rc 5 in the United States, meluding endociinalogists, cardiologise, hemiatalagists, internists, surgeons, ophthalmologists, and parasitologists (see Appendix 2). Vhe varietyofspecialists indicates the diversity of the examinations conducted over the years. Vhe BNL group bas been fortunate in maintinting aclose liaison with the Atomic Borb Casually Cominission in Japan. and several physicians formerly associated wah it have participated in our surveys. We have a'so had a close relatiatship with the people studying the Japanese fishes men esposed to the Bravo fallouty ia 146d exchange Visits were arianged for Dr. Rammator and the auther to attend saisess both af these fisheries and al the MLarshallese In May 10S 8 upon completion af the initial exAminations (conducted at Kwajalein). the 82 Rongelap people. because: of the contamination of their home islands, were mised tu: Majurea Atoll and they were examined there in September 1954 and in March 1999. 1990, and 1997. Vhev ree turned to Rongelap. tative ina newly built villages in July 1957, ater radiological surveys bad shown the ishund to be sate for habitation. Phe 137 Ctirik people were taken bameafter the inital ex- people every 6 months. At that time also diffi- culties were encountered in maintaining a strict thyroid treatment program in the exposed Rongelap people, with potential serious results, par- ucularty in the people who had had thyroid surgery. Uhe decision was therefore made to place «resident physician inthe Marshall Islands to keep check on the treatment program and assist the Vrust Verritury in general health care ui the Rongelap and Curik peaple. ‘Vhe medical findings on the Marshallese have heen pubblshed in numerous BNL. reports and journal articdes2°44 Someproblems have been encountered in carry: ing out the medical surveys in the islands. Careful contaminated and was considered sate for habitatien, The 28 inilitary perounel exposed on Ron- planning is required for all necessary equipment and supplies to be on hand at the remote location. and procedures must be adapted tu field condiGuns with proper clectronic support. Sume technical procedures such as staining of blood smears andcell cultures present problems under tropical. busnid conditions. Providing adequate transportation has been a major dilhiculty. While the Nav furnished LST's and amphibious planes, problems were minimal, but for most of the surveys we have had to rely on cargo ships chartered by the Trust ‘Territory, and these have sometimes proved unreRable in meeting schedules or hazardous because gerik Mtollwere take te Popler Anny blospital for of faulty life-saving devices and inadequate navi- aminations. since their istund was anty shighth further examinations. Following the doitiaal acure eHeets of radiation on the Rongelap people. Che ex inatiens over the neat venue rescued tow siauificant ands. Aninciease in iiscariages and stillbirths among the exposed woren during the firstyear was thought ta be relited .o cadsation exposure, but general health aod disease mneidence in Ue exposed people were about the sane asda the anes posed Rongelap people whe had returned from other is. Lands and served as a comparison population, Dur Ing this uneventful period, suggestions were a1ade lor reducing che scope or fequeney af the survevs. but these were never scomusthy considered: since it was tealizedd that lithe is hooa about the bate ef fects of radiation on hatians and clfeets aight still appear. Tn 1965 the unespected ape srance of growth retardation in some children and of thyroid abnormalities billy pustitied this reasoning. In L972 a Case af fatal acute ais cloucnous leukemia devel oped ina Ebyear-eold exposed Reongelip bow, taibeatiog the need far sdditiomal surveilince. The survess theretore were expanded to inclide A hematological check wa the exposed Rongelip gahonal equipment. Once the survey teant was lostaat sea dor more than a day trsing to find anisland. and twice ships ran aground on reefs. Smallboat Gavel in rough waters was hazardous; the tip trom ship te hore wa sometimes in Outage? canoes and might result in wet passengers and bawgage. Vo overcome these problems, an LOU was recently acquired for carrying out the VEC. sponsored radiological and medical surveys in the Marshall Islands. Other problems included the follawing: The language barrier hampered communication with the people. even though a limited number of reable Baghsh-speaking people were usally avail able. Vhe lack of adequate vital statistics resulted In uncertainty in the caact age of many of the people: and medical records were poorly kept. particular inthe outer islands (e.g.. the health aide would often give the cause of death as “too old) Tt was dilficult to obtain consent for ana topsy. even at district medical centers, because of lechinugs sgadast mutibition af the bode after death. Soyof the subjects thought that drawing blood made thea tech weak: and same questioned the