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  • Legal Issues Arising From Management Of Covid-19 Patients By Ahmed Adetola-Kazeem

    Legal Issues Arising From Management Of Covid-19 Patients By Ahmed Adetola-Kazeem

    Legal Issues Arising From Management Of Covid-19 Patients By Ahmed Adetola-Kazeem 1

    Legal Issues Arising From Management Of Covid-19 Patients By Ahmed Adetola-Kazeem 2


    A lot of legal issues are bound to arise as an aftermath of the outbreak of Coronavirus otherwise referred to as COVID-19.  There is therefore a need to shed light on some of the issues that may arise and how to navigate them. This article will x-ray the rights of patients, the rights of health workers and the basic minimum obligations of the government.

    The Code of Medical Ethics in Nigeria 2008 lists acts that constitute professional negligence. Rule 29.4 of the Code outlines some of these acts as follows:-

    a)      Failure to attend promptly to a patient requiring urgent attention when the practitioner was in a position to do so;

    b)     Manifesting incompetence in the assessment of a patient;

    c)      Making an incorrect diagnosis particularly when the clinical features were so glaring that no reasonable skillful practitioner could have failed to notice them; 

    d)     Failure to advise, or proffering wrong advice to  a patient on the risk involved in a particular operation or course of treatment, especially if such an operation or course of treatment is likely to result in serious side effects like deformity or loss of organ, or function;

    e)      Failure to obtain the informed consent of the patient before proceeding on any surgical procedure or course of treatment when such consent was necessary; 

    f)       Making a mistake in treatment e.g. amputation of the wrong limb, carelessness that results in the termination of a pregnancy, prescribing the wrong drug, or dosage in error for a correctly diagnosed ailment, etc;

    g)     Failure to refer, or transfer a patient in good time, when such a referral or transfer was necessary;

    h)     Failure to do anything that ought reasonably to have been done under any circumstance for the good of the patient;

    i)       Failure to see a patient as often as his medical condition warrants or to make appropriate comments in the case notes of the practitioner’s observations and prescribed treatment during such visits. It also includes failure to communicate with the patient or with his relatives as may be necessary with regards to any developments, progress or prognosis in the patient’s condition.

     

    Rule 11.2 of the 2008 Code of Medical Ethics in Nigeria provides that, “A physician shall preserve absolute confidentiality on all he knows about his patient even after the patient has died.”

                 Rule 44 of the Code of Medical Ethics has extensive provisions on Confidentiality and when disclosure of information can be made. The Rule provides in part that:

    “Disclosure of information on the patient by the doctor can only be made following an informed consent of the patient in writing. It is clear that the ethic covers even such information as induced abortion, venereal disease, attempted suicide, concealed birth and drug dependence but would exclude situations in which a discretionary breach of confidentiality is necessary to protect the patient or the community from danger and this must be made clear to the patient at the time of the confidential disclosure. Where statutory notification of disease is involved, the consent of the patient is not required.”            

                Confidentiality: To Disclose Identity Of Covid-19 Patients Or Not To Disclose?

    COVID-19 is an infectious disease caused by a newly discovered coronavirus. Most people infected with the COVID-19 will experience mild to moderate respiratory illness and recover without requiring special treatment.  Older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness.[1]

    The Federal Ministry of Health confirmed the first case of COVID-19 in Nigeria on the 27th of February 2020. It is the case of an Italian citizen who works in Nigeria and returned from Milan, Italy to Lagos, Nigeria on the 25th of February 2020. In reaction to the report, the social was divided between those who want the name of the Italian disclosed and those that preferred it remains confidential. The outcry was even more when the Chief of Staff to the President tested positive according to reports from various media houses[2], but the Minister of Health decided to keep mute on the identity of the President’s aide who contacted the virus, citing confidentiality.

    It will ordinarily be wrong to disclose the medical status of someone infected with COVID-19, for instancethe case of the Italian who was the index case. However in view of the proviso to Rule 44 of the Code of Medical Ethics 2008 which provides that a discretionary breach of confidentiality is necessary in order to protect the community from danger, I am of the view that the test results of popular figures who hold strategic offices like the Chief of Staff to the President or a Governor must be disclosed to guaranty public safety. This is necessary in view of the countless number of people from all works of life they come in contact with on a daily basis.  It will be correct to have made their status public in the overriding interest of the public, since it will enable those who have come in contact with them isolate, just like we have seen in the cases of the British Prime Minister, the Bauchi State Govenor, Prince Charles, the First Lady of Canada and many more. We must commend those who announced their status in public themselves-it is the best thing to do in the interest of humanity

    The World Health Organization (WHO) provides additional guidelines for the management of coronavirus patients specifically.[3]

    Health workers should:

    •follow established occupational safety and health procedures, avoid exposing others to health and safety risks and participate in employer-provided occupational safety and health training; 

    •use provided protocols to assess, triage and treat patients; 

    •treat patients with respect, compassion and dignity; 

    •maintain patient confidentiality; 

    •swiftly follow established public health reporting procedures of suspect and confirmed cases; 

    •provide or reinforce accurate infection prevention and control and public health information, including to concerned people who have neither symptoms nor risk;

    •put on, use, take off and dispose of personal protective equipment properly;

    •self-monitor for signs of illness and self-isolate or report illness to managers, if it occurs; 

    •advise management if they are experiencing signs of undue stress or mental health challenges that require support interventions; and 

    •report  to  their  immediate  supervisor  any  situation  which  they  have  reasonable  justification  to  believe presents an imminent and serious danger to life or health.

     

    Doctors and health workers in Nigeria must endeavor to digest the guidelines in the Code of Medical Ethics as well as the WHO Guidelines for management of Coronavirus victims and ensure they work strictly by their provisions. A breach of these duties have dire consequences. 

    Options Available To Covid-19 Patients Who Are Victims Of Medical Negligence

    A Coronavirus patient who has suffered medical negligence has a number of options:

    1. He could file a complaint with the regulatory body (e.g. the Medical and Dental Council of Nigeria, in the cases involving a Doctor). The Doctor will in the first instance be investigated by the Medical and Dental Practitioners Investigation Panel, after which he will be tried by the Medical and Dental Practitioners Disciplinary Tribunal. If found culpable,  the Doctor may be warned, suspended from practicing for a period not exceeding 6 months or in very serious cases, have his name can be removed from the Register of Medical Practitioners. The Medical and Dental Practitioners’ Disciplinary Tribunal does not award monetary damages.

    2. A suit can be filed against the Medical Doctor, the Hospital, Agency or Government in the High Court for Medical Negligence and monetary damages will be awarded if the Defendant(s) are found culpable.

          3.  If there is an element of Crime, a report could be made to the Police who would conduct Criminal Investigation and where the investigation reveals gross negligence, recklessness or wanton disregard for life of the victim, the police can prosecute or forward the case file to the office of the Attorney General of the State for possible prosecution in deserving cases.  

    A Need To Do More For Doctors And Other Professionals In The Health Sector

    Health workers are at the front line of any outbreak response and as such are exposed to hazards that put them at risk of infection with an outbreak pathogen (in this case COVID-19). Hazards include pathogen exposure, long working  hours,  psychological  distress,  fatigue,  occupational  burnout,  stigma,  and  physical  and  psychological violence. 

    During the outbreak of Ebola more than 500 health care workers died in Guinea, Liberia and Sierra-Leone alone. We also lost some of our finest doctors and health workers to the disease in Nigeria, the most prominent being Dr. Stella Adadevoh, who is credited with having curbed a wider spread of the Ebola virus in Nigeria by placing the index patient, Patrick Sawyer, in quarantine despite pressures from the Liberian  government. As we speak, The coronavirus is waging a war of attrition against health care workers throughout the world, but nowhere is it winning more battles at the moment than in Italy and in Spain, where protective equipment and tests have been in severely short supply for weeks. In Spain 13.6% (6500) of those affected with the coronavirus are health workers and in Italy 10% (7400) of those affected with the virus are health workers. [4] In New York dozens of health workers have been affected with the virus, while hundreds are in quarantine.[5] According to reports filtering in as the time of concluding this article, three health workers have been infected with COVID-19 in Abuja, Nigeria.[6]

    Human Rights Watch research into health system collapse in Hungary and Venezuela suggests the nations’ mismanaged, underfunded, and understaffed public healthcare system is poorly equipped to handle a COVID-19 outbreak. Patients and medical experts described a lack of basic hygiene protocol, lack of isolation rooms, and a shortage of health professionals, doctors and nurses, and medical supplies in general.

    The situation is not too different in Nigeria at the moment and except something drastic is done we might be witnessing a devastating effect of the pandemic. Nigeria’s, public health capacity has been diminished by large scale public sector corruption. Medical personnel lack surgical masks and local supplies have been diverted and shipped to other markets partly due to corruption. Many states are ill-prepared to combat the impeding surge in patients. A senior health worker with a government hospital in Abuja, in an interview with Sahara Reporters, lamented the lack of quality Personal Protective Equipment for them, adding that government must invest in the protection of health workers at the frontline of the battle against the virus. He said, “The unfortunate thing is that the government is not providing us with what to work with. It is sad that our PPE are not up to the world standard and can be penetrated by viruses. Some of us (health workers) have to use our personal funds to purchase gloves as we do not trust the ones government supplied. Nigerians should please remember us in their prayers and government should provide us with what we really need to work.” [7]

    There was report that in Bauchi State a Coronavirus patient rejected the isolation centre at the Bauchi Specialist Hospital and went back home while describing it as “too dirty”.[8]  

    It is disappointing to hear that the hazard allowance for doctors and health workers is N5,000 per month in Nigeria. The amount is very paltry compared to the risks and the attendant emotional and psychological stress suffered by the health-care workers (HWCs) particularly during monumental outbreaks like this. Unfortunately, when a patient is mismanaged, these doctors and health workers bear the burden of paying huge compensation and sometimes losing their jobs. More importantly, the brain-drain in the health sector is monumental, almost all my friends who are doctors, work abroad. Unfortunately, there are concerted efforts by the US Government to engage foreign Doctors to further fortify its health work force as COVID-19 ravages. Many young Nigerian doctors are already considering the offers because the Nigerian government has paid little attention to their welfare and the welfare of the general health workforce. To stop the exodus of our doctors, who are already in short supply, the government must act fast by improving their welfare packages in line with acceptable international standards.

    The psychological needs of doctors and health workers are also often ignored. Unsafe working conditions contribute to health worker attrition in many countries due to work-related illness and injury and the resulting fear of health workers of occupational infection, including from HIV and Tuberculosis. The 2006 World Health Report – Working Together for Health reported on a severe health workforce crisis in fifty-seven countries, most of them in Africa and Asia. [9]

    Protecting the occupational health of health workers is critical to having an adequate workforce of trained and healthy health personnel. Governments at the Federal and State levels are urged to do more by complying fully with the World Health Organization’s guidelines regarding the Rights of Health Workers while combating COVID-19. Some of the rights are:

    ·         assume overall responsibility to ensure that all necessary preventive and protective measures are taken to minimize occupational safety and health risks;

    ·         provide information, instruction and training on occupational safety and health, including; Refresher training on infection prevention and control(IPC); and Use, putting on, taking off and disposal of personal protective equipment(PPE);

    ·         provide adequate IPC and PPE supplies (masks, gloves, goggles, gowns, hand sanitizer, soap and water, cleaning supplies) in sufficient quantity to healthcare or other staff caring for suspected or confirmed COVID-19 patients, such that workers do not incur expenses for occupational safety and health requirements;

    ·         not be required to return to a work situation where there is continuing orserious danger to life or health, until the employer has taken any necessary remedial action;

    ·         allow workers to exercise the right to remove themselves from a work situation that they have reasonable justification to believe presents an imminent and serious danger to their life or health. When a health worker exercises this right, they shall be protected from any undue consequences; 

    ·         honour the right to compensation, rehabilitation and curative services if infected with COVID-19 following exposure in the workplace. This would be considered occupational exposure and resulting illness would be considered an occupational disease,

    ·         provide access to mental health and counselling resources; and 

    ·         enable co-operation between management and workers and/or their representatives. Etc.

    In conclusion, professional care givers for COVID-19 patients should uphold four basic principles formulated by Beauchamp and Childress in their book ‘Principles of Biomedical Ethics’ in order to protect themselves from liability for negligence. The four basic principles are autonomy, beneficence, non-maleficence and justice.

    Autonomy: People have the right to control what happens to their bodies. This principle simply means that an informed, competent adult patient can refuse or accept treatments, drugs, and surgeries according to their wishes. People have the right to control what happens to their bodies because they are free and rational. And these decisions must be respected by everyone, even if those decisions aren’t in the best interest of the patient.

    Beneficence: All healthcare providers must strive to improve their patient’s health, to do the most good for the patient in every situation. But what is good for one patient may not be good for another, so each situation should be considered individually. And other values that might conflict with beneficence may need to be considered.

    Non-maleficence: “First, do no harm” is the bedrock of medical ethics. In every situation, healthcare providers should avoid causing harm to their patients. You should also be aware of the doctrine of double effect, where a treatment intended for good unintentionally causes harm. This doctrine helps you make difficult decisions about whether actions with double effects can be undertaken.

    Justice: The fourth principle demands that you should try to be as fair as possible when offering treatments to patients and allocating scarce medical resources. You should be able to justify your actions in every situation. For instance, it will amount to a professional misconduct for a Health-care Worker to remove a poor man from the ventilator because a Senator was rushed in. 

    Ahmed Adetola-Kazeem is a partner in Adetola-Kazeem Legal Practice and specializes in Medical and Health Law

    Email: aadetolakazeem@gmail.com;aadetolakazeem@gaklp.com

    [1] https://www.who.int/health-topics/coronavirus#tab=tab_1(Accessed on the 28th of March 2020)

    [2] https://businessday.ng/coronavirus/article/abba-kyari-tests-positive-for-coronavirus-buhari-negative/

    https://www.channelstv.com/2020/03/24/buharis-chief-of-staff-abba-kyari-reportedly-tests-positive-for-coronavirus/ (Accessed on the 28th of March 2020)

    [3] Coronavirus Disease (Covid-19) Outbreak: Rights, Roles and Responsibilities Of Health workers, Including Key Considerations For Occupational Safety And Health”. https://www.who.int/docs/default-source/coronaviruse/who-rights-roles-respon-hw-covid-19.pdf?sfvrsn=bcabd401_0   (Accessed on the 26th of March 2020)

    [4] https://abcnews.go.com/Health/wireStory/collapsing-virus-pummels-medics-spain-italy-69789413 (Accessed on 26th March 2020)

    [5] https://www.washingtonpost.com/health/covid-19-hits-doctors-nurses-emts-threatening-health-system/2020/03/17/f21147e8-67aa-11ea-b313-df458622c2cc_story.html (Accessed on 28th of March 2020)

    [6] http://saharareporters.com/2020/03/28/exclusive-two-nurses-one-doctor-infected-coronavirus-abuja-hospital

    [7] Supra

    [8] https://www.dailytrust.com.ng/coronavirus-patient-rejects-bauchi-isolation-centre-returns-home.html (Accessed on 28th March 2020)

    [9] https://www.who.int/occupational_health/topics/hcworkers/en/(Accessed on 26th March 2020)

     

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  • We now know what causes wine ‘legs’ to drip down inside a glass

    We now know what causes wine ‘legs’ to drip down inside a glass

    Wine tears – the drops that form inside a glass after wine is swirled in a glass – are caused by the formation of an unstable shock wave
    We now know what causes wine ‘legs’ to drip down inside a glass
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    https://www.newscientist.com/article/2239298-we-now-know-what-causes-wine-legs-to-drip-down-inside-a-glass/?utm_campaign=RSS%7CNSNS&utm_source=NSNS&utm_medium=RSS&utm_content=home

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  • ‘Chloroquine’ used to treat Covid-19 patients since first wave: Health DG

    ‘Chloroquine’ used to treat Covid-19 patients since first wave: Health DG

    ‘Chloroquine’ used to treat Covid-19 patients since first wave: Health DG 3

    PUTRAJAYA: Chloroquine, a drug used for malaria, has been used to treat Covid-19 patients since the first wave of the outbreak in Malaysia and has shown its efficacy, according to Health director-general Datuk Dr Noor Hisham Abdullah (pix).

    He said the anti-inflammatory properties of the drug were effective in treating Covid-19 which caused inflammation in the lower respiratory tract.

    “When the Covid-19 virus attaches to the lower respiratory tract it causes inflammation and replication of the virus and this drug helps treat the inflammation,” he told a press conference, here today.

    Besides ‘Chloroquine’, Dr Noor Hisham said the combination of ‘Lopinavir and Ritonavir’ and Hydroxychloroquine have also been used by Ministry of Health (MoH) since the first wave of the outbreak.

    He said the drugs used in the first wave of the infection showed promising results in treating Covid-19, however, further research was still required.

    He explained that the number of deaths due to the virus had increased as the patients were either elderly, had comorbidities such as high blood pressure and kidney disease, or those who sought treatment at a later stage or after they began having breathing difficulties.

    “We have tried the drug and it is also part of a joint study with the World Health Organization called ‘Solidarity Trial’ involving many other countries,“ he added.

    He said besides those medicines, studies would also focus on the latest drug, ‘Remdesivir’ as announced yesterday.

    “This is only for research, and drugs that we have used off-label such as Lopinavir and Ritonavir, those we have been using since the first wave,“ he added. – Bernama

    ‘Chloroquine’ used to treat Covid-19 patients since first wave: Health DG
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    https://www.thesundaily.my/local/chloroquine-used-to-treat-covid-19-patients-since-first-wave-health-dg-FJ2193799

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  • Buhari Expresses Grief Over Killing Of Soldiers In Borno Boko Haram Ambush

    Buhari Expresses Grief Over Killing Of Soldiers In Borno Boko Haram Ambush

    Buhari Expresses Grief Over Killing Of Soldiers In Borno Boko Haram Ambush 4

    Buhari Expresses Grief Over Killing Of Soldiers In Borno Boko Haram Ambush 5


    President Muhammadu Buhari has expressed “grief and sorrow’’ over loss of soldiers ambushed by Boko Haram terrorists in Gorgi Village, Borno State.

    According to a statement by Garba Shehu, Senior Special Assistant to the President on Media and Publicity, Buhari while commiserating with families of the slain soldiers, said, “Sacrifices of our gallant patriots cannot be quantified, and their sacrifices cannot go in vain.’’

    The President said the death of every soldier causes deep pains because he knows what it means to be a soldier, and fully understands the extreme risks associated with the profession.

    According to the statement, Buhari appealed to the military “not to allow the incident to affect their morale’’. 

    Meanwhile, the Nigerian Army has dispatched a team to assess the situation and report back to the government.

    More than 50 military personnel including top commanders were killed during the ambush, which took place on Saturday. 
     

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  • The economic cost of female genital mutilation

    The economic cost of female genital mutilation

    An interactive data tool launched by WHO reveals for the first time the current and future financial cost of health care for women living with conditions caused by female genital mutilation (FGM).

    The total costs amount to USD 1.4 billion annually.

    fgm-cost-thumbnail

    The FGM Cost Calculator is being launched on this year’s International Day of Zero Tolerance for FGM. This new tool shows that if FGM were abandoned now the associated savings
    in health costs would be more than 60% by 2050. This data, available for 27 of the 30 countries where FGM is practiced, will strengthen the economic argument of community activists, policy makers, programme planners and donors working to end this
    human rights violation.

    Q&As on the FGM Cost Calculator
    Access the FGM Cost Calculator

    A human rights violation with economic costs

    FGM includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. More than 200 million girls and women alive today have been cut in 30 countries in Africa, the Middle East and Asia where FGM is concentrated.
    [1] An extreme form of gender discrimination, it is recognized internationally as a violation of the human rights of girls and women: including the right to health, security and physical integrity and the right to be free from torture and cruel, inhuman
    or degrading treatment.

    FGM has no health benefits and causes only harm. Women and girls who are subjected to FGM are at risk of both short- and long-term negative health consequences – including for their physical, sexual, mental, and social well-being.

    The direct financial cost of treating the negative health complications caused by FGM can span generations, starting as early as childbirth. This puts a significant economic burden on health systems and national budgets, especially in countries with rates
    of FGM greater than 10%.

    Until now, there have been limited data on the financial costs associated with FGM, making it hard to demonstrate the cost-effectiveness of programmes and policies that can prevent FGM by 2030 – a global priority in the Sustainable Development Agenda.
    The new WHO Cost Calculator now provides an economic argument which can be used by those advocating for an end to FGM.

    Calculating health care costs of FGM

    Users of the new FGM Cost Calculator can choose a country and identify current costs of treating health conditions caused by FGM. Since the tool is interactive, it produces bespoke graphs showing the potential amount of money saved if FGM is prevented
    by a selected percentage.

    If no action is taken to prevent FGM, it is estimated that related health costs will soar by 50% by 2050, as populations grow and as more girls undergo the procedure.

    How it works

    The FGM Cost Calculator combines data on health risk associated with FGM, health costs and national FGM prevalence to analyze the economic impact on national health services of treating the consequences of these harmful practices.

    Health risk data were taken from a WHO database created for this analysis, pooling all available information from systematic reviews of health consequences of FGM. The following categories were used, each with a biological link to FGM: gynaecological,
    obstetric, urological, mental and sexual, as well as the immediate health complications that can result following the cutting.

    To be included in the calculator, a health condition needed to show evidence of increased risk when comparing women with and without FGM. It also needed to have a treatment which could be implemented and costed in the health sector.

    Health costs were calculated from the WHO One Health Tool and other data. The financial burden of treating selected health conditions was calculated at a national level.

    A strong case for investment in preventing FGM

    Rates of FGM have declined over the past 30 years, but not fast enough to keep up with population growth. If trends continue, the number of girls and women undergoing FGM will rise significantly in the next 15 years, in turn raising national health care
    costs of caring for them.

    Additional resources are urgently needed to scale up interventions that can prevent FGM in the future and reduce health complications.

    By providing quantifiable numbers on the cost of treating health conditions directly linked to FGM, for the first time, the FGM Cost Calculator can be a crucial tool in building an investment case for a future where no girl or woman is cut.

    [1] Female Genital Mutilation/Cutting: A Global Concern, UNICEF, New York, 2016
    The economic cost of female genital mutilation
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    https://www.who.int/news-room/detail/06-02-2020-economic-cost-of-female-genital-mutilation

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  • Female Genital Mutilation Hurts Women and Economies

    Female Genital Mutilation Hurts Women and Economies

    Female genital mutilation (FGM) exacts a crippling economic as well as human cost, according to World Health Organization (WHO).

    “FGM is not only a catastrophic abuse of human rights that significantly harms the physical and mental health of millions of girls and women; it is also a drain on a country’s vital economic resources,” said Dr Ian Askew, Director of WHO’s Department of Sexual and Reproductive Health and Research. “More investment is urgently needed to stop FGM and end the suffering it inflicts.”

    New modelling reveals that the total costs of treating the health impacts of FGM would amount to USD 1.4 billion globally per year, if all resulting medical needs were addressed. For individual countries, these costs would near 10% of their entire yearly expenditure on health on average; in some countries, this figure rises to as much as 30%.

    The interactive modelling tool that generated these data was launched on the International Day of Zero Tolerance for Female Genital Mutilation.

    Severe physical and mental health impacts for women and girls

    Women and girls living with FGM face serious risks to their health and well-being. These include immediate consequences after being cut, such as infections, bleeding or psychological trauma, as well as chronic health conditions that can occur throughout life.

    Women who have undergone the procedure are more likely to experience life-threatening complications during childbirth. They may face mental health disorders or suffer chronic infections. They may also have pain or problems when they menstruate, urinate or have sexual intercourse. 

    All of these conditions warrant much-needed medical attention and care.

    “High healthcare costs for countries mount because of the tragic personal impacts on women and girls. Governments have a moral responsibility to help end this harmful practice,” says Dr Prosper Tumusiime, Acting Director for Universal Health Coverage and the Life Course in the African Regional Office of WHO. “FGM hurts girls, imposes lifelong health risks on the women they become, and strains the healthcare systems that need to treat them.”

    Preventing FGM brings major benefits for women, girls, communities and economies

    Using data from 27 high-prevalence countries, the Cost Calculator demonstrates clear economic benefits from ending FGM. If it were abandoned now, it shows that the associated savings in health costs would be more than 60% by 2050.

    In contrast, if no action is taken, it is estimated that these costs will soar by 50% over the same time period, as populations grow and as more girls undergo the procedure.

    Since 1997, great efforts have been made to end FGM, through work within communities, research, and changes in legislation and policy. 26 countries in Africa and the Middle East now explicitly legislate against FGM, as well as 33 other countries with migrant populations from FGM-practicing countries.

    WHO is also working with countries to raise awareness of the harmful impacts of the practice among their health workers, and to engage them in prevention efforts.

    “Many countries and communities are showing that abandoning female genital mutilation is possible,” states Dr Christina Pallitto, scientist at WHO. “If countries invest to end female genital mutilation, they can prevent their girls from undergoing this harmful practice and promote the health, rights and well-being of women and girls.”

    Female genital mutilation is internationally recognized as a human rights violation. It has no medical benefits and causes only harm. WHO’s position is that FGM must never be carried out.

    Further information

    The FGM Cost Calculator will be available here, as of 00:30 CET 6 February 2020:
    www.who.int/news-room/detail/06-02-2020-economic-cost-of-female-genital-mutilation

    More on FGM

    Notes for Editors

    About FGM

    FGM includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. More than 200 million girls and women alive today are estimated to have undergone the practice across 30 countries in Africa, the Middle East and Asia where FGM is concentrated.

    FGM is mostly carried out on young girls between infancy and 15 years of age.

    About the FGM Cost Calculator

    The WHO FGM Cost Calculator shows the economic cost of treating the health complications caused by FGM across 27 high-prevalence countries. These costs were calculated using the WHO One Health tool and other available scientific evidence.

    Users of the tool can calculate costs by country in a ‘business as usual’ scenario; a scenario of partial abandonment of FGM, and full abandonment of FGM over a 30-year period. In addition, the distribution of costs by different types of health complications is presented by country.

    The tool does not consider other indirect costs that hit families and communities, or the socio-economic impacts of the practice, which would be significantly higher still.

    The 27 countries modelled include Benin, Burkina Faso, Central African Republic, Còte d’Ivoire, Cameroon, Chad, Djibouti, Egypt, Eritrea, Ethiopia, Ghana, Guinea, Gambia, Guinea-Bissau, Iraq, Kenya, Mali, Mauritania, Niger, Nigeria, Soudan, Senegal, Sierra Leone, Somalia, Togo, United Republic of Tanzania, Yemen.

    Female Genital Mutilation Hurts Women and Economies
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    https://www.who.int/news-room/detail/06-02-2020-female-genital-mutilation-hurts-women-and-economies

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  • E-cigarette vapor does not cause oxidative stress in viable lung epithelial cells

    E-cigarette vapor does not cause oxidative stress in viable lung epithelial cells

    E-cigarette vapour is much less harmful to lung cells than cigarette smoke. Lab tests show that, unlike tobacco smoke, which causes oxidative stress and cell death, e-cigarette vapour does not. Oxidative stress and cell death are driving factors in the development of many smoking-related diseases such as COPD and lung cancer.

    Vapour from e-cigarettes has been found to contain significantly lower levels of the toxicants found in cigarette smoke (Chemical Research in Toxicology DOI: 10.1021/acs.chemrestox.6b00188), but suitable lab tests and clinical studies are necessary to understand whether this translates into reductions in biological responses and disease.

    Researchers at British American Tobacco have developed a standardized way of measuring and comparing the potential of conventional cigarette smoke and e-cigarette vapour to cause oxidative stress in an in vitro model of lung epithelium.

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  • Spinoza’s Ethics of Strength of the Emotions in W Somerset Maughm’s Of Human Bondage

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    The writer probes on the complex world of W. Somerset Maughm’s protagonist in the novel Of Human Bondage, using the propositions the Jewish Portuguese philosopher Baruch Spinoza postulated in his book Ethics in 1674. Some of Spinoza’s propositions are as follows( Morgan, 2006, pp 108-120):

    The following propositions of Spinoza enlighten the changing character of Philip in his own bildungsromans of his life. The force and increase of any passive emotion and its persistence in existing is defined not by the power whereby we ourselves endeavour to persist in existing, but by the power of external causes compared with our own power;

    The force of any passive emotion can surpass the rest of man’s activities or power so that the emotion stays firmly fixed in him;

    An emotion cannot be checked or destroyed except by a contrary emotion which is stronger than the emotion which is to be checked;

    Knowledge of good and evil is nothing other than the emotion of pleasure or pain insofar as we are conscious of it;

    An emotion whose cause we think to be with us in the present is stronger than it would be if we did not think the said cause to be with us;

    We are affected toward a future thing which we imagine to be imminent mo intensely than if we were to imagine its time of existence tofarther away from the present. We are also affected by a remembrance of a thing we imagine to belong to the near past more intensely if we were to imagine it to belong to the distant past;

    An emotion toward a thing which we think of as inevitable [necessarius] is more intense, other things being equal, than emotion toward a thing possible or contingent, that is, not inevitable;

    Emotion toward a thing which we know not exist in the present, and which we imagine to be possible, is, other things being equal, more intense than emotion toward a contingent thing;

    Emotion toward a contingent thing which we know not to exist in the present, is, other things being equal, feebler than emotion toward a thing past;

    No emotion can be checked by the true knowledge of good and evil, insofar as it is true, but only insofar as it is;

    Desire that arises from the true knowledge of good and evil can be extinguished or checked by many other desires that arise from the emotions by which we are assailed;

    The desires that arises from a knowledge of good and evil insofar as this knowledge has regard to to the future can be the more easily checked or extinguished by desire of things that are attractive in the present;

    Desire that arises from the true knowledge of good and evil insofar as this knowledge is concerned with contingent things can be even more easily checked by desire for things which are present;

    Desire arising from pleasure is, other things being equal, stronger than desire arising from pain;

    Every man, from the laws of his nature, necessarily seeks or avoids what he judges to be good or evil.

    The more every man endeavours and is able to seek advantage, that is, to preserve his own being, the more he is endowed with virtue. On the other hand insofar as he neglects to preserve what is to his advantage, that is, his own being to that extent he is weak.

    Philip is highly affected by nature. There is in Nature no individual thing that is surpassed in strength and power by some other thing. Whatsoever thing there is, there is another more powerful by which the said thing can be destroyed. And he was able to surpass all his problems because of the incoming different emotions, problems which proved to make him stronger if not released from “Human Bondage”.

    The force whereby a man persist in existing is limited, and infinitely surpassed by the power of external causes.

    Philip’s deformity limits his own persistence to live. But his meeting with Hayward, Clutton and Lawson, his former classmates in France, who taught him that life is all about passion and the pursuit of it, he became engross in his art. France did not also care about his clubfoot. Cronshaw taught him more philosophy in life about living in let live. Cronshaw even on his death bed, defied doctors’ prohibition. His life is anyway to end just like any other’s lives.

    Set in Kent, England, a sub-urban near London, the novel presents the multifaceted personal, social, political and religious experiences of Philip carey from his childhood to his middle age of thirty. A bildungsroman (1991, Smiley) in style, which highlights the formation of a youngman’s character through education, travels and early life experiences. Philip at the age of nine, as a young boy, is set apart from his peers by some misfortune and undergoes a humiliating experience that later proves strengthening. his first experience of love is unsuccessful or problematic one that nevertheless paves the way to a happy marriage with a suitable mate. The novel has ample observation, if not criticism, with the character’s institutions such as schools, churches and class structures.

    Philip’s personal life is truly an amalgam of life’s tragedies. But how he surpassed the seemingly insurmountable heap of oppressing weight, if not the meaninglessness or nothingness of life, is the focus of this attempt anchored on Spinoza’s propositions. To enumerate, at an early age, his mother died of tuberculosis and his father, a medical doctor, died of lung cancer. His innocence never understood the situation. He has only the temporary joy of travelling to Blackstable to live with his uncle William and childless Auntie Louisa. Forcibly liking his second family as an orphan, he is left reading his books without noise for his uncle, a Vicar in the community, is irated with children’s unruly behaviour. Aunt Louisa is incapable of understanding Philip. he is left with the care of the governess. His personal disability or deformity, being born with a club-foot, proves to be the stigma of his life forever. His early education in Kingston School, caused his early childhood bitter as his peers laughed at him, mocked and physically abused him because of his physical abnormality. Then, his adolescence which brings him to Heidelberg, Germany to study foreign languages, is never sweet. Girls chided him for his deformity. the consolation is meeting friends like Hayward and Miss Wilkinson, who flirted with him, to his disgust. His sojourn to France, albeit, his uncle’s disappointment, proves to be annihilating. His lack of talent in painting plus his deformity, made him a mediocre student. His classmate Fanny Price, who fell in love with him, on the pretext of sharing the same abnormality (hers is lack of beauty), committed suicide out of hunger and wretchedness.

    Then everything escalated to its height, when realizing that painting is not his passion, he goes back to England. He decides to change again to pursue what his uncle William tells him to do: to follow the footsteps of his father. To be a doctor. feeling he has nothing to do, he embraces the new idea. Sauntering along the Parliamentary Street of London, he is driven to dine in a cafe where he meets the slatternly waitress Mildred Rogers who awakens his sexual desire. But his languid mien, caused by his club-foot proves to be a disadvantage. the waitress prefers rugged and rich men. But his desire to pursue the pale, anaemic, aloof Mildred, beomes a challenge to him. Gradually, the two becomeclose. But the ambitious and materialistic waitress always insults him because of his deformity. to slander him cripple, would totally “cripple” his mood and emotion. Even when Philip is generous to the moody Mildred, she hurt him by marrying a German businessman Miller. His desperation is tantamount to his yearning for Mildred. He is left believing that one day, he would see Mildred again. His concentration with his medical study is forlorned. And Mildred came back,looking sickly, with a child. His generosity and forgiveness for his first love, who hurts him the most, is even greater than life. The ingrate waitress after a little recovery from poverty, elopes with Griffith, Philip’s handsome and robust classmate. That is the height of Mildred’s shamelessness. So her expected return is welcomed with derision by the newly awakened Philip. Even when Mildred turns into a prostitute, Philip is only capable of compassion, without passion or sexual desire. She is freed at last. And Philip is extricated from the pains excruciatingly caused by the destitute Mildred.

    His obsession to Mildred costs Philip his fortune and gradually his savings is left with seven pounds. He is forced to stop from his medical studies that brings him to experience unbelievable poverty. He meets the generous Athelneys who fed and sheltered him in his misery. His uncle’s death, leaving an average fortune, helps him to finish his medical studies. His fateful shelter with the Athelneys brings him to his final, harmonious and peaceful resolution to marry Sally Athelney and go on with his life beautifully. Shakespeare is affirmed by saying that “all is well that ends well.

    At this juncture, it is noteworthy to enumerate Spinoza’s propositions to elucidate Philip’s “bondage” and his strength of his emotion. Spinoza in his preface to his philosophical treatise wrote:

    I assign the term “bondage” to man’s lack of power to control and check the emotions. For a man at the mercy of his emotions is not his own master but is subject to fortune, in whose power he so lies that he is often compelled, although he sees the better course, to pursue the worse. In this Part I have set myself the task of demonstrating why is so, and also what is good and what is bad in emotions. But before I begin, I should like to make a few preliminary observations on perfection and imperfection, and on good and bad ( Morgan, 2006).

    In the beginning, Philip is a slave if not a victim of his emotion. His physical deformity, his club-foot, caused him too much pain. He learned to hate his classmates and,worst, abandoned his belief in God. He could not appreciate the God of his uncle vicar when God cannot give him the miracle he wanted to have normal feet. His painful childhood in school changed him to be rough character. He never wanted to become a vicar anymore. His obsession to Mildred indeed showed his real weakness as a man, and even wretchedness as a human being because of his deformity. he would always think that women cannot love him as he is because of his deformity.

    He who has undertaken something and has brought it to completion will say that the thing is completed; and not only he but everyone who rightly knew, or thought he knew, the intention and aim of the author of that work. For example, if anyone sees a work (which I assumed is not yet finished) and knows that the aim of author is to build a house, he will say the house is imperfect. On the other hand, as soon as he sees that the work has been brought to the conclusion that its author had intended to give it, he will say that the house is perfect. But if anyone sees a work whose like he had never seen before, and he does not know the artifecer’s intention, he cannot possibly know whether the work is perfect or imperfect.

    This appears to have been the original meaning of these terms. But when men began to form general ideas and to devise ideal type of houses, buildings, towers, and so on, and to prefer some models to others, it came about that each called “perfect” that which he saw at variance with his own preconceived ideal, although in the artifecer’s opinion it had been fully completed. There seems to be no other reason why even natural phenomena (those not made by human hand) should commonly be called perfect or imperfect. For men there are wont to form general ideas both natural phenomena and artifacts, and these ideas they regard as models, and they believed that Nature (which they consider does nothing without an end in view) looks to this ideas and holds them before herself as models. So when they see something occurring in Nature at variance with their preconceived ideal of the thing in question, they believed that Nature has then failed or blundered and has left that thing imperfect from their own preconceptions rather than from true knowledge.

    So perfection and imperfection are in reality only models of thinking, notions which we are wont to invent from comparing individuals of the same species or kind; and it is for this reason that I previously said (Def. 6, II) that by reality and perfection I mean the same thing. For we are wont to classify all the individuals in Nature under one genus which is called the highest genus, namely, the notion of Entity, which pertains to all the individuals in Nature without exception. Therefore insofar as we classify individuals in Nature under this genus and compare them with one another and find that some have more being or reality than others, to that extent we say that some are more perfect than the others. And insofar as we attribute to them something involving negotiation, such as limit, end, impotence and so on, to that extent we call them imperfect because they do not affect our minds as much as those we call perfect, and not because they lack something of anything except that which follows from the necessity of nature of its efficient cause; and whatever follows from the necessity of the nature of its efficient cause must be necessarily be so.

    To be a master of his emotion is to attain perfection. It may not be physical but spiritual, mental and emotional. His challenges may have hardened him but enlightened him to loosen up and later, embrace the beauty of life. The unattainable perfection, was answered, through his friend Cronshaw, a poet whom he met in France, that the meaning of life cannot be answered unless one lives it. he realized that men are born, study, work, marry, have children and die is the most beautiful pattern that the Persian rug edifies.

    As for the terms “good” and “bad,” they likewise indicate nothing positive in things considered in themselves, and nothing but models of thinking, or notions which we form from comparing things with one another. For one and the same thing can at the same time be good and bad, and also indifferent. For example, music is good for one who is melancholy, bad for one in mourning, and neither good or bad for the deaf. However, although this is so, these terms ought to be retained. For since we desire to form the idea of man which we may look to as model of human nature, we shall find it useful to keep these terms in the sense I have indicated. So in what follows I shall mean by “good” that which we certainly know to be the means for our approaching nearer to the model of human nature that we set before ourselves, and by “bad” that which we certainly know prevents us from reproducing the said model. For it is important to note that when I say somebody passes from a state of less perfection, to a state of greater perfection, and vice versa, I do not mean that he changes from one essence or to form to another (for example, a horse is as completely destroyed if it changes into a man as it would be if it were to change into an insect), but that we conceive his power of activity, insofar as this is understood through his nature, to be increased or diminished.

    Philip may have been both good and bad due to circumstances. he was good in the Blackstable with his Auntie Louisa and Uncle William. he became bad in school because his classmates taunted him because of his clubfoot. In Heidelberg, he is good to all the people even if he did not understand their silence and even their insolence. In France, was forced to become bad, to protect himself from the looming abuses of other foreigners. The death of an anti-social fanny Price, showed him to be the only compassionate painting student.

    Hence, after a series of Philip’s tragedy, his experiences, his meeting with different people, his education, his travel to Heidelberg, to Paris and to London, his affluence and reversal of his fortune to poverty taught him greatest lessons in life. That life can be beautiful if man knows to master his emotion, moderate his desire and be reasonable in every decision. A man is finally freed from the chains and cufflinks ” Of Human Bondage”.

    References:

    Maughm, Somerset W. (1991). Of Human Bondage.

    Canada: Bantam Book Doubleday.

    Morgan, Michael (ed.). (2006). The Essential Spinoza: Ethics And Related Writings.

    Cambridge: Hackett Publishing, Inc.

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    Source by Wilfredo M. Valois

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  • Ancient Medicinal Wisdom: Vedic Healing With Coriander

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    In Ayurveda, the rasa or taste of coriander is initially sharp or astringent. Digestion mellows this to sweetness.

    What is Ayurveda?

    This is the ancient medical system of India. Ayurveda postulates that there are three basic types of energy or doshas: Vata dosha or wind energy, Pitta dosha or fire energy, and Kapha dosha or water energy. Every individual, (indeed, all matter), is made up of different degrees and combinations of these doshas. This is called the prakriti or constitution of the individual.

    Ayurvedic belief is that coriander, seeds as well as the plant, is beneficial to all body types or doshas as it does not arouse pitta like most other spices.

    Coriander leaves, seeds and powder are used extensively in Indian kitchens because of their appetising aroma. Ancient Ayurvedic practice had recognized the benefits of coriander: the use of these seeds and powder is rooted in this.

    Multiple benefits of Coriander:

    • These seeds contain dietary fibre and this aids in good bowel movements. It also helps in removing intestinal gas and prevents nausea. Coriander seeds can be dry roasted, powdered and added to most dishes; it’s not all about flavor, they are a good digestive aid. Ayurveda tells us so!
    • It will stimulate appetite by helping to produce digestive enzymes and aid in the breakdown of food.
    • It is also good for liver function. This is probably why it is a good appetite stimulant.
    • Coriander powder and seeds do not arouse pitta. In modern scientific terms, coriander is alkaline. Thus, it is good for urinary tract infections. It is also a mild diuretic.
    • These are an age-old cure for menstrual cramps: just boil 1-2 teaspoons of coriander seeds in half a litre of water, add a teaspoon of organic sugar and drink warm. The relief is palpable.
    • Ayurveda has always known it; now modern research shows coriander seeds to inhibit bacterial growth thus making them a good anti-bacterial agent. This inhibitive property makes coriander a good fighter of stomach infections.
    • Anti-bacterial coriander is also a good anti-fungal. Coriander seeds are quite useful in fighting skin problems like eczema, itchy skin, and rashes.
    • It contain linoleic acid which is why they provide pain relief as well as act as an anti-inflammatory. This property also makes them useful in curing mouth ulcers and sores.
    • Ayurvedic cures for chronic conditions like arthritis make liberal use of coriander seeds/powder. A ‘tea’ is made by boiling ground coriander seeds in water and drinking the warm decoction.

    Here are some Ayurvedic recipes for different ailments which make generous use of coriander seeds:

    • That parched feeling that a fever causes can be relieved by boiling 1 teaspoon of coriander powder in 1 cup of water. Drink after cooling, and your thirst will vanish.
    • For fatigue or a burning sensation in the body, soak a teaspoon of coriander seeds in a glass of water. Let it stand overnight. Strain and drink first thing in the morning.
    • Boil 1 tsp of coriander seeds in half a litre of water. Let it stand for 10 minutes. Strain and drink. This relieves any burning sensation while urinating.
    • Do not pop a pill at the first signs of malaise.The harmful effects of unnecessarily medicating yourself can be controlled by these simple home remedies which carry the goodness of Mother Nature. Ayurveda views human beings as an integral part of larger creation and treats human ailments non-aggressively.
    • When medicines should be used with circumspection, what can one say about the harmful chemicals that we ingest every day unknowingly? Food production in the modern day is fraught with dangerous practices. The indiscriminate use of chemical methods of farming is poisoning almost everything we eat. The organic movement aims to reverse this. If you want to enjoy the maximum benefit of any food product, GO ORGANIC. Coriander is no different.
    • Terragreens Organic is a store of the freshest and most natural ingredients, untouched by chemicals. Enjoy the full benefit of this miracle of Mother Nature. Buy your coriander seeds or powder from the best!

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    Source by Karthik Guduru

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