poor job of managing hypertension. inservice euucacion for fealth workers as well as community education and screening programs would] appear to be high priority items. The final chronic disease of increasing significance] is diabetes. Though incidence figures are difficult to ascertain, anecdota] reports show it to be of real concern among both the health workers and the community. "Insulin clinics" operate on both Ebeye and Majuro where abetics come daily for their injections. y on some of These also operate intermitten the outer islands, but evidently all of these clinics are periodically closed because of insufficient supplies of one kind or another. Fortunately, most patients must not be ketogenic, as they olerate this intermittent schedule surprisingly well. velopment of insulin allergy/resistance must be The impact on the considerable approach to diabetic care must be developed. and a Oral agents, e are widely used for obvious reasons, and education regarding re rational .- Diabenese, oper dietary patterns and urine checking are not adequately promoted. Recommendations 1. Develop cancer, hypertension and diabetes educational m erials within the health education unit and promote these among both ealth workers and the general population. 2. Develop specific screening protocols for seleqted hypertension and diabetes that will be taught to the cancers, fedex (medical assistants) and health assistants through inservice eduqation and then be integrated into the primary health care system. 3. Identify a referral system for persons with selected tipes of cancer and communicate this to be primary care workers. 4, 5. Develop treatment protocols for hypertension and diabetks, along with appropriate equipment and supplies, for the outer islan# clinics. Start a research project to adequately ascertain the true relevance of the disease and its etiology (which seems to differ hare from other high diabetes populations). A cost estimate epidemiological study is included in Appendix L. [For such an