ChapterIX — Problems in the Aftermath of the Accident A. Background Several problems that affected the Brookhaven Medical Program developed in the aftermath of the accidental exposureof the Marshallese people to fallout. The background for these problems is complex and,I believe, related not only to the effects of the accident. - but indirectly to the socio-economic and political upheaval brought about by the U.S. administration. In carrying out the United Nations mandate to promote the developmentof the inhabitants of the Trust Territory toward self-government and seif-sufficiency, the Government of the Trust Territory of the Pacific Islands faced many problems. I mention some of these problems as backgroundfor the developments that affected the medical examinations (B-34.39.40). The Trust Territory Government was faced with the complicated task of governing about 1100 small islands scattered in a large ocean area about the size of the United States. often with inadequate travel facilities. Many popuiations with different cultures and different languages wereinvolved. Some problems were related ta the‘strategic’ nature of the Trust, with the overriding U.S. military interests such as the nuclear testingprogram, Pacific Missile:.Rangein the Marshall Islends, and milffary : bases in the Marianas Islands.Other problems. were reiated to the difficulty of getting trained ° personnel to work in this isolated area of the world; the turnover of personnel with changing Presidential administrations (the High Commissioner with Ambassadorial rank was a political appointment); demands for war claims and compensations related to the nuclear test-— ing program:difficulties in orienting the people toward self-sufficiency; increasing needs for expanded budgets; and political problems related to the development of independenceof the various Micronesian groups. The Trust Territory administration brought with it U.S. jobs. People flocked to the district centers. In the Marshall Islands, people from the outlying islands came to Majurofor government jobs and to Ebeye (near Kwajalein Island) to work for the Pacific Missile Range. The Outer Island population shifted toward more children and old people, which was aggravated by the 36 souls t population explosion taking place. Thelure of the district centers at Ebeye and Majuro with bright lights, night life and opportunities for employment wasirresistible to many. They acquired a taste for Western items such as beer, cigarettes, soda pop, canned goods, and other commodities in short supply in the Outer Islands (B-34,39,75). The influx of people resulted in overcrowded living conditions on this small island. The situ- ation was not as bad at Majuro as at Ebeye where the population increased from about 3000 to about 7000 in a few years and slum-like con- ditions soon developed. as relatives moved there to live with the working members of the family. Sanitary conditions became unsatisfactory and diseases such as influenza, pertussis, and poliomyelitis occurred in epidemic proportions. The hospital at Ebeye was often unable to handle such situations adequately. The good lifestyle of the Americans at nearby Kwajalein was in sharp contrast to the life on nearby Ebeye. The Marshallese were not allowed to live on Kwajalein nor use many of the facilities. The Situation brought aboutcriticisms of the U.S. authorities, by the Marshallese and athers; Recently, there hasbeen marked improvement in the conditions at Ebeye:-: As pointedout, during our examinations we found that therewere increasing numbers of| Rongelap and Utirik peapleta.be examined at Majuro and Ebeye which necessitated extending our medical facilities to include examination and laboratorytrailers adjacent to the hospi- tals. The increasing dependence of the Micronesianson the U.S. economyresulted in loss of self-sufficiency and lack of development of their own natural resources (B-34,35). Copra production lagged and fishing was low (B-40,75). There were increasing criticisms that the Governmentauthorities had not adequately promoted education and self-sufficiency in the people (B-24, 34, 40, 45) and the United Nations Trusteeship Council became morecritical of the Trust Territory, as stated in their Report of the United Nations Visiting Mission to the Trust Territory of the Pacific islands in 1976 (B-43).