Brookhaven program could help solve those needs, and the statcd goals of the program and how it thinks it should interface with the people. The people seemed to universally feel that in the past their opinions have not been understood or taken seriously for discussion. This report will attempt to clarify the expectations of both sides such that a better understanding can be reached. Iii. Philosophy of Program in Past The medical surveillence program as conducted by Brookhaven is a research oriented program. Its goal is to focus on the narrow subject of what are the late radiation effects in the exposed Marshallese people. The program has compiled notable results and the reader is referred to the recently published twenty year report. Under closer analysis, however, the program is even more limited in its objectives. In 1954 following the accident, the knowledge of radiation effects on man was markedly limited. Thus, the original purpose possible effects various sources should be found of the program was to be as broad as possible to discaver all known and unknown. Over the years, however, data frora and opinions of experts have assessed what long term eitects in the people. Thus, now the program seems to operate in a mode of looking for those effects predicted by experts in the field of radiation medicine. It is the original goal of a broad general program that the people have come to understand and expect to happen. They have heard scientists tell them over the yéars that the long term effects of fallout exposure are unknown and the program wants to determine what will occur. They see this goal being achieved by a qeneral but comprehensive nragram that assesses and treats all their health needs as well as the needs of their descendents. It would be so complete a program that the slightest change would be detected and assessed for its value. The program, however, does not see the need for such a general health evaluation program. Rather, it tends to focus on specific areas, such as the thyroid and blood, where the scientists expect effects to occur. it is the very narrowness of the program that the people have picked up on and have caused them to have disagreement with the program. The program as presently directed would function well in any sophisticated health oriented nation where a variety of medical care systems could be used to provide care for the general health care needs of the people not covered in the research program. Inthe Marshall Islands, however, the program operates ina virtual medical vacuum. The people on the islands of Rongelap and Utirik see more of the Brookhaven medical team in one week than any other medical personnel ina year. The philosophy of Dr. Conard and the Energy Research and Development Administration is that the Brookhaven research program should not be concerned with the general health care needs of the people except to assist local government programs. The general health care needs are said by both parties to be the full responsibility of the Trust Territory and Department of Interior, despite knowledge that neither has a workable plan for delivering health care to any of the outer islands such as Rongelap or Utirik. Some general health clinics have been conducted by the survey teams but not to the extent desired by the people lo meet their needs. tose 90113589 ‘The people also perceive