Tag: Resolution

  • Maternal infections in health facilities

    Maternal infections in health facilities

    A clearer picture of the global impact 

    New research from the Global Maternal Sepsis Study (GLOSS), a major WHO/HRP initiative, shows that infection has a much larger impact on global maternal mortality and morbidity than previously thought.

    Logo of the Lancet Global HealthThe
    results from GLOSS, published in The Lancet Global Health, are the first to provide data on frequency of maternal infections and
    sepsis across the pregnancy and post-pregnancy period, in a large number of health facilities around the world. 

    Around 11 women per 1000 live births had an infection which resulted in or contributed to what is known as a severe maternal outcome – either they died or nearly died – during their hospitalization. 

    Urgent improvement is needed to manage this life-threatening risk faced by all pregnant and recently pregnant women, wherever they are in the world. 

    What is maternal sepsis and how does it lead to maternal death?

    Maternal sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs during pregnancy, child-birth, post-abortion or the postpartum period.

    The latest global estimates place sepsis due to obstetric infections as the third most common cause of maternal mortality. However, this only includes infections as a direct result of pregnancy, such as endometritis or post-caesarean wound infections.

    Few
    previous studies include post-abortion infections. Neither do they address indirect infections such as respiratory and meningitis, which are aggravated by pregnancy but not directly caused by it.

    A better understanding of maternal infection

    GLOSS was a massive facility-based data collection effort led by WHO, accompanied by a ‘STOP SEPSIS!’ campaign to increase awareness among healthcare providers.

    The study gathered data on women who were admitted with suspected or confirmed infection during pregnancy or post-pregnancy over a one-week period in 2017. More than 2800 women participated in the study in 52 countries.

    GLOSS included healthcare facilities that care for women during pregnancy, childbirth or at the end of pregnancy, as well as facilities without maternity service but where women could be hospitalized during or after pregnancy, and data on infections
    which are not usually recorded as maternal sepsis, including post-abortion and indirect infections. 

    The result is a more complete understanding of the frequency and impact of maternal infections in health facilities. 

    GLOSS calls attention not only to the wider range of risks faced by pregnant women but also to the long period of time during which they are at risk. 

    Putting global numbers on maternal infection and sepsis

    Overall, around 70 pregnant or recently-pregnant women per 1000 live births were found to have a maternal infection needing hospital management. 

    Across the study, 11 women with either direct or indirect infection per 1000 live births developed a severe maternal outcome, but in low- and middle-income countries up to 15 women per 1000 births were affected.

    Infections were the underlying cause of most of the deaths recorded during the study, primarily post-abortion infection and indirect infections. Infections were also present in about a third of deaths attributed to other causes, such as postpartum
    haemorrhage.

    This suggests that the contribution of infection to global maternal mortality and morbidity may be larger than current reports of maternal sepsis mortality suggest.

    Preventing, identifying and treating maternal infection and sepsis

    Some of the most common maternal infections found in the study, such as urinary tract infections, post-caesarean and post-abortion infections, are largely preventable and treatable.

    GLOSS results suggest that current levels of monitoring and clinical care across health facilities are not enough to prevent, identify and treat levels of maternal infection effectively. 

    For instance, a complete set of vital signs was not reported for a third of the women in the study, on the day their infection was suspected or diagnosed. Delays in antimicrobial therapy were frequent.

    GLOSS also shows marked differences across countries, with the highest burden in low- and middle-income countries, compared with high-income countries.

    This may reflect the impact of broader health determinants in different country contexts. Challenges of overcrowding, limited access to water and sanitation and constraints to safe births by skilled birth attendants can reduce the ability of healthcare
    providers to manage the frequency and outcome of maternal infections.

    An opportunity to implement evidence-based practice

    GLOSS gives healthcare providers, policy-makers, and the public at large an opportunity: to mobilise around these data improve evidence-based practice, and save lives. 

    WHO has produced a number of resources which can support timely action to prevent, diagnose and treat maternal infection, as well as activities such as the upcoming SAVE LIVES: Clean Your Hands campaign
    on 5 May which celebrates the central role played by nurses and midwives in clean health care. 

    In addition, WHO will publish a global sepsis epidemiology report around the 73rd World Health Assembly (WHA) in May, as requested in the
    2017
    WHA Resolution on Improving the prevention, diagnosis and clinical managementof sepsis.

    Understanding why and how infection affects women is essential for equipping healthcare providers with life-saving knowledge and enabling health care systems to bring down global maternal mortality and morbidity.

    Related publications

    WHO recommendations for prevention and treatment of maternal peripartum infections

    WHO Clinical practice handbook for safe abortion

    Global guidelines on the prevention of surgical site infection

    WHO statement on maternal sepsis

    World Health Assembly resolution on Improving the prevention, diagnosis and clinical management of sepsis

    Health Topics

    Antimicrobial resistance

    Infection Prevention and Control

    Water Sanitation Hygiene

    Other links

    Global Maternal Sepsis Study

    SAVE LIVES: Clean Your Hands 5 May 2020

     

     

    Maternal infections in health facilities
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  • Schistosomiasis elimination: refocusing on snail control to sustain progress

    Schistosomiasis elimination: refocusing on snail control to sustain progress

    Substantial progress has been made during the past decade to prevent and control schistosomiasis (also known as bilharziasis) globally. The disease affects more than 230 million people, mostly in sub-Saharan Africa.

    Progress is mainly due to large-scale periodic treatment of affected populations with praziquantel, the only medicine recommended by the World Health Organization (WHO) against all forms of schistosomiasis. Regular treatment cures mild symptoms and prevents
    progression to severe, chronic disease.

    “Through progressive scale-up of periodic large-scale treatment
    to control morbidity in many endemic countries, we are closer to
    achieving the minimum target of 75% global coverage of all school‐aged
    children,
    ” said Dr Amadou Garba Djirmay, who leads WHO’s global schistosomiasis control programme. “But
    if we want to achieve elimination, we must go a step further to
    introduce snail control in hot spots and in areas targeting elimination.
    This is bound to increase impact and accelerate progress towards
    interruption of transmission
    .”

    Expansion of treatment is largely supported by donated praziquantel from Merck KGaA of up to 250 million tablets annually. In 2018, almost 78 million children were treated, representing 63% of all school‐aged children eligible for treatment.

    Transmission: role of snails

    Schistosomiasis is an acute, chronic parasitic disease caused by infection with trematode worms of the genus Schistosoma. It is prevalent in tropical and subtropical areas, especially in poor, rural communities that have little or no access to
    safe drinking‐water and basic sanitation. Infection is transmitted when people suffering from schistosomiasis contaminate freshwater sources when evacuating urine and faeces containing the parasite’s eggs.

    Once an egg comes into contact with fresh water, it releases miracidia (hatchlings) which enter a snail and produce hundreds of cercariae (larvae) daily. The cercariae enter the human body on contact with the skin and develop into adult worms.

    Besides treatment with praziquantel, eliminating snail hosts and improving sanitation are important methods for sustainable prevention of the disease. Dam and irrigation projects are known to be potential sites for outbreaks of the disease. Snail management,
    often achieved through mollusciciding, can help to reduce transmission by eliminating these intermediate snail hosts.

    Vector control

    In 2017, the World Health Assembly – WHO’s decision making body – adopted resolution WHA70.16 on the Global Vector Control
    Response, calling on Member States to develop or adapt national vector control strategies and operational plans. The strategy aims to reduce by at least 40% the incidence of vector borne diseases, including schistosomiasis, by 2025.

    In response, WHO is reinforcing snail control as part of its strategic approach to achieve the target of eliminating schistosomiasis as a public health problem and, ultimately, the goal of elimination of transmission. Snail control will complement mass
    treatment campaigns and sustain the public health impact of this core intervention.

    To facilitate implementation of snail control, in 2019 WHO published on specific, standardized procedures and criteria for efficacy
    testing and evaluation and in 2017 a manual on the use of molluscicides in the field. WHO is also planning to strengthen capacities
    of health staff in medical malacology in order to reinforce snail control activities in countries.

    In the past, molluscicides (particularly niclosamide1 based products) were widely used in schistosomiasis control programmes. For example, in China programmes largely relied on snail control for over 30 years to overcome the disease as a public
    health problem. In other parts of the world, however, snail control programmes were gradually discontinued and competencies faded away.

    “Snail control is a crucial component of the global schistosomiasis elimination strategy,” said Dr Rajpal Yadav, Scientist, WHO Department of Control of Neglected Tropical Diseases. “It
    is time we look for new snail control products that are cost–effective
    and of low risk to humans and the environment. Some efforts are being
    made to explore molluscicide compounds from plants, marine algae and
    microorganisms
    .”

    An integrated control strategy involving mass treatment with praziquantel, snail control and environmental modification, wider access to sanitation and safe water, economic and environmental development, health education and poverty-alleviation can greatly
    contribute to sustainable control and elimination of schistosomiasis.

    WHO’s new road map on neglected tropical diseases for 2021–2030, due to be launched later this year, advocates enhanced financial and political support to achieve the target of interruption of transmission. Additional research to address gaps,
    develop tools and optimize the impact of existing programmes with snail control will complement the core strategic approach.

    Schistosomiasis: forms of the disease

    There are two major forms of schistosomiasis – intestinal and urogenital.

    Intestinal schistosomiasis usually results in diarrhoea and blood in the stool; enlargement of the liver and of the spleen and portal hypertension are common in advanced cases.

    Urogenital schistosomiasis is characterized by the presence of blood in the urine. Chronic infection results in fibrosis of the bladder and ureter that can evolve to hydronephrosis and create conditions for bladder cancer.

    In women, urogenital schistosomiasis can cause vaginal bleeding, pain during sexual intercourse and nodules in the vulva, a condition now described as female genital schistosomiasis. In men, urogenital schistosomiasis can induce disease in the seminal
    vesicles and prostate.


    1Limitations with the use of formulations based on niclosamide include restrictions on the usage of water immediately after application and temporary toxicity to non-target aquatic organisms including
    fish, amphibians and invertebrates. 

     

        Schistosomiasis elimination: refocusing on snail control to sustain progress
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      • A 529 college savings resolution you can keep

        A 529 college savings resolution you can keep

        Recurring Contributions (automatic investments) is an easier way to save for college, allowing you to set up automatic payments to remove some of the stress of saving, often with less hassle than doing it manually.
        A 529 college savings resolution you can keep
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        https://investornews.vanguard/a-529-college-savings-resolution-you-can-keep/

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      • Novel inexpensive tactile sensor allows robots to feel

        Novel inexpensive tactile sensor allows robots to feel

        With the help of machine learning, ETH researchers have developed a novel yet low-cost tactile sensor. The sensor measures force distribution at high resolution and with great accuracy, enabling robot arms to grasp sensitive or fragile objects.

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        https://techxplore.com/news/2020-03-inexpensive-tactile-sensor-robots.html

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      • Mid-term review of the UN Decade of Action on Nutrition

        It is almost five years now since the Nutrition Decade was declared. It is time to reflect back on its achievements so far. FAO and WHO are convening an open and inclusive dialogue with stakeholders for the mid-term review of the Nutrition Decade.  DOA_logo2

        This review follows the ECOSOC Resolution 1989/84 regarding international decades, which provides that an appropriate inter-governmental body should appraise the implementation of a decade’s programme of work at the mid-point and at the end of the decade.

        The objectives of the Mid-term Review of the Nutrition Decade are to assess and evaluate the achievements in individual policy areas of the ICN2 Framework for Action, as reflected in the actions areas of the Work Programme of the Decade, over the time period from 2016 to 2020. The Mid-term Review aims to identify focus areas for priority action and promising opportunities in each of the six action areas for future progress from 2021 to 2025. This assessment will guide the revision of the ‘living part’ of the Work Programme of the Nutrition Decade as appropriate.

        The process will include a series of consultations and dialogues with member states, civil society organizations, private sector, UN partner agencies and others, as well as an open online consultation. Finally, a global event is envisioned to be organized to underscore the achievements of the first half of the Nutrition Decade and set the stage for the priorities during the second half. More information is provided in the concept note.

        The joint FAO/WHO Nutrition Decade Secretariat has developed the Mid-term Review Foresight paper, which will serve as the background paper for the consultation process. Reflecting on the broader development in nutrition globally, this paper develops a vision on actions to be taken in the different areas of the Work Programme of the Nutrition Decade, considering specific advances and opportunities in individual policy areas.

        Background documents for the consultation process of the Mid-term Review of the UN Decade of Action on Nutrition 2016-2025 can be downloaded here. We will add the other 5 languages when they are available, and meanwhile, publish some in English only.  

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        https://www.who.int/news-room/detail/12-03-2020-mid-term-review-of-the-un-decade-of-action-on-nutrition

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      • Cervical cancer elimination initiative updates

        Cervical cancer elimination initiative updates

         

        Banner of the Cervical cancer Elimination newsletter

        February: Garnering international support on the path to eliminate cervical cancer

        On
        5 February, the WHO Executive Board recommended to the 73rd World
        Health Assembly the adoption of the draft Global Strategy to accelerate
        the elimination of
        cervical cancer as a public health problem, and urged its
        implementation. The proposed resolution urges Member States to implement
        the strategy, calling for the support of international organizations
        and other relevant stakeholders, and includes a request
        for the Director General to support Member states in this endeavor.
         The WHA will consider the resolution when it convenes in May 2020.  The
        session included 23 interventions from EB Member States, most of them
        in full support of the Strategy and resolution;
        18 from other Member States, 6 observers and 6 non-state actors. Dr
        Nono Simelela, ADG and Special Adviser to WHO Director-General Dr
        Tedros, responded at the end of the session, thanking delegates for the
        broad support, and addressing some of the comments
        by sharing some of the ongoing work such as the efforts with the
        immunization partners to address HPV vaccine supply challenges and
        transparency in pricing.

        Read the full story

        Read the full draft resolution

        Download the
        Draft Strategy


        Dr Nono Simelela presented the draft Global Strategy towards Eliminating Cervical Cancer as a Public Health Problem during a webinar with partners. This presentation was given as part of
        the Us vs. HPV Prevention Week webinar series hosted by the Global
        Initiative Against HPV and Cervical
        Cancer. While highlighting WHO’s life-course approach to cervical
        cancer control, Dr Simelela also explained the proposed elimination
        threshold and targets as laid out in the strategy. She also discussed
        addressing salient challenges such as redressing inequities
        and taking special considerations for women living with HIV.

        Read the full story

        Listen to the full webinar “Gathering momentum for the global elimination of cervical cancer”

        Watch the video: Cervical Cancer Elimination – developed by Basic Health International (BHI), Union for International Cancer Control (UICC) and the Global Initiative Against HPV and Cervical Cancer (GIAHC)

        Read the story:To eliminate cervical cancer in the next 100 years, implementing an effective strategy is critical


        Dr
        Simelela was invited to Rwanda to support the kick off for a national
        cervical screening program set to put Rwanda on the path towards the
        Global Strategy goals
        for elimination of cervical cancer.

         

        Dr Simelala with the 1st Lady of of the Republic of Rwanda, Mrs. Jeannette Kagame

         

        HPV DNA test self-sampling demonstrated at cervical cancer screening facility, Muhoza Health Center

        Radiotherapy facility at Rwanda Cancer Center, colleagues from MOH, WHO, RBC and CHAI

         

        Amongst
        others, Rwanda’s First Lady Jeannette Kagame received her for a
        discussion on how WHO can support efforts against cervical cancer in her
        own country and
        throughout Africa. Dr Simelela held discussions on cervical cancer
        screening and treatment services, including building radiotherapy
        capacity, with the dedicated staff of Ruhengeri Hospital, Butaro
        Hospital, the Muhoza health center and hospital and the Rwanda
        Military Hospital. While cervical cancer and breast cancer are the most
        prevalent cancers among the women in the country, Rwanda has
        impressively reached a 97% HPV vaccination rate since introducing a
        vaccination programme in 2011, with a target to reach 70%
        screening coverage in five years. We look forward to a continuing and
        fruitful partnership with Rwanda and all the countries who have pledged
        their commitment to eliminate this preventable cancer. Together we can
        answer WHO’s call and improve the lives of
        girls and women around the world. 


        Follow us for more updates!

        Sign up for our newsletter
         

        Cervical cancer elimination initiative updates 5For
        news and real-time updates from around the world,
        follow Dr Princess Nono Simelela on Twitter
        @DrNonoSimelela
        ADG, Special Adviser to the Director-General on Strategic Programmatic Priorities

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        Cervical cancer elimination initiative updates
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      • WHO EB recommends the adoption of the strategy for elimination of cervical cancer

        WHO EB recommends the adoption of the strategy for elimination of cervical cancer

        20200203_WHO_Executive_Board_021

        Co-sponsored by 20 Member States and the EU, the draft resolution for the
        Seventy-Third World Health Assembly (WHA) was presented on 5 February,
        2020, at EB146.

         The proposal followed Executive Board Members’ review of the Director-General’s report.

        The proposed resolution recommends that the World Health Assembly adopt the global
        strategy to accelerate the elimination of cervical cancer as a public
        health problem and its associated goals and targets for the period
        2020–2030.  It also urges Member States to implement the
        strategy, calling for the support of international organizations and
        other relevant stakeholders, and includes a request for the Director
        General to support Member states in this endeavor.   The WHA will
        consider the resolution when it convenes in May 2020.

         

         

         

        WHO EB recommends the adoption of the strategy for elimination of cervical cancer
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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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