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Please register to attend this US Thalidomide Survivors Online Speaker Event with Licensed Marriage and Family Therapist Daisy Polido. She will discuss Childhood Trauma and on to Human Resilience. This is a topic that came up at our previous conference. The fact that US Thalidomide Survivors spent so many years NOT KNOWING the reach of Thalidomide here, nor our connections to the drug . . . has the potential to inflict unresolved childhood trauma. A topic you don't want to miss. Register today!
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