Dr. Robert A. Conard 3 November 22, 1976 There is one point which T did neglect to mention earlier in my letter. IT asked Dr. Tsuno what he felt would be the most effective means of restoring the confidence and trust of the involved individuals in the Marshall Islands. He said that a great deal more individual attention, particularly in regard to minor day-by-day problems, is the real solution to the problem. I then mentioned that the immediate problem is to again reestablish their cooperation in participation in the medical program. He was unable to come up with any additional suggestions, I'm afraid that there is no good solution to your problems through the medical channels in Nagasaki. My guess is that Dr. Kumatori will have some reluctance to become involved in the problem, but even if he does agree to write the letter which you would like to have UI have some reservations as to its effectiveness. It seems to me that the strong element of fear and the political forces that work finally had a very damaging effect. I'm afraid that any suggestions that I might have would either be impractical or too expensive. Furthermore, they might not be effective, but I will mention a few ideas that have come to mind. Perhaps wide dissemination of information concerning the late medical effects in Hiroshima and Nagasaki for those individuals who have had similar radiation doses might be reassuring. I would guess that the number of excess deaths that we have had in the dose range of individuals with whom you would be concerned would be negligible. I am uncertain as to just how you might distribute such information, but Iam sure that there are ways. Another suggestion might be to solicit the cooperation of the University of Hawaii Medical School through its program of training paramedical individuals for the Micronesian Islands. The dean of the Medical School is Dr. Terence Rogers, who is a good friend of mine, and he has told me much about their program. On some of the islands they have very well organized medical programs and on some of the other islands there are physicians who have been there for a number of years. In the dean's office at the Medical School there also is a British doctor who is in constant communication with the islanders and has worked with them for many years. It is quite possible that a medical or paramedical team could be organized to either intermittently or continuously monitor the health of the individuals with whom you are concerned. It is quite possible that Terry Rogers and his staff might have some other worthwhile suggestions to make. Even an organized team approach from the University of Hawaii Medical School might be effective, since they have invested so much in the medical care of the islanders. Another possible approach might be to have a small radiation effect trained paramedical team available for continuous follow-up medical care for these individuals. I know that there are many other possible approaches to your problems such as sending an independently sponsored medical team from Japan, or solicitation of the help of favorable political groups in