THE INTERNATIONAL HEALTH DIVISION OF THE ROCKEFELLER FOUNDATION AND THE TRAINING OF HEALTH PROFESSIONALS IN BRAZIL: THE CASE OF OLYMPIO

Our proposal, in this paper, is to discuss the role of the International Health Division (IHD) of the Rockefeller Foundation (RF) in the training of health personnel through the fellowship program of the North American philanthropic institution and, more specifically, the Foundation’s work in training professionals linked to Brazil, highlighting the case of Olympio da Fonseca. Olympio da Fonseca was an important Brazilian researcher. Among the positions held by Fonseca, we can highlight the direction of the Oswaldo Cruz Institute, between 1949 and 1953, and the organization and direction of the Brazilian Institute for Research in the Amazon (19541955). Several sources allow us to reflect on the professional trajectory of the doctor and his training from the RF fellowship, such as the record produced by the Foundation (Fellowship card) and an interview granted by Olympio da Fonseca to the Center for Research and Documentation of Contemporary History of Brazil (Centro de Pesquisa e Documentação de História Contemporânea do Brasil – CPDOC) of the Getúlio Vargas Foundation (FGV) in 1977.

Between 1917 and 1951, 88 researchers and professionals linked to Brazilian government institutions and/or departments received 92 fellowships from the International Health Division (IHD) of the Rockefeller Foundation (RF) to carry out studies in Brazil and abroad, in the areas of public health, nursing, medicine and biological sciences. Through the granting of fellowships, the American philanthropic institution aimed at training men and women to act in strategic positions in official health agencies or as directors and/or teachers in schools of hygiene, public health and nursing. Through occupying leadership positions in government institutions and/or departments in their home countries, the fellowship holders were able to determine institutional guidelines and priorities, reflecting some of the ideas and practices with which they had become familiar during the study period. In this article, we will discuss the role of the International Health Division of the RF in the training of health personnel through the fellowship program of the North American institution and, more specifically, the Foundation's work in training professionals linked to Brazil, highlighting the case of Olympio da Fonseca. 1 We are particularly interested in understanding the activities carried out by this person during his fellowship period. Olympio da Fonseca was an important Brazilian researcher. Among the positions held by Fonseca, we can highlight the direction of the Oswaldo Cruz 2 Institute between 1949 and 1953. Several sources allow us to reflect on the professional trajectory of the doctor and his training from the RF fellowship, such as the record produced by the Foundation. 3 However, we highlight the interview given in 1977 by Olympio da Fonseca and today deposited at the Museum of Astronomy and Related Sciences (MAST) and at the Center for Research and Documentation of Contemporary History of Brazil (CP-DOC) of the Getúlio Vargas Foundation (FGV), in which the doctor addresses, among other issues, the studies carried out from the fellowship provided by RF. 4

THE ROCKEFELLER FOUNDATION AND ITS FELLOWSHIP PROGRAM FOR TRAINING HEALTH PROFESSIONALS
According to John Farley (Farley, 2004, p. 2), before the foundation of the World Health Organization (WHO) in 1948, the International Health Division of the Rockefeller Foundation was probably the most important public health agency in the world. In the same vein, Anne-Emanuelle Birn (Birn, 2006, p. 15) states that, during the first half of the 20th century, no agency had as much reach or was as active in promoting international public health as the Foundation.
The Rockefeller Foundation, an American philanthropic institution, is defined, by Lina Faria, in general, as a "charity, non-governmental organization, which uses its own resources to finance social welfare activities in several countries of the world" (Faria, 2007, p. 103, note 2). Maria Gabriela Marinho states that the Foundation " [...] is at the heart of the process that generated and constituted the field of action for what was later characterized as scientific philanthropy" (Marinho, 2001, p. 14), understood as the allocation of private resources for the production of scientific knowledge (Marinho, 2001, p. 14 For Wickliffe Rose, Director of IHD between 1913 and 1923, professional education was an essential component for the advancement of public health at the international level. In Rose's conception, a select group of specialists in public health would disseminate the knowledge acquired in their respective countries through research, administration and teaching. In the interpretation of Anne-Emanuelle Birn (Birn, 2006), this approach would not only save financial resources, allowing the Foundation to implement programs in a greater number of places, but also international fellowship holders would be in a better position in relation to representatives of the Rockefeller Foundation to disseminate, in a relevant way, theories, practices and values to researchers, government agencies, professional communities and the general public. Having established links with leading universities in the United States -such as Harvard, Yale and Johns Hopkins -, the fellowship holders, upon returning to their countries of origin, would maintain a relationship with North American institutions and ideas during their professional trajectories. Still according to Birn, among the "possible" advantages of the distribution of fellowships would be the development of relationships with leaders and future leaders from other countries and the international scientific exchange (Birn, 2006, p. 197).

According to Marcos Cueto and Steven Palmer,
One presumption that came with the awards was that the fellows, once back home, would reproduce the U.S. model of medical education, public health, and scientific research (often taking as the prototype Johns Hopkins University, not only a model on which many U.S. schools refashioned themselves but also the institution where many of the Latin American RF fellows trained) (Cueto; Palmer, 2015, p. 118-119).
One result of these fellowships was, according to the researchers, the increased influence of the United States in relation to France and Germany, considered by some to be the Mecca of medical studies.
Through the granting of fellowships, RF aimed at training people to act in strategic positions in official health agencies or as directors and/or teachers in schools of hygiene, public health and nursing. Through occupying leadership positions in government institutions and departments in their home countries, the scholarship holders were able to determine institutional guidelines and priorities, reflecting some of the ideas and practices with which they had become familiar during the study period. In this sense, as Birn points out, the fellowship holders were transnational professionals, moving ideas and practices across borders. The direct or indirect influence of the fellowship holders could be felt for many decades, since, in addition to guiding work in health institutions and/or departments, they were also often teachers in their countries, thus influencing other generations of public health officials (Birn, 2006, p. 201). Through the fellowship holders, the Foundation could have a lasting effect on public health theory and practice in the different countries and regions in which it operated (Birn, 2006, p. 215).
In a June 1924 document entitled "Information concerning fellowships awarded by the International Health Board of the Rockefeller Foundation 6 ", the Foundation's New York office stated that Fellowships granted by the International Health Board are designed to meet definite needs in public health service. They are granted only to persons carefully selected for the work that needs to be done and with the understanding that the persons receiving them will, on the completion of their training, be appointed to important positions in the official health services of their own country or in schools of hygiene 7 .
The RF aimed, as we have already pointed out, the training of personnel to work, in their countries of origin, in strategic positions in official health agencies or as principals and/or teachers in schools of hygiene, public health and nursing. 8 Among the requirements to apply for a fellowship were high professional and scientific qualifications, as well as reliability and leadership qualities. The fellowships would be distributed, preferably, to applicants under the age of 35. The preliminary selection was carried out by the local representatives of the RF, in agreement with the official health authorities. Applications and required documentation were then sent to the New York office for the final decision. The documentation included personal history on a form to be provided by the Foundation, medical examination by a trusted professional, a statement of special courses in medicine, science and public health carried out by the candidate, a list of their publications on medical and scientific topics, a statement of their professional experience since their doctorate (in the original, "since receiving the doctorate"), as well as a statement of subjects that the candidate wanted to study from the fellowship. That is, the candidate should have already completed formal education. The fellowships could have varied duration, not exceeding one year. Extensions were subject to a satisfactory record and recommendations from those responsible for the appointment. The Foundation reserved the right to cancel the fellowship in the event of conduct deemed inappropriate or detrimental to the Foundation's objectives. 9

THE IHD AND THE TRAINING OF PROFESSIONALS LINKED TO BRAZIL -THE CASE OF OLYMPIO DA FONSECAA
Brazil received technical and financial support from the International Health Division of the Rockefeller Foundation in staff training. Dozens of countries counted on the cooperation of the Rockefeller Foundation, but, according to authors like Lina Faria, "Brazil was the country in the American continent in which Rockefeller invested the largest amount of capital. Out of around 13 million dollars, applied to health and education programs in countries of this continent, seven million were directed to the development of medical education, scientific research and health campaigns in Brazil" (Faria, 2007, p. 18). To exemplify, the Foundation acted, in the country, in the fight against hookworm disease (1916)(1917)(1918)(1919)(1920)(1921)(1922)(1923), malaria (1919-1928) and yellow fever (1923)(1924)(1925)(1926)(1927)(1928)(1929)(1930)(1931)(1932)(1933)(1934)(1935)(1936)(1937)(1938)(1939)(1940). 10 With regard specifically to fellowships, several authors highlight the high number of fellowships granted by the Rockefeller Foundation to Brazil in the Latin American context (Faria, 2007;Löwy, 2006;Cueto, 1994). Analysis of the information contained in a directory of RF fellows between 1917 and 1970 -The Rockefeller Foundation. Directory of Fellowships and Scholarships . Nova York: The Rockefeller Foundation, 1972 -indicates, however, that the number of fellowships awarded by IHD to Brazil was significant not only in the Latin American context, but in the general context: out of the total of 2,056 fellowships distributed by IHD to professionals from more than 80 countries between 1917 and 1951, 92 fellowships (4.4%) were awarded to professionals working in the country (Korndörfer, 2013, p. 286).
This number may appear small at first glance, which makes an observation necessary here. Out of the total of 2,056 fellowships, distributed among 1,990 fellowship holders (64 fellowship holders received two fellowships each and one received three), 622 (30.2%) were awarded to professionals working in the United States; 207 (10%), to professionals who worked in Canada and 114 (5.5%), to professionals who worked in India. Brazil, with its 92 fellowships (4.4%), occupied the fourth place in a list composed, remember, by more than 80 countries. Adding the fellowships received by professionals working in the United States, Canada, India and Brazil, we will obtain a total of 1,035 fellowships distributed to professionals working in four countries, that is, more than half of the fellowships (50.1%). Mexico, the second Latin American country in number of fellowships awarded by the International Health Division, occupied the 6th place in the overall Between 1917 and 1923, Fonseca served as assistant and deputy assistant at Oswaldo Cruz Institute. In 1919, there was a first attempt to grant a fellowship to Fonseca. In a document produced by RF, we read the following information: "F is Asst. to Dr. Carlos Chagas, Dir. of Oswaldo Cruz Inst., Rio de Janeiro, and is especially interested in physiological chem. and immunology. Is now devoting his time to medical science intimately related to p.h. [public health] work. Dr. Hackett states F. represents best that Brazil can offer both from point of view of scientific training and of intellectual capacity. Advisory Com. also recommends F. Upon returning to Brazil he would retain connection with Oswaldo Cruz Instit." 16 . As you can see, Hackett, with whom Olympio da Fonseca had previously worked, strongly supported the granting of a fellowship to the doctor, then assistant to Carlos Chagas at the OCI.
The selection of professionals who would receive the IHB fellowships took place in partnership with health professionals and Brazilian doctors. The analyzed documentation indicates the existence of a Committee composed of Brazilian doctors -Brazilian Advisory Committee on Traveling Scholarships -that also participated in the selection process for fellowship candidates. 17 A letter written by Hackett in January 1921 highlighted two aspects considered in the selection process for fellowship holders. The first aspect concerned the area of study selected by the candidate, an issue that, in Hackett's opinion, could be analyzed by the Interna-tional Health Board office in New York. In the words of the Foundation's representative in Brazil, Two questions arise with regard to every candidate, one of which the Board is competent to decide, the other it is not. The first is whether the field of study selected by the candidate is an important one to be developed at this time and whether the position which the candidate will return to Brazil to occupy is one with sufficient authority and influence to warrant the expenditure of the Board´s money in the man´s training. The Board can freely make its decision on this matter without causing the least embarrassment to anyone. 18 As you can see, it was necessary for the area of study selected by the candidate to be considered important by the Foundation, as public health was at that time, for example. In addition, the candidate was expected to occupy a position of "sufficient authority and influence" when they returned to the country to justify the Foundation's expenditure on their training. The fellowship holders, when returning to the country of origin, should occupy positions of responsibility.
Another aspect considered in the selection of fellowship holders was the candidates' personal fitness, and in this regard, Hackett stated that the opinion of Foundation employees in the country should be taken into account. There was a concern, on the part of the International Health Board, to be guided by universalist criteria in the selection of fellowship holders, thus avoiding the influence of political favoritism, as evidenced by Hackett in the following excerpt: The second question refers to the candidate´s personal fitness and in this, I submit, the Board must be guided by the opinion of those of us who are in Brazil and are thoroughly disinterested in the matter. No amount of references or estimates of the candidate´s ability by local committees composed of disinterested people can take the place of first-hand knowledge of the man gained by conversations with those who know him best. I would go so far as to say that the written documents which a candidate can assemble should be given very little weight indeed even if emanating from the highest sources, and to refuse a man on the basis of any such documents would be impossible. I myself have just had the occasion to quash the candidacy of a thoroughly worthless individual who had actually succeeded in getting not only the most exalted references but even the approval of the Advisory Committee. The man had a powerful friend whom no one cared to offend. I stopped the matter by announcing that the field of study which the candidate intended to explore was one of minor interest and that in view of the fact that there were more candidates than could possibly be accepted it would be useless to carry the matter to New York. 19 In Hackett's opinion and experience, little value should be attached to the letters of recommendation obtained by candidates in the selection process. Prior authorization from the IHB office in New York was necessary for Hackett to award fellowships. 20 Returning to the Olympio da Fonseca's record notes, we observed that the doctor was considered by Lewis Hackett "the best that Brazil could offer in terms of scientific training and intellectual capacity". Fonseca was dedicated to the medical sciences in his relationship with public health work, an area of great interest to RF at that time. After the fellowship period, he should maintain a link with the OCI.
But Olympio da Fonseca was unable to benefit from the fellowship in 1919, as he was requested by the federal government to act as an inspector for the Federal Sanitary Commission to combat yellow fever. In 1920, however, the scholarship was again awarded to Fonseca, then 24 years old. 21 The doctor arrived in the United States on January 9, 1920, armed with a letter addressed to William Welch, whom he was supposed to address at the Johns Hospkins School of Hygiene and Public Health, in Baltimore, to discuss his studies. Using the Fonseca record again, we find the following information: "F has had advanced training in medical natural history, medicine and parasitology. Has had 6 yrs. exper. in Oswaldo Cruz Inst. Hopes to obtain advanced work in Mycology". 22 A doctor with experience in medicine and parasitology, Fonseca sought improvement in mycology 23 . The Johns Hopkins School of Hygiene and Public Health, the destination of the Brazilian physician, was the first public health school in the United States. Elizabeth Fee highlights the importance of this institution: As the first independent, degree-granting institution for research and training in public health, the School of Hygiene was crucial to the process of professionalization of public health in the United States. As a leading research center, it helped shape the form and content of public health by developing new scientific knowledge, generating organized research, and training highly educated personnel to put this knowledge into practice. As a center for training international public health officers, it influenced the development of public health activities around the world (Fee, 1987, p. 1).
The first and largest in a series of public health schools created in the United States and abroad with investments from the Rockefeller Foundation, the Johns Hopkins School of Hygiene and Public Health was a model for other institutions, influencing public health and its professionalization "around the world" in the 20th century (Fee, 1987, p. 1). William Welch, whom Fonseca should address, was a professor of pathology and dean at Johns Hopkins Medical School, as well as an administrator at the International Health Board. At Johns Hopkins, Fonseca worked in the pathology laboratory with William George MacCallum 24 . The activities carried out by Olympio da Fonseca were praised by MacCallum: "F very intelligent and diligent in carrying out plan suggested for him at Hopkins, i.e. study of many forms of fungus concerned with disease production. He learned technic of growing them and did that neatly and well 25 . According to Fonseca's perception, MacCallum was "the greatest American pathologist at the time" (Fonseca Filho, 1985, p. 16). In Baltimore, the Brazilian doctor also worked with Thomas Casper Gilchrist, professor of dermatology at Johns Hopkins and the University of Maryland.
In April 1921, Fonseca was sent to Washington to work with Erwin Smith 26 , a pathologist at the Bureau of Plant Industry (U. S. Department Agriculture) 27 . According to Fonseca, the period of work in Washington was justified by the fact that he needed a "notion of plant pathology" and Smith "had created the bacteriology of plant diseases" (Fonseca Filho, 1985, p. 16-17). Between July and September 1921, Fonseca worked at the Bureau of Chemistry com Charles Thom (U. S. Department of Agriculture). 28 The research developed by Erwin Smith and Charles Thom was considered important by Olympio da Fonseca. According to the doctor: I learned a lot from Erwin Smith. One problem that he studied and that I came to study later was that of parasitic tumors of plants, at that time compared to those of human cancer. So, I also worked on the subject of plant cancers produced by pseudomonas tumefaciens. These mushrooms are very important because they are very common and intervene in many things. There is a group at the Bureau of Chemistry in Washington, which included Professor Charles Thom, a great expert on the subject. Charles Thom, throughout his life, studied aspergillus and penicillus from the chemical point of view and from the point of view of industrial fermentations (Fonseca Filho, 1985, p. 17).
In July 1921, Olympio da Fonseca's fellowship was renewed by the Rockefeller Foundation, but this time, to study in France, with Raymond Jacques Adrien Sabouraud 29 , Director of Laboratory at Hospital Saint-Louis. According to Fonseca, there was an understanding, on the part of the Foundation, that the learning of the Brazilian researcher in medical terms had not been satisfactory (Fonseca Filho, 1985, p. 22). In the record of Olympio da Fonseca, we find the following note regarding the issue: "(...) that type of work [the study of fungi in relation to diseases] seems very important in Brazil, and it would be hard to find any one else with same amount of interest in the subject combined with F´s ability". 30 In addition to activities with Sabouraud, Fonseca also worked at the clinic with Alexandre Joseph Émile Brumpt 31 and with Maurice Charles Pierre Langeron 32 at the School of Medicine. According to Fonseca, the activities carried out in France were part of a program aimed at organizing a Mycology section in Brazil. The program provided him with great learning and socializing with researchers from different parts of the world, such as Masao Ota 33 (Fonseca Filho, 1985, p. 23-24). In addition to Paris, Fonseca also visited Lion. Before returning to Brazil, in 1922, he visited laboratories in England, Belgium, Netherlands and Germany. With regard specifically to the work carried out in France, Fonseca's record contains the following annotation: "Report on work done in France: In Dr. Sabouraud´s lab where most of work was done, he succeeded in collecting one of the most complete collections of fungi cultures in existence. In Dr. Brumpt´s dept. studied literature on subject of fungi (…)". 34 Upon arriving in Brazilian lands, in the year of the centenary of in-dependence, the doctor brought with him an important collection of fungi 35 ; according to RF, one of the most complete existing at that time.
Carlos Chagas supported the activities developed by Olympio da Fonseca on his return to the country, ordering books and providing an assistant for the organization of the collection of Mycology at the OCI, according to Fonseca, the second in the world, behind only that of the British Institute, in London. Fonseca provided cultures to several researchers, including his masters in Paris, such as Brumpt (Fonseca Filho, 1985, p. 29). Analyzing his training in the United States and France through the RF fellowship, Olympio da Fonseca found it quite satisfactory: "(...) the interest of the Institute [Oswaldo Cruz] was more of a medical interest. There were people who had worked with Mycology here, such as Pedro Severiano de Magalhães and several others, but in isolated matters, with no one having the specialist training. I acquired this training, in part, in the Unit-  (1954)(1955) 36 .
In terms of international projection, Fonseca was a member of several academies and societies, such as the Mycological Society of France and the Royal Academy of Medicine of Belgium. He was President of the V International Congress of Microbiology, held in Rio de Janeiro in 1950, and Honorary President of the sixth and seventh editions, held in Rome (1953) and Stockholm (1958), respectively. In addition to several books, Olympio da Fonseca published dozens of works on different topics: protozoology, poisonous fishes, flu, yellow fever, bacterial plant tumors, history of medicine and science and mycology. 37

FINAL CONSIDERATIONS
Returning to the objectives of the Rockefeller Foundation's fellowship program -the training of personnel to act, in their countries of origin, in strategic positions in official health agencies or as directors and/or teachers in schools of hygiene, public health and nursing -, we believe it is possible to infer that the Foundation considered Olympio da Fonseca a successful case. When he effectively received the fellowship in 1920, Fonseca was linked to the Oswaldo Cruz Institute, an important Brazilian scientific institution. His nomination for the fellowship was made by Carlos Chagas, director of the Institute, and the candidate was positively evaluated by the RF. The activities carried out abroad, especially in France, were part, as we have seen, of a program aimed at organizing a Mycology section in Brazil.
When he returned to the country in 1922, Fonseca brought with him, in addition to the knowledge acquired (he was a specialist in Mycology) and international experience, an important collection of fungi, one of the most complete in the world at the time. Olympio da Fonseca returned to work at the Oswaldo Cruz Institute (OCI), as expected by the Foundation. At the Institute, Fonseca organized the collection of Mycology and also taught the subject as a teacher in the Application Course between 1922 and 1937, possibly disseminating part of the knowledge acquired from the fellowship. The researcher ran the OCI between 1949 and 1953. According to Fonseca, after his return to the country, he maintained contacts and exchanges with several researchers, including his professors in France, to whom he sent samples of the Institute's fungi collection. In this sense, we can highlight the participation of Olympio da Fonseca in the French Mycological Society, reinforcing his insertion in international scientific networks. Currently, the Mycology section reorganized by Fonseca constitutes the Laboratory of Taxonomy, Biochemistry and Bioprospecting of Fungi of the Oswaldo Cruz Institute/Oswaldo Cruz Foundation (LTBBF/IOC/Fiocruz) 38 , and the collection brought in 1922 started the Filamentous Fungus Culture Collection (CCFF) 39 of OCI, which gathers approximately 2,100 strains of fungi from different taxonomic groups and constitutes a center for the conservation of biological resources.