Radiological Assessments for the Resettlement of Rongelap in the Republic of the Marshall Islands (1994)

To ensure the continued well-being of the people of Rongelap and to ensure that the conditions of the MOU are being met, continuing post-resettlement radiation surveillance will be necessary. For the purposes of this discussion, we estimate that about 400 persons will elect to return to Rongelap. We suggest that this population initially be under rather tight surveillance, which can be relaxed as experience dictates.

It is suggested that the following activities be initiated before and continued after resettlement:

1. Each person should receive a whole-body count (WBC) before resettlement and a whole-body count annually thereafter with the counting activity to be conducted during one of four such activities each year.

2. A cohort of 80 persons stratified by age and sex drawn from the estimated 400 who may choose to resettle will be monitored for whole-body radionuclide burdens at each of the four WBC counting periods. This will provide cohort data on potential seasonal variations in the radionuclide intake. Persons found at an annual count to have unusually high body burdens should be immediately recounted to determine whether errors in counting had occurred; if not, they should be added to the group sampled quarterly until the cause(s) of their high body burdens is identified. Dietary intake should be assessed each time whole-body counting is conducted; this is best done with a carefully planned food-frequency questionnaire. The committee recommends that this dietary survey, including the questionnaire, be developed in consultation with well qualified experts in nutrition and diet, and with knowledge of the local culture.

3. A baseline urine sample should be obtained before resettlement and stored under ideal conditions for radioassay in case it becomes necessary. A limited number of samples, chosen at random, should be analyzed to test that plutonium levels remain at, or below, the levels of sensitivity of current analytic methods (50-80 aCi). Effort should be expanded to develop more sensitive analytic techniques, including a study of the emerging technology of mass spectroscopy, to enable more reliable and accurate monitoring of low levels of plutonium in the future.

4. An effort should be initiated to establish a central repository for both individual dosimetry records and biological samples as references for future individual medical concerns.

If the monitoring measurements indicate that the terms of the MOU are being adequately met and if remedial activities are then relaxed, surveillance should continue. If after several years of further surveillance it is clear, even with such relaxation of remedial measures, that the terms of the MOU are being met, the surveillance procedures can be further relaxed.

On the basis of current radiation dose estimates, there is no expectation that any medical illness due to exposure to ionizing radiation will occur in any members of the resettlement population of the island of Rongelap from either intake of native foods or environmental contact. Unrelated and perceived medical problems will occur, however, so basic medical-care and medical-surveillance programs should be developed that are closely integrated with continuing biodosimetry programs. The basic program should be conducted by the indigenous inhabitants of the island and should be designed to meet the challenges of the serious medical problems of a changing society in an isolated geographical environment. It is anticipated that the major medical concerns of the future will be high incidences of obesity, diabetes, and hypertension, most cases of which are related to increased acceptance of "westernized" diets with high sodium and fat content in association with a relatively sedentary life style.

The specific problems that must be addressed for those returning to the island of Rongelap require a reasonable and continuing medical program, which should consist of the following:

1. Regular medical surveillance.

2. Management of acute and chronic medical problems.

3. Capability to investigate changes in dietary patterns that might be related to diabetes, hypertension, obesity, vitamin deficiency, malnutrition, and related disorders.

4. Maintenance of individual medical records.

5. Ability to collect and prepare biological samples for medical laboratories and radioassay.

6. Staff and facilities for performing basic laboratory tests, including blood counts, urinalysis, and stool examination.

7. Central medical communication and evacuation programs.

To implement the medical program noted above, we offer the following recommendations:

1. Facilities. At a minimum, a centrally located government-operated health clinic should be established. It should contain adequate space and provisions for medical examination of adults and children, medical first aid, a basic medical laboratory, an office for administrative personnel and the maintenance of medical records, and equipment for telecommunication with a reliable source of medical consultation. The medical facility might also be an excellent location for whole-body counting and the maintenance of individual dosimetry records.

2. Personnel. At a minimum, one paramedical person (nurse, nurse practitioner, or physician assistant) with some training in nutrition and radiation effects should operate the medical aspects of the medical program. It would be advisable to have that person be a member of the resettlement population. Training of such a person should commence well in advance of resettlement. He or she should be capable of conducting medical interviews and physical examinations, maintaining medical records, performing basic laboratory examinations, administering first aid, operating channels to communicate with physician consultants, and preparing and storing or shipping biological samples for bioassay. It is conceivable that the same person might be trained to conduct and record the results of whole-body counting.

3. Medical Surveillance. The resettlement population should be encouraged to have regular medical interviews, physical examinations, and laboratory studies at intervals at least once every 2 years. The results of such examinations should be recorded in individual health records and be reviewed by a physician at least once a year. Morbidity and mortality statistics for the entire resettlement population also should be reviewed at least once a year by a qualified physician or epidemiologist. It is essential that a physician or other qualified person be available for consultation to determine whether a specific medical problem is radiation-related.