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Division of Biomedical and Environmental Research 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 Ronqelap people wl~ich thyroid lesions are included also. The Bikini data, I am sure, has added importance in view of the req~lests for information from the Micronesia Iezal people and we shall try and prepare more detailed reports as soon as possible. The three new Rongelap people with thyroid nodules (two 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 members of your staff. In the meantime if I can be of further help, let me know.
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SUMMARY OF THE 20TH POST EXPOSURE MEDICAL SURL’EY OF THE RONGELAP AND UTIRIK PEOPLE The twenty year survey was 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 }-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., I practitioner, 1 Medex and 3 technicians. Also Mr. William Streenan from the AEC and Mr. John Rosario representing the Congress of Micronesia accompanied the team. On the LCU there were 8 men in the crew plus a cook and as assistant making a total of 31 people on the ship. !-ledicalexaminat ions were conducted on a total of about 500 people at %juro March 18-23, at Ebeye (Kwajalein) March 25-29: then via LCU to Utirik April I-3, Ronge~ap, April 5-10 and Bikini, April 11-15. A roster of team personnel is attached. Village meetings were held at Utirik and Rongelap during which the objectives of the survey were discussed, team 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 tileCongress of Micronesia since they have not been translated into Marshallese. Further education of the people is necessary and a booklet written in Marshallese is being prepared by the Trust Territory which will help answer many of their questions. Support of the medical surveys voiced last year at Rongeiap 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 45-year old woman exposed on Ailingnae Island (whole body gamma dose estimated at 69 rads) and in a 20-year old boy who was exposed in-utero near the end of the second trimester. The latter case is interesting since this is the first thyroid abnormality developing in any of the four inutero exposed children. There was also one unexposed kl-year old Rongelap
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woman in the coritruL group who had deve cases are being brought to Brookhaven f, oped a thyroid nodule. All of these r more complete thyroid studies followed possibly by surgery in Cleveland by Dr. B, Dobyns”. There were two other exposed Rongelap people with borderline thyroid lesions and they will be observed carefully on thyroid treatment. Thyroid Reserve Study. Drs. .JanWolff 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.fTSH 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 sur’~ey. 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 appears to be a high prevalence of the disease mainly. in those greater than LO years of age. Infections and need for amputations are a source of great concern to the Marshallese Genetic Studies. Studies for possible inherited defects in children of people o; exposed 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 varietv of tests for metabolic defects and bucal smears for sex chromatin studies on 71 children of exposed parents, 2L exposed parents, 58 children of unexposed parents and 37 unexposed parents were examined in this study. A brief physical examination was carried out on each child. HO 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 results will be seen in this group. Honver, the psychological benefit associated with negative findings would be reassuring to the people. Radiological Survevs. Radiological surveys 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 home island 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 environ~ntal sampling by Messrs. Greenhouse and Ash and Dr.
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Nelson. At Rongelap and Utirik samples were ~athered to attempt to correlate radiation levels in soil with adjacent fruit trees (.pandanus, coconut; breadfruit) and arrowroot, messerschrnidia, 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. It will be some time before radiochemical analyses of these samples is completed and the data analyzed. Gamma spectrographic analysis (whole-body counts) were carried out on 22 people at Utirik, 46 at Rongelap and 31 people at Bikini, inciudi[lg members of the families who had returned. These data are undergoing computer analysis. F’reLiminary anaLysis of these data give the following estimated average body * Using 3 +Ci MPC-based on the standard 1/10 of the maximum permissible burden for industrial populations which is 30 MCi 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 95Z of the gamma radiation 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 averaee Bikini person spends 857. of their time in the village and L>7, in the interior area the whole body dose would be about the 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 The LCU. The newly acquired LCU immensely improved the survey procedures and living conditions. ‘I’heship 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 allouing 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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Meeting with ~ongelap People - April, 1974 The following is an account of the meeting on Rongelap Island on April 4, 197.4 on the day of our departure following the examinations. Our survey at Rongelap turned out successfully. HoSever, 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 to the 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. The 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 Rongetap 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 many of your questions have stemmed from lack of understanding. I was particularly disappointed to see the statement that the people did not trust the results of our reports. 1 have known you for some 20 years and feel that you have always been my close friends and that you have trusted us. We have greatly regreccea the Injuries ~ii~~~IaVC ~C=II done to you by the fallout, and have wanted to help you in every way possible. I was with Lekoj when he was sick and was very sad when he died. I felt as tho{lgh I had lost a brother or a son. Doctors on our medical team are honorable men and highly esteemed. They have helped to write these reports. This includes the Trust Territory medical personnel, such as Dr. John Ia~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 not read these reports and even if you have, the medical language would be difficult for you to understand. In September of 1972 there were four medical observers who accompanied our tra-:nforthe survey. These included Drs. Kumatori and Izaki of Japan, Dr. Pochin from England, who is with the World Health Organization, Dr. Cole from the National Health Service. The doctors read all of our medical reports carefully and took part in the examinations. They each made separate reports to the Congress of Micronesia. 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 Che people. They requested that you continue to cooperate
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with :~ur medical team since we ‘~ere doing what was q~od for you. Since the Conxress of Micronesia recognized that a lot of the misunderstandings were due to lack of communication between the medical team and the people, they have advocated severaL measures which they 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 we examine you that we try to let you know through a ,Harshallese practitioner or interpreter what the results of the examination are, and what treatment we recommend, if you are sick. As you know the Co~gress of Micronesia through their cominittee on Rongelap and Utirik has written a long report concerning the medical surveys. They have written a surmnary report of this which is being translated into Marshallese to be distributed to you. TIIis summary will include a summary aLso of the medical observers reports. The Trust Territory is also preparing a booklet on the effects of fallout radiation on the Rongelap and Utirik people. This booklet is based on answers to questions that you have asked about failmt. This booklet is in preparation and will be distributed to you before long. It is also planned to have visits by the Trust Territory Health Service personnel to Rongelap and to Utirik to talk to the people about effects of radiation and answer questions. I would like to talk now a little bit about what happened to the Japanese people who were exposed to the bomb in 1945. There were thousands and thousands of people there who were exposed to m>re radiation than ttle Ron,gelap people received. Many of these people died because of the large amount of radiation that they received. Children of the exposed Japanese people have been examined by the best doctors in the world to see if there was any’ radiation sickness that was handed down from the parents to t!le children. These doctors could find no evidence t!~at there was any radiaof the Rongelap people who were exposed and we have not seen aay effect-s that have been handed down to your children. I am glad to be able to reassure you on this point. Some of the Japanese people have developed leukemia, a cancer of …
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