Attendances over a one-year period at the sole dispensary on a coral atoll (population 2411) have been studied. The patterns of presenting illnesses for those under five years old and those over five years old were studied, and analyses made of usage of the dispensary in relation to distance. Under-5s have disease incidences some four and a half to five and a half times those of over fives, but the apparent detrimental effect of distance is less in the under-fives. The skills required in the management of presenting illnesses are analysed in relation to those available?village health worker, trained nurse, doctor?and most were considered manageable by a nurse or village health worker. The latter apeared to be under-utilized and possible reasons for this are discussed.