Chapter VI — The Medical Examinations A. Organization 1. Supporting Agencies In organizing and carrying out our medical mission in the Marsnall Islands, the assistance of many agencies, governmental and non-governmental, has been essential. Someof the key agencies include: a) Brookhaven National Laboratory (BNL) which has been the base of operations for planning and organizing the surveys under contract with the Division of Biology and Medicine of the | Department of Energy (DOE). b) The Department of Energy, formerly the Atomic Energy Commission (AEC), the Energy Research and Development Administration (ERDA), and the Offices of DOE at Nevada. Honolulu, New York. San Francisco, and Enewetak. c) The Department of Interior (DOI) and the Trust Territory of the Pacific Islands. The surveys were a joint project with the Marshall Island Department of Health Services of the Trust Territory. This collaboration has continued under the new administration of the Republic of the Marshail Islands (See Chapter IV). d) Department of Defense (DOD), particularly the Bureau of Medicine and Surgery of the Navyand its laboratories at the Naval Medical Research Institute. the Naval Radiological Defense Laboratory, and the Pear! Harbor Command: the Army Medical Center at Walter Reed and Tripler: the Armed Forces Special WeaponsProject/Defense Nuclear Agency; and the Army and Navy Commands at Kwajalein and Enewetak, which have furnished vital logistic support and have served as our advance bases in the Pacific. e) The Departmentof State, the National Institutes of Health, and the Radiation Effects Research Foundation in Japan. 2. Medical Participants in the Surveys We were most fortunate in obtaining outstanding physicians in many specialties and subspeciaities and technicians from the United States to participate in the examinations, including many who were experienced in radiation effects and also endocrinologists specializing in thyroid problems. They provided 18 20041649 extremely important diagnostic, therapeutic, and technical capabilities. Equally important has been the participation of a large numberof medical personnel (practitioners, technicians, health aides, and nurses) from the Heaith Services of the Marshall Islands, who contributed vitally in carrying out the examinations, in obtaining medical histories, and in acting as interpreters. The success of the program mainly has been due to the dedicated service of all of these participants. Appendix I lists the participants with their years of participation. 3. Supplies and Equipment Since the beginning of the examinations there have been changes and additions in medical equipment due to advancesin technology and to differences in medical approach. Blood counting by microscope has been supplemented with electronic counting and chemical analyses of the blood by electronic means. A mammography unit was added to the x-ray equipment. In 1957, a 21-ton steel room was constructed at BNL to measure internal radioactivity (described in Chapter VII). Some procedures were adapted to field conditions: for example, the Staining of blood smears and cei! culturing present special problems undertropical conditions. Getting together and packing the medical equipment, shipping numerousboxes to the Islands, and unpacking and setting up the examinations in the Islands are formidable tasks requiring considerable time and logistic planning. 4. Examination Facilities _ Early in the examinations tents were used on Rongelap and Utirik, which were gradually replaced with more permanentstructures. At Rongelap, sleeping quarters with adjacent shower and toilet were constructed, anda trailer was brought in for cooking and messing. The dispensary, school house, and council house were used for examinations. At Utirik, we acquired some butler-type buildings left over from the weather station, which were used for housing and examinations. Later, a new dispensary was constructed by the Trust Territory on the Island and was used for the examinations.