Te
Recommendations
l.
Majuro and Ebeye both require intensified immunization programs capable
of delivering full coverage to 100% of the school children and 90% of
the population at
large,
within a one year period of
the programs
initiation.
2.
Utilization must be made of Air Marshall Islands for
fhe delivery of
immunization supplies, and occasionally teams, to the odter islands.
3.
All children enrolled in outer island schools must be able
to present an
up-to-date immunization card showing current full coverfage within one
year of program implementation.
teams
and
local
This can be obtained [through mobile
health assistants
operating from th@
atoll's main
clinic, with cold chain maintenance capacity.
4.
Upgrade the supply and logistics system for immunizatipns, develop a
functioning cold chain system, and establish a detailedistatistics and
record keeping service for surveillance, evaluation,
and reporting.
The
cold
outer
island
clinic
refrigerators
and
central]
storage
facilities at Majuro and Ebeye will be crucial to ongoing programs on
the atolls.
4.
Chronic Diseases
Unlike many developing countries, the Marshal] Islands
significant
health
cardiovascular
problems
diseases,
with
the
latter
chronic
gre developing
diseases.
representing
hypertension and diabetes, are the leading killers.
the
Cancer
e
and
effect
of
While thefclinical care
of these problems will be covered by primary and secondary facilities, the
education and detection is often coordinated by public health
A
federally
funded
(DHEW)
cervical
completed in 1978 with moderate success.
cancer
screening|
personnel.
program was
After initial relubtance, there
seemed to be general acceptance of the program, including malefworkers doing
pap smears.
The program was limited primarily to Majuro anf
Ebeye where
coverage ranged from 12-47% in different years and locatiogs.
cancer
screening
or
education
programs
have
been
underflaken
No other
to
any
significant degree,
Hypertension is increasingly being recognized as a signifficant problem
in Micronesia.
affected.
It appears that from 7-15% of all Micronesians may be
The high mortality statistics for cerebrovasculag
undoubtedly a result of this problem.
Adequate evaluation anq
hypertension
component
has
not
been
a strong
of
the
treatment of
health
curriculum, so the existing primary care workers appear to be
S
disease are
assistant
doing a rather
He