{e)
Current practice
Annual costs for the medical monitoring, follow up care, and environmental
monitoring program of the Department of Energy for the people of Rongelap
and Utirik currently are in the range of $3-4 million.
In contrast, in
FY 80, the entire health budget of the Marshall Islands Government was
$2.7 million.
This amount had to provide curative and preventive medical
care and programs for a population of over 30,000 people, many scattered
on outer islands.
This amount supported the major hospital at Majuro,
which serves as the only major in-patient facility in the Marshalls.
The current hospital facility in Majuro has 90 beds and is in very poor
condition, but funds for a new hospital have been appropriated.
In
addition to the Majuro hospital and an Ebeye sub-hospital, the Marshalls
Health Department supports some 56 out-island dispensaries.
Some of
these are under-manned and ill-equipped.
Administrative and professional staffing of the health services of the
Marshalls has not met minimum acceptable health standards in the past.
In an attempt to improve health care, the Marshall Islands Government
recently concluded an agreement with a “medical care adjunct" of the
Seventh-Day Adventist Mission in Guam to take over the control and
management of health services from the Ministry of Health Services.
This new health care service agency should be brought into any planning
exercise by the contractor at an early stage.
(f)
Special Problems Related to Diversity of Residence
Monitoring and special health care for the people of Rongelap, Utirik,
Bikini, and Enewetak must be provided not only in their home atolls but
in other parts of the Marshall Islands where considerable numbers of
these individuals now reside either on a temporary or permanent basis.
For example, there often are as many Rongelapese and Utirikese living on
Ebeye and/or Majuro as are in residence on Rongelap and Utirik Atolis.
The past and current medical program under the auspices of the Department
of Energy has had to be tailored to the places where the residents are
living at the time of the quarterly or annual surveys.
This pattern can
be expected to continue in the future and must be an integral part of
any proposed health care program.
Large numbers of Bikinians also are scattered throughout the Marshalls
and these individuals also will be entitled to medical care.
Although
the people of Enewetak, having lived on the isolated atoll of Ujelang
for the past 34 years, are the most cohesive group, under the current
return program to the atoll of Enewetak, four communities will be in
existence.
There will be new communities on (1) Enewetak Island, on
Medren Island, and on (3)
Atoll.
(2)
Japtan Island in the southern part of Enewetak
Distance between these islands is too great to permit one centralized
local health facility.
For the foreseeable future also, there very
likely will be an Enewetak community of varying size on (4) Ujelang
Atoll, which is 124 miles southeast of Enewetak, and this community also
must be provided with medical care.
Phos
endl oy