Chapter IV — Health Care in the Marshall Islands 'n July 1947, the United States Navv assumed aamuinistration of the Trust Territory or the Pacific Islands with headquarters in Hawaii (B-4). The Navy’s Bureau of Medicine and Surgery sent survey teams into the islands of Micronesia to assess the health status of the people; they found that malnutrition was widespread. Sanitation, health care, and treatment of diseases were usuaily primitive and there was a vital shortage of trained medicai personnel. The health conditions in the islands were gtaphically described in the comprenensive reports of a remarkable voyage of the USS Whidbey \B-5, A-1). The Navy outfitted this ship with a medical staff and clinical and laboratory facilities. The ship visited many islands in Micronesia, including the Marshall Islands. documenting vital statistics and incidence of disease. Briefly, the surveys showed that unsanitary conditions with regard to flies. garbage disposal, and excretory habits made for multiple intestinal parasitic infestations and diseases. A high percentage of people had positive Kahn tests associated with yaws., for which treatment with penicillin proved extremely effective. Diseases of the eyes and skin, acute and chronic respiratory diseases, and vitamin deficiencies were especially common. Poor oral hygiene resulted in widespread caries and loss of teeth, even in young adults. No malaria, filariasis, yellow fever, or cholera were seen. Manyof the heaith problemsnoted in the Whideby report were present in the Marshallese people when we began our examinations in. 1954. (See Table 2 for a list of major medical findings in the Marshallese population on one of our early surveys.) The Navy knew that improvement in the heaith care system in Micronesia was a formidable undertaking. Paramountwasthe critical ‘shortage of trained medical personnel. Schools were established at Guam for training medical and dental practitioners, nurses, and technicians. Training of health aides to run the Outer Isiand dispensaries was undertaken at the Table 2 Major Diagnoses wee roms oe bie LL trun. fine . and eee . 2 aw sta Fhepsinide haewee OTe She tat one Perld Cuba , Diagnosis - 26 i ue I pnaee Hon pels: - Fy | ral b oe on® Ter NOMate! Aye Besential Dypertens1as 3. odeue wag % Arterjoscierotic heart disease” . Gast% as *. Cerebral arteriosclerosis Bronchiectasis Emphysems Cancer Tertiary syphilis Primary yaws Pulmonary tuberculosis G.I. parasites Congenital abnormalities (all types) Asthma Osteoarthritis Rheumatic heart disease Total examined*** Am : ae Béeeotig?: i y * ‘No. of Cases % iy 1h wt 3 1 1 8 7 = 7 8 1 1 ! 1 1 7 95 "Defined as systolic 140 mm Hg or diastolic 100 mm Hg. **Orbital tumor, type unknown; basal ceil skin carcinoma. ***Adults and children 13 SO0uI by