. . . . -7- - <e) -- ...... -------- . ------ . . . . . . . ....-. .. .. . . . .. .. .. . Current practice . . . --- . . tal AXUNSZ1costs for the medical monitoring, follow up care, and environment monitoring program of the Deparbnent of Bnergy for the people of Rongelap and Utirik currently are in the range of $3-4 dllion. In contiast, 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 supperted 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 r. 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 suppQrts some 56 out-island dispensaries. Some of these are “under-mannedand 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 wer the control and management of health services from the Ministry of Health S-ices. 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 ~nitoring 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 livingen Ebeye and/or Majuro as axe in residence on Rongelap and Utirik Atolls. The past and current medical program under the auspices of the Deparbent of Bnergy has had to be ~ilored to the places where the residents are living-at the time of the quarterly or annual sumeys. This pattern can be expected to continue in the future and mustbe an integral part of any proposed health care program. Large numbers of Bikinisns also are scattered throughout the lhrshalls and these individuals also will be entitled to medical care. Although the people of Enewe@dc, having lived on the isolated atoll of Ujelang for the ~-st 34 years, are the mst cohesive group, under the current return program to the atoll of Enewetak, four conununitieswill be in existence. There willbe new communities on (1) Bnewetak Island, on (2) Me&en Isl-md, and on (3) Japtan Island in the Smthem part of Enewetak Atoll . Dktsnce between these islands is too great to permit one centralizedkcal health facility. For the foreseeable future also, there very Mkelyw ill be an Bnewetak ccmuunity of varying size on (4) Ujelang Atoll, which is 124 miles southeast of Bnewetak, and this connsunityalso must be provided .. . ..-. with medical care. ,,. , ..-, ~ .