Thyroid Lesions in Marshallese - Medical Survey and Meetings

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Division of Biomedical and Environmental Research -d ‘\. Enclosed is a brief summary of the 1974 medical survey of the Rongelap and Utirik peoples including radiological surveys on Utirik, Rongelap and Bikini. Attached also is a summary of the village. meeting with the Rongelap people which thyroid lesions are included also. The Bikini data, I am sure, has added importance in view of the reqllests for information from the Hicronesian leeal people and we shall try and prepare more detailed reports as soon as possible. The three new Rongels.p people with thyroid nodules (ta,o exposed and one control) will be brought to Brookhaven the last of this month for complete studies and possible surgery in Cleveland in early July. I shall probably plan a trip to Germantown in the near future to discuss some of the current Marshall Island problems with xnembers of your staff. In the meantime if I can be of further help, let me know.

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1. Stastics based on original number people. 3. R= Rongelap exposed to 175 rad gamma dose; A = Rongelap people on nearby island receiving 69 rad gamma dose; U = Utirik people exposed to about a people on an atoll with no radiation exposure.

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Estimated Thyroid Maligniint Marshall Island Group Age at Thyroid ~ Lesions Island -69 rads gamma Utiriks (14 rads gamma 2Based on number of original people exposed. In parentheses number of cases/total number 3The thyroid is considered fully developed by age 16. 4Difference of opinion as to whether or not one lesion was malignant. Majority opinion was that it was benign. 5The more energetic shorter-lived isotopes of iodine contributed less to the total thyroid dose in the iltirik people due to later fallout. One might surmise also that the biological effectiveness of the thyroid dose per rad would be less in that group. 6Fifteen children 10-17 years of age at exposure in this group received estimated thyroid doses between 22 and 40 rads. 7In addition to thyroid lesions. one case of acute myelogenous leukemia was discovered in September 1972 in a 19-yesr-old Rongelap boy who had received 175 rad gamma radiation at one year of age. He died November, 1972.

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Brookhaven National Laboratory Trust Territory of Pacific Islands University of Washington University of Pittsburg School of Medicine National Institutes of Health AEC, Pacific Support Office Congress of Micronesia Observer John Del Rosario

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SUMMARY OF THE 20~d POST EXPO&E MEDICAL SURVEY OF The twenty year survey was AND UTIRIK PEOPLE highlighted by several special examinations and the use for the first time of an LCU newly acquired by the AEC for medical and radiological surveys in the Marshall Islands. .In addition to routine medical examinations several special medical studies were conducted, a thyroid reserve study and a diabetic and genetic study. Radiological surveys including personnel monitoring by “f-spectroscopy and environmental radiation studies were carried out at Utirik, Rongelap and Bikini. Results of these examinations must be considered quite preliminary at this time. The survey team consisted of 19 members: from the U. S. - 4 M.D.’s, 2 P.H.D.’s and 7 technical specialists: from the Trust Territory 1 M.D., 1 practitioner, 1 Meaex and 3 technicians. Also Mr. William Str~enan from the AEC and Mr. John Rosario representing the Congress of Micronesia accompanied the team. On the LCU there”were 8 tin in the-crew plus a cook making a tctal of 31 pecple on the ship. Medical examinations on a total of about 500 people at Flajuro March 1S-23, at Ebeye March 25-29: then via LCU to Utirik April 1-3, Rongelap, April April 11-15. A roster of te”am personnel is attached. and as assistant Village meetings were held at Utlrik and Rongelap during which the objectives of the survey were discussed, teem members introduced and questions answered. The meeting at Utirik was pleasant and uncomplicated, but the Rongelap meeting was disappointing in that there were questions presented by standing about the medical examinations and results. A transcript of this village meeting is attached. It appears that there must have been outside influence in presenting the questions since the people could not have read our reports, those of the medical observers or the Congress of Micronesi2 since they have not been translated into ?-larshallese. Further educztion of the people is necessary and a booklet written in ?@rshallese is being. prepared by the Trust Territory which will help answer many of their questions. Support of the medical surveys voiced last year at Rongelap by Senator Borja and Congressman Bales needs further reinforcement by these congressmen. Thyroid. Two additional exposed Rongelap people were found to have thyroid nodules, one in a 65-year old wo~~n exposed on Ailingnae Island (whole body gamma dose estimated at 69 rads) and in a 20-year old boy who was e~posed in-utero near the end of the second trimester. l%e latter case is interesting since this is the first thyroid abnormality developing in any of the four inutero exposed childrerr. There was also one unexposed L1-year.old Rongelap

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woman in the control group ‘JIO had developed a thyroid nodule. All of these cases are being brought to Brookhaven for more complete thyroid studies followed possibly by surgery in Cleveland by Dr. B. Dobyns. nere were two other exposed Rongelap people with borderline thyroid lesions and they will be observed carefully on thyroid treatment. Thyroid Reserve Study. Drs. Jan Wolff and Kund Knudsen were in charge of this study. In view of uncertainty of complete .compliance with the thyroid treatment program in some people a test of thyroid reserve was done in 41 people in this group who had not developed thyroid abnormalities. Thyroid hormone treatment was discontinued for 2 months prior to our examinations and then plasma samples were taken before and after the injection of 10 units o.f TSH for later analysis of hormone levels. Plasma samples for hormone levels were also taken on other people. In order to test environmental iodine levels on Rongelap diet and urinary samples were taken for iodine analysis. Diabetic Study. Dr. Reed Larson, headed this survey. This disease which is known to be of high incidence along with cataracts of the eyes in the Marshal Is, and this survey was carried out in Rongelap and Utirik people to determine its prevalence and attempt to advise the Trust Territory medical people concerning this serious medical problem. The volunteer response for this study was most gratifying - a total of 360 people being tested. Diabetic questionnaires and pre and post prandial blood sugars are being analyzed. Judging by the number of positive urine sugars, there appearssto be a high prevalence of the disease mainly. in those greater than 40 years of age. Infections and need for amputations are a source of great concern to the Marsha!lese Genetic Studies. Studies for possible inherited defects in children of people of exp-osed -parents was under my supervision, and is being carried out in collaboration with Dr. James Neel and Dr. Arthur Bloom of the University of Michigan. During this survey blood samples were collected for a variety C: tests for metabolic defects and bucal smars for sex chromatin studies on ?1 children of exposed parents, 24 exposed parents, 58 children of cnexposcd pzrents and 37 unexposed parents were examined in this study. A brief physical examination was carried out on each child. No obvious congenital defects were noted. In view of the general negative nature of the studies of the first generation Japanese children of exposed parents it seems unlikely that positive resulls will be seen in this group. However, the psychological benefit associated with negative findings would be reassuring to the people. Radiological Survevs. Radiological stirveys were carried out at Utirik, Rongelap and Bikini Islands. At Bikini there were about 80 people living there, 30 of whom (3 families) of Bikinians who have moved back, and the remainder are workmen and their families. In view of the anticipated return of larger number of Bikini people to their i-iomeisland in the near future additional data collected on this island will be given prompt attention. Whole-body gamma spectrographic analyses were carried out by Dr. Cohn and Mr. Rothman and environmental sampling by Messrs. Greenhouse and Ash and Dr.

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Nelson. At Rorigelap and Utirik samples were gathered to attempt to correlate radiation levels in soil with adjacent fruit trees (pandanus, coconut, breadfruit) and arrowroot, messerschmidia. scaveola plants for a possible extrapolation purposes at Bikini and Eniwetak where vegetation samples are limited. Other samples collected included 24-hour urine samples, water, coconut crabs and certain marine specimens. of these samples is completed people at Utirik, 46 at Ronge’ the families who had returned Preliminary analysis of these It will be some time before radiochemical analyses and the data analyzed. ysis (whole-body counts) were carried out on 22 ap and 31 people at Bikini, including members of These data are undergoing computer analysis. data give the following estimated average body No. Body burden z MPC* No. Body burden 7mc* Using 3 LACi MPC-based on the standard 1/10 of the maximum permissible burden for industrial populations which is 30 kCi according to the Recommendations of the International Commission on Radiological Protection, ICRP Public.2 A gamma survey was carried out on Bikini Island using a scintillation type survey meter calibrated for 137CS which represents about 957, of the gamma raaiation on the island. Preliminary analyses showed roughly the following levels on Inside cement houses with coral Outside cement houses with coral Inside cement houses without yard Outside cement houses without yard Along village road 13.1

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It is gratifying that the levels are below.those previously reported. Assuming that the average Bikini person spends 857. of their time in the village and 157, in the interior area the whole body dose would be about the same as the average U. S. citizen receives from natural background, the back- . ground level being higher in the United States than on Bikini. A more definitive gamma survey with thermoluminescent dosimeters will be made at Bikini on the Zhe LCU. The newly acquired LCU immensely improved the survey procedures and living conditions. T%e ship was clean and freshly painted (quite a contrast to the previous cargo ships used) and the air-conditioned sleeping trailer, clean galley with wholesome foods served and canvas covered afterdeck for eating and lounging greatly improved living conditions even though crowded. The vessel was slow. For instance, only an average of 4.8 knots were made between Kwajalein and Utirik (about 240 miles) hitting into the winds and waves. Beaching the vessel was a distinct advantage allowing easy access for people coming aboard for whole body counts and for moving equipment back and,forth. On my return from the islands, I attended a meeting held at the University of Hawaii, Marine Biology Laboratory, at Coconut Island. LCU alterations for improved specialized operations and scheduling of the vessel were discussed. It is obvious that from the number of people who want to use the vessel that supervised prior scheduling of the vessel will be necessary.

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The following is an account of the meeting on Rongelap Island on April 4, 1974 on the day of our departure following the examinations. Our survey at Rongelap turned out successfully. However, on our arrival there was considerable discontent among the people. There had been a shortage of food for some time and the territorial ships that had come to the island had insufficient food to give tothe people. The following meeting shows some of this discontent and reflects misunderstandings that still exist among some of the people concerning the medical examinations that we carry out. The Rongelap Survivors Fallout Association presented to me a list of questions and requests to be discussed at this meeting. These questions have been translated into English by Mr. Robert Harrison a peace corp man on the island. Tne context of the questions prompted the Marshallese medical practitioner who was with us to suggest that there had been some outside influence involved. The following is a summary of my remarks to the people. “Friends of Rongelap. This morning I will try to answer some of the questions and requests that have been presented to our medical team by the Rongelap Fallout Survivors Association. I will attempt to answer some of the questions, but others are outside our province and will be submitted to other authorities for action. I assure you we will do everything possible to get these requests presented before these authorities at the earliest opportunity. I feel that mny of your questions have stemmed from lack of understanding. I was particularly disappointed to see the statement that the people did not crust the results of our reports. I have known you for some 20 years and feel that you have always been my close friends and that done to you by the fallout, and have wanted to help you in every way possible. x was with when he was sick and was very sad when he died. I felt as though I had lost a brother or a son. Doctors on our medical team are hnnorable men and highly esteemed. They have helped CO ~’rite these reports. This incllldes the Trust Territory medical personnel, such as Dr. John lam-n. Dr. Ezra Riklon, Trigar, Ishoda, and others. I am willing to forgive you for doubting our reports since I know that many of you have noL read Lhese reports and even if yo(i have, the medical language would be difficult for you to understand. in September of 1’372 there were four medical observers who accompanied our t=m for the survey. T%ese included Drs. Kumatori and Izaki of Japan, !)r. Pochin from England. *O is with the World Health Organization, Dr. Cole from the National Health Service. me doctors read all of our medical reports carefully and Look part in the examinations. They each nmrie separate reports to the Congress of !licronesia. Senator Borja and Congressman Bales who were with us here on the island last year told you about the results of these observers reports and that the surveys were good for the people. They requesLed chat you continue to cooperate

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with our med were due to cal team since we were doing what was good for you. Since of Micronesia recognized that a lot of the misunderstandin~s ack of communication between the medical team and the people. they have advocated several measures which (hey hope will improve this situation. We are cooperating with the Congress of Micronesia and the Trust Territory in doing this. First let me say that at the time ve examine you that we try to let YOU know through a Marshallese practitioner or interpreter what the results of the examination are, and what treatment we recommend, if you are sick. As you know the Congress of Micronesia through their committee on Rongelap and Utirik “has written a long report concerning the medical surveys. They have written a summary report of this which is being translated into Marshallese to be distributed to you. This summary will include a summary also of the medical observers reports. The …