Recommendations
1.
Majuro and Ebeye both require intensified immunization programs capable
of delivering full coverage to 100% of the school children and 90% of
the population
at
large,
within a one year period of the programs
initiation.
2.
Utilization must be made of Air Marshall Islands for the delivery of
immunization supplies, and occasionally teams, to the outer islands.
3.
All children enrolled in outer island schools must be able to present an
up-to-date immunization card showing current full coverage within one
year of program implementation.
teams
and
local
health
This can be obtained through mobile
assistants
operating from the
atoll's main
clinic, with cold chain maintenance capacity.
4.
Upgrade the supply and logistics system for immunizations, develop a
functioning cold chain system, and establish a detailed statistics and
record
The
keeping
outer
service for surveillance, evaluation,
island
clinic
refrigerators
and
and reporting.
central
cold
storage
facilities at Majuro and Ebeye will be crucial to ongoing programs on
the atolls.
4.
Chronic Diseases
Unlike many developing countries, the Marshall Islands are developing
Significant
health
cardiovascular
problems
diseases,
with
the
latter
chronic
diseases.
representing
the
Cancer
end
and
effect
of
hypertension and diabetes, are the leading killers. While the clinical care
of these problems will be covered by primary and secondary facilities, the
education and detection is often coordinated by public health personnel.
A federally funded
(DHEW)
cervical
completed in 1978 with moderate success.
cancer
screening program was
After initial reluctance, there
seemed to be general acceptance of the program, including male workers doing
pap smears.
The program was limited primarily to Majuro and Ebeye where
coverage ranged from 12-47% in different years and locations.
cancer
screening
or
education
programs
have
been
undertaken
No other
to
any
significant degree.
Hypertension is increasingly being recognized as a significant problem
in Micronesia.
affected.
It appears that from 7-15% of all Micronesians may be
The high mortality statistics for cerebrovascular disease are
undoubtedly a result of this problem,
Adequate evaluation and treatment of
hypertension
component
has
not
been
a
strong
of
the
health
assistant
curriculum, so the existing primary care workers appear to be doing a rather
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