to the PI. have been intermittent resident physicians based in the Marshall Islands, however those physicians, with one notable exception, have frequently provided more problems that help 8. Staffing - for the last 24 years the full-time staff for this program has consisted of 1 full-time MD/director and 1-2 full time technicians. Over the last 6 years there screening for radiation related disease will detect this other group of health problems and pathologic conditions and that we are compelled by the lack of TT services to Consequently, with provide primary care. essentially level funding there has been a dilu tion of the research dollar. of the program have realized that adequate Both the field and the departmental directors high blood pressure and severe dental disease, to be related to radiation, i.e., diabetes and diagnosis and treatment of conditions not thought the comparison group. Over the last 10 years, there has been an ever-expanding concern with primary care problems that have been detected in this population who have not been taken care of even after referral to the TT health care The program has therefore delivery system. become more and more enmeshed in primary care, location) plus a group of 209 individuals in The study population now consists of 7. the 244 originally exposed (minus the individuals lost to the study by death or dis- Likiep Wotje Metjit 400 + 400 + 300 + In line with this effort, and effort to serve the medical needs of the Marshallese people. considering the projected increase in the study population, a position paper was developed by Since that time, Brookhaven National Laboratory for US ~ Department of Energy in December 1978. The program has been recent developments have necessitated a re-evaluation of personnel needs. without a resident physician in the island for six months and it is anticipated that a functional The annual surveys have been re-designed replacement will not be available for another six months. been a concerted effort by all parties concerned to develop a highly integrated and cooperative lastsix months, concurrent with the establishment of a new Marshail Islands government there has increasing perception of the critical role that communication (health and radiation education) plays in the delicate interface between the Marshallese and the US representatives. Within the Staffing - over the last year there have been major changes in the scope and responsibility 8. For the last 2 years there has been an of the Brookhaven National Laboratory medical program. protocol will need to be provided to characterize the populations, identify the dependent and independent variables and consider the need for/or availability of a comparison population. Bikini 6-800 Enewetak 4-500 TOTAL 2100 + This population has received a variable amount of background radiation ranging from ambient to indeterminate low. If this population is included in the study group, a careful epidemiologic . . . . . 7. %In addition to the group outlined in the traditional procram, the expansion of the program to include the following islands would increase the study population as follows: any significant accumulation of radioactivity. Since the condition for return to Enewetak involve the voluntary restrictions of movement by the people among the islands of their atoll and prohibition of consuming specific foods from chose areas the possibility or a situation developing analogous to that of Bikini exists. Because of this possibility the US - Department of Energy feels that it is mandatory that careful base line body burdens be obtained on all people returned to Enewetak and that this be done in conjunction with a careful medical examination, Subsequent WBC and medical examination will be necessary to detect SN Oar Ww