case 1a: LALLY Aliw Libre, a 22 year old commercial sex worker comes for regular check- ups.

She has two to three clients daily. She does not smoke but she admits to occasionally using intravenous drugs. As much as possible, she has her customers use a condom although if one is not available, she proceeds without one. She is an elementary school undergraduate and support her unemployed mother and younger siblings in the province. case 2a: JASTINE Nina Inocente, a 19 year old female with Downs syndrome was brought by her parents for bilateral tubal ligation. Nina has the mindset equivalent to that of a 7 year old. Her parents fear that she may be the target of abuse as she is a trusting soul. By undergoing BTL, they can rest they fears on her becoming impregnated. case 3a: JULIUS Ashley is a brain-damaged girl whose parents that as she got bigger, it would be much harder to care for her; so they set out to keep her small. Through high-dose estrogen treatment over the past two years, her growth plates were closed and her prospective height reduced by 13 inches, to 45,Ashleys smaller and lighter size, her parents write on their blog makes it more possible to include her in the typical family life and activities that provide her with needed comfort, closeness, security , and love; meal time , car trips, touch, snuggles, etc. They stress that the treatments goal was to improve our daughters quality of life and not to convenience her caregivers. But the treatment went further: doctors removed her uterus to prevent potential discomfort from menstrual cramps or pregnancy in the event of rape; and also her breast tissue, because of a family history of a cancer and fibrocystic disease. Not having breasts would also make the harness straps that hold her upright more comfortable. Ashley has no need for developed breasts since she will not breast feed, her parents argue, and their presence would only be a source of discomfort to her. Case 1b: KRISTINE GRANDE A resurgence of bird flu is affecting Asia again with new cases coming from Indonesia. Andy Macalma, a 33 year old OFW consults you for cough. Symptoms are rapidly progressive. A Department of Health directive requires you to report all possible cases. Andy requests you not to do so as he has not been home in six years to see his family. You tell Andy that you are bound by law to report his case. He immediately insists on leaving and says he is to be discharged against medical advice.

Case 2b: LALLY Kit Soprena, a 24 year old male with paranoid delusions goes to his psychiatrist for consultation. He has had no history of violence yet he repeatedly says that he thinks his helper in the household is slowly poisoning him. During the last visit, he said something to the effect that he was going to get her before she gets me. Case 3b: GRETTA Loida , a 33 year old married male was diagnosed with esophageal candiasis. You suspect HIV and ask him about risk factors but he remains tight-mouthed. You worry about his wife who is your patient too. When you discussthat HIV is controllable, he agrees to testing. ELISA and confirmatory tests are positive. He discloses that he has been having sexual activity with his wife and other individuals of both genders. He discloses several who are your patients as well