When one thinks of a pharmacist, most people’s first thought may be of the person standing behind the pharmacy counter at a local Walgreens or CVS, or a bustling hospital located in the centers of the biggest metropolitan cities in the world. However, in rural communities—particularly in Native American reservations—the pharmacy environment looks a bit different, and the role of the pharmacist in these communities is heightened in scope.

For Native American reservations, medical services are provided by the Indian Health Service (IHS), which is an operating division within the US Department of Health and Human Services (HHS) and US Public Health Service (USPHS). IHS provides direct medical and public health services to 2.6 million American Indians and Alaska Natives in 37 states.

Beyond providing care for indigenous populations in the United States, the USPHS also provides a pathway for students to work within these federal agencies through their Junior Commissioned Officer Student Training and Extern Program (JRCOSTEP).

For the summer of 2021, I had the opportunity to work as a Junior Commissioned Corps Officer at the Crow Service Unit in Crow Agency, Montana. JRCOSTEP students within IHS are those who pursue medical education and work as “seasonal” staff at the service unit. My main duties were to assist in the prescription flow in the outpatient pharmacy by filling, dispensing, restocking, and ordering medications, as well as working in the inpatient pharmacy by restocking the emergency room, inpatient clinics, and assembling crash carts.

As I look toward the start of my first professional pharmacy year, I’ve been thinking about the kind of pharmacist that I want to be in the future and whether I want to specialize in a specific area. Working in a clinical pharmacy has helped show me the varied roles a pharmacist can have, even within 1 hospital.

During my externship, I briefly shadowed Crow’s Pharmacy Informaticist, Kelsey Kroon, PharmD, to learn how drugs were entered into the system for use by providers and verification by other pharmacists. Kroon is responsible for updating the information on what drugs could and could not be accessed on Electronic Health Record (EHR) drug menus, following Pharmaceutical and Therapeutics Committee Meetings with other departments.

When supporting Kroon in this process, I was able to verify the EHR drug menu to see that the antibacterial options were up-to-date with advised first-, second-, and third-line of therapy, and so on. Furthermore, I double checked, revised, and formatted comments in the outpatient formulary excel spreadsheet.

One of the most interesting parts about the externship was working at the satellite clinics in Lodge Grass and Pryor, both located in Montana. Although both locations were hour-long drives from where I was living and located in the most rural parts of the reservation, these clinics are vital to the locals who cannot afford to make the lengthy trip to the Crow Service Unit. Without these satellite clinics, it would be difficult to ensure medication adherence and to monitor the effects and implementation of certain treatments. In emergencies, these clinics can immediately provide the stabilizing care that a patient may need until it is possible to transfer them to a larger service unit.

As part of pharmacy staff, I was able to engage in meaningful discussions with many of the pharmacists, physicians, nurses, dentists, and administration at the Crow Service Unit. Many of the health care workers at IHS are commissioned officers, which was extremely helpful in learning about what the process of working as an officer was like, why they decided to join, and what their experiences were like at other facilities. Dean Goroski, director of pharmacy at Crow Service Unit, has been with the USPHS as a commissioned officer for many years. This wealth of wisdom helped me develop a clearer picture of the types of careers available to pharmacists when working for the federal government.

The relationship between the federal government and Indian tribes was established in 1787, based on Article I, Section 8 of the Constitution of the United States.

 As the primary federal health care provider for natives, IHS continues to work to raise their health status to the highest level.

The IHS focuses on specific areas, such as encouraging natives to get the COVID-19 vaccine to help decrease overall deaths from COVID-19, as well as helping with the management of diet, nutrition, and exercise to reduce rates of obesity, heart disease, and diabetes on the reservation. The IHS also delivers sex education courses to support a reduction in teenage pregnancies and the spread of sexually transmitted diseases.

The focus on education and support can be seen throughout the clinic on posters and desktop screensavers that display facts about the importance of receiving vaccinations and getting tested for COVID-19, in addition to information on diet and safe food storage.

These educational efforts seem particularly effective as 71% of the IHS employees are Native Americans.

 Amber Walks Over Ice, PharmD, deputy chief pharmacist of the outpatient pharmacy at the Crow Service Unit, is originally from the native community in Flathead County, Montana. Most of the pharmacy technicians are native Crows, but some, like Jennifer Lawton, CPhT, are Navajo. As the vaccination rates slowly increase within the Crow reservation, the efforts of the IHS team at the Crow Service Unit become more visible.

Every summer, Crow Agency hosts Native Days, a series of events and festivities where members of the tribe can exhibit their physical and mental skills through competition. The main events include the rodeo, relays, arrow tournaments, and the Ultimate Warrior races, which involve a mile-long canoe race, a 6-mile foot race, and a 6-mile horse relay. There are also prayers, parades, and a powwow.

During my time at the Crow Service Unit, I was fortunate enough to watch the women’s Ultimate Warrior race alongside one of the native pharmacy technicians, Randa Black Eagle, CPhT. As part of the crowd, I could see how Native Days brought everyone together.

The time I’ve spent in Montana as a JRCOSTEP student has been invaluable. Beyond gaining experience in a clinical pharmacy, I have been able to interact with the Crow tribe—whose autonym is Apsáalooke, or Absaroka—both personally and professionally, which is something not many Americans have done. Since the Native American reservations are sovereign states and do not often house outsiders beyond IHS staff, most people have no concept of what it means to be Native American in the 21st century.

Natives’ most frequent media representation features a bow and arrow and a feather, and they’re often depicted as wild or savage—even today, in some Scholastic textbooks. However, the Native American population is not something of the past, and they are not relics of a time long forgotten. They are alive and have survived years of genocide. Today, they are continuing to revive their culture and heritage through language, Native Days, social events, like Crow Fair, and the employment of natives within IHS.

It may sound counterintuitive, but what makes a pharmacist great at their job is not just their understanding of pharmaceuticals, but their ability to show empathy for a patient. For this reason, my time at the Crow Service Unit taught me that truly great pharmacists strive to understand their patients’ way of life, their struggles, and their victories.

The road to becoming the greatest health care provider I can be is not just through school, but through genuine interactions with the humans I serve as well. This is why serving as a JRCOSTEP student at the Crow Service Unit remains instrumental in my understanding of who I want to be in my role as a pharmacist in any community I may work in, in the future.

Had it not been for my participation in the JRCOSTEP program, I would never have encountered the strength and resilience of the Crow tribe. The time I have spent with the USPHS will stick with me for the rest of my career. Despite working in the Crow Service Unit for only 3 months, the time I spent there made me excited for the rest of my journey as a student. One day, as a licensed pharmacist, I will have the opportunity to help make my community healthier, which is a goal I know I can be proud of.

Indian Health Service. July 20, 2021. Accessed August 17, 2021. https://www.ihs.gov/aboutihs/

Indian Health Service Fact Sheets. US Department of Health and Human Services-Indian Health Service. March 6, 2008. Accessed August 17, 2021. https://web.archive.org/web/20080423193111/http://info.ihs.gov/Profile08.as

Articles

Learning the Value of Community With the Indian Health Service

In this finals week special episode, Jessica Louie, host of The Burnout Doctor Podcast, discussed burnout among pharmacy students and how to have a long-term perspective on mental health.

Podcasts

Jessica Louie, host of The Burnout Doctor Podcast, discussed burnout among pharmacy students and how to have a long-term perspective on mental health. 

Pharmacy Focus: Student Edition - Episode 2

My favorite part about pharmacy school has been getting involved in professional pharmacy associations; attending events, holding leadership positions, and learning more about what the pharmacy associations have to offer has been the highlight of my 4 years and will continue to be long into my career as a pharmacist.

During orientation week in my first professional (P1) year, more than 20 organizations with chapters at Mercer University stood in front of us reciting their various acronyms and premises, and the decision about which organizations to join felt overwhelming. Since then, I’ve learned that each association provides unique reasons for students to join, most of which should overlap or coincide with students’ own niche interests. Most students join 1 or 2 organizations, but I chose to join every association that correlated with my future career goals.

I chose the National Community Pharmacists Association (NCPA) because my background in pharmacy had only been in community pharmacy, and I knew this was an eventual practice area where I hoped to find a career. I also joined the American Pharmacists Association-Academy of Student Pharmacists (APhA- ASP) because, as the largest pharmacy association in the country representing all practice areas, this organization serves as the voice of pharmacy to advocate for the profession, and I wanted to be a part of that voice.

Both the Georgia Pharmacy Association (GPhA) and the Tennessee Pharmacists Association (TPA) were also appealing to me because, while going to school
in Georgia and being from Tennessee, these are the 2 most likely states for me to practice in, and I wanted to be aware of what is happening in the profession in those states. Additionally, I joined the American College of Veterinary Pharmacy (ACVP) and the Alliance for Pharmacy Compounding (APC) due to my interest in both of these areas.

Attending conferences was the kick-start to my involvement in pharmacy associations. I made it my goal to attend as many as possible, which resulted in going to 11 conferences in my first year of pharmacy school while balancing time constraints and other responsibilities. Not only is each conference an opportunity to travel to interesting locations across the country, but it is also a chance to network with fellow attendees, find inspiration from the sessions’ content, and meet influential leaders in the profession.

The biggest concern I hear from fellow student pharmacists who are hesitant to attend conferences is the cost, which I believe is far outweighed by the benefits of attending. Budgeting for these types of events and making them a priority to attend will only result in positives as students will undoubtedly meet future colleagues, contacts/resources, or employers at these events.

Almost every association holds opportunities for student leadership, many of which I have sought out to learn more about and how to build essential leadership skills. I ran for an elected position at a regional level just 2 months into my P1 year, which included giving a speech in front of 500 people and campaigning for myself throughout the weekend, resulting in a win for the position of the APhA-ASP Region 3 Midyear Regional Meeting Coordinator for 2018-2019. This was followed by a whirlwind of other leadership opportunities, not only within APhA-ASP, but in other organizations as well. After this success, I felt ready to run and apply for other positions to follow the achievement of my first.

During my time in student leadership, my most notable positions included president for my APhA-ASP chapter at Mercer University, a member of the APhA-ASP National Standing Committee on Communications, secretary for Mercer University’s NCPA chapter, student board member for ACVP, and creator and president of the GPhA Student Leadership Board. Each position requires additional time—and often travel—but provides an opportunity to make connections and build leadership skills that will be valuable no matter the practice setting I choose. With the limited exposure to high level leadership positions I experienced before pharmacy school, I have done a lot of learning on the job, pushing myself to achieve, and sometimes surprising myself with success.

Leadership and involvement in associations can open doors and I often use these examples to encourage other student pharmacists to take advantage of these opportunities as well. I was offered a pharmacy intern job at Innovation Compounding, an independent pharmacy outside of Atlanta, Georgia, after meeting the owner while attending an APC Compounders on Capitol Hill conference. Additionally, a connection I made with the CEO of Pharmacy Quality Alliance (PQA) turned into a rotation at the organization, and a recommendation from an employee who held a similar leadership role at the National Alliance of State Pharmacy Associations (NASPA) became a year-long internship.

In addition to job opportunities, involvement and leadership can also lead to scholarships, which is always an advantage when you’re living on a student budget. Almost every organization offers student scholarships, and the required qualifications often include involvement or leadership.

Lastly, I have grown in my knowledge about future career paths that I didn’t even know existed. The value of associations in the profession of pharmacy is unparalleled, each acting as a collective voice stronger than individuals in a particular specialty practice area. More specifically, the organizations I am involved in focus on legislative advocacy, making efforts to create positive change in legislation that will propel our profession forward and break down barriers to practices that currently exist.

Student pharmacists often hear the phrase “pharmacy is a small world.” The chance to network with fellow association members can develop into jobs, internships, rotations, and connections for the future that will be valuable for the remainder of a student’s career. Associations also allow members to stay up-to-date on the profession, providing learning opportunities—like continued education and webinars—to draw from fellow members who are a great source of knowledge and advice. Perhaps most importantly, associations provide inspiration to achieve and to lead through innovation in the profession.

Notable pharmacists are always leaders in associations, and in order to join the ranks of these individuals, it’s necessary to first seek a seat at the table as well. Associations allow me to be the best future pharmacist I can be, and my drive to accomplish more for patient care and the profession can only be assisted by my membership and leadership in these organizations.

 is a 2022 PharmD candidate at Mercer University, a NASPA intern, an ACVP student board member, the GPhA Student Leadership Board executive director, and a Walgreens pharmacy intern.

The Importance of Getting Involved in Professional Pharmacy Associations During Pharmacy School

Today's special episode marks the first part of our new series, Study Break! This show is designed to focus on the latest news and trends from pharmacy schools across the country.


In this episode, Brooke Griffin, PharmD, founder of 21st Century PharmD, discussed how students have handled the pandemic, as well as how they can pursue leadership positions both during and after pharmacy school.

Pharmacy Focus Podcast: New Series - Study Break

Several third-year pharmacy students at the Washington State University College of Pharmacy and Pharmaceutical Sciences said they were involved with COVID-19 testing and vaccination efforts, including organizing mass vaccination events and testing patients in their communities.

For example, although he lives further away from the main campus in Spokane, Trevor Schultz said he has gotten involved through his internship position. Schultz said he has worked with his mentor to launch vaccination efforts in his community and added that he volunteered over winter break to get the first clinic up and running.

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Pharmacy Students Were Crucial to COVID-19 Testing, Vaccination Efforts

Although the COVID-19 pandemic has had a massive impact on their experiences in pharmacy school, students at the Washington State University College of Pharmacy and Pharmaceutical Sciences said the pandemic has also opened their eyes to the important roles pharmacists play in health systems, communities, and throughout the country.

Third-year student Shayne Fontes said that in addition to reminding him of the importance of pharmacists, the COVID-19 pandemic made the public more aware of the services pharmacists provide. Not only are pharmacists drug experts, Fontes said, but they can also perform COVID-19 testing and vaccinations alongside physicians and other health care providers.

Shannon Patterson, another third-year student, said the pandemic completely changed her outlook on the pharmacy profession. Prior to the pandemic, Patterson said she was feeling burned out and a little defeated, but the pandemic showed her firsthand how people can engage with and learn from their pharmacists.

Not only are pharmacists drug experts, but the pandemic demonstrated that they can also perform COVID-19 testing and vaccinations alongside physicians and other health care providers.

Pharmacy Students Say COVID-19 Pandemic Has Opened Their Eyes to the Value of Pharmacists

The COVID-19 pandemic has had a massive impact on pharmacy students’ educations, according to a group of third-year students from the Washington State University College of Pharmacy and Pharmaceutical Sciences, in a 

The students’ coursework went entirely online during the pandemic, according to Shannon Patterson. She noted that she learns best in a hands-on environment, so shifting to online has been a challenge. Staying focused and participating in online classes can also be more difficult than participating in an in-person discussion, and Patterson said it is easier to get distracted.

Shayne Fontes echoed Patterson’s challenges with the pandemic, although he added that the online learning has made him a more independent student. Similar to Patterson, third-year student Misty Lefler said moving the simulations online has presented challenges, since students would normally learn how to handle syringes and perform basic tasks in a lab environment.

“That’s probably been a little more difficult, but I think the faculty have really come together to make this an easy transition for all of us,” Lefler said.

The COVID-19 pandemic has had a massive impact on pharmacy students’ educations, according to a group of third-year students from the Washington State University College of Pharmacy and Pharmaceutical Sciences.

Pharmacy Students Discuss Challenges of Online Learning During COVID-19 Pandemic

Student Café series, we asked students at the Washington State University (WSU) College of Pharmacy and Pharmaceutical Sciences what drew them to study at WSU. Shannon Patterson, a third-year student, said she was drawn to the family atmosphere and close relationships within the program.

“When I first walked on campus, I engaged with many fellow students of many different years, as well as faculty, and I immediately felt a part of the family,” she said.

Trevor Schultz, a fellow third-year student, said he was drawn to the unique teaching style at the school, because professors use a flipped-model classroom in which students watch lectures and do required readings before class, leaving more time for discussion. Finally, third-year student Shayne Fontes said attending WSU has given him the chance to explore more of Washington State while still staying somewhat close to home.

In a recent Student Café series, we asked students at the Washington State University (WSU) College of Pharmacy and Pharmaceutical Sciences what drew them to study at WSU.

Students Discuss What Drew Them to Pharmacy School

Vaccinating more than 328 million Americans against coronavirus disease 2019 (COVID-19) will take many health care professionals. To accelerate the national vaccination campaign, Husson University (HU) in Bangor, Maine, has announced that it will provide training to any pharmacist, pharmacy technician, or pharmacy intern, regardless of whether they are enrolled at HU.

Pharmacists, pharmacy technicians, and interns are authorized to administer COVID-19 vaccines to the public under the Public Readiness and Emergency Preparedness (PREP) Act. HU is offering 2 nationally approved educational options to support these professionals in their vaccination efforts.

The first option is a 6-hour course designed for pharmacy technicians that teaches them how to administer the vaccine and respond appropriately to different emergencies that may arise in the pharmacy setting.

The second option is a 20-hour course available to licensed pharmacists and interns. This course also educates its participants on how to administer the vaccines and respond to potential emergencies. Additionally, it includes information on the use of the different vaccines available, as well as their indications and contraindications.

"Husson University has traditionally worked with our clinical partners to provide flu shots in past years," said Kelsie Snow, PharmD, an assistant professor at Husson University's School of Pharmacy, in a prepared statement. "This year, we are working in much the same way to provide the COVID-19 vaccinations to as many people as we can."

Each course of study has an asynchronous self-study component that should be completed before attending the in-person component. An evaluation of the ability to vaccinate is later completed by Snow, who is licensed and authorized by the American Pharmacists Association (APhA) to ensure adherence.

HU is offering the courses twice a month, although the university noted that it is willing to provide additional classes at a convenient time and location based on the needs of local pharmacies and hospitals.

"We are also looking into holding these courses in different locations around the state to minimize [the] need. to travel. Maine is an awfully large state, and we want to do all that we can to facilitate the response to the public health crisis," Snow said.

Additionally, the dean of the College of Health and Pharmacy at HU, Rhonda Waskiewicz, EdD, OT, explained in an interview with 

 that pharmacies provide critical access to health care for communities in Maine's rural central and northern regions.

"More than half of the 16 counties have a population density between 4 and 75 [individuals] per square mile. For many residents, pharmacies are the closest health care option, and [they] still may be a 45-minute drive. Additionally, Maine does not require pharmacy technicians to be certified, although many are, so being able to complete an [Accreditation Council for Pharmacy Education]-approved certification course for vaccination is critical," Waskiewicz said.

For these reasons, HU School of Pharmacy chose to focus on training pharmacy technicians while also offering classes to licensed pharmacists and interns who have not been certified or who need recertification to administer vaccinations.

"We are currently holding classes on campus and are working with our regional partners to determine if and when we travel to more rural sites to provide training," Wakiewicz said.

The ability for pharmacists and pharmacy technicians to administer vaccines was made possible by Congress in 2020 with the passage of the PREP Act. Before the PREP Act, pharmacy technicians were not authorized to administer vaccines to the public. Today, pharmacy technicians can receive the training necessary to provide this critical health care service during the COVID-19 pandemic.

Additionally, recent legislation has expanded the types of vaccines that pharmacy personnel can administer and order. Now pharmacy personnel can give routine immunizations to children, which previously was done only at pediatrician offices.

"Husson University has provided pharmacy students with training in providing immunizations for years. Now we're expanding the training to get students involved earlier," Waskiewicz said. "Being educated as a health care professional in such a turbulent, unprecedented time is both challenging and rewarding. This process to take a more active role in patient care. One of the major challenges posed by the restrictions of COVID-19 is restricted access to care, and this is one of the ways Husson is working to eliminate those barriers."

, Snow explained that HU will remain dedicated to providing these training options for as long as necessary and that faculty are willing to travel to participants to ensure they have access to the course.

"In addition to providing the accredited APhA programs for vaccination certification, we also work to put together educational materials that are more focused, if desired," Snow said. "For instance, my colleagues Drs Brian McCullough and James Singletary are [holding] an educational talk specifically concerning the COVID-19 vaccinations via Zoom."

Although there is the possibility of attending a portion of the courses virtually, there remains a required in-person, hands-on component that must be demonstrated in order to become certified.

"This typically entails having a pharmacist [who] is already certified to observe and evaluate the injection technique of the participant," Snow said. "APhA has issued specific guidance and instructions that must be followed for remote participants."

Waskiewicz noted that HU School of Pharmacy's dedication to train and educate a COVID-19 vaccination army is mission driven.

"Husson University School of Pharmacy's mission is to educate and mentor future practitioners in a collaborative and supportive environment to deliver and improve regional health care," Waskiewicz said. "In this care, it translates to our faculty and administration collaborating with university, community, and regional colleagues to shape the profession's ability to respond to COVID-19 through education and preparedness."

For more information on enrollment and the necessary course components, contact Kelsie Snow at 

To accelerate the national COVID-19 vaccination campaign, Husson University in Bangor, Maine, has announced that it will provide training to any pharmacist, technicians, or intern.

University Offers COVID-19 Vaccination Training to All Pharmacists, Technicians

I clearly remember the day I received the email informing me of my acceptance into the pharmacy school of my dreams. The first person I called was my husband, and I cried tears of joy as I spoke to him about my acceptance. I had reached my goal. Many of my peers and coworkers said, "Getting into pharmacy school is the hardest part." However, what none of us could have known was that the next chapter of my life would be far harder.

During pharmacy school, it was incredibly difficult for me to not only wake up every morning for school, but also stay awake for at least 8 hours of lectures. Sometimes, it was even hard to stay awake for 4 hours. Despite societal preconceptions of this being a sign of my laziness, it was actually just a part of my life living with an autoimmune disease; I received a diagnosis of an autoimmune disease during my second year of pharmacy school.

Autoimmune disease occurs when the body's immune system is unable to distinguish between the body's own cells and foreign cells, causing the body to attack its own normal cells inadvertently. There are approximately 80 different types of autoimmune diseases that can affect various parts of the body.

Most autoimmune diseases are invisible, meaning the symptoms can't be easily "seen" by those around patients living with the disease. Although it can be difficult to explain any newly diagnosed disease to one's family and friends for a multitude of reasons, it can be especially difficult when that disease is not widely known or understood.

After my diagnosis and throughout my journey through pharmacy school, there were numerous times that I felt alone, lost, and misunderstood for this very reason. I was also afraid to be labeled or defined by my diagnosis if my classmates and teachers knew about it. I doubted myself and my goals. I wasn't sure how I could move forward in life, and I was worried I might need to change my dreams because of it. I questioned whether it would even be possible for me to still become a pharmacist.

Fast-foward 2 years: I have just graduated pharmacy school, and I am getting ready to take my board exam. Two years ago, I was still trying to figure out how to live with my diagnosis, which required that I determine my limits. However, in the process of figuring that out, I also learned that my disease doesn't need to define me.

Pharmacy school was hard, but I was able to overcome it. And here's why: My diagnosis gave me a greater purpose. It changed my goal—not away from pharmacy but toward it, by helping my pharmacy career become about much more than a degree. It's not about becoming the person I am meant to be: a rheumatology clinical pharmacist.

During pharmacy school, I was fueled by this clear vision of my future, and I became involved on campus by joining different organizations and running and volunteering at various health clinics. I joined a mission trip to Guatemala to pursue my calling abroad and expand my horizons. I made sure that it was my passion for my career and my desire to help others that defined me, not my diagnosis.

In the past, I felt compelled to hold back on sharing my story due to stigma and biases around preexisting health conditions. However, during my clinical rotations in school, my perception changed. I was fortunate to provide care for patients with autoimmune diseases, such as lupus and ankylosing spondylitis, and they helped me realize that it's my duty as a health care professional to make sure my patients are seen, heard, and understood. I am a patient too, and I understand that being seen and heard by health care professionals is incredibly important. I learned that I can be a voice to break bias chains.

The fear of being judged by an illness is heartbreaking. Why would we feel the need to hide an illness when it's human to be ill? For many, facing an illness and learning to manage associated symptoms can even help build resilience, which is valuable in our professional careers. For me, I am stronger because of my illness. I am where I am today because I have to overcome the challenges my illness has posed in my life.

During my journey, I have learned it's necessary to celebrate the good days, as this helps make the bad days easier. The bad days are OK too—we all have them. And when they arrive, my friends and family are there to help me find hope. They are what got me through the tough days.

My experience in pharmacy school helped me learn that it is OK to ask for help when I need it, and that it's OK to listen to my body and practice self-care and self-love. I also learned that this lesson is important for all health care professionals: Although it is critical that we listen to every patient we treat, it's also important to listen to the needs of our bodies first, as this will allow us to better care for others.

 is a 2021 PharmD candidate at Midwestern University, Chicago College of Pharmacy.

Although it is critical that we listen to every patient we treat, it's also important to listen to the needs of our bodies first, as this will allow us to better care for others. 

Student Voices