> / Generally speaking the number of people served by each clinic is small, thus the patient load per health assistant is low. The number of people served per day at the clinics vary between none to 2-3 perfday (unless a flu epidemic is being fought). The low numbers of births month further confirm this fact. homes by house call. dnd deaths per In fact, most care is] delivered at Many ciinics have a total population to be served of less than 200, few attain 500 or more. The most frequent types of problems seen by the health those problems common to children and mothers, plus problems of older people (among which diabetes and hypert most common). apsistants are [some chronic sion are the It is not surprising then that health assis ants list as most common symptoms the following: flu (upper respirato ), headache, stomach, [and fever, diarrhea, skin problems, toothache, diabetic problems (insulin shots). Though from the patient loads it would appear there are to many clinics for number of people served, remoteness, bad weather, lack f transport, and poor supervision are all commonly a problem making effEctive access to health care, even to another island clinic on the same atoll, not always possible. | Real medical emergencies needing immediate evacuation t a secondary care facility are uncommon. low as once in three years. For some clinics it has been Waiting times and access in such cages has been extremely variable but usually lengthy and costly, if at Bll possible. The frequency of visits by supervisory staff for continuigg education, resupply of medicines, atoll] to atoll. and special clinics varies tremq@ndously from It has been totally dependent on the I"field ship” schedule (see transportation-communication section). Medical records at clinics vary between none at some, poer to fair at the majority, and good at very few. The forms are complicated and the system has broken down due to lack of nerally too supervisory Support and encouragement. Most of the health assistants visited in the survey are old. middle age to Most received their training in Majuro from navy corgsmen shortly after World War II. Their educational elementary school). Some of the level is newer recruits low (B-5 years of havefhigh school education and have been trained in a nine-month health assigftant program 1g