District Centers. This training program was expanded under subsequent administrations of the Trust Territory and under the Republic of the Marshall Isiands. The Department of Heaith Services of the Trust Territory Government was responsible for heaith care in the Territory. In the Marshall Islands the District Medical Centers were under the Director of Health Services of the Trust Territory and, more recently, as part of the government of the Republic of the Marshall Islands. The hospitals at Majuro and Ebeye Islands are staffed with local practitioners and Micronesian nurses and technicians. At times, a few American physicians were on the staff. The local practitioner, with less formal education than an American M.D., by necessity learned to carry out medical responsibilities, including | major surgeries, remarkably well. In the Outer Islands, the dispensaries are manned by a health aide, often with limited training, and visits of the field-trip ships carrying medical supplies and personnel were often irregular because of poor communication with the District Centers. The health services have faced many problems in rendering health care in these islands. _ There have been serious epidemics of diseases, such as poliomyeiitis, influenza, chicken pox, and pertussis, which'were brought intothe islands.’ These epideinies wereparticularly severe with high mortality before there were effective immunizationprograma. There were epidemic and receives referrals from other areas. As part of the new College of Micronesia at Majuro, a School of Nursing has been established with a training program for health assis- tants to serve in the Outer Islands. difficult for Marshallese students to get into U.S. medical schools. Recently, a school was established at Pohnpei in the Caroline Islands for medical trainingof Micronesians, and efforts are being made to attract more young Marshallese into the field of medicine. Increased emphasis is being given to improvement of health care in the outlying atolls (B-8). Medical teams regularly visit these islands on the Canvaséback, a sailing vessel. In addition, a sailing vessel, the Tole Mour, furnished and outfitted with medicalfacilities by the Marimed Foundation, with a staff of volunteer medical personnel, also regularly visits the outer Marshall Islands. The operation of these ships is supported by the Marshall Island Government.In addition to general medical care, the visiting teams carry out dental treat- ment, inoculations, treatment of venereal dis- eases, and conduct educational programs on sanitation, family planning, and training of - midwives. Radio communication has improved _, andair strips Ravdbeen constructed on some islands, including Rengelap and Utirik, allow- -,, ing for emergency visits of medical personnel insufficient medical personneltohandle health. , and evacuation of patientsa . -- care, including widespread diabetes and dental. problems. One of the most serious problems has been population growth in these islands with limited habitable land. There has been continued improvementin health care in the Marshall Islands (B-8, 14-17). A new $8,000,000 multi-wing hospital, planned as a referral center for Micronesia, was opened at Majuro in 1986. The hospital has been oper- ated by Mercy International Health Services (a U.S. organization) under contract with the Marshallese government. The U.S. staffis being replaced with Marshallese medical personnel (B-14). The hospital has a rehabilitation center, which was begun in the 1960s following a polio "In 1963, poliomyelitis was introduced into the Islands by an infected saior from a visiting ship. A widespread epidemic occurred, with neariy two hundred cases of paraiys.s. IOCHIbS 14 : There remainsa vital shortage of trained medical personnel, particulariy doctors. Insufficient premedical education has madeit Considering theisolationof these:islands, travel problems, and shortage of trained medical personnel, in my opinion there has been . good progress in health care. However, there is still considerable need for improvement.