Memo to DR. Marks, Subject: Copy of Summary of Medical Findings of the 1976 Survey of the Marshallese Exposed to Fallout in 1954

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SUMMARY OF MEDICAL FINDINGS OF THE 1976 SURVEY O F THE MARSHALLESE EXPOSED TO FALLOUT IN 1954 A 22nd year post exposure Medical Survey of the Marshallese was carried out March 12- April 8 , 1976. The medical team personnel with affiliations are listed in appendix 1. Accompanying the team to Wotje, Utirik, Rongelap and Bikini were Representat'ive John Haglelgam of the Congress of Micronesia, and a 3 man Japanese TV group (also listed in Complete physical and hematological examinations were .done on all exposed Rongelap people and all unexposed Rongelap people on the control list (about 210 people). Thyroid examinations were done on exposed Utirik people. In addition, in order to obtain better statistics on normal incidence of thyroid tumors in the Marshallese, thyroid exaninations (neck palpitations) were done on all available residents o f Wotje atoll greater than 15 years of age and on unexposed Utirik and Rongelap by the physicians at Wotje, Utirik, Rongelap and Bikini. A number of people were examined and treated at sick call daily Examinations were done at : Majuro - ERDA trailer at hospital; also thyroid surveys in Ebeye ' - New ERDA trailer at hospital; also village thyroid Wotje - Village dispensary, village thyroid surveys. Utirik - Sick call at ERDA building, village thyroid surveys. RongelaE - ERDA trailer, sick calls at dispensary, village Bikini - Sick calls, dispensary. Of the 86 (including 4 in utero) exposed Rongelap people, 66 are 'now ,living; of 157 Utirik people, 116 are now living. There are 149 people now on the unexposed control Rongelap group. This latter group changes somewhat from year to year due to attrition and addition. Complete physical examinations and sick call examinations revealed no unusual numbers or types of diseases compared with previous years either in the Marshallese living in the district centers or outer islands.

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.Nutrition appeared t o be reasonably good with the possible exception of people living on Bikini. and treated at sick calls on the outer islands. Skin infections,ot it is,. upper respiratory infections were commonly seen. No deaths from cancer or other causes were reported i n the Rongelap people during the past year. Preliminary review of blood counts and physical examinations did not reveal any evidence of leukemia. Venereal disease is not uncommon and sera were collected on all Rongelap people for test for syphilis t o be done a t the Communicable Disease Center a t Atlanta. Gonorrhea i s being surveyed separately by the Trust Territory. Skin test for tuberculosis were done on the Rongelap people. positive reactions was somewhat lower than expected (19%). A s previousl y noted diabetes (middle age onset type) i s prevalent and a number of glucose tolerance tests were run as a continuation of this study. Many babies and young children were ekarnined The prevalence of Reading glasses (a gift of "New Eyes For The Needy")'were distributed at Uti rik, Rongelap and Bikini and were gratefully received by the people. Tooth brushes were distributed to all individuals on Uti rik and Rongelap and a Peace.Corp representative on each island promised to instruct the * people in their use. Table 1 summarizes the thyroid findings t o date. Examinations this year revealed one new thyroid nodule ina 36 year old exposed Rongelap woman and 3 new ones i n exposed U t i r i k people (male 3 6 , females 56 and 59). The Rongelap case and the two Uti rik ca'ses will be brought t o BNL, i n the near future for examinations and possible surgery. The other new nodule inthe LTtirik group will be observed under ,treatment. Two new nodules were found inthe unexposed Rongelap people making a total of 5.3% i n ment. Thyroid surveys of people living on Wotje and unexposed Uti rik .people revealed a n expected prevalence of nodules, 4.4% and 3.6%. These cases will also be observed following hormone treat - I n view of the indications of slightly reduced thyroid function i n some of the exposed people without clinical evidence of thyroid abnormalit ites,a new sensitive test of thyroid function was done by measuring TSH response 20 minutes after an injection of TRH (thyroid releasing hormone) which i s now available. unexposed matched for age and sex, 13 exposed Uti rik people inthe youngest age group with8 unexposed controls matched for age and sex. These sera are being analyzed by D r . R. Larsen a t Peter Bent Brigham Hospital. Tested were 9 exposed Rongelap with 7 ,Examinations at Triple r Hospital: The 3 cancer cases from Rongelap were examined at Triple r Army hfedical Center followiag the survey. Thyroid studies revealed no evidence of thyroid cancer. I n one case (#18, age 42), however, a tumor was noted i n the

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region of the pituitary gland. There were no obvious symptoms related to tumor it was considered unlikely that it was a metastasic lesion from the thyroid cancer. Since the patient had to return to Rongelap to be with her daughter for birth' of her baby she will be brought to the United States for further studies and possible surgery, along with the 3 nodule cases possibly in May. Attitudes of the People: Since there was no uptake of radioiodine in the region of the On arrival at each island the team was most cordially received by the people who were on hand in large numbers with the customary flower leis. Cooperation in the examinations by the people was excellent. Village Meetings: Prior to examinations village meetings were held at Utirik, Rongelap and Bikini. At these meetings team members were introduced along with Congressman Haglelgam and the Japanese group. The purpose of the visit was outlined and their cooperation in the examinations requested. Time €or sick calls were announced and arrangements were made f o r movies and party. Gifts fpr the village were presented (rice, flour, sugar, toothbrushes, soap, towels). At the meetings ( 2 - 3 hours long at Utirik) many questions were asked. questions asked at Utirik and Rongelap concerned Public Law 5-52 (hospital benefits for those on our examination list). that there was considerable uncertainity about the law and the ERDA-T.T. agreement. At Utirik there was great dissatisfaction expressed that the unexposed Utirik people were not placed on our examination list (to obtain benefits of bill) since the unexposed Rongelap people were on it. At Rongelap there was dissatisfaction expressed that the children of exposed people were not included. Repeated attempts were made to explain to both island groups that the unexposed control list of Rongelap people did not include all of the unexposed Rongelap people; that the control group was - established in 1957 to include persons picked to match for age and sex of the exposed Rongelap group; that this control group was as large as necessary; that no children were in the group now since there were no longer any children in the exposed groups; that no exposed Utirik control group was necessary since the Rongelap control group served adequately for both Utirik and Rongelap exposed groups. It is feared that the'medical team is being blamed for not including the other groups in spite of explanation that the Law and the agreement were written by the Congress of Micronesia and ERDA and T.T. and not by the medical team. Congressman John Haglelgam unfortunately had not been sufficiently briefed on the situation and was at an disadvantage when questioned by the people. (It was a l s o apparent in meeting with Dr. M. Kumangai and Health Service personnel.of the Trust Territory at Majuro that there were many uncertainities in their minds . about implementation of the agreement, particularly regarding per diem payments). It would seem that further clarification of the bill and agreement are indicated. Another complaint at Rongelap was that the fruits from their trees were reduced in size and number which they relate to Almost a l l of the It was apparent This is a recurring subject which should be clarified.

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It had been thought unwise for the medical team to visit Bikini on this survey in view of the Bikini legal suit pending and the earlier adthe survey the people living at Bikini sent a letter requesting that the medical team visit Bikini routinely and indications were that that group did not share the sentiments of their brethren living on Kili. The people's lawyer, Mr. G. Allen, agreed to the reinstitution of the medical visits. After conferring with ERDA representatives it was agreed that the team should visit'Bikini but with careful explanation to the people of reasons for being there. . verse criticism by the Bikini people at Kili. However, just prior to On arrival at Bikini Island we were greeted warmly and held a meeting with the Bikini people in one of the empty houses. Dr. J. Iaman acted as interpreter. Briefly, the following points were made: 1) We appreciated the confidence of the people in asking u s to return. 2) The levels of radiation at Bikini and Enyu Islands are not high enough to' constitute a hazard to the health of the people living and working there, ' and so ERDA sees no requirement for medical examinations or medical monitoring of the Bikini people. 3 ) Following the Rongelap examinations it is often convenient for the doctors to go to.Bikini when our ship is here for survey purposes. When visiting here our doctors are glad to hold sick calls and assist the Trust Territory in general health care of the people. Our doctors do not come here to examine for radiatim effects, since there is no need for such examinations. 4 ) ERDA does have a responsibility to continuing checks on the inhabited islands in order to be sure that things we have done and are doing are effective in keeping radiation exposures to a minimum. These checks include measurements of the soil, air, water, plants, animals and fish. In addition, one of the most effective sensitive checks is a check of the people themselves. . Radioactive materials can be detected in the body in such small quantities that they have no significance to health. Using sensitive instruments and taking samples of urine we can find out if radiation is entering the people's body andif necessary make additional recommendations for the people's protection. These measurements have been and will continue to be made on Bikini people who are willing to participate. However, our doctors are not needed to come and give general medicalcare to the people. Kotrady will reimin several days to do this. continue to visit Bikini whenever our doctors are nearby. . make these measurements. 5) We are here today because you asked us to Doctors Knudsen and If the people wish we will Following these explanations there were some questions by the people most of which we believe we were able to adequately answer. some of the questions asked and subjects discussed were: Why has fish poisoning increased since their return? Is this related to the b b ? Why are breadfruit rtnd pandanus restricted? (The people have been eating some); Why were they not told not to eat them on their return? (La&& of cussed were radiation levels on Bikini compared with other areas of the world and urine analyses and whole body counts as an index of internal . availability of such fruits at that time was pointed out). Also dis-

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.Dr. Knudsen and Dr. Kotrady reported that, though they observed no frank malnutrition, they felt the nutrition of the Bikini people was somewhat deficient mainly with regard to protein, vitamins and possibly trace metals. General complaints of joint and muscle aches may have been related to such deficiencies, though psychosomatic effects of their apprehension regarding radiation may have played arole. subsidized by the T.T., appeared t o be heavy on the starches with less protein and practically no fresh fruit or vegetables. Recently powdered milk has been added to the diet but advice i n uses would be helpful. It is recommended that since it is difficult to get fresh fruits or vegetables to Bikini,that ample vitamin supplies be made available t o allow for daily tablet distribution to all the people. . Urine samples, rats, chickens and pigs samples were obtained for In addition,Mr. Greenhouse’s group collected water, watera na lysis. catchment sediment, dust samples from houses etc. for analysis. The Japanese TV Group: This group headed by D r . Hayakawa (a surgeon from Tokyo, who had been with us on a previous survey) accompanied the team on t h e LCU t o Wotje, Uti rik, Rongelap and Enyu. They were not allowed on Bikini nor were they permitted t o take pictures at Kwajalein. sound movies of the medical team in action in the outer islands. They were a pleasant group and inter ferre das little as possible with the survey. A 50 minute TV movie of the survey will be shown i n Japan a t The group also visited ERDA i n Washington and BNL after the survey. W e have every reason to believe that the program will reflect favorably on BNL and ERDA. They took many W e have requested certain personnel t o view .the program io Japan and send u s reports.

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Thyroid Lesions i n Marshallese, April 1976 Uti rik exposed Based on number of people exposed, excluding those in utero (nuniber of cases / total number The thyroid i s considered t o be fully developed by about age 18. One additional case of edenoma, found a t autopsy, not included here. Pathologists differed as t o whether this lesion was malign kt ; it was scored a s benign. for adults and 3-year olds (see Section 11). e Weighted mean dose.