Fallout, the Experiences of a Medical Team in the Care Of

BNL46444 informal Report

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The Experiences of a Medical Team In the Care of a Marshallese Population Accidently Exposed to Fallout Radiation

RobeflA. Conard

. BNL 46444 Informal Report

Fdloui_ The Experiences of a Medical Team In the Care of a Marshaliese Population Accidently Exposed to Fallout Radiation

Robefl A. Conard h n I 1

September 1992

MEDICAL DEPARTMENT BROOK HAVEN NATIONAL LABORATORY ASSOCIATED UN IV ERSITIES, INC. UPTON, NEW YORK 11973 UNDERCONTRACTNO.DE-AC02-76Cl+0CO16WITH THE UNITED STATES DEPARTMENT OF ENERGY DISCIAIMER

Thie report wu Prepared ae ●n ●ccount of work sponsored by an agency of the United Stetee Government Neither theUnitedSWteeGovernmentnorany ●gency thereof. nor any of their empioyeee. nor any of thmr cottuacIom. sub$ontmctors. or their ●mployees. mskee UIY wamentY. expr- or implied.or=--- ●nylegalliability or reeponeibility for the ●ccur8cY. completer-a. or useftdrte- of ●ny infonrmtton. ●pparatua, producL or [email protected] representsthat ita ruewould not infringe privately owned nghte.ibference herein to enY spectfic commemal product. proms. or eenme bytrade name. trademark. manufacturer. or othennce. doee not rtececsaniy conotmtte or Impiy NJwtdoreement.r-mmcndation. or favoring by theUnitedStatea Government or sny ●gency. contractor or subcont-fior thereof. The views and optniorm of ●uthore ●xpmeed herein do notneceuwtiyeta- orreflectthoseofthe United Stetu Government or ●ty ●gency. cortuector or ●hcontiaor thereof. Printedin the Unitd States ofAmerica Avaiiablefrom .NationaiTechnicaiInformationServrce U.S.DepartmentofCommem 52S5 Port RoyalRoad Springfield.VA22161 NTISprim codes: Printed Copy: A04: Microfiche Copy AOI Location of Marshall Islands...... Iv Chapter VII. The lbdioio~cal Surveys for Dedication ...... v Res]dual Radiation ...... 29 Foreword ...... vi A. The Surveys ...... 29 B. Findings ...... 31 Acknowledgments...... ~ii Chapter VIII. The DiapiacedBikinians . . 33 Chapter L Background ...... 1 Chapter IX. Probiems in the M&math of Chapter H. The Brauo Accident . . . . . 4 the Accident, ...... 36 A. Eariy Events ...... , 4 A. Backgroun d ...... 36 B. The Lucky Dragon Episode . . . . . 5 B. probiema AfTectingthe Program . . . 3a C. Evacuationofthe Marahalleae . . . . 5 Chapter X The Marehalleae Experience l. Rongeiap...... 5 Related ta Other Radiation Accidents . . 44 2. Utink ...... 6 Chaptur XI. Closing Remarks...... , 46 D. AtomIcEnergy Commiaaion (AEC), References A Selected TechnicalReports, 46 Washington ...... 6 B. Other References . . . . . , 51 E. NavalStation, Kwajalein ...... 7 Appendix L Marahall Iaiand Survey F. Initmi MedicalExanxmatione. . . . Partxipanta 1954-1990...... 54 l. Facditiea...... ,, : AppancUXKL ChmmoiogicaiListing of Petiinent Events in the Marshall Isianda 63 2..Medicai Findings ...... 7 G. DoseEstimatea...... 9 Chapter III. Return to Rongeiap. . . . . 11 Chapter IV. Health Care in the Marshall Islands ...... 13 Chapter V. The Continuing Medical Sumeya 15 A. NeedforContinuing Medical Surveys - AEC$fandau for the Examinations . . 15 B. Lim.kstionand Expansion of the Program ...... 15 Chapter VI. The Medical Examinations . . la A. Orgszuzation ...... 18 1.Supporting Agencies . . . . . 18 2. Wdical Parncipazite in the Surveya 18 3. Supplies and Equipment , ...... 18 4. Examination Facilities ...... 18 5. Transportation ...... 19 B. ScopeofExaminationa...... 20 C. ProblemsMeociated with the Exsmmationa ...... 21 D. BnefSurnma~ ofMedical Findings . . 22 E. Human Interest Relations ...... 24 1. In The191anda ...... 24 F. The MarshalleaePatienta in the United states ...... 25 G. Fanuiies Most AiTectedby Fallout . . . 27

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Village d Utirik AtQIL

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Dedication

This report is dedicated to John Anjain, who was the Marshallese .Mayor of Rongelap Village at the time of the fallout in 1954. John is a qui- et, unassuming man, well liked. and a respected leader of the Rongelap people. His family suffered extremely from the effects of the fallout. He and four members. of his family underwent surgery for removal of thyroid tumors. The tumor in his wife was malignant. His youngest son, who was one year of age at the time of the fallout, had a thyroid tumor removed at age 12 and later developed an acute fomn of leukemia when he was 19 years old. Although extensively treated in the United States, he died. His death was a cause of great grief to his family and to the Marshallese people. In spite of all these troubles, including evacuation from their home island and socioeconomic disruption, I have never heard John express bitterness. However, he has continued to champion the cause of his people. I am grateful that he has always appreciated and supported the efforts of our medical team to heip his peopie. He has remained a true friend over the years John Aa,jain (Left), Mayor of Rongelap in 1964 and I treasure his friendship. studing beside the oldest wommn on the island (over lW yearn old?).

v Foreword

More than thirty-six years have passed since our attempts to cope with some of the problems the Marshallese people of Rongelap and Utirik that developed. The medical findings will be were accidentally exposed to radioactive fallout referred to only briefly because they have been following the detonation by the United States of published elsewhere in great detail. (Section A, a powerful thermonuclear device called “Bravo” References. ) at Bikini, .March 1, 1954. The repercussions of I first went to the Marshall Islands during this accident have been widespread. This was World War H as a naval medical officer. The the first time that a human population had been Solomon Islands campaign had just been com- seriously exposed to radioactive fallout and the pleted and we were on our way to the Marianas carefully documented findings have formed an Islands for landings at Saipan, Guam, and important basis for action in other types of acci- Tinian. My first sight of Kwajalein and dents involving radioactive fallout, the most Enewetak revealed the smoldering ruins from notable being the recent reactor accident at the invasion. Little did I realize that I would Chernobyl in Russia. return to these islands for many years. As a Medical teams from Brookhaven National navai radiological safety officer, I returned to Laboratory, sponsored by the Department of participate in Operation Crossroads at Bikini, Energy LDOE), formerly the Atomic Energy and later, in Operation Greenhouse at Commission (AEC), have visited the Marshall Einewetok. However, my real interest was in Isiands regularly since 1954 to examine and the biomedical effects of radiation. I took a contribute to the medical care of the course in radiation physics at the University of Marshallese. The medicai findings have been California, followed by a year’s training in published in numerous Brookhaven National radiobioiogical research at Argonne National Laboratory reports and in medical journals (see Laboratory. Later, I continued this research at References, Section A).* I headed the medical the Naval Medical Research Institute and, still teams from 1956-1979. In carrying out these later, at Brookhaven.National Laboratory when examinations, the medical teams were faced my tour of duty with the Navy ended in 1955. I with many problems and dilemmas, some of participated in the initial examinations of the which were unforeseen and unique to a medical .Marshallese in 1954, and from 1956 until my group. Some of the problems were related to cui- retirement in 1979, I was responsible for orga- tural differences, and to the lack of understand- nizing the continuing medical surveys. For a ing by the Marshallese of radiation and its short period after my retirement, Hugh S. Pratt effects, resulting in unfounded fears and psy - and Eugene P. Cron”kite headed the program. choio~cal effects. Other problems were related Since that time, the program has been ably han- to displacement of the people, socioeconomic dled by William H. Adams and I have drawn on disruption, and increasing resentment against his reports for findings since my retirement. the United States with poiiticai involvement and demands for compensation. Nevertheless, the medical teams and the Marshallese people developed a strong feeling of mutual respect and friendship in spite of these problems, and the people have expressed their gratitude for the benefits rendered them. In this report an attempt is made to review, in an informal, nar- rative style, some of the highlights of events that occurred, the human interest aspects, and

me reference are dividedintotwoeectiom:A Sekcted Technxal&xxu andB.OtherReferences,includingcomeof thenumerousmesemedia eItldIP9. Acknowledgments I In wrlt~ng this report I am grateful for the Edward Lessard, Peter Rathvon, Charles help of several people at Brookhaven Nationai Meinhold. and David Potter. From other insti- Laboratory. Eugene P. Cronkite and Victor P. tutions: J. Edward Rail, Jacob Robbins, Jan Bond, who have been closely invoived with the Wolff, Baruch Blumberg, and Roger Rittmaster project since its inception, have encouraged me at the National. Institutes of Health; Brown in writing the report and given helpful advice. Dobyris and David Reid at Cleveland William A. Scott and Peter M. Heotis, who have .Metropolitan General Hospital; Wataru Sutow worked with me in organizing and carrying out and Ernest Libby at M.D. Anderson Hospital; the examinations, have been of great assis- Edward Held of the University of Washington; tance. I am grateful to Avril Woodhead and Shields Warren, Bentley Colcock, William Katherine Vivirito for editorial assistance, Meissner, and Marion Legg at New Engiand Robert Crease, BNL Historian, for his heip, and Deaconess Hospital; Leo Meyer, Veterans Bernice &mstrong for secretarial assistance. In Hospital, Brooklyn, NY; Lawrence Ackerman at I the Photography and Graphic Arts Department SUNY-Stony Brook; P. Reed Larson at Brigham I wish to thank Douglas Humphrey and Robert and Women’s Hospital; William Moioney at Smith for the photographs used, and Morton Boston City Hospital; John Bugher, Charles Rosen, Kenneth Boehm, Alan Schmidtchen, and Dunham, Mernl Eisenbud, William Streenan, Helga Pirozzi for their help. William Burr, James Liverrnan, and Harry John Tobin, former Trust Territo~ anthro- Brown at AEC; and Ruth Van Cleeve at the pologist, has been helpful regarding Department of Intenor. Marshallese customs. Roger Ray, former man- The staff at the Hospital at Brookhaven pro- ager of the DOE programs in the Marshall vided excellent care for the Marshallese Islanda, has helped me regarding events that patients. occurred since my retirement in 1979. We have In the Marshall Islands, I am ~ateful for the been most fortunate in obtaining excellent phy- support of Anata Kabua, President, and Oscar sicians and technicians to participate in the DeBrum, Chief Secreta~ of the Republic of the program. Some worked in the islands on several Marshall Islands. The participation of the occasions (see Appendix 1). Health Services of the Marshall Islands has The following resident physicians have pro- been invaluable: practitioners Ezra Riklon, vided invaluable service to the program in the John Iaman, Arabati Hicking, Issac Lanwi, Marshall Islands: Knud Knudsen (1972/74, Amer Ishoda, Tregar Ishoda, Isao Kasino, 77/78); Konrad Kotrady (1975/76); William Masao Korean, Jeton Anjain, and Maidher Grant (1979); Roger Rittmaster (1980/81); Kabua; technicians Sebeo Shoniber, Nelson James Harper (1981/83); Paula Barclay (1984); Zetkeia, Joseph Saul, Kilman Gideon, Helmer and John Engle (1984/86). Emos; and nurses Jenuk Kabua, Ruth Harris, Also essential to the success of the program and T. Leyjen. has been the staunch support of many agencies, I am grateful to Captain Keith Coberiy and particularly Brookhaven National Laboratory, the crew of the Liktanur for their outstanding the Department of Energy, the Department of setwices to the medical team. Defense, the Department of Interior, the Health Services of the Trust Territory, and the Republic of the Marshall Islands. I would like to name some of the many people who contributed a great deal during the 26 years I directed the program. At Brookhaven: ICnud Knudsen, James Robertson, Stanton Cohn, Lee Farr, Donald Van Slyke, Richard Stoner, Harold Atkins, W. Alvord Finn, Daniel Slatkin, Lawrence Hankes, Michael Makar, Darrel Joel, Arjun Chanana, Jack Rothmann, Robert Brown, Clyde Sipe, Douglas Clareus,

vii 1

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~ation of the Marshall Islands

Wii Chapter I — Background .

To appreciate more fully some of the events century, Protestant and Catholic missionaries that occurred during the medicai examinations were allowed to settle in the Islands, which of the MarshaUese people, I first brieily opened the door to colonization and to exploita- describe the Marshall Islands, their history, tion of the copra industry. Germany occupied and people. the Marshall Islands in 1885 but this did not The Marshail Islands are located m the east- cause nearly as much disruption in the life of ern part of Micronesia, roughly haif way the Marshallese as occurred when the Japanese between the Hawaiian Islands andbstralia, in took the Islands in 1914. Following World War a large ocean area (about 280,000 ~. miles) I, the Japanese held the Islands under mandate that includes also the Marianas andthe to the League of Nations. Clandestine y, the Caroline Islands. The total land area is about Japanese began fortifying the islands, and half that of Rhode Island. There are~irty-four building landing strips to develop military coral atolls and single islands in twoehains, supremacy in the Pacific. The life of the Ratak (sunrise) and Ralik (sunset) lfing Marshallese was regimented to help achieve between four and fourteen degrees north of the these purposes. Equator. An atoll is a ring of low-l- coral World War H brought hardship and misery to islands surrounding a lagoon. The tinds have the Marshallese, some of whom were wounded formed on the submerged rims of extinct volca- and killed in navai bombardments, particu.iariy nic craters. The waters abound in fish and during the invasion of Kwajalein and marine life. The sandy soil of the islands sup- Enewetak; some were executed by the Japanese ports growth of the ubiquitous coconut palms military. Many Marshallese made heroic efforts and other plants including pandanu~ bread- to aid the American forces. fruit, arrowroot, and, to a lesser extent, Foilowing the War, in 1947, the Mananaa, bananas and papaya. With the fish and marine Caroline, and Marshall Islands captured from life, these plants provide sources ofibod, Japan were formed into a Trust Territory of thatching for houses and mats, an~ more Pacific Islands administered by America under recently, copra from the palms for export. The the United Nations, with a mandate to advance sandy soil, scarcity of water, and thesalt spray the interests of the people of Micronesia. The earned inland by the trade winds limits the administration was first under the Navy and growth of other vegetables and flowers. later, starting in 1951, under the Department of In the northern Marshall Isiands, rainfall is the Interior. A High Commissioner, a civilian scarce during the six-month dry season, and” political appointee, headed the administration, because there are few wells, the Marshallese and its headquarters were first located at depend almost entirely on catchmenta from the Honolulu, then at Guam, and later at Saipan. roofs. Administration in the six districts was located In the 16th century, exploration of the Pacific in the district centers. In the Marshall Islands, was beginning and in the 18th and 19th centu- the center was at Majuro atoll. A Congress of ries ships from Russia, England, and America Micronesia was formed with representation landed in the Marshall Islands. The Marshall from the various districts to work with the High and Gilbert Islands were named after Engiish Commissioner and his staff. sea captains. During this period, trading ships After the war, the United States began fu- visited the Marshall Islands in search of prod- ther testing of atomic bombs. In 1946, Bikini ucts that might be of commercial value (peari atoll was chosen for the first atomic test shells, sea cucumbers, sandalwood, and sea because of its relative isolation from inhabited otter skins (B-l); copra (the dried meat of the areas. The following year, the need for develop- coconut) soon became the most profitable local mental testing resulted in the formation of the product. There were several bloody encounters Pacific Proving Ground, with Enewetak as the between ship’s crews and the Marshallese base of operation (B-3). The Bikini people were which made colonization hazardous at this persuaded to leave their atoll ‘“forthe good of time. However, around the middle of the 19th mankind’”. The subsequent attempt to resettle this population, who finally ended up on tiny

1 ited number of slight overexposures of person- fili IsIana. was an unfortunate chapter In the nei to radiation. During Operation Greenhouse, united States’ relationship with the fallout was recognized as a problem. However, Marsnallese. The people of Enewetak also were it was not until the “Bravo” detonation in the later evacuated to a much smaller atoll. With Castle Operation that the seriousness of high the “development of a naval station. and later, levels of radioactive fallout was adequately rec- the Pacific Missile Range at Kwajaiein, more ognized. Until a moratorium on atomic testing Marshallese were dispiaced to other isiands in in the Pacific was declared in 1958, 23 atomic that iarge atoll. The first Pacific test was devices were tested at Bikini and 43 at Operation Crossroads. at Bikini in 1946, foi- Enewetak Atoll. Iowed by. Operation. “sandstone”! ‘“Greenhouse” ~d “IvY”.These operations resulted in a lim-

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Handling copra, the dried meat of the coconut. A chief source of income in the Marahallese islands.

3 Chapter II — The Bravo Accident

At midnight the weather still held, “Bravo”, the first atomic test in the Castle but low altitude winds now light and vari- series. was a large thermonuclear dewce deto- able raised chances of fallout in the wrong nated on the reef at Bikini Atoil on March 1. place. Bikini’s weather outlook was down- 1954. An unexpected shift in winds caused an graded to unfavorable, and the task force unprecedented accidental failout. Two hundred ordered its ships 50 miles further out to and thirty-nine Marshallese on Rongelap, sea. Assuming the worst, some winds Ailingnae, and LTtirik Atolls, 28 American ser- might blow toward the nearest inhabited vicemen on Rongerik Atoll, and 23 Japanese atoils, but predicted speeds and altitudes fishermen on their ship, the Lucky Dragon, seemed to preclude any real danger; debris received significant exposure to radioactive fall- ,could reach Rongelap or Rongerik only out. after 12 to 15 hours, by then having decayed to safe levels. Two hours before shot time the earlier forecast remained valid. Task force commander Clarkson confirmed his order to fire at 06:45. The actual yield of the detonation was considerably more than expected, a surprising 15 megatons (almost one thousand times the yield ;N:MK;:$-;::;K’‘AILINGINAE. -. . . .“. ”.. . .- . .. of the bombs over Hiroshima and Nagasaki). . Winds high aloft carried the radioactive cIoud : “o’-’”’ in an easterly direction, depositing seriously Q KWAIALEIN high fallout on a Japanese fishing vessel and on s). Q= the inhabited atolls of Rongelap, Ailingnae, . Q Rongerik, and Utirik. Several naval vessels, thirty miles east of Bikini, unexpectedly encountered heavy fallout with white flakes falling on the decks of the ships. Top-speed retreat was ordered and, with crews below decks and salt water washing down on the decks, the hazard was greatly reduced. (Later, several sailors developed mild radiation bums of the skin. ) The realization of the extensiveness of the fallout in the area east of Bikini emerged slowly because of a series of confusing and overlapping Fallout area in the Marshall Islan&. events. Difficulties were encountered with the cloud-tracking planes and there was confusion A. Early Events about the radiological sftuation on Rongerik Most of the following events were atoll, where 28 American servicemen manned a excerpted from Barton C. Hacker’s repoti: radiological safety weather station. Elements of Controversy: A History of Radiation On Rongerik, a blast wave hit the island Safety in the Nuclear Testing Program (B-6). and shook the buildings about eleven minutes ,& was usual, numerous meteorological after the men had observed the flash from the observations were made to insure that the detonation. About four to aix hours later, a radioactive cloud from the detonation would not mist-like haze was noted. At seven hours, the move in the direction of the inhabited atolls to needle on a radiation- measuring instrument the east. went off scale at 100 plus mr/’hr. The Task Force

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Headquarters was notified by radio.: Crossroads. The Commander, Joint Task Force .+pparently, the message received by the Task 7, explains: Force was not clear, and was given no special The natives were not evacuated prior )-.anciling. Later, a second, more urgent message to the detonation because, on the basis of maae it apparent that the situation on Rongerik information available to us, it was not con- rmght be serious. The men were told to stay sidered necessary, and no fallout was indoors with the windows closed. These precau- expected in the inhabited areas. (B-7) tions. no doubt, accounted for the mildness of the radiation burns of the skin that a few men later deveioped. The following morning \.March B. The Lucky Dragon Episode 2), Captain L. B. Christensen (USA), a radiolog- On March 1, a Japanese vessel, the Fuktiru ical safety ofilcer, sent on the supply plane to Maru, (Lucky Dragon). with a cre”w of 23 men? Rongerik, found that the radiation leveis were was about 80 miles east of Bikini. The fisher- so high that evacuation was necessary. Unable men saw the detonation from their ship in the to contact the Task Force by radio, he took eight early morning, but were unaware of any danger. men to Kwajalein in his plane. The other twenty Soon a snow-like fallout covered the deck and men were evacuated that afternoon. stuck to the exposed portions of their bodies. Chmtensen recommended that planes be sent That evening the crew experienced nausea and to measure radiation levels in the inhabited vomiting which lasted for twenty-four hours. atolls and, realizing that Rongeiap might have The ship’s captain decided they should return to higher levels than Rongerik, he recommended Japan, where they arrived about two weeks lat- that plans be made to evacuate the Rongelap er. By this time, skin bums were developing people. About 36 hours post-detonation, pianes and the crew was put into hospitals. measured high levels of radiation on Rongelap The United States later compensated and Utirik, showing that evacuation was neces- Japan in the amount of $2,000,000 for the sary. Lower levels were found on Ailuk, an atoll effects of the fallout on the fishermen. and on just south of Utirik, but the Task Force decided the fishing industry (A-38, B-3, B-9). The that evacuation of the 400 people on that atoll Japanese subsequently undertook several was unnecessary. On March 2, the USS Philip marine surveys in the Pacific to study the (DDE 498) was ordered to Rongelap to evacuate effects of fallout on ocean currents and on their the people, and on March 3, the USS Renshaw fishing industry. The accident added fuel to the (DDE 489) and the USS Monroe (DDE 422) were arguments of the anti-nuclear groups in Japan ordered to Utirik for the possible evacuation of against the US testing program; these repercus- the people there. Seaplanes with Task Force sions later caused problems and disrupted one and Trust Territory representatives were sched- medical survey. uled to meet the ships at these islands. The external radiation effects on the What went wrong? In reviewing the events fishermen were similar to those in the RongeIap that occurred soon after the accident, I think people. Their absorption of radioactive material that the state of confusion was responsible for via ingestion was less since their food and the chronology of events that occurred. water, except for fresh fish, were in closed con- Certainly, no ulterior motive is evident. In ret- tainers. No thyroid abnormalities were found rospect, one does wonder why the people of (A-14, 38). Rongelap had not been evacuated for Operation Castle, as they had been for Operation C. Evacuation of the Marshallese 1. Rongelap 2Memi Eieenbud. then Head of the Health andSefety I&mtmy (WL) of-C NewYorkOpereUoNOffxe,tald On March 1, there were 64 Marshallese me:‘TheHASLrepreeent@ve on the Estee(Breeim)reoeived wordthat the monitoringine~ent onROngenkwentoff-eceie people on Rongelap island and 18 others were atH+7houre. Hsadvieedmeaboutthb inNewYo&fouo~ fishing and gathering copra at Ailingnae Atoll, whi&tie ~k forcedeniedhimtheuseofmdi~~i~tiom about 18 miles southwest. Based on statements forabout30 houre. The first notifkation to the AEUHQS wae ●t abut H+24 when I tsld Bugher (Head of the Divimon of Biolosy made by John Anjain, the Magistrate of the vil- end Medicine, AEC) aboutmy - fromBreaiinAeday before. Iage, and other sources, I have reconstructed There were apparentlynom~ fromCJTF7toDCfor●t the events of that fateful day. Ieest24 hour s.’ 5 .tijain was preparing breakfast while his people left on the ship about noon for Sifo Island wife was nursing their one-year old child. at Ailingnae Atoll where the other 18 Rongelap “ Sudaeniy, there was a blinding flash, and they people were picked up, and the snip proceeded saw a huge red fireball ascending upward to Kwajalein. Shower facilities were made ‘“,..like the sun rising in the west. ” Minutes lat- available to attempt to decontaminate the peo- er. a tremendous blast knocked thatched win- ple, and some of their clothes were laundered. dows out of the huts and coconuts out of the The ship arrived at Kwajaiein at 8:30 a.m., trees. March 4. In the late morning the atmosphere 2. Utirik became murky, and a snow-like, gritty material began falling from the sky; this continued for The 159 people living on Utirik Atoll saw some hours, covering the ground and palm trees the flash of the detonation in’the western sky in with a white coating, adhering to the skin and the early morning of March 1 and felt the con- in the hair of the people, causing itching and cussion of the blast wave. Fallout was not seen burning of the skin and irritation of the eyes. on Utirik, probably because there was less and Many children played in the ash; some of the it had dispersed by the time it reached that children frolicked in the lagoon edge and thus. island. It was later estimated that the fallout unknowingly, helped prevent or modify the began at about 4:00 a.m. on March 2 (about 22 development of radiation burns of the skin. The hours after the detonation) and continued for fallout sealed on their food; some said the coco- about 4-5 hours. The Utirik people did not com- nuts tasted bitter. Since it was the dry season, plain of symptoms, such as skin irritation or the water in the catchment systems was low, gastrointestinal effects as the Rongelap people and a brief rain shower that evening caused the experienced. The first of two ships ordered to water in the cisterns to turn yellow. Jabwe Utirik to evacuate the people was the USS Joru, the Health Aide, advised the people not to Renshaw, which arrjved about 6:30 a.m. on drink the water. However, many did. March 4 and sailed again at 1:30 p.m. The USS During the night of March 1 many people Monroe did not arrive until after the peopie lost their appetites and became nauseated: a were evacuated. - few vomited and had diarrhea. These symptoms persisted into the next day. D. Atomic Energy Commission (AEC), On the afternoon of March 2, the Task Washington Force sent two men on a seaplane to Rongelap to The Joint Task Force Command notified measure radiation levels. They were on the the AEC in Washington about the evacuation of island only 10-20 minutes and did not speak to the Marshailese from Rongelap and Utirik and the people, perhaps because they did not know the servicemen’from Rongerik and requested a .MarshaHese. medical team to evaluate possible fallout effects At 7:30 a.m. on March 3, the USS Philip on the people.’ John Bugher, Head of the anchored in the lagoon at Rongelap. Shortly Division of Biology and Medicine, called on the afier, a seaplane arrived from Kwajaiein with Surgeon General of the Navy to form a special A~arit)n Wilds, a Trust Territory Representative, medical team. E. P. Cronkite at the Naval and Oscar DeBrum, a Marshallese interpreter.3 Medical Research Institute was asked to head a The following description is taken from the offl- joint AEC-Department of Defense emergency ciai account of the Captain of the USS Philip medical team. The expedition was outfitted in (B-1O). record time and left for the Marshall Islands on A radiological monitoring team went March 7. ashore with the landing party and measured On March 11, the Atomic Energy radiation levels on the island. Anjain, the Commission made the following announce- .Magistrate, was informed that it was necessary ments to evacuate the people. He designated 16 people (older people, and those with sickness) to return ‘In March, the AEC ieaued a teree reieaae stating that ● tut to Kwajalein on the plane. The remaining 45 detonation had ocmrred. There waa little reaction in preaa.l%- Taak Force personnel were advised not to tik about the a+- dent. It was some weeks before the U.S. public became ●wue of 3~eBm Iaur ~e &fH~ Island District Admini~~a~r the e-rid of the amdent (B-8). under theTrustTemtmy Government,andthen Secreq ta ‘our group felt that this ~ouncement waa misleading and the Republic of the Marehall Isla.nda. inaaura~ mrxe.at that ume. some eITectawere bang obearmd.

6 During the course of routine atomic .. I tests m the .Marsnail Islands, 28 United States personnel and 236 residents were -.#-- . -- > :- transported from neighboring atolls to Kwa]aiein Island. according to plan as a precautionary measure. These individuals were unexpectedly exposed to some radioactivity. There were no burns. All were reported well. After the completion of the atomic tests, the natives will be returned to their homes. (B-3)

E. Naval Station, Kwajalein . When the evacuated personnel arrived at Kwajaiein, they were given brief physical examinations including blood counts at the Navai Dispensary. A shower facility for decontamina- Marshallese bathing in the lagoon of Kwsjalein to ting personnel and laundry facilities were remove fallout contamination established. .Most people still showed some residual radioactive contamination of the skin and ciothing. Their clothing was laundered and. to aid in decontamination, they were encouraged to bathe in the nearby iagoon. .Uost people had few clothes, and some had to be discarded due to persistent radioactive contamination.

F. initial Medical Examinations 1. Facdities When the medical team arrived at Kwajalein on lMarch 8, we found that the people were adjusting well to their new surroundings. There was some worry about possessions left behind, and they were told that their boats and livestock would be cared for. Anjain, the rnagw trate, expressed concern that the Rongelap peo- Medied exmninations ●t Kwajdeim ple might have the same fate as the Bikini people who had been away from their island for 2. Medical Findings many years. The details of the medical findings in our With the cooperation of the Navy, we setup initiai survey can be found in Reference A-2. examination and laboratory facilities in a build- During the first two days after detonation ing adjacent to the living quarters of the of the bomb about two-thirds of the Rongelap Marshal lese. Further decontamination of per- people experienced anorexia. and nausea; a few sonnel and clothing was instituted. Members of vomited and had diarrhea. The majority had the team were assigned responsibilities for itching and burning sensations of the skin in examinations. Daily sick call and treatment in exposed areas. Only one of the 18 people who the Clinic were established. Medical histories had been on Ailingnae Atoll had these symp- were taken and physical examinations were car- toms and none of the symptoms were noted in ried out with the assistance of Jack Tobin, a the Americans and people of Utink. Trust Territory anthropologist; Kathleen Emil, Significant exposure to radiation depresses a Marshallese nurse, and BilIiet Edmond, a some elements of the blood, particularly the ?chooi teacher, who served as interpreters. white cells which protect against infection and

7 I I piatelets which prevent bleeding. “\Vithlarge amounts of radiation, such depression may lead to death from infection and bleeding. Therefore. numerous examinations of the blood were carried out during the six weeks of examinations. Increasingly severe depression of the white blood cells (lymphocytes) and piateiets was noted during the first few weeks, falling to about one-half to one-fourth normal levels. The greatest drop occurred in the children. This depression was much less in the Rongelap people who had been on Ailingnae and the Americans who had been on Rongerik. The people of Utirik, who had received a much smaller radiation exposure, showed only slight ciepres- sion of the average platelet count. By six weeks, .. when the initial examinations were concluded, the blood eiements in the Rongeiap group showed recovery approaching, but not reaching, normal levels. Beginning about 10 days after exposure, radiation burns of the skin began appearing in the Rongelap people. These so-tailed “beta burns’” appeared as dark pigmented spots on the scalp and on parts of the body that had not been covered by clothing.s The top layer of skin of these spots then peeied away, leaving depig- mented areas: some lesions iater became ulcer- ated. The majority of the Rongelap children had these bums. The bums were much less pro- nounced in the Ailingnae group and the American servicemen. No beta burns were noted in the Utirik group. Loss of hair was asso- Exteneive radiation bume in a young Ftongelap boy. ciated with the scalp bums. The bums were accompanied by itching and burning sensations. At the outset, the medicai team had no way and some of the lesions on the top of the feet of estimating the whoie body dose rece~ved by were painful, particularly during walking. peopie. In accordance with good medical proce- Biopsies of the lesions showed severe injury to dure, we decided that the clinical findings, par- the skin surface, but littIe injury to the deeper ticularly the degree of depression of blood tissues, showing that the effects of the beta elements, would be the index used to estimate radiation were superfkial. After two to three the seriousness of the effects of the exposure. weeks, the beta bums began healing, with Animal studies had shown that such a ‘“biologi- repigmentation and regrowth of hair. cal dosimeter” was valid. This decision proved Except for the changes in the skin and to be a good one. The doses estimated later blood, the exposed people appeared to be gener- agreed well with the clinical findings that ally in good health, and there were no differ- might be expected, based on animal studies. ences between the more exposed groups During the first few weeks when the blood compared with the lesser exposed groups. Some counts were dropping and numerous skin bums slight weight loss was noted in the Rongelap were appearing, serious consideration was people, which may have been related to the given to the possibility that further medical change of environment and diet. assistance, such as the use ofa hospital ship, might be necessaxy. Admiral Bartholomew Hogan, the Pacific Fleet Surgeon of the Navy at Hawaii, said that naval assistance would be available (B-12). 1 t I

# Fortunately, this course of action was + .-. . t’ q - ., unnecessary. The exposure to gamma radiation received by the people was sublethal. Based on the known effects of radiation in animals, an additional 100 rad of radiation might have resulted ‘in fatalities, perhaps even with treatment. It is fortunate that no one lived on the northern islands of Rongelap atoll since the radiation levels there were definitely in the lethal range. In spite of the significant degree of hematological depression, there was no evidence of bleeding nor evidence of increased susceptibil- Rediation bume of the nee~ ity to infections in the exposed people. An epidemic of upper respiratory infections that occurred in the Marshallese during the period of the examination was no worse in the more heavily exposed than in the less exposed Utirik group. Blood transfusions were not considered. (Blood transfusions had been used in treating the exposed Japanese fishermen, one of whom later died of hepatitis.) It was decided not to use prophylactic antibiotics since the possible development of bacterial resistance to antibiotics might reduce their effectiveness if infections developed. Muter the initial examinations were corn- pieted, the AEC deeided to move the Utirik people back to their home island since the low residual radiation levels were considered safe for habitation (A-3). In June, they were returned and provided with supplementary Redktion bume of the feek food. However, surveys of Rongelap island showed that radiation levels were too high to permit the people to return. Therefore, they were moved to temporary quarters” set up for them on a small island (Ejet) at Majuro Atoll several hundred miles south of Kwajalein. Following our initial examinations of the American servicemen, they were taken to Tnpier Army Hospitai in Hono@iu for further examination by Army physicians. The exposed Marshallese would continue to be examined by our medical team. G. Dose Estimates The Japanese at Hiroshima and Nagasaki were exposed mainly to direct gamma radiation, with a small neutron contribution from the det- onating bombs and the resulting fission products. They suffered extensive trauma and thermal bums. There was no significant fallout. On the other hand, the Marshallese suffered no Loss of hair in a young Rongelap girl due to fell- direct effects from the detonation itself, and out deposit on the scalp. their exposure was due entirely to radioactive

9 fallout. They safferea no blast trauma nor ther- :WOwe”eicsafter exposure. Oniy radioactive mal burns. The fallout material consisted of strontium (egSr) and iodine (1311)were near the numerous radioactive fission products. some maximum permissible levels. Based on later neutron-induced radioeiements, and a small studies, plutonium, a long-lived element, was amount of fissionable material. The present in small amounts and well within the Marshaliese were exposed to (1) penetrating Federal Guidelines (See Chapter VII). This eie- gamma radiation resuiting in whole body expo- ment and strontium can be deposited in the sure, (2) skin radiation from deposition of fall- bones. However, no effects of any of these out on the skin, and (3) internal absorption of absorbed elements, except for radioiodine, radioactive materials from consumption of con- which concentrates in the thyroid giand, have taminated food and water and, to a lesser been detected in the Marshallese people. By six extent, from inhalation. months, there was barely detectable radioactiv- Calculation of the acute radiation doses ity in the urine of the Rongelap people. received by the people depended upon the In view of the extensive later development results of radiological surveys of the islands, of thyroid abnormalities (largely from radioiodine exposure), it became apparent that the length of time of exposure to the fallout, the i amounts of contaminated food and water con- the original doses estimated to this organ were I sumed, and, !ater, urinalyses on the exposed too 10wUand re-evaluation of the doses-received people. There were many variables and uncer- by the Marshallese, based on later data, are tainties in these calculations. The estimated presented Table 1. The dose to the thyroid gland dose of gamma radiation probably was the most was much greater in the children due to the accurate. The skin exposure was spotty and the smaller size of their glands. doses are not accurately known, although in When the exposed Marshallese people were many cases, they were estimated to be weil taken back to their home islands, they were above 1000 rad from soft beta rays. The amount exposed to low doses of radiation from residual of internal exposure was derived by radiochemi- fallout. This will be discussed in Chapter V. cal urinalyses carried out beginning at about

Table 1 Dose Estimates (rad)”

Group’oa Age External Dose Thyroid dose (ave-msx)””

Rongeiap 1yr. 190 5000-20.000 (67people) 9 yr. 190 2000- 8.000 Adult 1000- 4,000 Ailingnae 1 yr. 110 1300- 5,200 (18 people) 9 yr. I10 540- 2,200 Adult 280- 1,120 Utirik 1yr. 11 670- 2,700 (167 people) 9 yr. 11 300- 1,200 Adult 11 150- 600

“FromLexurd●t al., 19SS(A-S2) “’hex not tndude etimal doee ●**Includestime ●xposedinutem.

10 .- -. ,.. 4= ..

Chapter III — Return to lbngelap

During the three years on Ejet Island, the school, warehouses, and water systems. Plans -Rongeiap people Ionged to return to their atoll also included some dwellings and cisterns on and were greatly disappointed at the length of nearby isiands. We designed plans for the dis- time they were kept away. .Meanwhile, the pensary and requested a two-way radio to be deserted village at Rongeiap had deteriorated installed for medical consultations and emer- with overgrowth of weeds and vines, their gencies. thatched-roof huts were sagging or coiIapsed, In February 1957, the AEC, with concurrence and the church had burned (B-3). of the High Commissioner of the Trust By 1957, there had been 10 radiological sur- Terntory, announced that Rongeiap could again veys of Rongelap: seven by the Appiied be inhabited and construction of the village Fisheries Laboratory of the University of began (B-3). By June, the construction was com- Washington and three by the Naval pleted and an LST was sent to Majuro to trans- Radiological Defense Laboratory. As early as port the people home. June 1956, surveys indicated that the radiation The following account is excerpted from the levels on Rongelap Island had declined to such a Holmes and Namer, Inc. Report of Repatriation extent that the island might soon be habitable. of the Rongelap People for the Atomic Energy The AEC, with the concurrence of the Trust Commission, Albuquerque Operation Office, Territory Government, authorized Holmes and Contract AT(29-2)-20, Nov. 1957. Narver (a Los Angeles construction company) to plan a new village on Rongelap in conference Boarding the LST were 250 Rongeiap with the AEC, Trust Territory, and the people with their personal belongings car- Rongelap people. The new village wouid include ried in every conceivable kind of container, homes, a church, council house, dispensary, from woven mats to galvanized washtubs

& . New villsge -t Itangelap.

11 to new airplane luggage, 40 pugs, 60 chick- We hope that vour return to your atoll is a ens. 6 dogs, 1 cat, 1 duck, 1 pet pigeon. Also thing of joy and your hearts are happy. on board were 5 coffins bearing the Food subsidization was provided on a dimin- rema~ns of Rongelapese who had died dur- ishing basis for the first year by the Trust ing the 39 months since their forced evacu- Territory. The cost of the rehabilitation pro- ation in 1954. Before sailing, the people of gram was about $560,000. Ylajuro gathered on board to wish them Unfortunately, the stay of the Rongelap peo- farewell and good luck and sing hymns of ple on their home island was not to be perma- thanksgiving. The voyage home was pleas- nent. In 1985, the local Rongelap authorities, ant and uneventful. doubting the U.S. claim that Rongelap was On arrival, before debarking, the people radiolo@cally safe, arranged to have the people gathered under the deck awning and moved to an island in Kwajalein Atoll. As of offered prayers and hymns of thanksgiving now, the people have not yet returned, and to God for their safe return to their native re-evaluation of the radiological situation of the land. On the beach was a huge sign in island is in progress (see Chapter IX). ?darshallese: Greetings, Rongelap People.

\:.

People on ship re m.tm,ing to Rongehp. Flag raising on ROngehp. i Chapter IV — Health Care in the Marshall Islands I4

ln JUIV 1947, the United States Navy diseases. A high percentage of people had posi- assumed administration of the Trust Territory tive Kahn tests associated with yaws, for which oithe Pacific Islands with headquarters in treatment with penicillin proved extremely Hawaii iB-4). The Navy’s Bureau of Medicine effective. Diseases of the eyes and skin, acute and Surgery sent survey teams into the isiands and chronic respiratory diseases, and vitamin oi Micronesia to assess the health status of the deficiencies were especially common. Poor oral people; they found that malnutrition was wide- hygiene resulted in widespread caries and loss spread. Sanitation, health care, and treatment of teeth, even in young adults. No malaria, fila-” of diseases were usually primitive and there riasis, yellow fever, or cholera were seen. was a vital shortage of trained medical person- Many of the heaith problems noted in the nei. Whideby report were present in the Marshallese The heaith conditions in the islands were people when we began our examinations in. graphically described in the comprehensive 1954. (See Table 2 for a list of major medical reports of a remarkable voyage of the USS findings in the Marshallese population on one of Whidbey (B-5, A-l). The Navy outfitted this ship our early survey s.) with a medical staff and clinical and laboratory The Navy knew that improvement in the facilities. The ship visited many isiands in heaith care system in Micronesia was a formi- Micronesia, inciuding the Marshail Islands. dable undertaking. Paramount was the critical documenting vital statistics and incidence of shortage of trained medical personnel. Schools disease. Briefly, the surveys showed that were established at Guam for training medical unsanitary conditions with regard to flies, gar- and dental practitioners, nurses, and techni- bage disposal, and excretory habits made for cians. Training of health aides to run the Outer muitipie intestinal parasitic infestations and Island dispensaries was undertaken at the

Table 2 MaJorDiagnosaa

Unerpoeed Exposed Rongelap Utirik Rongelap

No. of LNO.of No. of Diagnoaia Caees% cases% Ceaes%

Essential hypemnsion” 11 11 13 9 7 7 Arterioscleroticheart disease 3 3 22 3 3 Carebral artarioacleroaia 1 1 64 1 1 Bronchiectasia 1 1 11 Emphysema 10 ‘7 1 1 Cancer 2** 2 Tefiizuysyphilis 11 1 1 Wmsry yaws 11 Pulmonary tuberculosis 1 1 G.I.parasites 11 Congenitalabnormalities (all types) 8 8 13 9 10 11 Asthma 43 Osteoarthritis 7 7 85 5 Rheumaticheart disease 2

Toti examined””” 95 144 93

“Mined M systolic 140mm Hgordimtohc100mm I-Ig. “*Orbitaltumor, type unknown: basal cell kn carcinoma “*”.4duiti andduldren

13 District Centers. This training program was epidemic and receives referrals from other expanded under subsequent administrations of areas. As part of the new College of .Micronesia the Trust Territory and under the Republic of at Majuro, a School of Nursing has been estab- the Marshall Islands. lished with a training program for health assis- The Department of Health Services of the tants to serve in the Outer islands. Trust Territory Government was responsible for There remains a vital Shortage of trained heaith care in the Territory. In the Marshall medicai personnel, particularly doctors. Islands the District .Medicai Centers were under Insufilcient premedical education has made it the Director of Health Services of the Trust difficuit for Marshallese students to get into Territory and, more recently, as part of the gov- U.S. medical schools. Recently, a school was ernment of the Repubiic of the Marshall established at Pohnpei in the Caroline Islands Islands. The hospitals at Majuro and Ebeye for medical training.of Micronesians, and Islands are staffed with local practitioners and efforts are being made to attract more young Micronesia nurses and technicians. At times, a .Marshallese into the field of medicine. few American physicians were on the staff. The Increased emphasis is being given to local practitioner, with less formal education improvement of health care in the outlying than an American M.D., by necessity learned to atolls (B-8). .Medical teams regularly visit these carry out medical responsibilities, including isiands on the Canvasbacks, a sailing vessel. In major surgeries, remarkably well. addition, a saiiing vessel, the Tole Mour, fur- In the Outer Islands, the dispensaries are nished and outfitted with medical facilities by manned by a health aide, often with limited the Marimed Foundation, with a staff of volun- training, and visits of the field-trip ships carry- teer medical personnel, also regulariy visits the ing medical supplies and personnel were often outer Marshall Islands: The operation of these irregular because of poor communication with ships is supported by the Marshall Island the District Centers. Government. In addition to general medical The heaith services have faced many prob- care, the visiting teams carry out dental treat- lems in rendering health care in these islands. ment, inoculations, treatment of venereal dis- There have been serious epidemics of diseases, eases, and conduct educational programs on such as poliomyelitis, influenza, chicken pox, sanitation, family planning, and training of and pertussis, which were brought into the midwives. Radio communication has improved islands. yThese epidemics were particularly and air strips have been constructed on some severe with high mortality before there were islands, including Rongelap and Utirik, allow- effective immunization programs. There were ing for emergency visits of medical personnel Insufficient medical personnel to handle health and evacuation of patients. care, including widespread diabetes and dental Considering the isolation of these islands, problems. One of the most serious problems has travel problems, and shortage of trained medi- been population growth in these islands with cal personnel, in my opinion there has been limited habitable land. good progress in heaAth care. However, there is There has been continued improvement in still considerable need for improvement. health care in the Marshall Islands (B-8, 14-17). A new $8,000,000 multi-wing hospital, planned as a referral center for Micronesia, was opened at Majuro in 1986. The hospital has been operated by Mercy International Health Services (a U.S. organization) under contract with the Marshailese government. The U.S. staff is being replaced with Marshailese medical personnel (B-14J. The hospital has a rehabilitation center, which was begun in the 1960s following a polio

‘[n 1963,poliomyelitiswasintroducedintothe Mandabyan U&CMmdorfroma vtaitins ship. Awidespread●pidemic occumed,WAneadytwohundred cases of paraiyau.

14 Chapter V — The Conthtig Medical Surveys

continued under contract with BNL. I was A. .Need for Continuing Medical Surveys - AEC .Mandate for the Examinations asked to be the program director. a The examinations by the Brookhaven medi- Following the imtial medical examina- cal team have been a joint project with the tions, the people of Rongelap were reexamined Trust Territory under the Department of by medicai teams heaaed at six months by V. P. Interior and, more recently, the Republic of the Bond (Naval Radiolo@cal and Defense Marshall Islands. The participation of the Laboratory) (A-3), at one year by E. P. Cronkite health service personnel of the Marshall (Brookhaven National Laboratory) (A-4) and at Islands has been indispensable to the success of two years by me (A-5). In 1956, I resigned from this project. During the early phases of the the Navy and joined the staff at Brookhaven. examinations, the need for, and extensiveness The Rongelap people had moved to a tem- of, the examinations had to be clarified with the porary village constructed for them at Ejet Trust Territory officials. Also, there was con- Island, .Majuro Atoll. For the examinations, the cern that the Rongeiap people were not adjust- people were transported by boat to the main ing satisfactorily since returning to their island island at .Majuro, several miles away. An unex- and that the crew going ashore from the Navy posed population of Rongelap people living at LSTS at the time of the examinations might Majuro was selected as a comparison group and have a disrupting influence. Subsequently, the given the same examinations as the exposed situation improved when Trust Territory ships people. This population was blood relatives of were used and the number of survey personnel the exposed people, living under the same con- reduced. ditions, and matched reasonably well for age and sex. B. Limitation and Expansion of Program Examinations during the first two years showed that the initial acute effects of the radi- The Brookhav~n medical program in the ation exposure had largely subsided (see next Marshall Islands was designated by theAEC as Section). The people were reasonably healthy a research program with a mandate to examine and no deaths could be attributed to radiation and treat the Marshallese people who had been exposure. exposed to fallout. The responsibility for the The lack of further significant findings was general health care of the Marshallese, includ- most encouraging despite the significant radia- ing the exposed populations, had been estab- tion exposure the people had received. However, lished as a responsibility of the Trust Terntory in view of studies of the Japanese exposed to the Government. As time went on, it became atomic bombs at Hiroshima and Nagasaki and increasingly apparent that the pnmafy health of other irradiated populations, the exposed care afforded by the Tntst Ternto& in the MarshalIese were at greater than normal risk of Outer Islands was inadequate, and the medicai late effects, such as leukemia and other types of team attempted to increase medical care. Our cancer (B-3 1). Therefore, we recommended that team was later criticized for not assuming annual examinations of the Rongelap peopie be greater responsibility for general health care of continued indefinitely. Looking at the small’ the MarshaiIese. Another criticism was that the radiation exposure of the Utink population, we people were being treated as “guinea pigs”, considered that examinations every three years which was probably related to the fact that would be adequate. (Later, when thyroid abnor- numerous examinations and tests were being malities appeared in that population, annual earned out by the medical team because of the examinations were carried out). limited knowledge about the effects of fallout The Division of Biology and Medicine of the AEC agreed with these recommendations, and ‘It ehouldbepointi outthat the AECnetwelly turned ~ W 4 under amtrect ta them, principally the NatioMI in 1957, with the concurrence of the Trust Lebomtie8, foreeeie-ce in Iwndlingmdiationpmbleme. Territory, requested that the examinations be Except for the military Ieboretaria,thereue fewother~ tit havethe-Debilitiesforsuchemietuwe.

-. .—-.. - :.. . radiation in humhn beings! and per~a?s also to (namely, Wotje, Likiep, and Majuro J were given the designation of the program as a research thyroid (neck) examinations. On arrival at project”. these atoils, a meeting was held to tell the peo- In spite of limitations of the program ple that we would make “street surveys” start- established by the mandate, the AEC recog- in’g at one end of the village and going down the nized that it would be necessary to examine a street, asking the people to iet us examine their control, unexposed population and that the phy- necks. There was usually complete coopera- sicians would treat diseases other than those tion.g caused by radiation. Later on, the AEC/DOE In 1974, a “Fallout Survivors’ Bill” (B-18) further expanded the program. There was never was passed by the Congress of Micronesia and any effort by AECfDOE or any other agency to later funded by the United States (B-47). Those influence the conduct of the examinations. who were ill were granted free hospitalization During their stay on the islands, the medi- in the Islands and free travei, with per diem cai team routinely carried out “sick call” for allowances. Both exposed Rongelap and Utink anyone needing medical attention. It should be people, and the unexposed control people could emphasized that the amount of health care that participate. When referrals to U.S. medical could be given by the medical team was limited facilities for further treatment were necessary, not only by the mandate but also by the time the expense was borne by the Trust Territory available for the examinations. government except for illnesses which might be Since an unexposed population of Rongeiap related to radiation exposure, which continued people were given the compiete battery of exam- to be funded by the DOE. Because of funding inations and tests given to the exposed people. and administrative difficulties, payments were the other unexposed people on Rongelap and often delayed, which resulted in considerable Utirik eventually requested that they receive unrest and criticism expressed at our village the complete examinations. Therefore, by 1972, meetings. Later, representatives of the DOE all the people on Rongelap and Utirik were accompanied the medical team to clarify these included. issues. . Following the death of a young Following my retirement, Hugh S. Pratt Rongelapese in 1972 from leukemia. which was headed the program in 1980. He was followed probably related to radiation exposure, we for a brief period by E. P. Cronkite, who headed decided that hematological examinations of the the first team in 1954. Since 1981, William H. Rongelap people would be done every six Adams has abiy directed the program. In 1991 months. Also, we became aware that the treat- Jean Howard joined Adams in directing the pro- ment program with thyroid hormone was not gram. being sufficiently monitored, which could be The examinations are now carried out serious, particularly in people who had had thy- twice a year. The first examination, usually in roid surgery. In addition, it was increasingly apparent that greater continuity was necessary % 1962, the MarahailIalaadAtamic TestingLitigationR@eu in the medical care of the populations being (be Angeles}Qupportadssumeyfor thyroid nodules in the examined. Therefore, a resident physician, bhall Ialanda(HamiltomT.E.,vanBelie.G.,andLoGa’ti% J.F., Tliyroid Neoplaaia in Manhall Xalanders Exposed to Knud Knudsen, from BNL, was stationed in the Nuclear FaUouL JAMA 258:629-35, 1987). The study mportad Marshali Islands at the Ebeye Hospital near that there waa an ixtcreaae of thyroidnodulesin peopleoftha Kwajalein to coordinate the medical programs northernMarahalls(otherthan F&ngelapendUtiriidcompaA withpmple in the eouthem atdla. which they believed waa due at Rongelap and Utirik, and the District Center ta expoeureto fallouttkomthe Bravomciden~ They ckimed at Majuro, in collaboration with the that the imident of nodules we reported for our contd popde- Department of Health Services of the Trust tian wea too high.Iftree,theriskfactor for thyroid nodulee in the RongeIap and Uthikpeoplewouldbeincreeaed.However, Territory. whenonecoaeidere the fact that the Sreateet damaga ~ the thY- Beginning in 1973, when thyroid roid gland waa from the short-livediaotopeeofiodinewhich nodularities were developing in the lower-dose decay in ● mat@r of hours, it iahardtobelievethak by the time the falloutreachedmoredistant●tolla,the thyroid domewould Utirik population, we decided that more infor- have been sufficient to remit in laterdevelopmentofnodule.e. mation was needed on the natural incidence of Wecmchxled fromourexamin citionof people on two aMla in thyroid tumors in the Marshallese people. the notiem Mershalls (~ep and Wotje), and the Rongalap and Utink people whohad notbeen●rpoaedin 1954, that the Therefore, more than nine hundred people liv- inadence of thryold ncdulea in theme peopie wea similar to other ing on atol~s south of Rongelap and Utirik world poptdations (A-15).

16 \larcn. examines aii avai~able people: a second Free Association permitted the Department of examlnauon, about six months later examines Heaith Services to increase health care in the those missed in the first examination, and pro- outer atolls, particularly in the northern atolls vides foilow-up medical care. Until 1985, res]- affected by fallout. Chapter IX discusses the cient pnyslcians. sponsored by Brookhaven, Compact of Free Association between the continued to serve in the Marshalls for one to United States and the Republic of the Marshall two years (See Appendix I). After 1986, the pro- Islands, and the compensation granted to the gram director decided that it was not necessary people of the atoils affected by the atomic test- to have a resident physician in the Islands since ing program. U.S. funds made available under the Compact of

17 Chapter VI — The Medical Examinations

A. Organization extremely important diagnostic, therapeutic, and technical capabilities. Equally important 1. Supporting Agencies has been the participation of a large number of In organizing and carrying out our medical medical personnel (practitioners, technician, mission in the .Marshall Islands, the assistance health aides, and nurses) from the Health of many agencies, governmental and non-gov- Services of the Marshall Islanda, who contrib- ernmental, has been essentiai. Some of the key uted vitally in carrying out the examinationa, in agencies include: obtaining medical hiatonea, and in acting as a) Brookhaven National Laboratory (BNL) interpreters. which has been the base of operations for plan- The success of the program mainly has ning and organizing the surveys under contract been due to the dedicated service of all of these with the Division of Biology and Medicine of the participants. Appendix I lists the participant Department of Energy (DOE). with their years of participation. b) The Department of Energy, formerly the Atomic Energy Commission (AEC), the Energy 3. Supplies and Equipment Research and Development Administration Since the beginning of the examination (ERDA), and the OffIces of DOE at Nevada. there have been changes and additions in medi- Honolulu, New York, San Francisco, and cal equipment due to advances in technology Enewetak. and to differences in medical approach. Blood c) The Department of Interior (DOI) and counting by microscope has been supplemented the Trust Terntory of the Pacific Islands. The with electronic counting and chemical analysea surveys were a joint project with the Marshall of the blood by electronic means. A mammogra- Island Department OfHealth Services of the phy unit was added to the x-ray equipment. In Trust Territory. This collaboration has contin- 1957, a 21-ton steel room was constructed at ued under the new administration of the BNL to measure internal radioactivity (de- Republic of the Marshall Islands (See Chapter scribed in Chapter VII). Some procedures were Iv). adapted to field conditions: for example, the d) Department of Defense (DOD), particu- staining “ofblood smeara and cell culturing pre- lar] y the Bureau of Medicine and Surgery of the sent speciai problems under tropical conditions. Navy and its laboratories at the Naval Medicai Getting together and packing the medical Research Institute. the Naval Radiological equipment, shipping numerous boxes to the Defense Laboratory, and the Pearl Harbor Islands, and unpacking and setting up the Command: the Army Medical Center at Walter examinations in the Islands are formidable Reed and Tnpler; the Axzned Forces Special taaks requiring considerable time and logistic Weapons ProjecUDefenae Nuclear Agency; and planning. the Army and Navy Commanda at Kwajalein 4. Examination Facilities and Enewetak, which have fumiahed vital logistic support and have aerved as our advance Eariy in the examination tenta were used bases in the Pacific. on Rongelap and Utirik, which were gradually e) The Department of State, the National replaced with more permanent structures. At Institutes of Health, and the Radiation Effects Rongelap, sleeping quarters with adjacent Research Foundation in Japan. shower and toilet were constructed, and a trailer waa brought in for cooking and meaaing. 2. Medical Participants in the Surveys The dispensary, school house, and council house We were most fortunate in obtaining out- were used for examination. At Utirik, we standing physicians in many specialties and acquired some butler-type buildings left over subspeciaities and technicians from the United from the weather station, which were used for States to participate in the examinations, housing and examinations. Later, a new dispen- including many who were experienced in radia- sary was constructed by the Trust Territory on tion effects and aiso endocrinologists specializ- the Island and was used for the examinations. ing in thyroid problems. They provided

18 The setting up of the heavy 21-ton steel 5. Transportation room. used during the eariy years for wnoie During the early years, transportation body counting, presented problems. It was from Hawaii to the Islands was by mditary prop instailed aboard ship at Enewetak. aiong with a aircraft. With the advent of jet pianes, travel to clothing change-room and shower room. and the islands has been faster and more comfort- connected to the ship’s power supply. The peo- able. Transportation in the Marshall Islands pie were brought to the ship by small boats. has been a problem, since, until recently, the Later, an arrangement of lead bricks (“shad- only way was by ship except for a time when the ow-shield”) was substituted for the steel room Navy at Kwajalein helped by flying some of the and set up permanently ashore along with a team to Rongelap and Utirik by seaplanes. In clothing change and shower facility. A gener- 1958 and 1959 the Navy furnished LSTS that ator was installed on the Islands to furnish were beached at Rongelap and Utink and the power for the examinations and for the opera- medical team lived aboard. Subsequently, we tion of the whole body counter. relied on Trust Territory cargo ships to get to As more and more peopie from Rongelap the Outer Islands. and Utirik gravitated to the District Centers at On arrival at the Islands, getting ashore Majuro and Ebeye (near Kwajaiein Island). was by smail boat or by outrigger canoe. When more permanent facilities were needed, so trail- the examinations were done ashore, it was diffi- ers were set up adjacent to the hospitals and cult to get the heavy boxes of medicai equip- furnished for the examinations and laboratory ment and supplies ashore. Therefore, the iater work. Since 1972, we were fortunate in having ships assigned to the medicai teams. These ves- seis, though small, have adequate living facilities, and trailers instailed on the cargo deck are equipped for the examinations, while an area below deck is used for the laboratory and x-ray examinations. There have been four such ves- seis (Liktanw 1, II, and 111 and the G. W. Pierce). The Rongelap and Utirik people are brought by boat to the ship anchored near the shore. To avoid the risk of travel by small boat, the children are examined in the dispensary ashore. At the District Centers at Majuro and Ebeye, the ship is moored to the docks where the Rongelap and Utirik people living at thes’e Tnsst territory cargo vessel camying pemonael locations are brought in for examination. end supplies for medical survey, 1-

I : Vessel assigned to the medical team for examina= ‘Tmsstterritory vessel stranded on reef after / tionm 1974. departure fkom Rongekp, 1872 I { 19 acquisition of our own survey ships was a great was unique. There had been no previous serious boon ]n carrying out our mission. exposure of a human population to fallout. In recent years. airstrips have been buiit Consequently, numerous examinations were on Rongelap and Utirik and a locai commercial necessary to diagnose and treat possible radia- amline at .Majuro has a limited small-plane ser- tion effects at an early stage. As the examina- vice to these Islands. tions pro~essed through the years, new findings required new tests to be added to the B. Scope of the Examinations protocol. As a result, a considerable battery of To detect and treat radiation effects in the examinations and tests. have been earned out: Marshallese, it was necessary to conduct longi- these are listed in the published medical tudinal, prospective follow-up studies, probably reports. for the lifetime of the people. To accurately Routinely, the examinations began with a” assess possible radiation effects, it was neces- medical history of the individual, taken by a sary to examine an unexposed population for Marshallese practitioner, followed by a com- comparative purposes because data on the inci- piete physical examination, a detailed examina- dence of various diseases in Micronesia were tion of the blood, and an x-ray examination. incomplete or nonexistent, and vital statistics Examinations focused on the detection of any were inadequate. late effects of radiation, particularly cancer. As a basis for planning the examinations, Thyroid examinations, including hormonal there was considerable information avaiiable on studies of the function of the glands, and growth the effects of radiation in animais and also from and development studies of the children exposure of human beings, such as the Japanese received particular attention. Some other exam- casualties to the atomic bombs, from people inations were included to detect possible inher- receiving radiotherapy, and accidental radia- ited effects of radiation, cataracts of the eyes, tion exposures. However, the exposure of the immunocompetence (ability to resist diseases), iMarshallese to the complex radiations of fallout intestinal parasites, and dental problems.

Medical Team being greeted on arrival at Rongelap, lWI.

20 C. Problems Associated with the Examinations There were several probiems in carrying out the examinations. The language barrier hampered communications with the people. However, we were fortunate in having English-speaking Marshallese participating in the program who aiso acted as interpreters. Sometimes peopie were unsure of their exact age, which caused particular problems in aasessing growth and development in the children. The diagnosis of an illness was often va~e and the cause of death was often ‘“too old”, and it was difficult to obtain consent for autopsies, even at the District Medical Centers Laboratory sacup in new diapenauy at Rongelap. because of feelings against mutilation of the body after death. Some people complained that drawing blood made them feel weak, while oth- S ers questioned the need for continued examina- j tions, particularity during the early period when a- there were few significant findings. L=. Psychological reaction to the fallout was a reflected in various ways. In the, early years, fears regarding fertility were present, and there B were complaints of weakness believed to be due to exposure. Many ailments common to the i Marshallese were believed to have been made : w worse by the fallout:such as fish poisoning and :. inflammation of the mucous membranes from . arrowroot flour, which, when improperly prepared, causes such effects. Almost all deaths were thought to be related to radiation exposure. When a young man died of leukemia, there Moving equipment aahore ●t Rongelap for examinations. was great concern that many people would die of that disease. With the development of th,yroid tumors, many were concerned that they might develop such cancer. Other complaints not related to the examinations were that the coconuts, when mature, were smaller than usual. There was considerable unhappiness that the coconut crab, considered a great delicacy, had to be banned from the diet for about ten years due to unacceptable levels of radioactivity y. Further, during our examinations people could not forage for food adequately and requested that we furnish food. Recognizing that our visits disturbed the normal rhythm of life on the Island, we subsequently brought in food to cover the period of the examinations. .“ . .- Village meetings were held with the people ...... - on our arrival at the island to explain the purpose of our visit, and at the end, another meet- Awaiting exams at Ftongelap.

21 ing was held to explain the findings,l” .4t such related to radiation exposure but were not asso- meetings, problems and fears were discussed ciated with any ciinical findings (A-27). Some of and we attempted to correct misconceptions and the findings had been noted in studies of the explain the possible eifects of radiation. Due to Japanese fishermen (A-55) and Japanese language difficulties. lt was not easy to be sure exposed to the atomic bomb (A-63). about the mterpretatlon of our remarks; indeed, Examinations of babies and children of as time went on, it became apparent that our exposed parents for possible inherited effects of explanations were not being fully understood. radiation have not revealed any unusual con- This is not surprising. People with more sophis- genital anomalies. Although inheritance of ticated backgrounds than the Marshallese have radiation-induced genetic mutations has been difficulty in understanding radiation and its seen in animal studies, such effects have not effects and, as with the Marshallese, the issue been demonstrated unequivocally in humans. is often charged with emotion. Studies on large numbers of children born of exposed Japanese parents at Hiroshima and Nagasaki, many of whom received larger D. Brief Summary of Medical Findings amounts of radiation than the Marshallese, The following is a brief summary of the medi- have not demonstrated any clearcut genetic cal findings. Detaiied findings have been pub- effects (A-28). James Neal was unable to dem- lished in numerous BNL reports and medical onstrate any inherited genetic effects in blood journais tReferences. Section A). sampies from the Marshallese (A-30) and in Ex.aminations of the exposed Rongelap people view of the dose of radiation and the small num- at six months showed that they had largely bers of Marshallese involved, it seems unlikely recovered from the acute effects and were gen- that such effects will be detectable in this or eraily in good health; no deaths were attribut- future generations. able to radiation exposure. There was further Regular examination of the eyes, including recovery of the blood elements, though they slit-lamp studies for cataracts, have not were not yet up to normal levels. The skin burns revealed any radiation- induced effects. An had healed with slight scarring and pigmenta- unexpected finding has been the failure of some tion changes in a few people, and hair had blood elements (white blood ceils and platelets) regrown to its normal color and texture. in the exposed Rongelap people to completely The most serious late consequences of fallout recover to levels in the control group. There has exposure of the Marshailese have been the been concern that this slight depression might development of thyroid abnormalities and prob- lower resistance to disease. However, compared ably one fatality due to leukemia. Except for the with the unexposed population (types of dis- thyroid abnormalities, the generai health and eases and resistance to diseases), the exposed mortality of the exposed Marshallese have been people do not show any such effect. similar to that of the unexposed MarshaHese The studies of the Japanese exposed to the populations, with about the same incidence and A-bombs and other studies in humans have types of diseases. During the first few years, revealed that certain types of cancer are more there was an increase in tniscarnages and still- likely to occur from such exposure, such as leu- births in the exposed Rongeiap women, but the kemia, cancers of the thyroid, stomach, and numbers were small and it is uncertain if this breast (A-31). Therefore, we emphasized cancer increase was related to radiation effects. Based detection in the examinations. on birth rate, fertility has been about the same We knew that the thyroid glands of the in the exposed and in the unexposed groups. exposed people had received larger doses of The exposed people have not aged faster than radiation than other parts of the body because unexposed people. At ten years post-exposure, the thyroid selectively absorbs the several the chromosomes in cultures of white Mood cells forms of radioactive iodine in the fallout. from the people of Rongelap revealed a small Therefore, the thyroid glands were examined number of aberrations which appeared to be carefully each year. However, the development of thyroid abnormalities was not expected since the early dose estimates for the thyroid were 10Presently, peopleerr gwen copiemof their medical recordsmd considered too low. Later, the dose estimates Propoeedtreatment. and any speed test4 are discuseed WA the .MaAalkse practmoner. were revised upward and the importance of sev-

22 eral forms of radioactive iodine In producing population. Recurrence of non-cancerous thyroid injury was more fully appreciated and tumors in two individuals following surgery has accounted for the increased thyroid abnormali- required a second operation. Table 3 lists the ties noted (see Tabie 1). number and types of thyroid tumors diagnosed Several years after exposure, a trend toward at surgery. retardation of growth was noted in some of the The time of development of thyroid tumors exposed Rongelap children, particularly in boys was related to the amount of radiation to the exposed when they were less than five years old gland, i.e., the greater the amount of radiation, (A-22,24). At ten years oid, two boys, exposed at the earlier the development of the tumor. one year of age, became markedly stunted. In We found later that the exposed Rongelap fact, they were shorter than their brothers who people generally showed reduced thyroid func- were a year younger. At this time, they exhib- tion, even those that had not had thyroid sur- ited clinical signs of severe 10SSof thyroid func- gery (A-36); aiso, the degree of reduction in tion. It was not immediately apparent that the those that had had surgery was greater than growth retardation was related to thyroid mal- would be expected from the amount of thyroid function since the thyroid hormone levels were gland which was removed (A-19). One exposed normal. Soon after, a more refined test of thy- Utirik man, who had not had thyroid surgery, roid hormones showed that a form of protein in had slight reduction of thyroid function. A the blood, peculiar to the Marshallese people, treatment program giving thyroid hormone to had caused spurious readings of thyroid hor- Rongeiap people, although not strict!y adhered mone levels. The hormone leveis were depressed to, apparently prevented clinical effects of this and were responsible for the growth retarda- reduced function. However, it was apparent tion. that serious effects of loss of thyroid function Nine years after exposure, thyroid nodules could develop, and the importance of maintain- were detected in a 12-year-old Marshallese girl ing a strict program of thyroid treatment was and the following year two other exposed children developed nodules of the giand. Tumors of the thyroid gland, II both benign and maiig?tantt continued to deveiop in adults as well as children, particularity in the exposed Rongelap group, to a lesser extent in the exposed Ailingrtae, and, later, a slight increase was noted in the lesser-exposed Utirik group. The incidence of thyroid tumors in the unexposed group was the same as in other world populations. About one-third of the exposed Rongelap people have developed thyroid abnormalities (see Table 2). The greatest incidence was in children exposed at less than 10 years of age, which is due to their smaller and more active thyroid glands. Two of the three Rongelap children exposed in utero later deveioped benign thyroid tumors, suggesting that radioiodines transferred from the mother to the fetus were partly responsible for development of the thyroid tumors.12 The incidence of thyroid abnormalities in the Utink population has been slightly higher than that seen in the unexposed

l%e tam “’thyrmdtumor” is ueed hem to include adenonutoue n ulee, adenornae end cemer. LF Ibom.iy, a thynnd tumor wee foundina U- man (one of eight) expoeed m utero. It ie less certun that he tumor wee Two Rongelap boy- with growth retardation due rela-d ta the mothefs expomre. to radiation effecte on their thyroid glanda.

23 Table 3 Thyroid Tumor Diagnosesat Surgery tthrough 1987)”

Group (No.) Non-Maii~ant (%) Cancera (%)**

Zxposea*** Rongeiap(67) 19 (28.4) 5.(7.5) Ailingnae~19) 4 (21.1) Utirik (167) 15 (9.0) 4. (2.4) Unexposed(227)**** 5 (2.4) 2. (0.8)

*Wdif%?d from Adams ●t al. 1989 (A-19) O-DOeSnot mciude occult cancem. which are not conmdered ciinicxiiy sign.it%nt “-”includesm UWOexposedpersons “*=*!ncludesallunexposedpereonsin theregularcompamon group since 1957 emphasized for the lifetime of the Rongeiap peo- In a recent report, Adams lists additional ple. cases of cancer of various organs in both the It is encouraging that the development of thy- exposed and unexposed populations (A-19). roid tumors appears to be declining, that none However, he observed no increase in cancer of the thyroid cancers spread beyond the neck mortaiity in the exposed compared with the area, and none recurred or resulted in death unexposed .Marshallese population. Concern (A-19). However, although the radiation-in- has been voiced about the present-day radiolog- duced tumors, have not been lethal, the people ical safety of habitation on Rongelap Island. have suffered considerable adverse conse- Adams reported that prolonged habitation of quences of the tumors, such as surgicai proce- the unexposed Marshallese on Rongelap Island dures under general anesthesia with its atten- from 1957 to 1985 has not resulted in any short- dant risks, inadvertent injury to the ening of life expectancy related to cancer nor in parathyroid gland in two cases, and effect on any increase in thyroid tumors (A-19, 56). one of the nexwes in the neck in one case: also, Over the years the medical teams have diag- the widespread development ofhypofunction of nosed and treated many diseases not related to the thyroid gland requires medication for their radiation exposure, particularity the middle-age lifetime. onset type of diabetes. which is common in the In 1972, a 19-year-old Rongelap man. Marshallese peopie and a ieading cause of exposed at one year of age, developed acute death. As a result, advice about the disease and myelogenous leukemia and, in spite of extensive its treatment has been passed on to the treatment at the Clinical Center at the Marshallese medical personnel. National Institutes of Health, he died several About one-third of the people in the original months later (A- 14). It is likely that his leuke- examination groups are still living. It is impor- mia was related to radiation exposure. tant that continued examinations be carried out Follow-up examinations of the beta bums of for their lifetime since further late effects of the skin showed only minimal scarring and pig- radiation exposure might deveiop. ment changes in a few cases. In spite of the extensive irradiation of the skin and prevalence E. Hts&Is Interest Relations of skin burns shortly after exposure in the Rongelap peop]e, only one case of low-grade can- 1. In the Islands cer of the skin has developed in an area of pre- On our visits to the islands, the medical vious beta bum (A- 19). teams enjoyed pleasant associations with the Three exposed women developed brain Marshallese people and learned to appreciate tumors. TWO(pituitary tumors), which were their lifestyle and culture. Lifelong friendships successfully treated, could have been due to were established. When we arrived on the radiation injury to the thyroid gland. The third island, the people gathered on the beach and woman had a meningioma which proved fatal greeted us warmly, placing fragrant leis around (A-19). It is uncertain if this tumor was reiated our necks. Members of the ‘medical team some- to radiation exposure. times joined the Marshailese in softball and 24 volleyball games. The movies shown outdoors in the evenings were greatiy enjoyed by the people. particularly by the children. The big event of our stay was the party given at the end of our exammations. We brought food and, in addition. the Marshallese furnished fish, sometimes longusta, and even turtle meat. They brought paim-woven baskets filled with coconuts for drinking. After the feast, the children were given candy and toys: a movie was shown and the Marshallese sang some of their songs. This was followed by a special ceremony in which the women, while singing a traditional song, siowiy marched in a single file and presented each member of the team with gifts of handicraft and shells. ● During our free time. we enjoyed the Party t the end of the examismtions. unique recreational features afforded by the island, particularly swimming and snorkeling in the crystaA-clear waters, marveling at the beautiful coral formations and colorful fish. The .Marshallese men took us fishing, longusta hunting, and on rides in outrigger canoes. Hiking across the island under the palms was pleasant, emerging through thickets of scaveoia into the glaring sun on the beach with the steady trade winds blowing and large waves crashing on the reef. YIspecially enjoyable, on a weekend, waa a trip by small boat to unin- habited islands in the atoll for exploration, snorkeling, shell collecting, and a picnic lunch.

F. The Marshallese Patients in the United States As I discussed, we greatly regretted the harm Children enjoying ● Laud and Hardy movie. that was done to the Marshailese from radiation exposure, and were keenly aware of our responsibilities to help them in every way possible. l’hia was particularly true when it became necessary to bring patienta who had developed thyroid tumors to the U.S. medical facilities for further treatment. We explained the need for this treatment and requested their consent. We realized that we had a considerable responsibility in taking them, since most had never left their small islands and would be faced with new situations of Western culture. Naturally, they were apprehensive about going so far from their homes for treatment, including surgery. We assured them that they would be well cared for and that one of our group and a Marshallese practitioner would accompany them. When the Marsimllese entertaining the medicai team at the first group returned to the Islands after having P-. had thyroid surgery, the peopie saw that even

z though they had scars on their necks they During their stay in the United States. we appeared healthy and they heard many inter- took our .Marshallese visitors on a number of esting tales of their sojourn in the United sightseeing excursions, including automobile States. After this, there was less apprehension tours around the countryside and villages, as about going. weii as visits to our homes. Sightseeing visits to There were usuaily several Marshailese in New York City included a boat trip around the the group going to the United States for hospi- harbor. They were greatly impressed with the talization. In one group there were five big cxty and were awe-struck by the towering patients. They were taken to Kwajalein, where buiidings, the streets crowded with bustling they would meet the plane taking them to the people and the congested traffic with cavernous United States. Meanwhile, we took them to the sounds of honking horns and screeching brakes. one department store on Kwajalein, and neces- They marveled at the view atop the Chrysler sary clothing, including warm winter clothes, Building and enjoyed guided tours of the Uriited toilet articles, and suitcases were purchased for Nations Building. The Marshallese were most them. grateful for these excursions and took back The patients usuaily were taken to the tales of their adventures to their fellow island- Hospital of the Medical Department of BNL for ers. one to two weeks for preliminary examinations before surgery at the New England Deaconess Hospital in Boston in the first years, and later, 7 to the Cleveland Metropolitan General , ..- - Hospital. The hospital rooms were warm, but I .- the Marshallese were sleeping under several blankets and complaining of being cold. We had to turn the heat up to a level which was uncom- fortably warm for us. At first, they were apprehensive about sleeping on the high hospital beds since they had been used to sleeping on the floor. By putting up the side bars on the beds, they were less afraid of falling out of bed. The Hospital at Brookhaven was small, and the nurses and hospxtal staff were friendly and solicitous of the patients who had come from so far. In this informal milieu, the people became at ease with the hospital surroundings and the .MamhaAlesepatients arrive at the hospital at many examinations being performed on them. Brookhaven National Laboratory for examina= tion.e prior to thyroid surgery. Following the preliminary examinations at the Brookhaven Hospital, the patients were then taken to Boston or Cleveland hospitals for surgery. la At these large hospitals, the Marshallese patienta were on wards with many other patients and, although they were given as much consideration as possible, they could not receive the personai attention that they had been given at our small hospital. As the time of surgery approached, they were naturally apprehensive. We stayed with them to reassure them during the surgical procedures. It was gratifying to see the rapid recovery of the patients with only slight discomfort and, on healing, the surgicai scar was usually hardly discernible.

Marshailese enjoy a boat trip around New York 13Aof 1989,77 Marehde=e id tkomd ●usen. Harbor after visitingthe United Nationa Buiiding. 26 G. Families Most Affected by Fallout The next few months were a sad and trying time. On arrival at BNL. the diagnosis of acute Several families on Rcmgelap sufferea the myelogenous leukemia was confirmed. This dis. greatest effects of fallout exposure. This was ease is almost invariably fatal. We arranged particularly true of the Anjain family. with the Hospital of the Clinical Center at the In 1966. *Mijjua Anjain developed a thyroid Nationai Institutes of Health, one of the leading tumor and, along with several other Ronge~ap medical centers for the treatment of leukemia, people, was taken to the United States for sur- to accept Lekoj as a patient. gery. She was found to have a cancer of the thy- Sebeo Shoniber, a medical technician from roid which required extensive neck surgery. Majuro, who had participated in many of our Hers was the first case of thyroid cancer found medical surveys, arrived from the Marshall in the exposed people. Her recovery was satis- Islands to serve as a companion and interpret- factory and we were able to keep her in good er. Lekoj underwent extensive treatment at the health with thyroid treatment. Within the next hospital. He was given continuous intravenous three to four years, the two older sons deveioped benign thyroid tumors which had to be removed. In 1963, there was an epidemic of poliomyelitis in the Marshall Islands, and several people on Ronge]ap were stricken. One was a younger son of John and Mijjua Anjain, who had been born since the accident. As a result of his iH- ness. one leg was paralyzed, requiring the USe Of a crutch. Seeing him hobbling about on a crutch, I could not help but reflect that his infir- mity was an example of one of the ill effects of our incursion into their islands. Lekoj Anjain, who had been exposed to fallout when he was a year old, returned with his parents to live on Rongelap in 1957. Just before he was ready to go away to high school in 1968, he Lekoj Anjain being examined for thyroid tumor. developed a thyroid tumor and was taken to the He died six yeare later of leukemia. United States for surgery. His tumor was benign, and he quickly recovered. At that time, injections of several antileukemia agents (in: he appeared quite healthy with no indication of eluding Cytosine Arabinoside) in an attempt to “ the serious illness which was to later deveiop. kill the cancer cells in his blood. It was about 1970, two years before Lekoj’s Lekoj’s roommate was Stew-t,Asw, a death, that his father retails that he was begin- well-known journalist, who later wrote several ning to show signs of not being well, tiring more articles about him (B-65, 86, 87). easily. Later, he noted that he bruised easily In view of the seriousness of Lekoj’s illness, and had some bleeding from his gums. Still lat- we sent for his parents. Their reunion with er, he developed a swelling in his groin which their son was sad, and the next few weeks were was treated (unsuccessfully) by a Marshallese extremely painful for them. woman (B-85 ). We on the medicai team were not Increased bleeding in Lekoj required platelet made aware of these symptoms and did not see transfusions. In order to get a more compatible Lekoj until September 1972, because in March blood, his older brother, George was flown in . 1972 our examinations were prevented for polit- from the islands for a transfusion. In spite of ical reasons. We found that although he this, Lekoj grew gradually worse, deveioped appeared otherwise healthy, his blood tests pneumonia, and died on November 15th. showed ominous signs of possible leukemia. I In 1973, John Anjain was found to have a sus- met with John Anjain and told him of the seri- picious nodule in his thyroid gland and surgery ousness of our findings and that it would be nec- was performed in the United States. The nodule essary to take Lekoj back with us for further was not cancerous, and he had an uneventfitl examinations to arrive at a more definitive recovery. He was the “fifth member of his family diagnosis and to treat him. to undergo thyroid surgery.

27 Another family that was strongiy affected by was about four months pregnant at that time. the fallout was that of Boas Jellan. His wife. Their son, Alet, suffered severe thyroid injury Ellen. two daughters, and two sons had thyroid and was one of the two boys who developed tumors removed. One daughter suffered injury marked signs of thyroid deficiency with growth to the parathyroid gland during surgery, requir- retardation. The response of these retarded ing spec:ai treatment along with thyroid treat- children to thyroid treatment, with recovery of ment for a lifetime, Ellen later developed a growth, was one of the most gratifying results of brain tumor (pituitary) possibly related to radi- our treatment program. Another son, Robert, ation exposure, which was successfully treated. who was exposed in utero, later developed a thy- Billiet Edmond was a school teacher on roid tumor which had to be removed. His tumor Rongeiap at the time of the fallout. He and his “may have been partly caused from radioiodines wife, Alrnira, had a one-year-old son and she absorbed by his mother from the fallout.

28 —

Chapter VII — The Radiological Surveys for Residual Radiation

A. The Surveys the radiological surveys were conducted by the The Atomic Testing Program in the Pacific University of Washington School of Fisheries contaminated the atolls of the Northern Laboratory (now the Laboratory of Radiation Marsh ail Islands to varying degrees. The great- Biology) (A-41-45, 47), the Naval Radiological est contamination on the atolls of Bikini, Defense Laboratory (A-2, 3 l.), the Safety and Rongelap, Ailingnae, Rongerik, and Utirik was Environmental Protection Division at BNL from the Bravo detonation in 1954. Atolls just (A-52, 52, 54), and the University of California to the south of this group received a small Lawrence Liverrnore Laboratory (A-49, 50). On amount of contamination, and there was slight several occasions, the University of Washington additional contamination from other tests. group accompanied the Medical Team on the The effects of the testing program on their surveys. The Japanese have independently car- atolls have been deeply resented by the ried out oceanographic surveys (B-8). Marshallese people and have presented the Shortly after the accident we obtained sev- United States with increasing problems since eral animals (pigs, chickens, and ducks) from 1958 when the moratorium against testing in the deserted villages at Rongelap and Utirik; the Pacific was declared. The people who were also, some fish and clams were brought back. displaced before and during the testing program The animals, although contaminated with have been disappointed in the length of time .- radioactivity and malnourished, showed no away from their homes. This is particularly true effects of radiation exposure (A-31). Internally of the people from Bikini, who have lived else- absorbed radioactive materials were found where for 44 years. These displaced people have largely in the intestinal tract, with only slight exerted considerable pressure on the U.S. activity in the lungs, suggesting that the most authorities to return to their homes; even so, important route of internal radiation absorp- they had some uneasiness about residual radia~ tion was from ingestion of contaminated food tion on their islands. Unfortunately, in spite of and water rather than from inhalation of radio- reports to the contrary, this fear of radiation active material. and the suspicion that the U.S. authorities had At the time of the return of the people, the played down the dangers of residual failout radioactive elements of concern were cesium resulted, in 1985, in the evacuation of the (137CS, a gamma emitter with a half-life of 30 Rongelap peopie, who had been resettled on years), strontium (90Sr, a beta emitter with a their island for 28 years. half-life of 28 years), and zinc (65Zn, a gamma Numerous radiological surveys of the con- emitter with a half-life of 247 days). Small taminated atolls were earned out to (a) deter- amounts of other radioactive elements, such as mine radiological safety for rehabilitation of the cobalt (soCo) and iron (ssFe) (A-45), were of displaced isianders, and (b) study the radioecol- much less concern. Low levels of plutonium ogy of the fallout on the islands and surround- were noted and will be referred to later. The ing ocean. These surveys were conducted before radioactive iodines were no longer of concern, and continued after the return of the 120ngelap because they had practically decayed away. The and Utirik people; the surveys provided valu- other radioactive elements, cesium and stron- able information on the radiological safety for tium, were found in low amounts mainly in the habitation, based on movements of radioactive pandanus, coconuts, breadfruit, and arrowroot elements from the soil through the marine and plants grown on the islands. Unexpectedly high plant food chain to humans. The contaminated levels of radioactive cesium and strontium were environment of these islands provided tracer found in the coconut crab, a great deiicacy to the quantities of tagged elements, on a scaie impos- Marshallese (On Rongeiap they were temporar- sible to achieve in a planned experiment. These ily banned from the diet). studies have been an important adjunct to the Examination of the Marshallese people when medical assessment of radiation exposure to the they returned to live on their home islands .Marshallese. Under the aegis of the AEC/DOE, imposed a unique, added responsibility to the medical team. Basea on preliminary sum’eys, ir we did not expect that there would be overexpo- fi sure of the peopie to radiation from the environment. However, our objective was to Y continuously monitor the people, so that if there P was any indication of exposures higher than s expected, appropriate corrective steps could be II taken. Since gamma radiation had decayed to f an acceptable low level, the most important determinations concerned the amounts and distribution in the body of internally absorbed radioactive elements from water, foods grown on the island, and marine life, particularly fish. Radiochemical analyses of urine and direct measurement of radiation from the individual were used to determine the amount of absorbed radioactive elements. Studies of the dietary habits of the Marshallese permitted indirect assessment of the amounts of radioactive eiements likely to be absorbed from consumption of water and food. Individual and pooled radiochemical urine analyses were done at various laboratories in the United States. 14 About this time i 1.957), a relatively new method of determining the amount and type of gamma-emitting elements in an individual was Steel rcmm weighing 21 tone built at Brooklmvea being used at Argonne National Laboratory in National Laboratory beimg used for meaeuremeat Chicago. Gamma radiation was measured using of radiation in the Marehailese people. a sensitive crystal-electronic setup in a steel room shielded to reduce background radiation. a naval LST. Before being measured, the people To test the potential of this method for use in were required to shower and put on paper cover- the *Marshall Islands, we arranged with ails to reduce external contamination. Results Argonne to measure four Rongelap men (who showed that small amounts of radioactive had not yet returned to live on their home cesium and zinc were present and the method island) and two men living on Utirik Atoll. The waa considered to give a sensitive estimate of results showed that low levels of radioactive the body burdens of gamma-emitting isotopes. elements could be easily identified and mea- Unfortunately, before this survey could be ana- sured and were well within the permissible lyzed, a plane carrying the data to the United range. The two men from Utirik had radioactive States experienced difficulties and jettisoned zinc in their bodies which was later found to the cargo, among which were boxes with our have come from eating contaminated fish data. A second-survey was carried out by three (B-26). Since this method of measurement of us from Brookhaven. The survey was fraught seemed feasible for our studies, a 21-ton steel with difficulties. When we arrived in room was constructed at BNL and shipped to Enewetak, we transferred the steel room and the Marshail Islands. equipment to a Navy LCU. During this time, a The Marshallese on Rongelap were first mea- nuclear device was tested. Our LCU was trans- sured for radiation in 1958, in the new steel ferred to Rongelap on a dry-dock ship, where we room which had been placed on the tank deck of discovered that due to contamination at Enewetak the level of radiation on the LCU was too high for accurate measurements. Still worse, the deck beneath the steel room had been 14FromtheseMIAI?=S.Itww P-ble @ e~t-~ the *Y b~- densoftheradioacuveelemenw. AMAYSISforplutamumpI’oved painted with non-skid paint which included moretroublesome. but latert.echmques pernntd more reliable radioactive sand. from Enewetak. However, anaiym for thu element m the urine and eeumatmn ofbody using a paint remover and with generous wash- burden.

30 ing, we lowered the background ofraaiation suf- tion on the absorption and excretion pattern of ficiently to permit measurements to be made. these elements in the body. The steel room was used for a number of years. but because of the difflcultiea oftrans- B. Findings portation and assembly in the cargo holds of By the time the ,Marshallese returned to their snips, a less cumbersome portable assembly of. home islands, most of the radioactive elements leaa bricks was devised and proved satisfactory they had absorbed intemalIy at the time of the for use on the island. fallout had been excreted (A-3). However, on . . their return, the consumption of foods grown on . =a the island and local fish resulted in the absorp- .- tion of radioactive elements, principally cesium --.. (137(2s),strontium (90Sr), and zinc (@sZn).The :.- only food that was banned was the coconut crab at Rongelap; later, this ban was lifted in the southern part of the atoll. For the first five ., years the body burdens of the above radioactive elements increased, reaching equilibrium with the environment, and then gradually declined. .- On Rongelap, strontium levels reached a peak during 1962-1965, at 6% in adults and 11% in children, of the maximum permissible lifetime body burdens for world populations. Analyses of bone samples from several autopsies during the first 25 years showed that the level of radioactive strontium in the bones agreed reasonably well with estimates based on urinalyses. The radioactive cesium body burdens also reached their peak in 1965, atabout 23% of the permissible levei. The values for the Utirik population were about one-third those of the Rongelap population. Analysis of the plutonium levels was more difficult. Urine samples analyzed at BNL in 1984 showed higher body levels than were estimated by the Lawrence Livermore Laboratory, based on plutonium intake from food. It was later found that BNL’s method measured certain contaminating elements (naturally occurring polonium and uranium) giving spuriously Anmngement of lead bricks used for whole-body high plutonium levels. A more refined, specific eouziting. technique for plutonium (A-38) recently showed levels in the Rongelap and Utirik people agreed A third method of estimating the body bur- with those estimates of the Lawrence Livermore dens of radioactive elements was to measure the Laboratory and were well within the federal amounts that might be absorbed in their daily guidelines. diet. This method is not as reliable as the direct Unfortunately, the earlier discrepancy in pht- methods. On one occasion, one of us ate a diet tonium levels reported by the two laboratories for a week consisting of specific amounts of caused anxiety among the Marshallese people foods grown on the island. Daily measurement and may have been partly to blame for the were made by gamma spectroscopy of the body Rongelap people being evacuated in 1985. (See and radiochemical analyses of urine and fecal Chapter IX.) specimens. The levels of radioactive cesium and The cumulative estimate of dose for continu- strontium absorbed internally, though low, ous habitation on Rongelap from 1957-1979 were measurable and gave important informa-

31 was 4.5 rem (A-57). Because the Utirik people those received by the average U.S. citizen moved back earlier, their cumulative dose was {about 5 rem in 25 years) or by Inhabitants of about 16 rem, despite the fact that their Initial Denver, Colorado (about 7 rem in.25 years). exposure was less. However, since both groups When the Rongelap people left their island were eating quantities ofsubsidizea foods again in 1985, the exposure rate was Iess than brought in during the eariy years. and because that of the people in the United States. This was most of the people were away part of the time, partly due to lower levels of the natural back- these estimates were probably high. ground in the Marshall Islands. The cumulative radiation doses received by the .Marshailese are not very different from Chapter VIII — The Displaced Bikinians

In 1946 Bikini Atoll was chosen as the site of no lagoon for fishing or anchorage, and rough the frost atomic test, Operation Crossroads, in seas made access to the island impossible much the Pacific that was designed to test theeffects of the year. ‘Fishing was very difilcuit. of atomic weapons on navai vessels. The atoll When the peopie moved to Kili, they found was chosen because of its reiative isolation, and the environment aiien and had difficulty in the large lagoon where naval vessels could adapting to it. In the years that followed, sev- anchor. Use of the atoll required the ev=”uation eral devastating typhoons wreaked havoc on of the residents. In eariy 1946, representatives some of the southern atolls and one of the large of the Navy met with the 166 people liviag on vessels used by the Bikinians for fishing and Bikini, and expiained the importance ofthe test traveling to other islands was sunk (B-33). At for U.S. national security. They were toiti that, times, food shortages required that the Trust g in agreeing, they wouid contribute to warid Territory Government provide supplies. Some peace. The magistrate met with his ishatd coun- peopie moved to nearby Jaluit Atoll to live, and cii and, after much discussion, they agrsed to some moved to the District centers at Majuro i the request. There is little doubt that their and Ebeye to work. acquiescence was influenced by their impress- In 1956, the U.S. Government provided the ::. . ion of the immensity of the U.S. military might Bikini people with a $300,000 trust fund, which in ousting Japan from the islands. The peopie helped reiieve their economic distress. and the Naval officials believed that their exile The people continued to press their request would not be long, and that they would move for a return to Bikini. In 1966, the Department back when the test was completed. of Interior requested the AEC to consider this There were few suitable locations to which possibility. The AEC sponsored a radiological the people could be moved. Rongerik AtrAl was survey of the Bikini environment in 1967 to finally chosen because it was not far away (a lit- determine if the island was safe for habitation tle over 100 miles east of Bikini) and many of (A-46-48). The sumey showed that the principal the Bikinians were related to the Rongelap peo- radioactive elements present were cesium ple who owned Rongenk Atoll (B-32,3377). In (137CS),strontium (gOSr), and alight amounts of March 1946, the Navy moved the Bikinians other elements, including plutonium. Whereas with their belongings to Rongerik, where the radioactive contamination on Rongelap and SEABEES had consttmcted a temporary viilage. Utink was fairly uniform, the contamination at The people attempted to settie there, brat this Bikini was quite variable due to contamination atoll proved to be a poor choice. The land area from the atomic tests. In 1968, the AEC con- and the lagoon were only one-third th~ of vened an Ad hoc Committee, of which 1 was a Bikini. The local foods were insufflcieti, and member, to determine the radiological safety of the amount of marine life less than that avail- Bikini Atoll for habitation (B-72). We decided able at Bikini. Consequently, there began a long that the two main islands. Eneu and Bikini, series of requests to be moved back to Bikini. A were safe, provided that certain measures rec- naval officer visiting the island found that the ommended to reduce exposure were taken. people were malnourished and the island’s These measures included habiting of Eneu first; resources inadequate. Therefore, in 1948, the covering the housing sites on Bikini with coral Bikinians were moved to a tent city at rock, as is the custom; removing scrap metal; Kwajalein, where they lived for eight months” reducing the land-crab population; removing Another location had to be found for them. Kili top soil from planting sites on Bikini; and sup- Island, several hundred miles to the south, was plementing of powdered milk to the diet to the oniy other site available. The island had for- reduce the possibility of radioactive strontiw merly been used by the Germans for producing uptake. The estimated doses to the people who copra, and was quite verdant, with abundant would live on Bikini were so low that medical rainfall. However, there were several overri- surveillance was not considered necessary. dingdisadvantages. The island was small, only Nevertheless, the Committee recommended one-seventh the land mass of Bikini. There was that the inhabitants be monitored regularly to

33 insure their radiological safety. I was asked to showed that the levels of radiation in the inte- r: head up the monitormg program (B-37). rior of the island were higher than had been 1! I went to Kili Island in 1969 and explained to reported in the 1967 survey, and that further ~ the people that Bikini Island was considered housing would have to be built at nearby Eneu v safe and that our medical team would monitor Island. Furthermore, the well water was found u them to insure them radiological safety. Urine to be contaminated and consumption of panda- d samples then were colIected for baseline stud- nus and breadfruit grown on the island had to ies. be restricted. Therefore, plans for the immedi- o The cleanup of Bikini Island began in 1969 ate return of the people to Bikini were can- e with bulldozing of scrub growth and other mea- ceiled. n sures to reduce radiation, as recommended by In August, a meeting was held with the peo- s the Ad hoc Committee. Thirty workers, camped ple at Kili to discuss the prospects for further r on Eneu, began to construct the first 40 cement resettlement of Bikini (B-38). Among those pre- o houses, provided with water cisterns and pri- sent were Roger Ray, DOE representative; ‘1 vies.Later plans called for 40 more houses, a Oscar DeB rum, District Administration of the I council house, a church, and a dispensary. .Marshall Islands; and George Allen from the t Unfortunately, the recommendation of the Ad ?vficronesian Legal Services, Inc. The people i Hoc Committee to begin habitation on Eneu expressed diaappointment at not being able to i Island, where radiation levels were much lower, return to Bikini. Some older people wanted to t was not followed. New plantings of coconut and return regardless of.radiation exposure, while a t pandanus trees began on Bikini and later on younger group was more vociferous in their ( Eneu. In 1971, several families moved back to complaints. AS an aftermath of the meeting, Bikini, and by 1978 there were 145 people living Allen instituted a suit for the Bikini people 1 on the island. The Trust Territory Government against the United States, demanding further i furnished all their food, including powdered evidence that Bikini was safe for habitation. milk. We monitored the people annually, using Those families that returned to Bikini the sensitive whole-body counting technique received a complete food subsidy from the Trust 1 and radiochemical urine analyses, as used on Territory Government. Before locally grown the Rongelap and Utink people; radiological fruits (coconuts, pandanus, breadfruit) became surveys of the environment continued. available, radiological monitoring showed that Although medical examinations were not con- the levels of absorbed radioactive materials ducted on our visits (except on one occasion were in the acceptable range. When these fruits referred to below), the medical team was avail- became available several years later, the levels able for ‘“sicktail-. of radioactive cesium and strontium had In April 1974, it was planned to return more increased and the people were told not to eat people to live in the 40 houses which had been them. Examinations in April 1978 showed a built on Bikini. However, the people had become sharp rise in body burdens of these radioactive concerned about the radiological safety at elements due to consumption of these fruits Bikini and deciineti to return. This refusal was (A-15, 54). Since continued habitation on the believed to be patily based on their unhappi- isiand could result in unacceptable levels of ness about not having received a $3,000,000 these radioactive elements in the people, they U.S. compensation payment in their suit were evacuated from Bikini in August of that against the United States (B-41,42). They felt year (B-76). Most of the group moved to Majuro they desemed this payment, since the and received follow-up examinations by the Enewetak people had received an ex gratia pay- medical team. Many of the Bikinians expressed ment of over $1,000,000. As it turned out, their further dissatisfaction with life on Kili and refusal to return proved to be to their advantage requested that a home be found for them else- in view of subsequent events. where, such as Hawaii or Florida. During the As part of the second phase of rehabilitation examinations at Bikini in April, at the request at Bikini, it was planned to build more houses of the Bikinians, we conducted a medical su.mey in the interior of the island. In preparation, of the people on the islands. Our examinations another radiological survey was conducted to showed no indications of radiation exposure. obtain more precise radiation measurements in Greenhouse et al. (A-51) calculated the dose the interior of the island (A-50,51). The survey equivalent from both internal and external

34 miiation for the people iiving on Bikini from sions. ‘s In 1988 the Congress granted the .969 to 1978. The average dose was 1.2 rem, sum of 90 million dollars to the Bikini peo- vlth a maximum of3 rem. These Ievels were not ple to enable them to select and implement .ery different from those receives by other remedial measures from Liver-more and world populations and were not expected to pro- BARC studies. ~uce any discernible effects. In the meantime, the population on KiIi In 1978, a comprehensive radiological sutiey Island had expanded to over 1000 people due to If the northern Marshall Islands was conduct- influx of Bikinians from other atolls. They now ed, using helicopters equipped with gamma- appear to have become better adjusted to life measuring instruments. LManyfood, water, and there. They have used financial assistance to soil samples were collected from the Islands for improve housing, build a gymnasium, and a new radioassays. DOE’s policy was to furnish copies dispensary. The village at Kili is looked upon by of all of its technical reports anti findings to the other Marshailese as a model village (B-73). Trust Territory government and to the Marshall The long years away have not lessened the Island authorities. This practice was followed in desire of the people, particularly older people, the dissemination of radiological survey results to return to Bikini. Most of the younger genera- in the 1970s, and because of the direct personal tion, has never seen the island. Their nostalgia impact of these reports on the resident popula- has been somewhatassuaged in the past few tions, the DOE commissioned a series of simple years by allowing small groups of Bikinians to bilinguai booklets, which were delivered and make short visits to the island. The recentiy expiained to the affected people (A, 53, 58). completed Council House on t~e island affords a In late 1978, the Trust Territory Government center for activities. began new construction on Kili Island to make DOE scientists are advising the Bikini people it more permanent and habitable (B-73). about possible methods for radiological clean-up The following personal communication from of their Island. (B-104). It will probably be some Roger Ray, former Manager of the DOE pro- years before resettlement is possible. Time has gram in the Marshall Islands, describes more taken its toll, so that the numbers in the origi- recent events regarding the resettlement of nal group evacuated in 1946 are gr@atly Bikini. reduced. It is sad that many of the older people At Bikini, DOE-directed Lawrence may never realize their dream of returning to Livermore Laboratory initiated a program live on their home island. of agricultural and environmental studies In an effort to control and reduce the uptake ofradioactlve matemais into the human food chain. One of the traditional residence islands, Eneu, had environmental radiation leveis which were low enough to permit resettlement, but neighboring Bikini Island, from which the atoll takes its name, required further study and treatment. Bikini was the traditional population center and ancestrai home of many Bikinians, and without the productive land of Bikini a resettlement was not apt to suc- ceed. By the mid- 1980’s, the Liverrnore work had demonstrated several promising tech- niques for making Bikini Island habitable and for improving conditions at Eneu. The United States Congress authorized independent studies by a group of scientists selected by the Bikini people and their %’heBikini Atoll Rehabilitation Comrmtti (BARC), advisors to verify the Livermore conclu- Clminaem Henry Kohn. Chapter IX — Problems in the Aftermath of the Accident

A. Background population explosion taking place. The lure of Several problems that affected the the district centers at Ebeye and Majuro with Brooithaven .Medical Program developed in the bright lights, night life and opportunities for aftermath of the accidental exposure of the employment was irresistible to many. They Marsnailese people to fallout. The background acquired a taste for Western items such as beer, for these problems is complex and, I believe, cigarettes, soda pop, canned goods, and other related not only to the effects of the accident. commodities in short supply in the Outer but indirectly to the socio-economic and politi- Islands (B-34,39,75). cal upheaval brought about by the U.S. admin- The influx of people resulted in overcrowded istration. living conditions on this small island. The situ- In carrying out the United Nations mandate ation was”not as bad at Majuro as at Ebeye to promote the development of the inhabitants where the population increased from about 3000 of the Trust Territory toward seIf-government to about 7000 in a few years and slum-like”con. and self-sufficiency, the Government of the ditions soon developed, as relatives moved there Trust Territory of the Pacific Islands faced to live with the working members of the family. many problems. I mention some of these prob- Sanitary conditions became unsatisfactory and lems as background for the developments that diseases such as influenza, pertussis, and polio- affected the medical examinations (B-34,39.40). myelitis occurred in epidemic proportions. The The Trust Territory Government was faced hospital at Ebeye was often unable to handle with the complicated task of governing about such situations adequately, The good lifestyle of 1100 small islands scattered in a large ocean the Americans at nearby Kwajalein was in area about the size of the United States, often sharp contrast to the life on nearby Ebeye. The with inadequate travel facilities. Many popula- Marshallese were not allowed to live on tions with different cultures and different lan- Kwajalein nor use many of the facilities. The guages were involved. Some problems were situation brought about criticisms of the U.S. reiated to the “strategic’” nature of the Trust, authorities, by the Marshailese and others. with the overriding U.S. military interests such Recently, there has been marked improvement as the nuclear testing program, Pacific .Missile in the conditions at Ebeye. Range in the Marshall Islands, and military As pointed out, during our examinations we bases in the Marianas Islands. Other problems found that there were increasing numbers of were reiated to the difficulty of getting trained Rongelap and Utirik people to be examined at personnel to work in this isolated area of the hfajuro and Ebeye which necessitated extending world; the turnover of personnel with changing our medical facilities to inciude examination Presidential administrations (the High and laboratory trailers adjacent to the hospi- Commissioner with Ambassadorial rank was a tals. political appointment); demanda for war claims The increasing dependence of the and compensations related to the nuclear test- Microneaians on the U.S. economy resulted in ing program; di~lculties in orienting the people loss of seif-sufilciency and lack of development toward self-sufficiency; increasing needs for of their own natural resources (B-34,35). Copra expanded budgets; and political problems production lagged and fishing was low related to the development of independence of (B-40,75). the various Micronesia groups. There were increasing criticisms that the The Trust Territory administration brought Government authorities had not adequately with it U.S. jobs. People flocked to the district promoted education and self-sufficiency in the centers. In the Marshall Islands, people from people (B-24, 34, 40, 45) and the United Nations the outlying islands came to Majuro for govern- Trusteeship Council became more critical of the ment jobs and to Ebeye (near Kwajalein Island) Trust Terntory, as stated in their Report of the United Nations Visiting Mission to the Trust .. to work for the Pacific Missile Range. The Outer Island population shifted toward more children Territory of the Pacific islands in 1976 (B-43). and old people, which was aggravated by the 36 I The present .Mission. while acknowledg- about $11,000 per exposed person (B-46).*7 At ing that the people of! ’vlicronesiaenjoy a this time. those exposed had no detectable thy- standard of living which compares favor- roid effects and no leukemia had developed. The abiy with that of many developing coun- people received the money in 1966. Payment tries, must also report that there has been was not made in the, form of a trust fund, as had surprisingly little progress towards been recommended in the bill, ~t was paid self-sufficiency. Commodity exports directly to the individual or relatives of those amounted to just under $7,000,000 and who were deceased. earnings from tourism to about $5,000,000. In the meantime, the Utirik people com- Imports amounted to just over plained that they also had been exposed to fall- $38,000,000. Thus, the deficit in the bai- out and had received t-mcompensation. I ance of payments was over $26,000,000. explained that we had not found any harmful effects anti that, in view of the estimates of the The attainment of self-sufficiency in smail amount of radiation they had received, ‘we Micronesia will not be easily achieved. Except did not expect to find effects. They then asked for the abundant marine life and coconuts for me why it was necessary for us to continue copra production. economic resources are examining them. I explained that although we largeiy iimited to handicrafts and tourism did not expect to find effects, we should con- (B-40,44,45,75). For some years the Islands will tinue to examine them so that if any effects did require U.S. assistance in the Compact of Free develop we would be able to treat them. On my Association. recommendation we later got a small payment In the years that followed the fallout accident of $16,000 for the Utirik people, amounting to in 1954, the Marshalle.se people became about $100 per person, as an “inconvenience” increasingly aware of the effects of the accident payment. Later, when the Utirik people showed (the displacement of the people with disruption a slight increase in thyroid tumors, they were of lifestyle, the harmful effects of their radia- included in further compensation. A “Fallout tion exposure, and contamination of their home Survivors Bill” in 1974, provided funding for islands) (B-34,39). When the Rongelap people treatment in the Marshall Islands hospitais. returned to a new village on their home island with travei and per diem allowances for the after a three-year absence, their adjustment exposed Rongelap and Utirik people, as well as was not satisfactory. Copra production and fish- the control, unexposed population. In 1978, a ing was low. The village became overcrowded bill was passed by the U.S. Congress compen- with relatives from other atolls. The Utirik peo- sating individuals who had developed radiation ple, who had been returned to their village ear- illnesses (those with thyroid surgery, and the lier. readjusted their lifestyle more parents of the young man who had died of leuke- satisfactorily. mia) (B-47). In 1959, the Rongelap people submitted a ‘ When the Trusteeship ended in 1986, the suit through their lawyers for an $8,000,000 *Marshall Islands became the Republic of the compensation for the harmful effects they had Marshall Islands. A Compact of Free “ Although the U.S. sustained from the fallout. Association was signed with the United States Government recognized that the people were (B-19). The Compact granted the Islands full entitled to compensation, the suit was illegal internal self-government with authority and because the United States could not be sued by the Marshallese, who lived in a foreign country. Finally, in 1966 the U.S. Congress passed a bill “’lbeBill atatad The affected individuaiehavealready~ granting an ez gratiu payment of $950,000 to giveneateaaivamedial caresnd treatment. They were pmdad houa.ing,cbthins, d ~ ce during their abeenca &om the exposed Rongelap people, amounting to their ialaad. Sin= tbsir return.inaddition m new houeee.a echool.s church● communiwbuilding. and other fmilitiea. they have beerIgiven new livestock and agricultural aid, ae weLlaa mbaiatena in deueming amounta. Small claims for pro- loseae, mcb u ciothing and handtuis. wem paid by the ‘sSeveral poiitical leaden fromthe Marahall bland. including Departmentof Defenee. DwightHeineendtiata Kabuaappearedbeforethe Uniti It cannotbe -d. however, that the compeneatmy meaaums Nations Trusteeship Counal pleadins the cmae of the Rongeiap heretoforetaken are fully adequate. Enactment of H.R 19S6ia people. neededtopermitthe UnitedStatw todojusticetotheeepeople..

37 ica responsibility for ioreign affairs, including them to evacuate the island in 1985. F marine resources. However, the United States Amata Kabua, MarshaUese Senator in the pe{ would maintain fuil responsibility for security Congress of Micronesia during our early sur- and defense and would be allowed cefiain land veys, questioned the need for the extensiveness of rights for these purposes. During t,he 15 years of of the examinations. Therefore. before our cc the Compact, the Marshall Islands would annual visit to Rongeiap in 1963. we met with a: receive an estimated $750,000,000 in financial him and explained the need for the examina- ac aid in addition to other assistance. tions. On our arrivaI at Rongelap, the people M were at first reluctant to be examined, but d~ learning that Kabua ‘had approved, they B. Problems Affecting the Pro@amiS J: cooperated fully. el Some of the difficulties experienced in carry- Beginning about 1970, problems developed u ing out the medical examinationsmccurred from an unexpected quarter: Japan. I had vis- u mostly in the earlier years and were related to ited Japan on several occasions to confer with Ii the lack of knowledge of the peopk about radia- the doctors at the Atomic Bomb Casualty (. tion effects and the need for extensive examina- Commission (now the Radiation Effects t tions. We were trying to explain a complicated Research Foundation) in Hiroshima and t subject hampered by the ianguage barrier, and Nagasaki about the effects of radiation on 1 were often uncertain about the transition of humans and treatment of the exposed popula- I our statements into Marshallese. The tions. Also, I had been corresponding with T. 1 ~Marshallese are a very poJite people and reluc- Kumatori, Director of the National Institutes of i tant to express displeasure, so that it was diffi- Radiological Sciences, who was in charge of the c cult at times to know their true feelings. Not annual examinations of the fishermen expoied unreasonably, some people harbmed suspicions on the Lucky Dragon. We agreed that it would about our motivations. We reprewmted the be mutually beneficial for me to participate in American presence on their island and were the examinations of the fishermen and for him considered part of the AEC (the “AEC doctors”), to participate iri the examinations of the which had deveioped the bomb and brought Marshallese. Therefore, in 1964, I went to about the catastrophic events that had dis- Japan and he returned with me to the Marshall rupted their lives. There were increasing criti- Islands. cisms by local politicians and outside groups, When I arrived in Japan, I was surprised at particularly in Japan, regardingtie handling of the amount of publicity given to the examina- the aftermath of the nuclear testing program. tions and the extent of the strong emotional There were criticisms regarding the medical reaction of the Japanese to the exposure of the care of the exposed people and the suggestion fishermen on the Lucky Dragon, to the effects was made that the Marshallese had been delib- on their fishing industry, and to failout effects erately exposed to fallout to study the effects of in the Marshall Islands (B-49). The Congress of radiation. Micronesia formed a ‘“Special Joint Committee In spite of these influences, the people contin- on Rongelap and Utirik” to look into the situa- ued to be friendIy and cooperative, and, as time tion. In July, 1971, the Committee visited went on, became more cognizant Dfthe impor- Japan to learn about the aid being given the tance of the examinations, particularly after Japanese people who had been exposed to radia- the development of thyroid problems and the tion (B-50); they were impressed with the treat- death from leukemia. However, there continued ment being given. Later, they visited Rongeiap to be a smoldering distmst of theAEC’s envi- and Utirik and interviewed the peopie there ronmental and medical reports of the radiologi- (B-51). The Committee reported that the people cal safety of Rongelap, which eventually led were uncertain about the effects of radiation and what they were being treated for; they wanted more frequent treatment. Further, they felt that the compensation they had received 1‘The probleme ckmseed in thi9 Chspter moiniy concern the examinstlonc of the Rongelap and Utirikpeople.Probleme was inadequate compared with the compensa- relatedtothe Bikim peopie are diecued in Chap=r VIII. tion the Japanese fishermen had received. Problemsrelati tothe●vaution endresettlementofthe As a result of their investigations, the Eneweti people WWnot be diecu-d in this repro ●ince our medicd team were not uwoiveduiexemningthatgroup. Committee planned to ask an independent med-

38 :cai group from the United Nations or other not cooperate in any way hereafter in the AEC groups not reiated to the AEC to examine the medicai survey s...” (B-58,59). However, Baios z peopie. was reported as saying “...1 don’t think there is ... [n August 1971, Ataji Bales, a representative anything to hide on Rongelap and Utirik. The of the Rongelap and Utirik people in the peopie were just anxious to see the (Japanese] Congress of Micronesia, was invited to Japan to doctors...” On his return to Japan, Ezaki was a symposium on nuclear bomb testing; he was quest~oned about the U.S. medicai team (B-60) accompanied by John Anjain, who had been and stated “’...To be honest, the U.S. conducts Magistrate of Rongeiap at the time of the acci- such detailed surveys and careful treatment dent (B-52). On his return, Bales stated that the that we feit it a shame to tail ourselves “survey Japanese were very interested in the fallout team’’... The treatment given to the crew mem- effects on the ihfarshallese people and that the bers of the No. 5 Fukuruyu-Maru (Lucky United States was unwilling to give them infor- lhagon ) Yazu is no comparison to theirs. A fol- mation (B-53.54). I wrote a letter to Bales, pub- low-up is made on each survivor. It is said that lished in the Marshall Island newspaper at one time a very extensive unit called a (Micronitor), setting the record straight about Human Counter had been brought there to the availability of our publications and informa- determine the residuai radiation in the body. tion on medical findings (B-55). This was fol- Neither the Hiroshima University nor ABCC lowed by an exchange of friendly published has such a unit. Not oniy the survivors, but also letters in which Bales questioned me about the the inhabitants in general are weil cared for, radiation exposure of the Marshallese, our find- having to pay almost nothing for medicai ings, comparative radiation effects in the care... ” Japanese fishermen compared with the In retrospect, I beiieve it wouid have been Rongelap people, how long our studies wouid better if the U.S. authorities had allowed the continue, and the lower compensation of the Japanese group to go to Rongelap or to accom- Rongelap people compared with the fishermen pany our medicai team for their observations. (B-56). I was happy to answer these questions In March 1972, our medical team, consisting because I felt that I might clear up misconcep- of six doctors, nine technicians, and severai tons tions about our examinations and improve our of equipment, arrived at Rongeiap’ aboard the relations with the Marshallese. This was not to Trust Territory ship, M. V. Mtiitobi, for the be the case. Further problems were developing. annual medicai examinations. With us were On his visit to Japan, Baios invited a Charies Dominick, a Congressman representing fact-finding group of Japanese to the Marshall the Utink people, and Mike Malone, a reporter Islands to examine the fallout victims. The (B-61). The people, as usuai, weicomed us “ group of six consisted of reporters, a photogra- warmly, but it soon became apparent at the vil- pher, and two doctors, one of whom was Hario lage meeting that the peopie were ill at ease. Ezaki of Hiroshima University. The group The main problem centered around the fact that asked Bales to help in obtaining visas. With they had been toid not to submit to the examin- tourist visas only, the team arrived in the ations. The team held sick tail and a few peo- Marshall Islands in early December (1971), only pie came into be examined, in spite of to find that the Trust Territory authorities admonitions from some of their elders. The refused their request to visit Rongelap because refusal of examinations was a discouraging and their objective was to engage in surveys and frustrating experience for our team, who wem research for which prior permission was neces- prepared for a detailed survey. sary (B-57). Ezaki then returned to Japan. The Before departing from Rongelap, I asked remainder of the group stayed on at Majuro, Dominick if he would be wiiling to iet us exa.zn- while Congressman Baios and Senator Kabua, ine the Utink peopie, explaining that even as well as the Micronesia Legal Services, though we had not found radiation effects, they attempted unsuccessfully to get the decision shouid be under careful medicai surveillance in reversed. The group then returned to Japan and view~fthe long iatent period for development of abandoned plans for the survey (B-58). thyroid tumors. He said that if they were not This event caused considerable criticism of sick they shouid not be examined, and if they the U.S. authorities among the Marshallese. were examined they shouid receive compensa- Senator Kabua made it known that “...he would tion.

39 Malone wrote, “...The people on Rongeiap got Pochin of the University College Hospital, Ieuke the snort end of the deal. A lot of taienc was on Medical School, England;’g I-Iaruko Ezaki, and montl their aoorstep this week and they were used Tashiuki Kumatori of Japan, and William Cole, are di like pawns in a chess game. Although Bales Associate Director of the Bureau of Public m{ rejects the idea. compensation may weil be the Health, from the U.S. Public Heaith Service. obser key to the Rongelap problem. But the Our team consisted of five doctors, two tions. Congressman insists he simply wants an inde- .Marshallese practitioners, and five technicians. locati pendent non-government medical team to exam- Two representatives of the Congress of Rong ine the people... ” (B-61). .Micronesia, Hans Wilander and Ataji Bales, natio During our stay on the island, we found one also accompanied the team. Below is a photo of big c woman who had an abdominal tumor and the special medical team. Coml brought her back with us to Majuro for surgery. The survey proceeded smoothly and the peo- datic There were three Rongelap women who needed ple cooperated fully (B-62). Except for the find-. a sec post-surgical checkup at Hawaii. They were not ings of two Rongelap people with thyroid Corn allowed to go and were returned to Rongelap. nodules requiring surgery, there were no other recol Unfortunately, one of the young men exposed on findings related to radiation exposure. tion: Rongelap, who died later that year from leuke- However, on subsequent examinations of people cal t mia, missed our examination. His disease might living at Majuro and Ebeye, a young man, Lekoj reco have been treated earlier, although it still AnJain, who had been exposed on Rongelap at follo would probably have been fatal. one year of age, was found to have a very 10VV cian Following the aborted survey, the Joint white blood ceil count. He accompanied us back spec Committee on Rongelap and Utirik of the to Brookhaven Nationai Laboratory and acute arrs Congress of Micronesia arranged for a special Maj medical survey to take place in September 1972. alre They invited four well-known physicians to be pie ~ consultants to accompany the medical team and tion evaluate the program, namely, Edward E. stat ing ah ROI Ch[ exF Col frh w Stt in(

*1 ac, Ut en ef w: at c’ al b~ s] t] t] o t“ 1 The March 1872 Medical Teem with observers ●ppointed by the Congress of Mkronesim 40 leukemia was diagnosed. He died several English as an addendum to our 20-year report. ) months later. His death and its repercussions (A-14). In addition, Jan Naidu of the Safety and are discussed in Chapter VI. Environmental Protection Division of The medical consultants and the Committee Brookhaven National Laboratory spent four obsemers seemed pleasea with the examina- weeks on Rongelap and two weeks on Utirik tions. Ezaki remarked that “...considering the island meeting the people and presenting infor- location and logistics problems, the people of mal illustrated taiksi translated into Rongeiap receive medical treatment and exami- .MarshalIese, about radiation effects and the nations that would equal that provided by any Brookhaven program. Naidu feels that he big city hospitals...” (B-63). The Joint helped the peopie better understand this diffl- Committee published a report on the recommen- cult subject which, in the United States, is dations of the survey (B-18). In February 1974, poorly understood by the general public. a second report was published by the When Senator Borja was with us for the 1973 Committee on the actions taken regarding their examinations, he impressed on the people the recommendations (B-64). Most recommenda- importance of the medical examinations. This, tions had already been instituted by the medic- in conjunction with our renewed educational al team before the 1972 survey. Some of these efforts, did much to improve the people’s under- recommendations and the actions taken were as standing of the examinations, The AEC wrote to follows: continued presence of a resident physi- Senator Borja expressing general support for cian in the islands (already planned); use of a many of the recommendations that had been special ship for medical purposes (already made by his Committee (B-66). arranged); additional examining facilities at ln spite of these favorable developments, Majuro and Ebeye (new medicai traiiers were more disturbing events followed before our xned- already in place); vilIage meetings wif~ the Pf- ical pro~am was out of rough waters. ple to explain the results of the last examina- In 1975, Nelson Anjain was Magistrate of tions and answer questions (already done ); Rongelap. He was thb brother of John Anjain, statement in .Marsha)lese to the people regard- who had been Magistrate at the time of the falling findings (to be done). The Committee report out. He had spent very little time on Rongelap also proposed further compensation for the and was not one of the exposed group, nor was Rongelap and Utink people (PL5-52, see he on the isiand at the time of our 1975 exami- Chapter 5) and a Senate Joint Resolution nations, but was traveling in Japan. Upon his expressing “...the sorrow and sympathy of the return, he submitted a letter to me which was Congress of Micronesia to the family and published in the Iocai newspaper, ,Ificronitor friends of Lekoj Anjain for his untimely and (B-67). A few excerpts from his letter areas fol- unwarranted, irreplaceable loss...” An article bY lows: “...Since leaving Rongelap, I have learned Stewart A.Isop about Lekoj’s death, was a great deai... you have never reall y cared about included in the report (B-65). us as peopie--only as a group of guinea pigs for In March 1973, Borja and several members of your government’s research efforts... we want the Joint Committee including Ataji Bales medical care from doctors who care about accompanied our medical team to Rongelap and us...we no longer want you to come to Utirik for the annual examinations. They pres- Rongeiap...” This letter was very discouraging ented a questionnaire to the people on radiation to me, but I thought that it did not reflect the effects and treatment. From their answers, it true feeiings of the Rangelap people. Chips was apparent that our explanations about radi- ,Barry, formerly an attorney with the ation and treatment had largeiy failed. The Micronesia Legal Services at Majuro, published Consultants for the Congressional Committee an open letter to Nelson Anjain criticizing his also had recommended that communication attitude and urging the people to continue being between the medicai team and the people examined by the Brookhaven medical team should be improved. To remedy this situation, (B-68). Ataji Bales told me not to worry about the following year we collected questions from the letter, that the matter would be taken care the people about their radiation exposure and of. It was gratifying that he now accepted the our treatment. Then. we published an i~lus- merits of our examinations: I beiieve that trated question anti answer booklet in Congressman Bales has always sincerely had Marshaliese. (This booklet is duplicated in the welfare of the people at heart.

41 Beginning in the mid-1960s, severai hundred through the Compact of Free Association agree- Peace Corps volunteers came to Micronesia, ment which would help bring about an improve- including Rongelap and Utirik where they were ment in primary health care (B-19). most helpful to us. Others were critical of the In Japan, there was continued interest in the U.S. Administration (B-34,39,40). This was a Bravo accident and the Marshallese fallout vic- period when there was increasing criticism tims. In .March 1976, a Japanese movie team about the Bravo accident by locai politicians (NHK} accompanied us on our medical examinat- and lawyers representing the Marsnallese. ions at Rongeiap and Utirik and produced a While at Utirik, there were complaints that the 50-minute movie, “Bikini Atoll”, a reasonaide people with diabetes had not been given insulin portrayal of our examinations, which was later by our resident physician. We explained that we televised throughout Japan. had been advised by specialists in the treat- In May 1976, the Japanese Gensuikin anti-A ment of diabetes that such treatment was not and H-bomb groups obtained medical charts of appropriate for their type of diabetes (mid- 66 exposed Rongelap people. (It is not clear dle-age type) in these isolated isIands. The what these charts were nor how they got them. ) Utirik people were also disturbed because we The charts were turned over to the Nagasaki had told them they would not likely develop Red Cross Hospital and Nagasaki University for radiation effects and they had. We discussed the analysls, who reported the following (B-70). fact that our predictions had been based on esti- Some cases showed bone marrow disor- mates of the amount of radiation they had der 18 years after the exposure differing received, and later, revised estimates showed greatly from the onset at 4-5 years later in that they had received larger amounts of radia- case of Nagasaki. In any case, when the tion, particularly to the thyroid gland, which bone marrow is impaired, there is a great caused the development of a few thyroid risk ofhemopoietic disturbance appearing tumors. and careful sumeilla’nce seems to be indi- Later that year I received a letter from the cated. However, these medical charts have Magistrate (Mayor) of Utirik, expressing appre- been reported in Chapter 12 of “Atomic ciation for the past work of the medicai team Medicine” printed in the U.S. in 1969 and and hoping we would continue the examina- the results of the analysis are nothing new tions. to medical scientists. In 1976, at the end of his tour, Knudsen was replaced by Konrad Kotrady. Before his retire- Also at this time, the Gensuikin group ment a year later, I heard that Kotrady had invited two Rongeiap men who had been become critical of our medical program. Without exposed to the fallout to Japan, where they were consulting me, he wrote a reportzo and publicly exammed at the Nagasaki Red Cross Hospital criticized the program. The main thrust of his (B-71). Later, two Rongelap women were also criticism was that the program was “too nar- examined at that hospital. The examinations row’”. We, of course, were aware of the limita- revealed nothing that had not been reported by tions imposed on our program by our mandate our group. and financial restrictions. The primary health In 1977, a Japanese group from the care of the people of Rongelap and Utirik Gensuikin organization visited Majuro and dis- always had been the responsibility of the cussed with Ataji Bales the medical treatment Health Services of the Marshali islands under of the Rongelap and Utirik bomb victims. (B-74). the Trust Territory government. However, reai- Bales reassured them that he was satisfied with izing the limitations of their capability, we had the way the examinations were being done. gone weil beyond our mandate in providing Since that time, as far as I am aware, there has health care and establishing a resident physi- been no further involvement by the Japanese in cian program to help in the interim. (The physi- our examinations. cians were employed by BNL). Eventually, the In the ensuing years, unrest continued United States made further funds available among the Rongelap people. Their village had deteriorated considerably, with houses in need .. 2071he Bm~ave~ M~~ * to h- ‘dation of repair. Since they had returned, they had not Effects m the Marahalleee Peopie: A Compenscmof the Peopies’ been satisfied about the radiological safety of VS.the Program’s Attmde- (unpublished). their island despite our assurances from sensitive measurements of radiation on the Island After an exhaustive review of the DOE data on and in the people that the Ieveis in the peopie Rongeiap, the project reported in 1988 (B-83) remalnea weil within the acceptable range and that Rongeiap Isiand waa safe for habitation for. were lower than people in the United States aduits, but that further study was necessary to LA-15). be certain that the island was safe for chiidren. Radiological studies had been conducted at The Rongelap Council was unhappy with the Enewetak, Bikini, and other Northern MarshaiI Kohn report, claiming, among other things, that Islands. The results were presented in several the data submitted by the consultants they had biiingual booklets with illustrated maps of the nominated were not properly used. Brookhaven atolls. In the booklets describing the results of National Laboratory and Lawrence Livermore the 1978 Northern Marshalls Survey (A-53, 58), Laboratory then carried out further studies a numerical designator was used to show rela- which substantiated the eariier data, showing tive radiation levels on the various atolls. This that Rongelap Island was indeed safe for habi- mode of presentation was confusing and was tation (B-79). In November 1989, a hearing on misinterpreted as showing a radiation profile the radiological safety of Rongelap was held by for Rongelap similar to that of Bikini. Before the House Subcommittee on Insular and our medicai visit, a team of DOE scientists and International Affairs (B-80). At this hearing, administrators visited each of the populated Kohn declared that on further review of the atolls in the survey area to explain the contents data on Rongelap the island was considered safe of the booklet. Regrettably, at Rongelap, a dis- for habitation by both adults and children. Still turbance in the community terminated a DOE dissatisfied, the Rongeiap Council petitioned visit prematurely. Although there waa no rea- the U.S. Congress for funds for further inde- son to believe that the disturbance was related pendent surveys to evaluate the radiological to the DOE presentation, one DOE official was safety of Rongelap and, if necessary, clean up injured, and the party leader decided that it the island and construct a new village (B-84). In was prudent to move on (B-80). I was toid by February 1992 the DOE and DOI signed an Roger Ray that this was done with considerable agreement with the Republic of the Marshall regret, and that had the party been permitted to Islands and the Rongelap people allocating 2.5. complete its question and answer discussion, million dollars to continue studies of the radio- the later evacuation of Rongeiap might not have logical environment on Rongeiap (B- 103). The occurred. Despite DOE’s efforts to clarify the radiological analyses will be conducted by misunderstandings in discussions with the DOE’s Lawrence Liverrnore Laboratory and Marshall Islands authorities, there remained a Brookhaven Nationai Laboratory. The Nationai degree of true and justified apprehension Academy of Sciences will carry out an independ- among the Rongelap peopie (B-81). ent review of the findings. With this action it Finally, in 1985, things came to a head. The appears that progress is finally being made local Rongelap Council, under the leadership of toward the eventual resettlement of Rongelap. Jeton Anjain, a Senator in the Nitijela (the In the meantime the Rongelap people continue Marshall Island Parliament), who represented to live in an unsatisfactory situation on Mejato the Rongelap peopie, permitted the Greenpeace Island in Kwajalein Atoll. i Organization to send their ship, The Rainbow The Compact of Free Association, passed in Warrior, to Rongelap to evacuate the island. 1986, would provide an estimated 750 million i The people were taken to a small island, Mejato, dollars over 15 yean to the Republic of the in Kwajaiein atoll, where a temporary village Marshall Islands. As part of the agreement had been set up. The island was most unsatis- (Section 177), 150 million dollars (of the 750 factory, with minimal natural resources, and million ailocated) would cover the claims of the worst of all, no anchorage for ships. people of the atolls of the Northern Marshalls The Rongelap Councii began efforts to reeval- resulting from the nuclear testing program, uate the radiological safety of Ronge]ap (B-82). including radiation injury, property damage, The Rongeiap Reassessment Project was estab- and continuing medical care. The claims are lished under contract with the Republic of the handled by a Nuclear CIaims Tribunal, dhar- Marshail Islands. Henry 1. Kohn, an Emeritus tered under the terms of the Compact of Free Professor from Harvard Medical School, headed Association. Exposed individuals with certain the program with ten consultants, three of diseasea are automatically reimbursed; those whom were nominated by the Rongelap Council. with other diseases are reviewed. 43 Chapter X — The MarshalIese Experience c’ Related to — Other Radiation Accidents f aci Before the Bravo accident, there had been extensive fallout, with few, if any, detectable M~ some fallout from other tests, but it was not effects in the populations surrounding these ml until this accident that the importance of the plants (A-62). At Chernobyl, human errors ac fallout hazard became fully appreciated. Some resulted in melting of the reactor core which 19 features of the accident and its consequences breached the shielding, sending a plume of ha were unique in comparison with what might radioactive material downwind over a consider- ar occur in other geographical areas. The detona- able area of Western Russia; the plume was tion occurred on a tiny, isolated coral atoll with detectable in other countries of Northern m m oniy sparseiy inhabited islands 100 miles or Europe and, to a slight extent, in the United St more distant. This powerful detonation, greater States (A-59-62). Inadequate emergency plan- c than expected, deposited large amounts of ning resulted in uncoordinated emergency p( incinerated coral dust mixed with radioactive action. One hundred and thirty- five thousand fa elements in areas east of Bikini. Fortunately, people were evacuated from a 30-kilometer area because of their distance from the detonation around the pi ant. There were 31 deaths from e site, the amounts of fallout on the inhabitants acute effects of people exposed at the reactor c1 of the islands were too small to cause acute site. Over 200 people were treated in hospitals t] lethal effects. The radiation exposure of the where extensive supportive care was instru- F Marshallese was due entirely to fallout. The mental in saving lives (A-60). Of concern is the r people on Rongelap Atoll, where the heaviest large number of people exposed to radioactive t fallout occurred, lived in the southern islands of fallout, particularity the large number ofchil- b the atoll and sustained a sublethal dose ofradi- dren, who are most sensitive to such effects. A ation. Had they lived on islands 10 to 15 miles large number of-people, including 80,000 chil- F t further north, undoubtedly there wouid have dren (A-68), are believed to have received sig- 1 been deaths due to the exposure. nificant thyroid exposure and are being E The Rongelap people (who were nearest to examined regularly. Thus far, no thyroid o Bikini) were not evacuated before the scheduled tumors have been reported but, based on the findings in the Marshailese people, I believe ‘1 detonation as they had been before Operation t Crossroads, and, in the subsequent confusion, that thyroid abnormalities will eventually evacuation was delayed. Because there was no develop (A-59-62). There are reports of an radio communication with the island, the increase in leukemia in the exposed children Lhfarshallese were unaware of the danger of the (B-101,1O2). fallout and took no protective measures to The MarshaUese experience has shown that reduce their exposure. Their houses offered lit- certain prophylactic measures are heipful in tle protection. They ingested food and water people receiving significant radiation exposure contaminated with the fallout and did not wash to the thyroid from fallout. These measures the fallout from their bodies nor change cloth- include early surgical removal of thyroid ing. In contrast, the American servicemen on tumors and use of thyroid hormone. Rongerik atoll were aware of the fallout and its Consideration should also be given to the pro- dangers and took protective measures which phylactic use of stable iodine (potassium iodide reduced their exposure. tablets) to people at risk of such exposure to The medical findings in the Marshallese are reduce the absorption of radioactive iodine by applicable to accidents involving nuclear power the thyroid gland. reactors where fallout has been shown to be a serious problem. The worst radiation reactor accident occurred at Chernobyl in Russia in 1986. Earlier, there were reactor accidents at Windscaie in England (1957) and at the Three Mile Island plant in Pennsylvania (1979). These accidents were less serious, involving much less

I ~hapter XI — Closing Remarks ●

This report has presented an historical When we arrived in the islands, our medical ccount of the experiences of the E3rookhaven team was faced with the medical care of a popu- .Ieciical Team in the examination and treat- lation with ethnic background, life style, cus- aent of the AMarshallese people following their toms, and language that are different from ours. iccidentai exposure to radioactive fallout in In retrospect, due to a certain naivety on our ;954.21 This is the first time that a population part, we did not at first appreciate how these las been heavily exposed to radioactive fallout, differences might apply to the conduct of our md even though this was a tragic mishap, the examinations. The language barrier made it dif- medical findings have provided valuable infor- ficult for us to communicate with the people and mation for other accidents invoiving fallout help them understand their radiation exposure such as the recent reactor accident at and the need for the examinations, particularly ChernobyL Noteworthy has been the unex- blood tests. (Later, when they began to develop pected importance of radioactive iodine in the thyroid abnormalities, they came to realize failout in producing thyroid abnormalities. more fully the importance of the examinations. ) The orgamzation and carrying out of these Unfortunately, they were never able to under- examinations over the 36 years proved to be a stand very much about radiation and its effects complex and formidable undertaking. Many of on them. They were afraid of this unseen, unfelt the problems were unique to a medical program. “poisonous powder” and its effect, and this Fortunately, many of us had had previous expe- became a strong psychological factor. They con- rience with radiation effects, some having par- tinued to believe that every ailment and every ticipated in atomic tests. The mission cou~d not death was somehow related to radiation expo- have been successfully carried out without the sure. participation of some of the finest specialists in It is understandable that with the disruption the various fields of medicine and the staunch of their lives, the development of radiation support of many agencies, particularly effects, and the contamination of their islands, Brookhaven National Laboratory, Department there was increasing bitterness towards the of Energy, 22Department of Defense, and the United States about the accident and, justifi- Trust Tetitory of the Pacific Islands. It is for- ably, increasing demands for compensation. The, tunate that since my retirement the medical local politicians and lawyers representing the program is continuing under the able direction people became ever more vocal in their criti- of William Adams and his medical team. cisms of the United States in handling the post- Some of the difficulties in carrying out these accident problems. examinations in a distant area of the world The criticisms increased and the years 1972 have been described, including organization of to about 1977 were troublesome ones for us. the medicai teams, scope of examinations, tr- Unexpectedly, the Japanese anti-A and H-bomb iage problems related to assembling and ship- groups became involved with the Marshailese ping of medical supplies and equipment, and politicians in criticizing the way the fallout vic- establishment of examination facilities on tiny, tims were being handled. These groups were remote islands in the Pacific. very active in Japan and created much publicity concerning the fallout exposure of the Japanese fishermen on the Lucky Dragon. The Marshallese politicians were greatly angered when the Trust Territory Government refused 211n Appendix 11,a chronological oudine of the p-pal evente to allow a Japanese group that they had invited to visit Rongelap to examine the exposed people on their National Laboratories foraestitan~ in rediation prtb and the group had to return to Japan. This Iernssince there were DOother qmncies with the_ ~Pe- action precipitated a cascade of events: the bihty and faciiitiee. it shou.id be repeated that dthOU@ OIM abortion of our 1972 medical examinations after p~ wae under the ae@ of BNL and tknded by AEC, there wee never any st~mpt to influence the conduct of the ~- the team had arrived at Rongelap due to poiiti- tione which we cerned out independentlywth the edviee end cal interference; the formation of a special pu2tcipau0n of medhl peopie fim ouw~* fi~tufione ~ investigative committee on Rongelap and Utink the united stawe.

45 by the Congress of Micronesia with arrange- to continue regular, detailed examinations ments for medical observers to accompany our because of the paucity of information about late examinations and other probiems that devei- effects of radiation in human beings. This deci- oped during this time, as outlined in the report. sion proved to be fully justified when thyroid

Following this ciifflcuit period. it was encour- effects began to appear, and we were able to 4, aging that there ensued a marked improvement detect and treat them at an early stage before in attitude toward the program. There were sev- complications developed. eral possible reasons for this: the favorable When the Rongelap people moved back to report of the medicai observers to the Congress their atoll in 1957, there were persisting fears of Micronesia on the conduct of the examina- about the low levels of residuai contamination tions; our efforts to increase communication of their island. This undercurrent of fear contin- with the people about the effects of radiation ued in spite of further comprehensive radiologi- and the objectives of our program, and our cal surveys showing the radiological safety of increased efforts to expand primary health care the island, and our annual, sensitive monitor- by placing a resident physician in the Islands; ing of the people for internally absorbed radio- and, last but not least, the increased response of active elements and our reassurances that their 1 the United States in compensation settlements. radiation exposure from living on the island It was also encouraging that the Japanese was less than that of people living in the United groups no longer became involved w]th the pro- States. It was unfortunate that in 1986, after gram. living on Rongelap for nearly thirty years, the In retrospect, it was unfortunate that the people chose to evacuate their island. This AEC, because it was a research organization, event was followed by a complex series of did not include support of basic health care of actions initiated by representatives of the populations under study. For this reason, the Rongeiap people to investigate the DOE reports 1 Brookhaven medical program in the Pacific of the radiological safety of Rongelap. They i could not be designated other than a research requested funds to carry out an independent project, restricting the scope of the program to investigation of the radiological safety of their the diagnosis and treatment of radiation effects island for habitation. Recently DOE and DOI , in the exposed people. 23General health care of provided a fund for this purpose and such an the AMarshallese had been established as a investigation is in progress. In the meantime responsibility of the Health Services of the the Rongelap people continue to live on the , Government of the Trust Terrjtory of the Pacific unsatisfactory island of Mejato in Kwajalein Islands and later. the Republic of the MarshaAl atoll, Isiands. With increasing effects of radiation in Equally discouraging has been the unfortu- the exposed people and the need for mbre health nate saga of the Bikini people who were care, particularly in the Outer Islands, the pro- removed from their atoll 44 years ago before i gram was expanded (unofi~cially) within fiscai Operation Crossroads. Resettlement on and time limitations beyond the limitations Rongerik Atoll resuited in near starvation of imposed by the original mandate. This expan- the people and they have never been satisfied f siofi included establishing a resident physician with life on Kili Island. The early attempt to I in the Islands. The limitations of the program recolonize Bikini with several famiiies had to be described above was the basis for criticisms of abandoned when it was found that radiation I the scope of our program described. levels on its island were higher than previouaiy During the early years of the examinations, had been reported, and that there was an unac- when there were few findings related to radia- ceptable increase in absorption of radioactive tion exposure, there were suggestions that the elements in the people due to consumption of examinations might be reduced in scope and fre- newly grown fruits on the island. Although quency. However, we felt that it was important efforts have been made to make Kili Island more habitable, the people are not happy there 23ne ~diation Eff’~ Raaaarch ~OUn&tiOZL a ]oht and yearn for the long overdue return home. It AEC’Japanese project m Japan to study the eff- of the atomic can be hoped that the recent allotment of U.S. bomb. radiation on the Japaneee people, Likemse did not include AEC suppon for generai health care of the ~pulationa under funds to the Bikini people to handle the radio- mudy.

46 Ioglcai clean-up of their island will be success- Although there are continuing problems that fd. need to be resolved, the relationship of the The dislocation of the people and increasing Republic of the Marshall Islands with the dependence on subsidization and compensation United States appears to be on a smooth course. had a disturbing influence on the lifestyle of the The new government is facing up to problems exposed people, resulting in a loss of incentive such as the alarming population increase, the to pursue their native skills. This was more need for improvement in health care and educa- apparent in the Rongelap people. who had suf- tion, and further development of their local fered the greatest dislocation. The Utirik peo- resources. ple, who were returned to their homes after only During their histo~, the Marshallese, per- a iew months absence, seemed to adjust better haps more than any other population, have been to these conditions. At present, there is a subjected to numerous perturbing influences, clamor among the people of the Northern such as visitation of foreign ships, occupation MarshaUs to benefit from the funds allocated by by foreign governments, epidemics of disease, a the United States in the Compact of Free major war partly fought on their soil with casu- Association Agreement for those affected by the alties among their people, adverse effects from Bravo accident. The number of people applying our nuclear testing program, and problems for radiation effects is far greater than was pre- associated with the missile test range at sent on our list of exposed peopie. As is to be Kwajalein. Through it ail, the Marshallese have expected, determining which people are eligibie maintained their individuality, their dignity, to receive these funds is a dif’flcuit undertaking and their reverence for their past. for the Tribunal appointed for this purpose.

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16 17 lE

50 References — B. Other References

1. Hatzei. F. W. The First Taint of Civiiizatton. A 21. Children Hit Meet by Aah of the H-Bombs. N. Y. Histo? of the Caroiine and Marshall islands m Herald Tribune, June 9, 1955. Pre-Coloniai Days. Univ. of Hawti Press, 1983. 22. Acute Radiation Threat to Man and His Children. 2. Oliver, D. The Paciftc Islands. Revised Edition. Buriiz@cm Free Preae, Aug. 12, 1955. Harvard University Press, Cambridge, 1962. 23. Atomic ARarmath. Newsweek, June 25,1956. 3. Hines. N. O. Pmuing Grounds: An Account of the 24. Islandera Still Dread Fallout Despite Full Physical Radtologtcai Studies in the Pactfic 1946-1961. Recovery. United Nationa, NY. N.Y, Times, see Ref. Univerwty of Washington Press, Seattle, 1962. 41, May 22,1959. 4. K;chard. D. E. U.S. Naval Administration of the 25. H-Bomb Fallout Damage Appeara in Test Victims. Trust Territory of the Pac#ic Islands. Vol. I. The Washington hat, Nov. 3, 1965. Warnme MilitaV Government Period 1942.1945. 26. Six South Pacific Atom victims Undergo Tests at Office of the Chief of Naval Operationa, Argonne. Chicago Daily News, Apr. 6,1957. Washington, DC, 1957. 27. Radiation Tells ita Tale in South Pacific. Medical 5. Ibid. Vol. 11. The Post War Militam Era 1945-1947. World News, Aug. 1965. 6. Hacker. B.C. Elements of Controversy: A Histom of 28. Thyroid Cancer Found in Fallout Victims. Medical Radiation Safety in the Nuciear Testing Program. News. JAMA- Dec. 1,1969. Renoids Electric Co. for U.S. Dept. of Energy, Lea Vegas, .NV, 1985, Washington, DC, 1957 29. Atari Fallout Victizne in Boston for Surgery. Record &nencan, June 1966. 7. Chief, Joint Task Force 7 to Chairm~ AEC, Mar. 18, 1954. Quoted in Ref. 6. 30. Gillrnan. D.S. 12 Years Afler the Bomb. Medical News (London) June 17, 1866. 8. The Marshall Islands Guide Book. Micronitor News Press, G, Johnson. Ed.. .Majuro!Ml., 1989. 31. Kreba nach Bravo. Modizim Der Spiegai M. 39* 1970. 9. Lapp, R. The Voyage of the Lucky Dragon. Harper and Brothers. New York 19513. 32. Mason, L. The Bikiniana. A transplanted population. Human Organ~ation 9, No. 1,5-15,1950. 10. Report of the Commanding Officer, U.S.S. Philip (DDE 498) on Evacuation of Rongelap and 33. Tobin, J. A. Background Information Paper-The Ailingnae Atolls on 3 March, 1954. H-21 SeriaA 002, Bikini Situation. Office of District Administrator, 5 March 1954. Marahalla, Apr. 1974. 11. Repofi of the Commanding Officer of the U.S.S. 34. McHenry, D. 3?. Micmneeia: Trust Betmyed. Renahaw (DDE 499) on Evacuation of Natives of Carnegie Endowment for International Peace, U- Adl on 4 March, 1954. A-9, Serial 038,18 washington, DC, 1975. March. 1954. 35. Van Cleve, R. The Office of Territorial Affairs, 12. Cronkite, E. P., Personal Communication. Dept. of Interior, 1974. 13. Bergson, J. C., to Nichols, KD. Conaiderauon by 36. Tobin, J. Land Tenure in the Marahall Islands. Irx the United Nations Trusteeship COuncd in Lnd Tenure Patterna, TrustTernto~ to the Connection with the Marshall Islandem Petition 20 Pacific Is fancia, Vol. I. Office of the High July, 1954. Cited in Ref. 6. (Xnmnisaioner. hat Territory of the Pacific Ialanda Guasm M.I. 1958. 14. The New Hospital in the hfarehad Is4ands Guidebook, Refi 8. 37. Conard Named to Monitar Bikinians. AEC Release M108, May 1,1969. 15. Mercy Phases Down as Marehalleae Move Up. Marshall Islands Journal (M.I.J.), Oct. 27,1987. 36. ~1~6Meeting. hficronesian Independent, Sepk . 16. Outer Island Health PuahecL JMJ.J., Nov. 18, 1986. P 39. Kahn, L J. A Reporter at Large. Micronesia. The 17. Big push for Doctors. M.1.=J., Nov. 21, 1968. New Yorker, 3 articles, June 11,18,25,1966. 18. A Report on the People of Roagelap and Utirik 4U. Kahn, L J. A Reporter at Large. Micraneaia Relatwe to Medical As-of the March L 1954 Revisited. The New Yorkep, Nov. 18,1971. IncidenC Injury, E~tions and Treatment! presented by the Special Joint Committee 41.29 Yeere After the U.S. Moved ‘Them, Bikini Concerning Rongelap and Utirik Atolls (Public Law Nativea Sue for Safe Return. The N.Y. TYmes, Oct. *NO.4C-33) at Fifth Con-- of Micmnesti. Fimt 17,1975. Regular Session, Feb. 1973. 42. Bikini Island Too Hot for Habitation? Micronesimt 19. U.S. Congress Compact of Free Aaaaciation. Act of Independent, Aug. 29,1975. 1985. U.S. Public Law 99-239, Jan. 14, 1986 (99 43. United Nations Truateeahip Council, Oflicial Stat. 1783-84). Records: Forty-Third Session. Report o.fthe United 20. Ra From the Sky. Time, June 20,1955. Nations Visiting Mission to the Trust Temtory of the Pacitic Mantis, 1976, Supplement No. 3, pg. 66.

51 44. An &nerican Temtory in the South Pacific. Report 67. Letter to R.A. Conard from N. Anjain. Micronesia on \licronesla 1978. The La~ers’ Committee for Independent, Apr. 25, 1975. Intemat~onai Human Rights. 236 East 46 Street, 68. ktter from C. Bam to N. Atjain. Lawyer Urges New York, .NY. Rongelapese to Continue Treatment with AEC. 45. Micranesian: “Time to be seif-reliant”. Honoiulu .Uicroneszan Independent, Mar. 16, 1975. Adcert~ser, Feb. 10.1973. 69. Monument Unveiled to H-Bomb Victim. 46. U.S. Congress. HR 1988, Jan. 1964. Washington Post, May 30, 1976. 47. U.S. Congress. Omnibus Territories Legmlative 70. Bikini Surnvors Suffering Bone Mamow Report 96.467, Sectton 103. To accompany HR Impairment. Nagasaki Shinbun, Aug. 5, 1976 3756, Dec. 7, 1979. (Translation). 48. Joint Examination of Fallout Victims. 71.2 Microneaians tive for A-Bomb Treatment. Z%e American-Japanese Team. The Mainichi Daiiy Japan Times, May 13, 1976. .Vews, Feb. 18, 1964. 72. Report of the Ad Hoc Committee to Evaluate the 49. Two Rival Groups Hold Fukuryu Maru Sernces. Radiological Hasards of Resettlement of the Bikini Japan Times, Nov. 3,1964. Atoll. Atomic Energy Commission, Washing&n+ 50. Mairs of the Legislative Council, News Release DC, May 1968. No. 10, Congress of Micronesia, July 3, 1972. 73. Bikini 40th--and a Big Discovery. Marshail Islands 51. Rongelap/Utirik Committee Returns from - Guiddoak, Majura, M.I. 1987. Rongelap, Utirik. Micronitor, Aug. 8, 1972. 74. Japanese Bomb Victims Vhit ‘IT Counterparta. 52. Wish to Appeal ‘Exposed’” Vktims of Bikini. The .Uicronesian Independent, Nov. 5, 1977. Asahi Newspaper, Japan. July 19.1972. 75. The improbable Welfare State. The New York 53. Japaneee Want Look at Fallout Victims. Thea Afagaaine, Nov. 27,1927. Micromtor, Aug. 21,1971. 76. Bikini Island: bat Again to Radiation. LA ~rnea, 54. “Human Guinea Pige” Charge Roil July 23, 1978. U.S.-Micronesian Relations. Honoiuiu Aduert;ser, 77. Hacker, B.C. 2%e Dragon’s Tail. Raciiatwn S~ety Apr. 28, 1972. in the Manhattan Project 1943.1946, Univ. of 55. AEC Information ‘Public” IAter to Ataji Bales Celifomia Press, 1987. from R. A. Conard and reply IYom A. Bales. 78. DOE Claim Nothing ta Prevent Rongelap Rattmt. Micronitor, Sept, 4,1971. M.Z.J. , Dec. 8,1989. 56. Scientist Answem Questions About Radiation 79. Criticism of DOE Unjustified. R. A. Conard L@ter Victims. Letter frum R. A. Conard ta A. Balos, to the Editar. JM.I.J.,Jan. 23, 1989. Micronitor, Oct. 1971. 80. Ray, R., Pemonal Communication, Apr. 1980. 57. Bikini Fact-Finding Team Refused Entry. Mainichi 81. Lasting Fallout from Bravo. Newsday, Mar. 11, Daify News, Japam Dec. 16, 1971. 1985. 58. .Micronesia H-Bomb Survey Team Abandons 82. Rep Mar ta Fund Comprehensive Radiologic H-Bomb Survivore Survey. Chugoku Press. Japan, Smwey of All”Marshe.ila. M.I.J., Dec. 8,1989. Dec. 15, 1971. 83. Kahn, H. I. Reassessment Repofl Pursuant to 59. What Are We Hiding? Pacifi Daily News. Dec. 22, Compact of Free Aamciation, Oct. 1985. Berkeley; 1971. California, July, 1988. 60. Refusal of Entry Reproached by Inhabitants. ABCC 84. Fallout From Pacific Teate Reaches Congress. Translation, Dec. 18,1971. Science 246,14 July, 1989. 61. Administration Medical Team Help Refused. 85. The Death of Lekoj Anjeh Lettar tiom J. An@@ Pacific DaifyNewe, Mu.*, 1972. Friends of Micnnl& Oct. 1973. 62..AEC Medical Survey Well Received on Rangdap, 86. Stawti AlaOp. why Thie ChHning Young Man? U* Micmnti, Sept. 26.1972. Paci/ic Daily iVewe, Nov. 23,1972. 63. Radiation.Inducd Thyroid Disorders in Stable 87. Stew- Alsop. Stay o~Excution. J. B. Lippinmtt Stage Saye Prof.Ezeii on Return &m Company, Philadelphia and New York, 1973. Investigation at Marshall Islands. Ch&oku 88. Marshall Islandera’ Death Tied to Fallout. N*w Shinbun, Japam *PL 26,1972. York ?%nes, Tuee., Nov. 21,1972. 64. Compensationfor the People of Rongelap and 89. Leukemia Kills Man in Fallout. %’ashington Utirik. A Repofi by the Special Joint Comnnttee Evening Star, Feb. 17,1972. Concerning Rcm@ap and Utirik Atoils. Fifth Cmgress of Micronesia, Feb. 28, 1974. 90. Compact of Free Aeeaciation. A Unique Political Statua. Marshall Islands Guide Book, Majuro, ML 65. Lekoj end the Unusable Weapon. Newsweek, Oct. 1989. 30,1972. 91. M.I. Where We Are. Ibid. 66. AEC Staff Comments on the Report on Rongelap and Utirik to the Congress of Micronesia, June 92. A New Look at Ebeye. Ibid. 1973.

52 93. llajuro Seen as Center for U.S. Tuna Industry. 100. ‘.Greenhouse’ Meeting m Majuro. M. I. J.. June 23. .\!.I.J.. May 19, 1989. 1989. 94. Buliding Boom m Marshails. .V.l.J., Jan. 26, 1990. 101. Legacy of a Disaster. A Soviet Photographer 95. Papaya Plan: No Riskier Than Any Business. Captures Haunting Images of Life Mter Chernobyl. M.I.J., Apr. 28, 1989. Anaatasls Toufaxis. Time Magazine, Apr. 9,1990. 96, Bikinis ac Bikini: Tourist Attract~on Eyed. ●.LJ.. 102. Four Years Later, Kremlin Speaks Candidly of Apr. 28, 1989. Chemobyi’a Horrors. N.Y. Times, Apr. 28.1990. 97. Problems Facing the Marshalls. Marshall Islands 103. US, RMI, Rongelap Agreement Launches Study. Guide Book, Majuro, M.I.. 1989. .W.J., Feb. 18, 1992. 98. Teen Babiea Booming. M.I.J., NOV. 14, 1989. 104. Bikiniana IUady for Powwow with U.S. Scientiate. .U.1.J., Feb. 28, 1992. 99. Census Showa Marshall’s Unemployment is 12.5%. ●.Z.J., Apr. 28, 1989.

53 Appendix I — Marshall Iskmd Survey Participants Nat 19541990 Btd Cal

cat Yame Specinlty Affiliation, Location Year Cal .idanuk. E. Technician BNL, .NY 59,61-62 Clx Adams, D. Technician BNI+ .NY 81-85 Ca Adams, W.H., M.D. Hematologist BNL, ANY 81-90 Ca hderson, J., M.D. Geriatrician NYU-Belleview Hosp., NY 87 Anjain, J. MedicalTranslator M.I.G. 77 Ca Anjain, J., D.O. Dental Officer ‘TTPI 64,72 Arelong, T., RN. ?4urse M.I.G. 82-85.87 Ck .tigotua, W.S. Technician US Navy, NRDL 54 a.

.tion. D., M.D. Endocnnolo~st Case Western Raseme Univ., 89-90 OH Ci bh, J.A. Techrucian BNL. ,NY 74 Cl Bach, S.A., M.D. Phy.wclan us Army, AFSWP 57 c1 Barclay, P., M.D. AHergisulmmunologist Central Gen. Hosp., .NY 82,84,87 G Barton, M., ,M.D. - Physician US Air Force,AFSWP 58 c Bateman, J. L., .M.D. Internal Medicine BNL .NY 69 c

Bauman, A., M.D. Endocnnologist V.A. Hosp.,WT 88 c

Becker, D., M.D. Radiologist NY Hosp. - Cornell Med. Ct. 81 c Bellu, W. Techrucian M.I.G. 83 c

Bender, B., Ph.D. Anthropologist ‘lTPI 64 c Benes, S.. .M.D. Ophthaimologiat Ohio State Univ. 87 ( Benton. .M. YutntiowFitness Private Business, .NY 89 (

Bettne. K TechnicIan .M.I.G. 82 ( Beydoun, S., M.D. ObstetnciadGynecologist U. Miami Sch. of Med., FL 86 t Biancaniello, T., .M.D. Pediatrician SUNY, Stony Brook, NY 81

Bien. P. Medex TTPI 70,7475,81

Bliss, M., M.D. Gastroenterologist Bostin City Hospital, MA 85,87,89

Blumberg, Baruch, M.D. Endocrinologist NIH, Bethesda, MD 59 Boccia, B,, .M.D. Internal Medicine Brookhaven Mere. Hosp., .NY 79

Bond, V., M.D., Ph.D. Physician BNL, ANY 54

Boon, R. Technician TTPI 61

Border, W.K. Technician NMRI, Bethesda, MD 55-56 Boyd, L. Technician BNL, NY 85 Brown, E., M.D. Cardiologist SUNY, Stony Brook, NY 82 Brown, R.A. Technician BNL, .NY 73-74,77-81 .. Browmng, L.E.. .M.D. Physician us Army, AFSWP 54

54 I Yame Specialty AfTiXiatiow Location Year

Bullis, J. Technician BNL, NY 86 Calmon, J., M.D. Infectious Diseases Medical Coil. of 89 Pennsylvania. PA

Cannon, B.. M.D. Surgeon .Mass. Gen. Hosp., LU 56-57,63 Carter, E. L.. M.D. Intemai Medicine NTKRI, Bethesda, MD 57 Carter, R.E., M.D. Pediatrician State Univ., Iowa & Career, R.K Parasitologist USPHS, Washington, D.C. 58 Carroni, M.. M.D. Physician Walter Reed Army Med. Ct., 90 Washington, D.C. Catto. B,, M.D. Internal Medicine Case Western Reserve Univ., 81 OH Chapman. W.H. Radiation Scientist NMRI, Bethesda, MD 54-57 Cheatman. W., M.D. Endocrinologist Walter Reed Army Med. Ct., 83-84,86 Washington, D,C. Cizinsky, J.. D.Ph. Pharmacist BNL. NY 88 Chreus. Il. Electromc Speaalist BNL. .NY 61-70,72-79 Clutter, W.G. Technician .NMRX,Bethesda, MD 54-57 Cogsweil. F., Ph.D. Parasitologist US Public Heaith Hosp., IA 86 Coicock. B. P., M.D. Surgeon Lahey Clinic, Boston, MA 67,75 Cole, W., M.D. Radiologist USPHS, Washington, DC 72 (%ok. K, M.D. Family Practitioner Kwajalein Hosp., M.I. 81,88 Cook, L. Technician BNL, ANY ~ 63,65 Caoper, A., M.D. Surgeon Univ. of Pennayhwmia, PA 75 Canard, R.A. M.D. Physician BNL, NY 54,56-80,82 corm, S.H., Ph.D. Scientist BNL, LNY 54,59,61,74 Cronkite. E. P., M.D. Hematologist BNL, NY 54-55,80-81 Croniute, T. Technician Medical Coil. of Wisconsin, 79 WI Culbert, S., M.D. Pediatrician M.D. Anderson Hosp., TX 77 Davenpofi. D.. .M.D. Obstetrician/Gynecologist SUNY, Stony Brook, NY 82 Dekun, R. Medical Translator US Dept. of Energy, Majuro, 80-90 M.I. Dsc, W., M.D. cardiologist Harvard Med. School, MA 85 Deisher, J.B., M.D. Physician ‘ITPI 66 Dekle, M., M.D. Physician U.S. Public Health Hosp., 79 CA

Demoise, C.F., Ph.D. Scientist BNL, NY 68-69 Dob~s, B.M., M.D. Surgeon Case Westan Reserve Univ., 69-70,72-73,79- OH 80,82,85,88-89 Donato. D., M.D. ObatetriciarJGynecoio@ U. ofhfiami Med. School, FL 90 Duhaimes, S. Technician SUNY, Stany Brook, NY 87

3s ?Jame Specialty AfKliation, L9cation Year

Dungy, C., M.D. Pediatrician U. of Califorrua, Irvine 82-83 Dunham. C., M.D. Physlclan AEC, Washington, DC 54-55 Dwyer. M., M.D. Ophthalmolo@st Walter Reed AI-XIIyMed. Ct., 89 Washington. DC Either. .M. Electronic Specialist NMRI. Bethesda, MD 57-59,65,73 Elanjo, L. Technician TrPI 74,76-81 Emil. M.. D.O. Dental Officer TrPI 67 Emos. H. Technician BNL NY 79-90 Engie, J., M.D. Internal Medicine B~ ,NY 8466 Evert. H.. M.D Physician Medical CoIl. of Wieconain, 79 WI Ezaki. H.. M.D. Surgeon Hirosiuma Sch. of Med., 72 Japan Farr, R.S., M.D. Hematdogxst NMRI, Bethesda, MD 54 Ferguson, F., DDS Pediattic Dentistry SUNY, Stony Brook. NY 82-85 Ferguaon, IL Technician BNT+ NY 82-84,88 Ftig, S., M.D. Pediatrician SUNY Health Center, 90 BrooklP, NY Flanagan. J. Technician NMRI, Bethesda. MD 54 Gard.iner, M., M.D. Rheumatologist Medical Coil: of 89 Pennsylvania, PA Gatz, J. Ektronic Technician B~ NY 89 Gays, W. Technician ‘ITPI 64-65 Geller, P., DDS Dentist Private Practice, NY 83 Gio~o, B., M.D. ObsteticianiGmecoiogist private Practice, HI 80,83-85,87 Gior~o, L., RN Nurse Private Practice, HI 85 Gibbs, W.H. Technician NRDL, Bethesda, MD 54 Gideon. K Techniaan ‘ITPI 64-65,7-1,86 Gilmartim J.T. Techniaan BNT+ NY 59 GlaesfomL K. Technician Bethesda, m 59 Glynn, R, M.D. Phyaiaan US Public Health Heap., CA 77 Goldman, M.. Ph.D. Paraaitologiet USPHS, Waehingtm+ DC 58 I Gomez, W. Technician ‘ITPI 67,69 Grant, W., M.D. Internal Medicine BNL, NY 78-79 Green, A., M.D. Endocrinologist SUNY, Stony Brook NY 89 Greene, G., M.E. Pediatrician U. of Califozma, tie 85 Greenhouse, N. Radiation Scientist BNL, NY 74,78 Greenough, J.J. Technician Bm NY 57,59 Griffin, D., M.D. Physician US Navy, NRDL 55 Gusmano, E., Ph.D. Radiation Scientist BNL, NY 61,65

56 4

.. Year Affiliation. Location Speciaity Name 54-57 XMRI. Bethesda. MD ‘rechmclan 63 Hamby, J.W. BNL, .~ Scientist 54 Hammerstrom, R., Ph.D. US Naw, >WRI Techmclan 58 Hansei]. R.E. us Naw, >WRI Technician Hartley, M.L. 72 Tokyo, Japan Physlclan Hayakawa. C.. J1.D. 57-58 NRDL *tlstlcian Hechter, H. 80-83.86.88 F~iy practitioner BNL. .~ Harper, J., M.D. ~ma Linda U.. CA 79 pediatrician Heidinger, H.. M.D. 87,90 BNL. NY Technician HeinrldM. J. 60 ~n~ Officer mPl Heuena, J.. D.O. 54 US Nav, mDL Technician Hendrie, J.C. 73-90 BNL. NY Technician Heotoa. P.M. 62-68 ~edi~ Officer ‘ITPI ~~~ng A., M.O. 82 BNL. ~ TechIucian Hicks. E. 80 ~ndocnnoiopst M.D. Ana;rson Hosp., TX fill. s., M.D. 59 ~Wm~ Medicine ABCC, Japan Hollingswomh, J.W.. M.D. 90 Oregon Health Services U:, mdiologist Howleson, J.. M.D. OR 56 ~~mai Medicine NMRI, Bethesda, MD H~gp, C.E., M.D. 70 3Jhotographer BNL, ~ HumphreYt D. 88 ~~mal Medicine U. of Mass., Worcester. MA H~Owitz. J., M.D. 5g,76-77,79-82 ~edicai Officer ‘lTPI Iman, J., .M.O. 80 ~~y practitioner M&e Medical Center Inga.lls, J., ,M.D. 86,88 . M.I.G. Nurse 86,88 Jacob, D. M.I.G. T~cian Jacob, S. 83 In~mal Medicine Ohio State Univ., OH Jackson. R.. M.D. 60-61” ‘ITPI Dentist Jaffe. A.A-. DDS 88 New York Hospit.alJComell tidiologiet Jag~ath, A.. M.D. 85 U. of hf.iami school of Med., ObsteticitiGp-lo@at Jemen, L., M.D. PL 65 BNL, ~ ‘Surgeon Je~seph, J.E., M.D. 67,72 Technician ‘rI’PI 61-63 Jomule, J. So. Nassau Comm. Hosp., THhnicitM3 Jones, I. NY 78-90 BNL, Ebeye, M.’I. Nurw Kabua, J. 79 T~cian M.I.G. Kabua, M. M.LG. 81 Nurse 83 Kfiiko, R. Nephd@8t SUNY Stony Brook, NY 61 Kaloyanides, G., M.D. Sloan- Ketta* Illat., NY oncologist Karnofsky, D.. M.D.

— .- ..= . . .

Yame Specialty Affiliation, Location Year

Kehne. 5., M.D. ~eurologist Boaton City Hosp., .JL4 84-86 Kenny, J. Techmclan NMRI, Bethesda, MD 55 Kern. J., M.D. Physman Walter Reed Amny Med. Ct.. 90 Washington, D.C. Iietchum. D., M.D. Pediatrician Tulane M. Hospitals, LA 81 Kilwe, H. Av urse M.I.G. 90 Kindermann, R., M.D. Ophthalmologist FWvate Practice, NJ 81,83,85 Knudsen, K, .M.D. Internal Medicine BNL, NY 71-74,76-77 Korean, .M. MedicaA Officer M.I.G. 78 Kotrady, K. .M.D. Faxmly Practitioner BNL, NY 76 Kramer, K, .M.D. Ophthalmologist Walter Reed Army Med. Ct., 89 Washington, D.C. Krippaehne. M.. .M.D. Physlclan Oregon Health Sci. U., OR 90 Krotoski. A.. DDS Denust Private Practice, CA 79-80 IQotoski, W., .M.D. Parasltolo~st US Public Health Service, 77-79,82 LA Kumatori, T., M.D. Phys]cmn NI Radiological Sci:, Japan 64,72 Lakahmanan. M., ,M.D. Endocnnologist Nat. Institu~ of Health, ,MD 86-87,90 Lalimo, T. Nurse M.I.G. 90 Landsber.ger, E., M.D. ObstetnciawGynecologist Albert Eina’tein Coil. Med., 86 NY Lang, J. Techmcmn M,I.G. 81 i Langrine, H. Nurse M.I.G. 85-86 Lanwi, I.. .M.O. .Medicai Officer ‘ITPI 59-60,64,67 i Larsen. P. R.. M.D. Endocnnolo@st Univ. of Pittsburgh, PA 72,74 Lehman. W. Techmcmn BNL, .NY 81,86-90 Le Maire, W., .M.D. Obstetrician/Gynecologist U. of Main Sch. Med., FL 88\ i Laner, M.. *M.D. Pediatrician Univ. of California, Irvine 84. LeRoy, G.V., M.D. Internal Medicine AEC, Waahingtoi, D.C. 54 Lessard, E. Radiation Scientist BNL NY 78 i Lewis, H., M.D. cardiologist Memorial Hospital, NY 59 / Leyjen, T. Nurse M.I.G. 88-89 Libby, E. Technician ‘ITPI 67-69,71-73 I

Lindborg, E., M.D. Family Practitioner Kwajalein Hosp., M.I. 89 I “! Lees, L., M.D. Obstetrician/Gynecologist Women-Children Med. Ctr. 89 ! i Lowrey, A., Jr., JM.D. Ophthalmologist Walter Reed Army Med. 56-59,62,64,67, Ctr., Washington, D.C. 71-72,75,78 I Lyon, H.W., DDS Dentist Bethesda, MD 59 I .MacDonaid, H., .M.D. Phywcian ‘xTPI 60-61 I I

1 .Name Speciaity Affiliation. Location Year

!Magner. J., M.D. Endocrmologm Michael Reese Hosp., 90 Chicago, IL Makar. M.S. Technician BNL, NY 69-78,79 Mandelkem. M., M.D., Ph.D. Internal Medicine U. California, Irvine 79 .Malerkey, W.. M.D. Endocrinologist ohio state University, OH 83 Maclsso, D. Technician Main Medicai Center, ME 80 MacKay, D., M.D. Infectious Diseases Darmouth-Hitchcock Med. 87 Ctr., .NH .Maisel. J., M.D. 0pthalmologi9t SUNY, Stony Brook, NY 85 ?daxon. H., M.D. Nuclear Medicine U. of Cinn. Med. Center, OH 87 McCIim.ock, C., 3f.D. Gastroentertdogist Bostin City Hosp., MA 83-8S,88-90, 90 McPherson, S. D.. .M.D. Ophthalmologist .NMRI, Bethesda. MD 55 Melkoruan. R., M.D. ObstetriciaruGynecoio~st SUNY, Stany Brook. NY 87 .Mellen, .M. Nurse M.I.G. 87 .Meyer, L..M., .M.D. Hematologist V.A. Heap., NY 61-65,67,72, ’74 ?diltenberger, R. Radiation Scientist BNL, ,NY 78 Miller, ?4., M.D. Hematologist BNL, .NY 81 Mizutaru, Kosan Technician ‘ITPI 67;72,74-75, 89 Moloney, W.G., .M.D. Hematologist Boston City Hospital, MA 62,63 Momotaro. F., D.O. Dental Officer ‘ITPI 72 Morgan. D., M.D. Pediatrician U. of Cali.fomia, Izwine 82-84 Mueller. L., M.D. Farndy Practitioner Brookhaven Mere. Hosp., ANY 80-81 .Murrav, W.G. Photographer NRDL, San F’rancmm, CA 57-58 Nakasone, K. .M.D. ObatatriciadGynecologist Honolulu Med. Group, HI 84 Naylor, R., M.D. Radiologist Dartmouth Med. Sch., NH 89 Nelson, W., M.D. Pediatrician Nationai Inst.of Health, MD 78 Neamon, M. Technician hf.I.G. 79 NetisuL N., R.N. Nuree BNL. NY 89 Nicoloff. J., M.D, End-ologist U. of Caiifomia Sch. of Med. 78-79 Nicoioff. R., M.D. Obatreticia.n/Gynecologist Permanent Med. Center, 78-79,82 CA Obten, Antak Technician T1’PI 62 O’Connell, B., .M.D. Obstetrician/GDecologist” Univ. of Wbm.ein, Madison, 90 WI Oh, Yang, H.. Ph.D. Scientist B~ NY 71 OSullivan, M., M.D. ObstetriciadGynecoiogist U. ofhfiami Sch. of Med.. FL 84 Otto, JS. Technician US Naw. Naval Med. Center 58

59 Name Speciaity Affiliation. Location Year

Pagha. D.E.. M.D. Hematolo~st UCLA.CA 68,76.79,81 S1 Palmer. L.. M.D. Intemd Medicine Yale-New Haven Hosp., CT 82

Parun. J.. M.D. Pediattiian SUNY, Stony Brook, .NY 81 s!

Paclfico, A.. M.D. CardiolO~st Baylor Sch. of Med., TX 87 s: Panebianco, R., .M.D. Intemai Medicine Private Practice, NY 85 s Peck. W.. M.D. Physician TrPI 72 s

Philip, R. Technhan M.I.G. 80-81 ,s ~ Pochin, E.. M.D. Radiolqist U. COILMed. Sch&l, 72 London, UK c Potter, D.W. Scient* BNL. ANY 58-59 L c Pratt, H., M.D. Intemai Medicine BNL, NY 78-80 & .c Prem. K. M.D. ObstatziciamGynecoiogist U. Of Minnesota Med. Sch., 88-89 MN .t

4 Rai. KR.. M.D. Pediatrician BNL, NY 70 . RaiL J. E., M.D. Endocfioloast NIH, Bethesda, MD 57,65,71 Rsndell. D., .M.D. Ophthaimoio~st Private Practice, HI 81,83 Rantak. N. Nurse M.I.G. 89 Reidel, A. Technician M.I.G. 80-82 Richards, J. B., ,M.D. Phyaickn NMRI, Bethesda, MD 56 Riklon, A. Nurse M.I.G. ‘ 88 Riklon, E.. M.O. iMedical Officer TI’PI 59-63,69,72- 73 R&Ion, K Tecimizian ‘11’PI 72 Rittmaater, R.. M.D. Endocx5noiogist BNI./NIH 80-81,85 Robbins. J., M.D. Endocrinologist NIH 66,72,76,79 Robertson, J.S., M.D., Ph.D. SCis!atti BNL, ANY 54,58,65 Rothman. J.C. TecixMan BNL, NY 74,77 Saul, J. Technician ml 71,72,82-88,89 Schaeneu W., M.D. Intanmi Medicine NY Univ. Bellevue Hosp., 68 NY Schlissei, E., DDS Dentist SUNY, Stiny Brook NY 81 Schork, P.K Technician NMRI, Bethesda, MD 54,57 Scott, WA Atitration BNL, NY 56-89 Severson,C.D. T-an NMRI, Bethesda, MD 56 Sherman, L., M.D. Endoct5.nologint SUNY, Stmy Brook+ NY 64 Sharp, R. Radiatin Scientist NMRI, Bethesda, MD 54 Shomber. S. Technician ‘TTPI 56-83,85,87-90 Shulman, N. R., M.D. Hematologist NMRI, Bethesda, MD 54 Sipe, C. Technician BNL. NY 5455,58

60 ?/ame Specialty Affiliation, Location Year

51ivka. W. pulmonary Technician Walter Reed Army Ct., 90 Washington, D.C.

Smith. E.. .M.D. Famdy Practitioner Brookhaven Mere. Hosp., NY 80 %uth, L.J. Radiation Scientist NRDL..San Francisco, CA 5.4 Smith, R.F. Photographer BNL, .NY 59,67 Snow, L.D. Technician NMRX. Bethesda. MD 56,59 Soras, P. Technician ITPI 61 Smry, M., M.D. Physician “ US Public Health Setwice, 79 LA Stewart, D., M.D. Pediatrics U. of California, hwine 85 Stone. M., M.D. ObstetriciaruGynecologist SUNY, Stony Brook, NY 83 Steele. J., M.D. Pediatrician ‘ITPI 74 Stravmo. M. Techrucian BNL, Xl’ 87 Strome, C.P.A. Technician ANMRI,Bethesda, MD 54-56 Sutow, W., M.D. Pediatrician MD Anderson Hosp., TX 58-59,63-65, 67-72 Sullivan, M,, M.D. Pediatrician M.D. hderaon Hosp., TX 79 Syraes, D., M.D. Ophthalmologist Private Practice, AZ 87 Taguchi, D., M.D. ObstatriciamGynecologist I%+ate Practice, ,CA 81 Takamura, B. Technician M.I.G. 90 Tenorio, P. Technician US Navy, NMRI 58,59 Territo. M.. M.D. Intemai Medicine U. of California, LA 79 Thomaa, R., M.D. Emergency Room Med. Bradley Mere. Hosp., TN 80 Thomas. C., RN Nurse So. Missionv Coil., TN 80 Tomeech, C. Techoiaaa BNL. NY 71 Tommy, M. Medical Translator “ M.LG. 87,88 U@ni, V., M.D. Cardiologist Southwestern Med. Sch., TX 87 UlyaL H. Techaiaan BNL NY 88,89 Urschei, H.C., Jr., M.D. Physician NMRI, Bethesda, MD 58 Waithe, W. Tehniaan New York University, NY 64 Watne, AC., M.D. Surgeon Univ. of West Virginia, WV 64 Wedon. E.A., Jr., M.D. Physiaan NRDI+ Sea Francisco 54 Weldon, T. Technician BNL NY 67,80 Werth, V., M.D. Demnatoiogiat New York University, NY 86 Williams, K, M.D. Iatirnal Medicine Cornell University, NY 86 Wiiaon, R., .M.D. Family Practitioner Iadiaa Health Setice, NM 89 Wolff, J., M.D. Endocrinologist NIH, Bethesda, MD 74,77-78 Wolins, W., M.D. Iaternsd Medicine BNL, NY 58 Woodward, KT., .M.D. Radiologist Us. Army, AFSWP 55

61 Name Specialty AfFNiation. LOcation Year

Wynn. s.. RN Xurse BNL. ANY 79 YosIuzame,S. Surse M.I.G. 81

Zetkela. Nelson Techmclan lTPI 61,66-79 1946 Zimmenna, S., M.D. Intemai Medicine Main Medical Center, ME 81 Ysawa. W. Student Nurse M.I.G. 90

Listof Acronymm

BNL Brookhaven National Laboratory M.I.G. .Marshail Island Govem.ment, Majuro Naval Medical Research Institute .NMRI 194” .NRDL Navai Radiological Defense Laboratory TTPI Trust Territory of the Patic Islands

195

62 Appendix II — Chronolo@cd Listing of Perttient Events in the Marshall Islands

1946 Bikini people moved from home island to T’hyrmd abnomnaiities begin to appear in the Rongenk Atall. Later evacuawd to Kwajalein Rongeiap peopie. Thyroid surgery pefionned on and finally settled on Kili Island in the Southexn three children at Guam Naval Hospital. Marshails. 1965 Thyroid surgery on 12 Rongelap people at New Kwa]aiein established M U.S. Navy Base. England Deaconess Hospital in Boston.

Operotaon Crossrooda at Bikini. 1969 hnual examination of Utirik people.

Trust Temtory of the Patilc Islands estab- Clean-up of Bikini begins. lished. administered by U.S. Navy. Thyroid surgery on five Marahallese at 1948 Enewetak people moved to Ujehmg Atoll. Clevehmd Metropolitan General Hospital, Enewetak established as a base of operations for Cleveland. future nuciear @sting. 1971 Congressman from Mamhall Island visita Japan 1951 Administration of Tiust TerntoW transferred to and intites a Japanese team m examine the U.S. Department of In@nor. Rongeiap peopie. Team *vee. but denied visit to Rongelap due w improper visas and forced to 1954 March 1: Fallout accident following detonation of return to Japan. Return of two families w Bikini Bravo, a thermonuclear device. Evacuation of to live. BNL medical team aamunes responelbil- exposed people: 28 American seficemen from ity for radiological monitoring of returning Rongenk Atoll, 82 MarahaUese from Rongelap Bikini People. and Ailingnae Atolls, and 157 from Utizik Atoll. A Japanese fishing vessel. the L~ky Dmgonv Documentary movie “Thpwid Neoplasia as a with 23 aboard, exposed to fallout and returns to Late Sequels of Radioactive Fallout’”filmed in Japao amving March 14. ‘I’he fishermen are hos- Marabail Islands. Shows the medical team in pitalized. Near panic in Japan about the effect of action. fallout on fishing industry. 1972 MarahaUeae Congreaaman accuaea the U.S. of March 8: AEC-sponxored emergency medical knowingly ailowing the MarahaUese people to be team arrives at Kwajalein to CaITYout examina- exposed to radioactive fallout in order to study tion and treatment of the exposed people for the the effect of radiation on human beings; accuses next two months. medical team of using Rongelap people as guinea pigs end not gi~ them proper medical exanu- April 15: Ametican servicemen tranafemd to nationa and adequata treatmant. In March he Tnpier -y Hospnal under the care of the U.S. told the Rongeiap and Utirik people not to coop- Army. erate mth the medical team. The annual medical sumy was not completed. Also, four patlenti May: The Utirik peopie returned to their home who had been operated on for thyroid cancer and atoll. Rongelap people mov~ to a tem~r- m~- were to be reexamined at Tripler &my HoapWsl Iage on Ejit Island, Majuro AtoIL were etopped and told by the MarahaUese potiti- cel Ieaderz to return home. 1956 Regular, continuing ~tione and ba~ent program of the Marshalleee established under Congmsaof Micronesia establiahea a Special the auspices of BNL and coordinated with the Joint Committee to investigate the medical Health Services of the TrustTerritory. Robert examinations at Rongelap end Utirik Atolls. Conard appointed Director ofthe Pm-” ChairmaJX Senator Olympio G. Borja.

1957 Examinetiom ofthe mngelap -d u= peoPle. First resident phyeiaan stationed in the NewviUageat Rongelap completed and the Marshail Islands. Rongeiap peopie returned to their home atoll. Periodic environment radiation surveys contin- Annuei medicai aumey resumed, with coopera- ued along with the medkxd examinatio~. tion i%omCommittee !+om Congress of Micronesia and partiapation of four appointed 1963 Poliomyelitis epidetic in M-W Islade medical observers fkom several countries. including Rongelap. Paci15cMissile Range under Comprehensive report generally favorabIe to the U.S. /mny Commend established at Kwajalein. medical examinations published.

1964 Ex gmtia compensation granted Rongeiap people A young Rongelap man, found to have acute by U.S. Congress ($11,000 per pereon). myelogenoue leukemia, dies at the National

63 Cancer Institute. Bethesda. .MaryIand, and is overexposures were found, it was necessary to returned for burial at Rongelap. evacuate the peopie in order to prevent unacceptable increases m their body burden of these ele- A group horn the Safety and Enwronmental ments. Protection Division at BNL ca~ out radiological surveys in the Marshall Islands to be coordi- Aerial radiolo~cai surveys of the Northern nated with the medical examinations and per- Marshall Islands compieted. somei monitoring. Robert Conard retires. Medical Director of the Special bills passed by Congress of Micronesia program for 26 years. Hugh Pratt and Eugene regarding further compensation to Rongelap and Cronkite temporarily headed the program from Utirik people, and providing special benefits and 1979-81. hospitalization pwileges m caae of illness from any cause. 1981 William Adams assumes directorship of the Marshall Island Medical Program. Twenty houses completed at Bikini and more people returned. 1905 Rongelap people, mistrustful of DOE repmta of the radiological safety of their atoll, are evacu- Between 1969-74, 14 Marahallese, one exposed ated fkom their ishmd by Greenpeace to an in utev-o,had’th~id surgery in the U.S. The unsatisfactory island (Mejato) in Kwajaiein total thus far is 26 people. Atoll.

The firstship ta be used for medical examina- 1986 BNL’s resident physician program termmated tions obtained, named Liktanur. because of increased U.S. funding for general heaith care m the Northern Marshall Islands. 1977 Marahallese nurse and laboratory technician hired by BNL to support the resident physician 1990 The appearance of thyroid tumors has declined in the islanda. in the paat five yeasa. About on-third of the exposed Rongelap people and a small number of 1978 Radiological monit.ming of 140 peopie on Bikini Utirik people have developed tumors. reveals unexpected increase in absorption of radioactive elements from the consumption of 1991 Jean Howard joins Adams in administering the freshly grown fiuita on the island. Although no program.

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Falout BNL 46444 Informal Reporl 1IIQ ~x~)cl iel Ices of a Medical Team in he Care of a Marshallese Population Accidenlly Exposed to Fallout Radiation ● Robed A. Co/uwd