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Anargyroi Graduating Scholar: Jochebeth Joi Trocino

(L-R) Janssen Hinlo, M.D.  (UST Med Batch 2013), Albert Flores, R.N., and Jochebeth Trocino during cesarean delivery at a local hospital at Brooke’s Point, Palawan

Who would have thought that an ordinary person, born and raised from a small home, will be a doctor someday? Gratitude is an understatement from what I feel from all the support I have been a recipient of that led me to who I am today. I still cannot believe that this is all happening. As I look back, I am always amazed at how God orchestrated my path towards UST Faculty of Medicine and Surgery, from the year I was born and graduated college.

The founding year of the AnargyroiFoundation was perfect timing as I became one of their first scholars and be part of the sesquicentennial batch. Because of that, I truly believe that I am blessed by God through all the people who helped in supporting this Foundation.

​When I first entered the premises of the University of Santo Tomas, I was really nervous and was overwhelmed by what I saw.  Being a new student entering a big and prestigious school gave me a mixture of fear and excitement. The journey was not really that easy as I had a hard time adjusting especially on the expensive meals, on how people were different from my previous school, and on how heavy the study load was. However, I am blessed for having a co-scholar, Carmela Tormo, who is also in the same section, for she has helped me in my needs and has comforted me with the small talks we would usually have. The encouragement that I received from the doctors and the people that I met in the Development Office is something I keep close to my heart. On top of all these, the Anargyroi Foundation has been generous in addressing my other needs, such as: dormitory, allowance, books, medical bag, and more. Little by little, I was able to adjust and survive in medical school as I give and still is giving all the best that I can. Every morning when I wake up, I really thank God because I continue to receive His blessings through His grace.

​During this pandemic, our clerkship is online. I struggled during our classes since our internet connection in the province is poor. Good thing, I was able to practice in a hospital in our hometown since we almost had no COVID cases. I also met two Thomasian physicians who practice in our municipality. During my stay, I saw the reality of our place. We lack specialists and by observation, the doctor-patient ratio is way beyond the norm. I also cannot help but imbibe what UST has taught us—to be compassionate, competent, and committed physicians. I realized how blessed I am that I am able to study and train in the biggest, brightest, and best medical school in the country. With that, I am really inspired to become the best I could be and help my fellow Palaweños in the near future.

Jochebeth Joi Trocino s is one of the first Anargyroi FMS Foundation, Inc. Regent's Scholars.

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Studying the History of Medicine in the Philippines: A Survey of the Field (Part 3)

Medicine, disease and demographics--Comparative Approaches 

'Birth, copulation, and death' as the American historian Norman Owen writes, borrowing T.S. Eliot's memorable phrase, are areas of key conference held at the National University of Australia attempted to systematically approach the subjects of morbidity and mortality (but not fertility), focusing on epidemic disease and other disasters, and death. The resulting volume Death and Disease in Southeast Asia, published in 1987 by Oxford University Press, was the first edited volume to explore the social, medical, and demographic history of Southeast Asia. Owen's volume, which has so far not been superseded, gathered together papers that examined Vietnam, the Indonesian islands of Java and Bali, the Dutch colonial capital city of Batavia in Indonesia, Thailand, and colonial Malaya.  The papers were organized under three sections: "The Demographic Evidence" which focused on rates of fertility and mortality; "Culture and Curing" explored Southeast Asian approaches to diagnosis and healing, particularly the place or religious cosmologies in the understanding of disease and ill health; and "Biology and Politics of Death" examined death and government policy. For the Philippines, Norman Owen's contributed essay "Measuring mortality in the 19th century Philippines" painstakingly examined population figures and burial records compiled from parish registers in the Bikol region in the mid-1840s, to give a picture of the dramatic nature of death during crisis-- food shortages, cholera epidemics and devastating typhoons. Through meticulous quantitative analysis, Owen has brilliantly shown how death has historically struck in the Philippines - who was most affected, when, where and by what.

These questions were again central to the recently published volume edited by Daniel Doeppers and Peter Xenos, Population and History, which demonstrated the continuing usefulness of population figures in reconstructing periods of crisis mortality and times of normalcy in which endemic afflictions were responsible for the majority of deaths in the Philippines. Included in this volume, Linda Newson's essay explored old world diseases such as small pox and the appalling devastation these caused in early colonial Philippines. Drawing on insights from her path-breaking research on disease and death from within lengthier periods and the impact of foreign presence over time on morbidity and mortality rates.

Colonialism and medicine

The study of colonialism and medicine has been, by far, one of the most stimulating and provocative areas of investigation in Philippine medical historiography. Much is owed to the high quality work of three scholars in particular - Ken de Bevoise, Reynaldo Ileto and Warwick Anderson. Concerned with the late 19th and 20th century Philippine health crisis, de Bevoise was interested in explaining why morbidity and mortality rates were astonishingly high during the 1883-1903. His study, Agents of Apocalypse: Epidemic disease in the colonial Philippines, eventually published in 1995 broke new ground in methodology and the interpretation of a period that was mainly approached by historians from the standpoint of revolution and war. In de Bevoise's study, war is but one strand in explanations of disease causation, part of a web interacting factors that could be traced back to the mid-16th century. De Bevoise was interested in mapping the historical processes involved in archipelago-wide contagion, focusing on venereal disease, small pox, beriberi, malaria and cholera. By "embedding" human interactions within complex networks or webs of "ecological interdependence", he shows how late 19th century health crisis was a result of cumulative changes and long term processes that progressively upset ecological equilibrium. As he writes: "I have tried to think ecologically, seeing human health as an outcome of multiple, reciprocal and continuing interactions among pathogens, hosts (both animal and human) and enveloping environment." De Bevoise thinks multi-causally and sees colonialism as but one in several interlocking systems in which epidemiological events unfolded. Ecological imbalance and the disease process are thus mapped with equal reference to early Spanish efforts to develop land and to American military offensive against Filipino resistance to American colonial rule.

Investigating the tangle of interactions and causal processes in health crisis requires scholars to approach their material with fresh eyes, using analytical tools taken from different fields. As we have seen, most scholarship on early 20th century American health and sanitation systems has tended to simplify the picture of American benevolent intentions in the institution and implementation of disease eradication programs. The work of Reynaldo Ileto and Warwick Anderson has dismantled the mythologized benevolence of American colonial medicine by carefully analyzing colonial medicine and sanitation as technologies of colonial rule. In Ileto's seminal essay "Cholera and the origins of the American Sanitary Order in the Philippines", the Filipino-American war of 1899-1902 and the fight against cholera epidemic in 1902-1904 are seen through a single optic - militarization and its technologies. Ileto's compelling argument shows how both the war against Filipinos and the drive against cholera were conducted by the same military personnel and along the same lines of order, that is, to establish the basis of colonial authority and mold disciplined, hygienic subjects malleable to American tutelage. Yet, as Ileto also describes, such well-meaning measures as the wholesale evacuation and burning of villages, forcible quarantines, reconcentration and enforced cremation were rarely greeted with passivity. Ileto teases out indigenous agency from colonial sources by interpreting the frustration experienced by the American military during the health campaign as instances of Filipino resistance. Through tactics of evasion and concealment, Filipinos defied colonial efforts to standardize definitions of sickness and approaches to death and dying, by continuing to turn to traditional healers, and continuing to practice in secrecy burial rituals and thus reassert local concepts of bodily order. In this way, Ileto challenges the common representation of American medical sanitary measures as medical heroism and progress, and popular resistance as superstition and backwardness, by foregrounding war and underlining American sanitary measures as continuing acts of war and military violence.

Focusing on the same period, the American medical historian Warwick Anderson analyses a variety of health campaigns and sanitary measures for instituting public health and disease control as different mechanisms of colonial rule. Anderson's scholarship is broad ranging and sophisticated, encompassing subjects that include vaccination, tropical medicine the colonial laboratory, hygiene and the construction of white, male subjectivity. His recently published book Colonial Pathologies: American Tropical Medicine, Race, and Hygiene in thePhilippines examines American hygiene reform and tropical medicine as mechanisms intrinsic to the "civilizing process". Throughout his work on Philippine medical history, Anderson draws from a wealth of sources from U.S. government reports to the correspondence of U.S. soldiers, to chart the colonial development and deferral of what he calls Filipino "biomedical citizenship", or the colonial business of training Filipinos to behave hygienically thereby producing 'germ-free' Filipinos. As he writes:

This means tracking the development of civic bacteriology - following medical bureaucrats as they quickly move from mapping biological difference onto a "tropical" territory to mapping human difference and civilizational potential in the new American possessions. Microbiology rapidly became civic destiny, organized into a typology that positioned immature native germ-carriers (and distributors) against responsible, clean yet especially vulnerable whites.

Conclusion

Philippine medical historiography, to sum up, is developing in exciting directions - in demography, in medical biography, in biomedical history, and in the study of colonialism. Interest in disease prevalence, epidemic and endemic diseases from diverse perspectives is steadily growing; along with those works I have already mentioned, I would add the excellent essays on water and sanitation, and cholera published by the French historian Xavier Huetz de Lemps and the work on smallpox vaccination currently being undertaken by the American researcher Tom Colvin. Gaps in scholarship abound. It is surprising for instance that so little work has been done on venereal disease whose focus is on treatments and the body, rather than prostitution, as well as historical studies on malaria. The most interesting to see however, is research that focuses on historicizing indigenous medicine, local concepts of sickness, healing and the body, and medical pluralism in the Philippine context. The absence of indigenous written records has compelled historians to contemporary accounts of folk medicine and medical knowledge, sorcery and witchcraft, and traditional concepts of health and illness such as usug, kulamand pasmaThis is an especially challenging area of research for historians of Philippine medicine but one that is also incredibly promising.

Reference from pages 17-31, "First International Conference History of Medicine in the Philippines" Edited by Rev. Fr. Angel A. Aparicio, O.P. , 2008

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Studying the History of Medicine in the Philippines: A Survey of the Field (Part 2)

Histories of Medical Specializations

While some strides have been made in the area of general histories, research on medical specializations has been neglected with offerings currently on the paltry side. To my knowledge, only the following areas have so far received investigation - ophthalmology, mental illness, midwifery, and obstetrics and gynecology. I shall now deal with these in turn. The avid interest in ophthalmology stems of course, from the abiding interest of scholars in the Philippines' foremost national hero, Jose Rizal, the country's most famous ophthalmologist. Novelist, patriot, and polyglot, Rizal was keenly interested in medicine and science as disciplines that, in his view, crucially offered the key to progress, modernity, and most instructively, a vocabulary through which nationalist longing could be articulated. He eventually specialized in ophthalmology, training in clinics in Paris and Heidelberg from 1885 to 1886.

Inevitably, this association with the First Filipino (as Rizal has come to be regarded) has privileged ophthalmology, with scholars from a variety of disciplinary backgrounds -- within the humanities as well as the sciences - confining their investigations to the myriad ways in which medicine exerted an influence in Rizal's life and developing nationalism. This has been to the detriment of research on other medical and scientific specializations. An issue of the Philippine Journal of History published in 1961, to commemorate the 100 year anniversary of Rizal's birth, drew together a collection of essays focused exclusively on ophthalmology in relation to aspects of Rizal's life from his training in Europe, the treatments he applied on his patients at the clinic he briefly established at his parents' provincial home in Laguna, and how the restoration of sight to the blind informed his patriotism.

Nevertheless, it is important to mention how studies on the medical aspects of Rizal's life have done much to promote research into 19th Century medical education, tentative explorations into the lives of other 19th century elite medicos, and cultivate an interest in the writing of biographies of other pioneering Filipino physicians who began to emerge in the early 20th century. There is a growing body of work on the training of Filipino physicians in the Philippines prior to the 20th century with scholars examining institutional structures, personnel, specifically medical teachers and mentors, medical curricula, classroom teaching and laboratory work. We wait for example, Fidel Villaroel's forthcoming monograph on the history of the Universidad de Santo Tomas and the establishment of the Faculty of Medicine and Surgery. The physician and historian Luciano Santiago has recently offered two essays that give invaluable basic details on the careers of the first Filipino graduates in medicine, pharmacy, and law from the Universidad de Santo Tomas and those who later went to Europe to continue their training, taking up internships at clinics and hospitals during the late 19th century. Important biographies have been written on the careers of the first women doctors such as Honoria Acosta-Sison and Paz Mendoza Guazon, and doubtless there will be more. The physicians Willie and Anna Liza Ong have recently contributed to the documentation by interviewing a number of distinguished late 20th century physicians, some of whom have since died.

If biographies are promising to be an area of growth, the topic of mental illness in Philippine history continues to be ignored. The publication of Foucault's renowned work Birth of a Clinic, brought about extensive scholarly interest in Europe and the United States on the history of mental illness, insanity and mental asylums in the west. In contrast, literature on the histories of health care in Southeast Asia has generally neglected this topic with scholars tending to focus on tropical medicine, malaria in particular, nursing and health care in rural areas. The neglect of Spanish colonial records on insanity in the Philippines is difficult to explain as the subject poses an intriguing conundrum. Insanity seems not to have been considered by pre-20th century Filipinos as ill health and therefore treatable. Insanity, like leprosy, as the American demographic historian Ken de Bevoise has speculated, may have been thought of as a non- disabling condition of 'non-health', rather than ill health, and a condition that was either inherited or innate. Sufferers were therefore permitted to live amongst a well community unmolested but also untreated. What the Spanish colonial physicians and health policy-makers made of this would be an interesting area of study and there are glimmers in this direction. An unpublished masteral dissertation by a Filipino student at the University of the Philippines on mental illness in late 19th century Philippines marked a promising flicker of interest in the topic. Mainly bibliographic rather than analytical, the dissertation brought to light available sources on mental illness in that period which could be found in the Philippine National Archives.

Research on the subject of midwifery and the birth of obstetrics and gynecology has fared better. Medical anthropologists in general have long taken interest in birth practices, customs and beliefs found within an astonishingly diverse range of societies and cultures. Historians, however, are only just beginning to make inroads in the historical study of midwifery, and the development of modern obstetrics and gynecology, Philippine sources on midwifery, indigenous practices and customs on child birth, the care of parturient and post-partum women are abundant and richly detailed. Description can be found in 16th century Spanish missionary chronicles, the Jesuit Chirino's Relacion, is but one example, later travel accounts by European visitors carry insightful observations and vivid anecdotes such as those recorded by the French 19th century administrator Jean Mallat; treatments and remedies for women experiencing difficult childbirth and in a post-partum condition, are also detailed in popular books on medicine that were written in the vernaculars and proliferated from the late 18th century until the beginning of 20th century, childbirth customs were detailed in studies on the superstitious beliefs of Filipinos by Orientalist scholars writing in the 19th century including the Bohemian historian and friend of Rizal, Ferdinand Blumentritt, and the Spanish journalist turned historian, Wenceslao Retana, in his study Supersticiones de los Indios Filipinos: un libro de aniterias published in 1894.

Sources on midwifery and licensed midwives, the matronas titulares, the opening of the Escuela de Matronas in 1875, and the introduction of gynecology in medical courses offered at the Faculty of Medicine at the Universidad de Santo Tomas (UST), are equally abundant and can be found in a number of folletos at the archives of UST and the National Archives in Madrid. Cynthia Luz Rivera has commented on the collection of papers at the UST concerned with the enrollment, training of midwives and their course of study in a recently published article. Megan Thomas, an American political historian, recently delivered a conference paper, as yet unpublished, on 19th century midwifery using the UST papers; and Maria Luisa Camagay, again drawing on manuscripts from the UST and the Philippine National Archives has published two important essays on indigenous and 'unlicensed midwives- hilot, partera, comadrona, and the matronas titulares which has broadly contributed to scholarship on the history of women, and more specifically working women in the 19th century Manila.

to be continued...

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Studying the History of Medicine in the Philippines: A Survey of the Field (Part 1)

Photo from pre-colonial filipiknow

By Raquel Reyes, Ph. D.

The study of the history in the Philippines has undergone changes since the publication of the path breaking work, "A Short History of Medicine in the Philippines during the Spanish Regime, 1565-1898”, by the physician Jose Bantug in 1953. Filipino, Anglo-American, as well as European historians interested in the history of medicine from an array of perspectives--(social, demographic, cultural, political, colonial and post-colonial-) drawing on diverse inter-disciplinary approaches, have offered new studies on a range of issues. These include hygiene and colonial regimes, war and epidemic diseases, vaccination, and medicine in relation to science and racial theories. This paper provides an overview of past and recent scholarship, and assesses the new and emerging research trajectories with an eye to forecasting future developments in the study of medicine in the Philippines.

From Darkness to Dawn

In late September 1935, Jose Bantug, a medical physician by training, travelled to Madrid along with a few other Philippine delegates, to participate in the 10th International Congress of the History of Medicine. The papers he delivered at that Conference would eventually appear in published form almost two decades later, in a pioneering study on Spanish colonial medicine in the Philippines, entitled “A Short History of Medicine in the Philippines during the Spanish Regime, 1565-1898”. Bantug's work identified and outlined three epochs or periods that, in his view, best presented the story of the history of medicine in the Philippines. He called these periods 'the mythical', 'the superstitious', and 'the empiric'. Despite the absence of citations, Bantug's work evidently drew on a diverse range of sources, written in Spanish, Tagalog, and English, that included mid-16th century Spanish missionary chronicles; botanical compendia that appeared from the late 17th to the end of the 18th century compiled mainly by Spanish priests, most, but not all of whom were members of the friar orders, interested in pharmacology and the classification of medical plants; 19th century popular books on remedies and treatments or 'recipe books'; accounts by Spanish and German historians interested in indigenous 'superstitious' beliefs and practices; works by European-trained Filipino ethnographic accounts, as well as, and interestingly, material artefacts such as amulets. Bantug's study provides a rich sampling: he gives attention to pre-colonial indigenous cosmology, beliefs and rituals, the knowledge and work of an assortment of indigenous community healers, herbalists and shamans--curanderos, arbularyos, manghihilots, and katalonan; there is a broad discussion of the Spanish colonial health care system particularly in relation to vaccination, the cholera and smallpox epidemics that periodically swept through the archipelago during the 19th century and early 20th century, but also in the treatment of beri-beri; and a short chapter devoted to early hospitals and charitable institutions that cared for the indigent sick.

Indigenous healers and their contribution to an understanding of local practices and differing conceptions of medicine in history found some sympathy with the author; he sought to find the rational and scientific foundations that seemed to underpin those practices and ideas, though the attempt did not strictly conform to his three period conception of medical history. Generally, Bantug orders the history of Philippine medicine within an evolutionary developmental path that moves from primitive medical thought and the darkness of superstitious beliefs to the light reason and the triumph of biomedical science as distinguished by the empiric period.

Since the publication of Bantug's work, Philippine scholars have tended to concentrate on the history of public health care systems in the country during the American colonial rule and beyond. This focus may perhaps be because later generations of scholars, unlike Bantug's generation, do not have an adequate of knowledge of Spanish. Secondly, American period sources can be found in well- kept U.S. archives, in greater abundance--in manuscript form, journals and correspondence and in records that are more consistent. However, Bantug's evolutionary model has proved resilient, remaining the overarching conceptualization of Philippine medical history that has predominated in the few later studies undertaken by Philippines scholars such as Teodora Tiglao and W.L. Cruz, “Seven Decades of Public Health in the Philippines”, 1898-1972, Enrico Azicate, "Medicine in the Philippines: A historical perspective".

More recent attempts to write a general history of medicine in the Philippines have utilized a text book format. In History of Philippine Medicine, a study published in 2002, Conrado Dayrit, Perla Santos-Ocampo, and Eduardo dela Cruz, all eminent Filipino physicians, respectively, in the fields of cardiology, pediatrics and pharmacy, sketch a century of public health care in the Philippines from 1899 and the end of the Philippine-American war, until 1999. The authors try to understand shifts in medical thinking during that period by examining certain benchmark years and highlighting significant policies and initiatives in medical education in relation to changing colonial and political regimes. Relying on boxed insets and appendices to provide further detail. The authors moved swiftly through the American colonial period taking in the establishment of the College of Medicine, the American Insular Board of Health and government laboratories along the way, the brief period of Japanese occupation and the commandeering of hospital resources, to the late 20th century and the achievements of today's Department of Health, the strongest section of the book.

For the most part, the history of medicine is treated by Dayrit, Santos-Ocampo, and Dela Cruz as a series of episodic moments or milestones in medicine and health care. The American public health system and Filipino doctors integrated into Anglo-American health care in the Philippines is unquestioningly seen in terms of breakthroughs, reform, and improvement. Dayrit in particular makes his politics plain and emphasizes, often wearyingly so, the blessings brought by American health care in the fight against the darkness of the archipelago--characterized by filth, disease and unsanitary conditions, and a people of dirty habits, lacking in discipline, ignorant and stubborn:

"If America had not come to colonize the Philippines and force on our resisting people the vaccines, hygienic habits and sanitation programs... it is difficult to imagine what the Philippines could have become, considering its horrible state of public health and education in 1898."

American colonialism and the arrival of American health care, in other words, brought medical salvation. Anything prior to the arrival of the Americans were considered as unenlightened. Consequently, medicine prior to the 20th century is given scanty treatment and neglectful of existing pertinent secondary literature (though this is generally the case for the American and post-colonial periods as well).

This is an unwieldy book filled with charts, graphs, tables and divided off sections that cover an enormous range of topics. Some are medicinal plants used in traditional medicine for example. However, through copious lists of names and successive deans, administrative heads of various health boards and hospitals, the appendices at the end of the book are made to do a lot of the work--summarizing time periods, the work of pioneering individuals and institutions mainly in the late 20th century and it is really here, rather than earlier periods, that the authors are on a stronger footing.

For Dayrit, lead author of the book, the Philippines remains in a pre-modern state, unable to care for her population nor compete or contribute to science and scientific advancement. "We are still in the age of pestilence", he writes. Yet, paradoxically, Dayrit considers the contemporary interest in and search for alternative remedies and treatments as the next episode in the story of Philippine medicine; "Biotechnology" he states, is the technology of the future". Author of several highly acclaimed articles on the therapeutic properties of virgin coconut oil, Dayrit has veered towards the current interest in the efficacy of so-called traditional or ancient indigenous alternative remedies, especially those derived from Philippines plants and local healing practices, as akin to an indigenous medico-cultural resurgence, indeed, a way in which Philippine medicine in specifically local forms can undermine the hegemony of western medicine and the domination of foreign drug companies.

to be continued...

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Anargyroi Graduating Scholar: Cloie Anne Rabinetas

When I graduated in college, there was no way I could guarantee someone that I knew what to do after. Being a doctor has always been the goal. But in times I least expected, certain situations made it more difficult for me to achieve that goal. Being a scholar in the Faculty of Medicine and Surgery is undoubtedly one of the most gratifying moments in my life and the beginning of a long winding road to MD.

Looking back in my first year in Medicine, I was still the naive medical student who was still unaware of the gravity of what lies ahead. I entered medical school with the same heart and determination as a kid who wants to become a doctor. The first year in Medicine is never easy. A typical day involved sitting for long hours, listening to lectures, and juggling the time to study for the next quizzes. Going home also meant having more time to review. My first year was entirely different from what I was used to, so I had to adjust to the new academic demands, the new people, and even to the new environment. Slowly, I started to fully realize the responsibilities, the heartbreaks, and the long years of study that I have yet to do. Despite of all these, being a scholar during my first year serves as a constant reminder that despite being in an uncharted territory, there are people who were willing to lend a hand and support me. Just the thought of that helps me get through the days and inspires me to be better always.

Now, I am in my last year in Medicine. Things have not been getting easier since then. Every day is a struggle, but each day is also an accomplishment. It does not feel like it was a long time since I started as a medical student. Though I still feel like that wide-eyed medical student I was before. There are still many things I do not know and many more things to experience. However, what has come along those years in medical school is maturity and responsibility. Besides, being a doctor is indeed a lifelong commitment to learning and service.

There are only a few months left before we graduate. It may be nice to wear a white coat soon because we can finally see that our sacrifices, hard work, and sleepless nights are starting to pay off. But in the patients' eyes, that very same white coat is a symbol of healing and relief. That is one of the things I learned during my stay in medical school. There may still be a lot to be done and understood, but I trust that all of our efforts, sweat, and tears will eventually be worth everything once we get our turn to save lives ourselves.

Whenever I look back, my four years in Medicine were not easy. However, thinking about all those years I have dedicated to study makes me feel accomplished and grateful at the same time. There may have been a number of ups and downs along the way of becoming a doctor, but being here right where I want to be, in a medical school that has been entirely supportive and generous during the last years, makes the whole road to MD a lot easier to endure and love.

Cloie Anne Rabinetas is one of the first Anargyroi FMS Foundation, Inc. Regent's Scholars.