Recently, a full-time Marshallese nursepractioner has beea added to the staff in the Marshalls and a technician previously based at Brookhaven National Laboratory has been transferred to the Marshall Islands. The remainder of the staff over this 25-year period have been volunteers recruited from leading medical centers and research centers throughout the U.S. They have most frequently been unpaid, highly qualified sub-specialists with 2 primary interest in the area of thyroid pathology. Ac ~ the pattern of professional ° over the preceding 25 years as b ri on aji:l basis ~ using many of the country's outstanding researchers. to balance the field survey staff so that the basic adult screening protocol can be obtained in a five week survey, beginning in mid-January, including a staff of 14 professionals (4 MD's and 2 RN's). Two and a nalf months later, a five week survey begins in mid-May, directed primarily toward” pediatric care but designed also to follow-up on abnormal thyroid findings and to examine paticcts missea on the January survey. The staff is essentially the same with the substitution of a pediatrician for a thyroid specialist. . The third survey occurs two and one half months later in mid-September and concentratas primarily on delivering dental care and performing ancillary studies..., i.e., diabetes, etc. The stafi is as before with the substitution of a dentist for the pediatrician. The rapidly expanding character of this program has made it necessary to add the following positions: i. Researcn Coordinator - since the principal investigator has been traveling 60% of the time since assuming direction of the program, and there has been a marked increase in the complexity of the program involving multiple governmental agencies and academic institutions, it is mandatory that some individual familiar with the intricacies of the program be available and resident at Brookhaven National Laboratory during the absence of the principal investigator. This individual should be supported by: 2. Secretary - sinee the vast majority of the staff will continue to be voluntary and in many cases, in a compensatory pay status, rapid hard copy communication end coordination is essential to the program. In addition, the need for 2a full-time, nighly qualified, innovative heajth educator has been identified. This request has come not only from all segments of the Marshallese people and government but also from the affiliated atademic institutions and consultants. Since one of the primary criticisms repeatedly brought against the US Department of Energy program has been the lack of communication the present principal investigator feels that initially top priority should be given to developing a health education program designed: 1) to explain the role of each medical/radiation programs 2) discuss openly and freely radiation risks and to put them in an understandable cultural centext and in turn to put those risks in relationship with the indigenous primary health risks. 3) such a program will necessitate the close integration and cross-cultural ties necessary to provide effective communication. The plan will be to develop a core of innovative health educators to train Marshallese from the affected atolls. These Marshallese will in turn, train a cadre of Marshallese. The goal of this program is to establish a fully competent and independent Marshallese training group using a Brookhaven National Laboratory health educator as a resource person. 4) with the incremental increase in the population under study (from 400 to 2000) and characteristics of the current logistic support system, i.e., at present the medical team is limited to 16 shipboard personnel who are able to examine approminmatiy 500 people in a 5 week period, it becomes obvious that multiple field teams must be developed and logistic support must be refined. The new liasons will therefore involve cooperative efforts with large academic and contractural centers who are able to mount and maintain major fieic surveys. It is the opinion of a number of experts in this field that the medical programs for the low level radiation groups be university based with a non-nuclear identity. Therefore we have contacted the dean of the medical shool at the University of Southern VOL 1189