siderable number of unexposed persons.Al] the inhabitants of Rongelap. Mejato. and Utirik are eligible for medical attention at the time of the team visits to those islands. Team physicians need not be aware of the status of radiation exposure of the individual patient because health care delivery is the same for everyone. The only difference allotted to the exposed population is a U.S. Departmentof Energy-sponsored referral system to the Marshallese health care system or to tertiary carefacilities in the United States for diseases that can reasonably be considered to be radiation-related or for diagnosis of such diseases. Unexposed persons are directed into the referrai channels of the Health Services of the Republic of the Marshall Islands whereby referrals are assigned on the basis of priorities set by a medical committee in Majuro. Any exposed person who has. or who might have. a malignant neoplasm. is referred to secondary or tertiary medical facilities for a definitive evajuation and for therapyif a lesion 1s found. The usual hospitals to which patients are referred are in Honolulu and Cleveland.the latter because of the presence there of a preeminent thyroid surgeon who has long been involved with the exposed and Comparison groups of Marshallese. The medical program aiso dispenses primary medical care and preventive medical services, such as immunizations, during visits to the exposed population. In bringing modern facilities for diagnosis and treatment of disease to the exposed Marshallese. the physicians of the medical program comeinto contact with children and other family members of the exposed. as well as other inhabitants of the tslands. It has been the policy of the Department of Energy to support the medical programin its efforts to provide primary medical care to these individuals on the basis of humanitarian need and as resources permit. The medical direction of the Marshall Islands Medical Program and the organization of the medical missions to the Marshall Islands are centered at Brookhaven National Laboratory. The staff of the program includes a physiciandirector. an administrator. and a technical speclalist at the Laboratory, and a Marshallese laboratory technician on Ebeye. At the time of the missions a variety of physicians are chosen for the medical team. They are skilled volun- I004 102 teers. primarily faculty from medical schools, often with past exp.rience with the program. Logistical support is provided by the Department of Energy, capably facilitated by Holmes and Narver. [nc.. Honolulu. HI. The Marshall Islands government. as requested. temporarily assigns nurses. translators, and other health care workers to each mission. Although there are two medical missions each year. in the interim the exposed population has access to the Marshallese health care system. To expedite exchange of medical information, copies of all examination and laboratory data from the Marshall Islands Medical Program are forwarded to the Marshall Islands Health Service hospitals on Ebeve and Majuro and to the special programsset up for persons from the radiation-affected atolls, currently the 177 Health Care Plan with administrative offices at the Majuro hospital. In addition. copies of the examinations and laboratory data are given to the examinees. . A computer program with data base was developed for portable (lap-top) computers. Computerization of the clinical data permits rapid access while in the field to all findings obtained during the preceding five years of examinations and to selected data collected over more thanthirty years. It is hoped that in the near future the development of compatible programs by the Marshallese 177 Health Care Plan will permit sharing of up-to-date problem lists and other medical record items that are important to effective continuity of care. The Marshall Islands Medical Program. as a satellite clinic of the Clinical Research Center, Brookhaven National Laboratory, is accredited by the Joint Commission on Accreditation of Healthcare Organizations, a nationwide organization that sets standards of performance for institutions dispensing medical care and monitors compliance with those standards. By voluntary participation in the accreditation process, the Marshall Islands Medical Program receives a valuable and impartial external review of its policies and procedures, as well as an assessment of the adequacyof the servicesit provides. Laboratory and radiological services, medical records, patient satisfaction. pharmaceutical services, and clinical competence of physicians are among the manvitems reviewed by the Joint Commission.