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 those areas the possibility of 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 any significant accumulation of radioactivity. ‘ 7. The study population now consists of the 244 originally exposed (minus the individuals lost to the study by death or dislocation) plus a group of 209 individuals in the comparison group. Over the last 10 years, there has been an aver-expanding concern with primary care problems that have been detected in this population who have not been taken care of aven alter referral to the TT health care delivery system. The program has therefore come more and more enmeshed in primary care, diagnosis and treatment of conditions not thought to be related to radiation, i.e., diabetes and high blood pressure and severe dental disease. Both the field and the departmental directors of the program have realized that adequate 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 provide primary care. Consequently, with essentially level funding there has been a dilu tion of the research dollar. 8. Staffing - for the last 24 years the 1 full-time staff for this program has consis- i of ne MD)/director and 1-2 full time t Over the last 6 years there have b mittent resident physicians based in the Marshall Islands, however those physicians, with one notable exception, have frequently provided more problems that help to the PL. 7. In addition to the group outlined in the traditional program, 1. 2. 3. 4. 5. Likdep Wotje Metsit 400 + 400 + 300 + Bikini 6-800 Enewetak 4-500 TOTAL 2100 + This population has 8 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 protoce] 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. 8 Staffing - over the last year there have been major changes in the scope and responsibility of the Zrookhaven National Laboratory medical program. For the last 2 years there nas been an rv g ception of the critical role that communication (health and radiation education) i elicate interface between the Marshailese and the US representatives. Within the lastsiz months, concurrent with the establishment of a new Marshall Islands government there has been a concerted effort by all parties concerned to develop a highly integrated and cooperative effort to serve the medical needs of the Marshallese people. In line with this effort, and considering the projected increase in the study population, a position paper was developed by Brookhaven National Laboratory for US - Department of Energy in December 1978. Since that time, recent developments have necessitated a re-evaluation of personnel needs. The program has been without a resident physician in the island for six months and it is anticipated that a functional replacement will not be available for another six months. Sari 184 the expansion of the progran to include the following islands would increase the study population as follows: The annual surveys have been re-designed