness with radiation. 3. The BNL medical team, becauce of its frequent surveys has, in the eyes of the Marshallese, come to represent the U.S. "presence" in the islands. The BNL Medical Program has, therefore, become the target of many attacks directed towards the United States agencies responsible for other programs in the Marshall Islands. These unwarranted attacks have, on several occasions, seriously compromised the goals of the Medical Program. Two major problems of health care delivery for all of the Marshallese involve: (a) communications, and (b) transportation. To the best of our knowledge, these problems have not been addressed independently as health care problems. DISCUSSION With the rapid growth of the medical program and the development of this matrix of compounding variables, Dr. Burr and Dr. Wyzen requested a position paper that would outline for DOE the alternatives for the support of a study of radiation-related injuries in the Marshall Islands. These options should include a wide spectrum of alternative programs, keeping in mind the inextricable interrelationship between BNL screening and the health of the people of the Marshall Islands. We feel a failure to deal effectively, in sone way, with the primary care requirements of the people will lead to further ill will, failure to comply with the research protocol (e.g., finally, thyroid therapy), and, litigation and a call to foreign and national antinuclear groups to witness the "mistreatment" of the Marshallese by the U.S. government. Since primary medical care is clearly not the mandate of the DOE, perhaps some