poor job of managing hypertension.
inservice euucacion for
fealth workers
as well as community education and screening programs would] appear to be
high priority items.
The final chronic disease of increasing significance] is diabetes.
Though incidence figures are difficult to ascertain, anecdota]
reports show
it to be of real concern among both the health workers and
the community.
"Insulin clinics" operate on both Ebeye and Majuro where
abetics come
daily for their injections.
y on some of
These also operate intermitten
the outer islands, but evidently all of these clinics are periodically
closed
because
of
insufficient
supplies
of
one
kind
or
another.
Fortunately, most patients must not be ketogenic, as they
olerate this
intermittent schedule surprisingly well.
velopment of
insulin
allergy/resistance
must
be
The impact on the
considerable
approach to diabetic care must be developed.
and
a
Oral agents, e
are widely used for obvious reasons, and education regarding
re
rational
.- Diabenese,
oper dietary
patterns and urine checking are not adequately promoted.
Recommendations
1.
Develop cancer, hypertension and diabetes educational m
erials within
the health education unit and promote these among both
ealth workers
and the general population.
2.
Develop
specific
screening
protocols
for
seleqted
hypertension and diabetes that will be taught to the
cancers,
fedex (medical
assistants) and health assistants through inservice eduqation and then
be integrated into the primary health care system.
3.
Identify a referral system for persons with selected tipes of cancer
and communicate this to be primary care workers.
4,
5.
Develop treatment protocols for hypertension and diabetks, along with
appropriate equipment and supplies, for the outer islan#
clinics.
Start a research project to adequately ascertain the true
relevance of
the disease and its etiology (which seems to differ hare from other
high
diabetes
populations).
A
cost
estimate
epidemiological study is included in Appendix L.
[For
such
an