E. Communication The very large geographic territory served by the heal care system of the Marshall Islands creates unusual communication requi ments. Assistants need consultation hours with their supervisor medex (medical assistants). regular times. Typically these can be scheduled at specifiq Health Supply requests may be forwarded to a central logistics support facility at Similar scheduled times. The community health aids also neefl to communicate with their supervisors in emergencies at unexpected and unscheduled times 24 hours a day. Communication links must be reliable and apailable at al] times. Present System Telephone systems exist only in the urban areas and do n outer islands. system. High Written communications are restricted by th frequency single side band transceivers extend to the transportation poweged by gasoline generators were installed in many of the outer island clinics andj in magistrate's offices. fiave resulted in The harsh marine environment and operating conditions rapid deterioration of equipment. ‘repair. The highest priority has been given to the magistrate'sfradios. the clinics now have radios. radio. Most units have been returndd to Majuro for Those clinics near a magistrat® None of depend on his A few borrow (rent) privately owned walkie-talkies to rg@lay requests to the magistrate on their atoll for forwarding via his radio to Majuro. are now without communication capability except by word of mout§ But many or field ship. Reliable communications using the current high frequency equipment is possible only part of the time because of atmospheric disturbances from stbrms and varying skip disturbances caused by variations in the ionosphere. messages can be relayed from one station to the next. at scheduled communications messages. net at times other when times al! stations only one are unmanned Under But this iB attended. practical only For emergency station bloc§s the relay of No attempt is made to man all of the stations excegt scheduled net times. fhese conditions at the weekly Plans to restock the clinics with new} high frequency transceivers will not resolve these problems. A multichannel] sqdlar powered VHF system is being discussed, but will still have incomplete coverage, requiring relaying of messages. health. Highest priority will still be for services other than