One of my favorite movies of all time is the classic from 1999 Office space if you haven't seen that movie as much as I hate to tell you to do this Please pause this video right now go watch office space. You're gonna enjoy it It's it's really really funny and I think it holds up after 20 plus years Especially as I get older and have more work experience and have my own Then I can really relate to the plight of Peter the main character in the movie who has a bunch of different bosses Who are constantly coming by to give him what they think is helpful feedback on his job performance You know and somebody will come by and say, you know, we have covers on these TPS reports now And then five minutes later somebody else will come by and tell them the same thing and give him more feedback on that Not really helpful. He's getting all kinds of feedback They even bring in consultants to evaluate the performance and provide feedback on Performance of individual employees to make cutbacks and things It's no wonder that the guys in this movie end up go crazy They take they steal you know a printer a copy from the copy from the office and and bust it up when they all get Let loose sorry spoiler alert, but they they do that and there are days when I can certainly relate to that I would say the desire To do that based on you know, how you're getting feedback and what feedback you're getting really an important part of Leadership and communication and leadership is performance appraisal and and the systems that surround Performance appraisal. So that's what we're gonna take a look at in this video. How can we? Select an appropriate performance appraisal system How can we use it to the benefit of the organization and the employee and and what are some of the considerations then they go into things like that? So first of all, what do we mean by performance appraisal system? Well, a performance appraisal is really just a means of systematically evaluating a person and or process to establish Perform across established performance dimensions, right? So let's break that down just a little bit first of all performance appraisals are a system They're systematic for a variety of reasons not the least of which is so that we can apply them evenly across the organization and Use the same standards for people in the same roles or similar roles But there's a system there needs to be a process that everybody understands How they're being evaluated what they're being evaluated on and things like that. We use it to evaluate people We're gonna focus on people in this you can use it to evaluate evaluate a process as well But we're gonna focus on the people aspect of this and and then it's across established performance dimensions as I mentioned It's it's something that is known. This should not be a secret. These things should not be secret We want people to know what the expectations are and and help them achieve that. That's the goal So that's what we're looking at when we talk about performance appraisal How's performance appraisal used in organizations? Well, it's gonna vary from organization to organization But one of the primary things that use performance appraisal for is to provide feedback As much as I just trashed it from the movie office base really It's not the fact that he's getting feedback that's a problem in that movie It's how he's getting it and the fact that it's not very systematic and things but feedback is essential We need to let people know what they're doing and and then engage them on whether they're doing it Well, where where there are things they can improve upon those types of things So we need to be able to we need to have a system through which we can provide feedback to the members of our team So performance appraisals are effective for that function We also use performance appraisals to guide development As people grow in their jobs and in their careers. They need Assistance they need help knowing how to grow and how to develop new skills and refine skills that they should have and So for so we use performance appraisals to to guide development Okay, we also use it to inform our personnel decisions. We use it as a way to measure You know who's doing a good job? Who has room for improvement? Who do we want to move to different positions? Who do we need to let go who should we promote those types of things? So we use performance appraisal to inform our personnel decisions We also use it to determine rewards and compensation if you're looking at who's gonna get a raise Who deserves a mump and pay who deserves a new title or promotion so forth? Rewards of that sort. We're gonna use performance appraisal to make those determinations And then we use it to identify A team member's value to that organization in the end the organization directly is there to accomplish something usually That's to accomplish, you know some sort of profit if you're if you're a for-profit business Or if you're a nonprofit or some sort of organization like that then The organization exists to achieve a goal and to to meet some sort of purpose So we're identifying the value of each individual to that organization in meeting those goals Whatever those goals may be so we use performance appraisal to to weigh out Is this person providing value to our organization or are they not? So again, there are a variety of things that we use performance appraisals for these are some of the key ones some of the More common ones, but there are lots of things that we use performance appraisal for There are also as I've kind of alluded to lots of issues in performance appraisal lots of ways the performance appraisal Can go sideways and be less functional and not as useful and in fact can be Destructive or distracting in an organization. So let's take a look at some of these first of all We need in performance appraisal to be concerned with right validity and reliability Validity and reliability what we mean by this first of all validity means does the instrument measure? what it's supposed to measure so whatever performance appraisal instrument or or System technique that we're using Does it actually measure what it's supposed to measure? Is it appropriate for a person in that position in that role with those goals? Is it is it measuring what we think it's measuring? So we need to be sure that it's a valid Instrument and then we need to be sure that it's a reliable Instrument so we examine reliability which is does this instrument yield consistent results each time? That it's used now that doesn't mean each person gets the same rating or ranking necessarily, but Does it really does it does it tell us kind of the same information from situation to situation is it applied? It cannot be applied equitably across an organization or across a particular function You may have different performance appraisal standards and systems that use for different levels or different employees different areas, but When we're talking about people who all work in the same general area doing the same sort of function and we're using that same Performance appraisal system or technique to evaluate them. Is it yielding consistent results? Is it telling us the same things each time or is it more wildly different and dependent on the person administering that the performance appraisal and You know different factors like that. So we want to make sure that the instrument is both valid and reliable So we check validity and reliability In addition, we need to look out for a couple of different errors here There are a variety of different errors that are common here one is central tendency error So if you're using a ranking system, for example, that that uses a system, you know one through five or Pour through excellent and you have different Levels that you're like a Likert scale that you're using, you know to to evaluate There is a tendency at times for people to just put a C or three Right down the middle whatever the middle one is they just choose kind of right down the middle And we have this ability this tendency to just kind of evaluate everyone right there in the center So that nobody really is ever doing very poorly, but also not really excelling or doing well That's not really informative It doesn't accurately represent. I mean certainly not everybody in the organization is straight down the middle So we need an instrument and and the application of that instrument that avoids the central tendency error We also need to avoid going either in the other directions We want to avoid being overly strict or overly lenient you'll have people that you know will mark all you know Outstanding performance for everybody and that's not very helpful and or the other direction They'll say oh poor performance because they think oh everybody has room to improve So we have those tendencies as well We need to avoid those things and be on the lookout for those things so that we are giving you know an accurate and fair reflection of the performance We want to avoid the halo effect kind of assigning Sainthood to a particular employee for whatever reason they've done something really great So we just all of a sudden constantly giving them High ratings and all the areas and so it's carrying over We need to be able to evaluate people fairly in the different areas that we're evaluating them in if somebody's really good And one thing that's great indicate that but they may not be great in other areas It's okay to indicate that just because they're super good at one thing doesn't mean we have to rate them highly in everything That's what need to watch out for the recency error meaning we tend to be more influenced by the things that have happened Most recently right so if you if you're evaluating somebody on the basis of you know a year or six months or whatever We need to look at that time in full and not just rely on what happened in the last couple weeks Something really bad happened yesterday So now everything on their evaluation is in the dumpster right or something they did something really spectacular a week ago We let that override maybe their performance from the rest of the year. We need to be able to evaluate Consistently across the board for that year. We'll talk about one of the ways we do that Maybe is either evaluating more frequently or Taking notes along the way so that we can review that if we are you know looking at this over a longer period of time So but we want to avoid that that recency error And of course we always need to be aware of and try to avoid our personal biases If you're somebody who I'm you know, I had a professor in in in college who just very clearly Had a bias toward the males in the class and was much harder on The ladies in the class much harder on the female students than he was the male students And that showed up in his grading and showed up in how he just how he Called on us for answering questions and treated us with in the tone of his voice and things His personal bias was getting in the way of his evaluation of our performance in that class Well, you know, none of us are any different if we have personal biases Against somebody for things that are unrelated to that job performance Then we need to really work to set those aside and focus strictly on The tasks and things that are related to that job performance and just be cautious to try and avoid as much as possible our own personal biases in Performance evaluation, but these are all really very common things Which is why we engage in training for people who are doing performance appraisal and we should engage in norming What we call norming for people who are engaging in performance appraisal If you have, you know, a handful of people who are evaluating a larger group We want to get those that handful of people together for norming so that we're all Reading things the same way and understanding what the standard is in the same way and applying it in relatively the same fashion Okay, so we want to be on the lookout for these issues in performance appraisal There are a variety of techniques we can use in performance appraisal and this is just a listen We're going to go through each of these individually real quick here But we're talking about graphic rating scales critical incident technique behaviorally anchored rating scales behavior observation scales management by objectives and then briefly assessment centers as well Let me give you an example of each of these just real quickly here So you can see kind of some of the different technique techniques though that we use in performance appraisal So the graphic rating scale is classic one It's pretty much just you know There's a general category of things and you indicate whether that person again kind of a Likert scale have they met the requirements? Have they not have they partially done it that you know on a scale of one to five Where would you rate them on each of these categories and this is applied then across people in all areas of the The the area where the organization or whoever you're evaluating but pretty straightforward and then you can make comments as You know as it relates to this to support your decision why you pick this or that these again are the types of areas where we want to avoid those central tendency errors and the strictness and leanness errors, you know giving everybody all Straight down the middle or all far exceeds or all does not meet or whatever We want to be sure that we are accurately identifying across the scale on each of these items But but pretty classic pretty pretty easy to use a graphic rating scale Critical incident technique goes a little more in detail We have the duties that are listed there and this could vary from organization organization Obviously, but you have some in some standard that you're looking at there for the duties or whatever tasks you're evaluating that person on Then you'll identify what the target is for that what they should be doing what your hopes are for them to be doing it And then you identify specific incidents along the way not just all again avoiding recency avoiding that type of thing We want to look along the performance evaluation schedule and and identify and take notes on when certain things happen So that we can have specific examples of critical incidents that identify whether or not they're Actively meeting these goals, and then we can discuss and go from there toward development. So there's the critical incident technique There's the behaviorally anchored rating skill. This one gets a little more complicated a little more Detailed which is you know good and bad complicated means more time-consuming and and and really takes a lot more training to For the evaluator to be able to apply effectively. So it does take more time and resources in that regard Also provides the employee with some great feedback tone gives them very detailed information on Where they're at and why they're there why they're at that level or whatever So we you have these different levels of groups and then specific identifiers That identify where they fall on that scale And then these are these are related to then behaviors as you might imagine from the title behaviors that that employee demonstrates in relation to those items the behavior observation scale is kind of a mix between the the the the the other behavior scale and the The first one we talked about just kind of a Likert scale, right item. So it does apply specific tasks Then identifies specific tasks, but then a basic Likert scale on usually on whether or not the person is meeting That task so it's a little less detailed a little less in depth So it's a little easier to use for most evaluators, but it doesn't provide quite as much depth in like a three three-dimensional type way for the employee, but But it can be a good hybrid of those things providing more detail than the one and less time-consuming less Evaluation error than the other Let's have manners management by objectives where this is where the organization specifically lays out This is what you're being evaluated on this is what you're being judging on in detail These are not you know general categories or broad categories They are and it's usually part of a larger system management by objective is usually a larger system That's in place in that organization, but and then it's used for the evaluations as well where we identify Okay, this is what we said are our goals and this is have you met these and have you worked toward these and and you're gonna Give a rating your supervisors gonna give a rating you're gonna get input from a variety of different areas and usually in MBO as well and Then finally one that some organizations have begun to use what we call assessment centers where they send their employees out to a You know off usually an off-site center where they're evaluated for different a variety of different things could be Could be their aptitude in a particular task area could be You know for some aspect of leadership development. It could be for a variety of different things But assessment centers are usually off-site centers where different types of evaluations and performance appraisals are Administrative so when you're performing a performance appraisal one of the things that you're doing Obviously is giving feedback and that can go a lot of different ways So I have a couple tips here for you just on providing feedback effective feedback things to keep in mind when you're Addressing an employee in an important in a performance appraisal. How do we provide them with effective feedback? Well, first we want to be specific You don't just want to you know be generalizing things. Yeah, you're doing a pretty good job in this area, and it's okay That's not helpful for anybody. You want to be specific These are the things in detail that you are doing well These are the things that you're accomplishing and these are the areas specifically that I need you to You know work on improving and give them some specific areas not just you need to work harder, you know do better Again, that's not very helpful. How do you how do they do that? How do they work harder? How do they do better give them some specifics on that? So you want to be specific in your feedback? You want to offer examples again part of being specific then is you know offering examples of well, how can you work hard? You need to you need to Better production out of you. So offer them some examples So, you know there are times when you extend your lunch break a little bit too far or you're obviously on social media a lot Or whatever let's cut those things out Let's offer some examples of things that they can do to improve their performance We need to show a desire to help them improve It shouldn't just be all coming down on them like a ton of bricks right and telling them how terrible they are and Giving them the sense that they're going to be on the way out the door unless that's the case But but we need to as a you know somebody in this type of position if we're giving that performance appraisal presumably We're somebody who's in a position then to help them improve and and would benefit from that ourselves So we need to let them know that we want them to improve that we are here for them to improve that We're going to support them in that and and help provide them with the tools that they need to do so So we need to show a desire on our part to help them improve We need to balance the positive and the negative these don't all have to be you know just massively critical sessions They shouldn't all be Rainbows and unicorns either it should be some balance of the positive and negative We need to acknowledge what where there's area for improvement and and encourage the employee to Improve in those areas and give them the tools to do so, but we also need to acknowledge where they're where they're doing Well, what are they doing? Well, let's give them some kudos Let's let's balance the positive and the negative so that they don't leave these feeling like they just got knocked around a bit We need to frame things in proactive and positive terms Even when you're given bad news there are different ways that you can give that bad news Right, and I'm not saying, you know sugarcoat everything I'm saying though that there are ways that we can frame things with our language with a Broad and wonderful language that we can use to frame things in a way that is proactive that shows a light sort of at the end of That tunnel, you know, this is an area where you need some improvement I need to see some improvement in this right away And here's how you're going to be able to accomplish that you have the ability to do this it is achievable Let's go after it. Let's put those things in proactive and positive terms then for that person We need to check for understanding at the end of all this We need to ensure that that the the person walks out of there understanding what it is They're doing well where they have area for improvement and and what we expect from them moving forward And we need to check for that understanding not just assume that they've grasped it But we need to check for that and and make sure that they that they have a full understanding One last thing in terms of performance appraisal that tends to come up is this idea of rewards and motivation So a couple things to keep in mind again There there are a couple of different functions that we have for reward systems and these are oftentimes tied to performance appraisal You know when you're somebody's doing a good job They sometimes get rewards or if they're not and you eat angle that carrot in front of them So that they will go after it and try and do better jobs so there are lots of different functions for reward systems include things like this like job effort and performance that We can use it to try to increase job effort and performance improvement performance We can use it to try to improve attendance and retention rewarding things like showing up for work on time and showing up for work every day and and sticking around you know longevity retention meaning People stay with the organization. We can reward people for staying with that organization We can use it for to enhance employee commitment Reward system to enhance employee equipment commitment to that organization by rewarding them in some way based on performance With job satisfaction a lot of this, you know rewards can can bring obviously job satisfaction can help us enjoy our job more and just in general occupational organizational choice and kind of tied back to retention are people going to Remain in this occupation is this where they for example right now teaching is an area where they're struggling with occupational and organizational choice right they're struggling to get people first of all to commit to remaining teachers because the It's not what they did the teacher said idealized and it's it's becoming a real struggle to get people to stay in teaching They're leaving teaching to go to different Occupations and if they are staying in teaching they may be moving to a different school if they're not pleased if they're not Satisfied with the rewards in the system that they're in so we need to think about those things as sort of functions of a reward system Why that system can be important? The other thing we need to bear in mind is that there are different types of rewards and people are Motivated differently as a result. They have extrinsic rewards and intrinsic rewards Extrinsic rewards are those that are external to us so things like money things like You know objects every once in a while my employer will send me little trinkets and say hey, thanks You're doing great John. They'll send off, you know great great things like a phone charger or I've gotten socks before we got a really cool Yeti water bottle the the logo on it the organization So those are extrinsic rewards and they provide you with things in addition to things like money in general and certainly raises and Additional vacation time or benefits like that. Those are extrinsic rewards but we also need to remember that that people can be motivated intrinsically and that's some people are are Primarily rewarded or motivated intrinsically meaning within themselves This idea of you know would do the work because the work matters Because enjoy honestly, that's why I teach one of the reasons I teach. I don't know for you So I get paid for for teaching and I'm grateful for that. But but I really do love Teaching because it fulfills me it gives me a purpose It makes me feel good about myself and good about a job. Well done when I when I leave a class And I feel like students really have an understanding or had you know kind of that aha moment the light bulb went off There's nothing more motivating for me and that's totally an intrinsic thing for me. I'm very motivated intrinsically. I'm very Internally challenged, you know, I challenge myself. I want to win I'm a competitive person that and I'm motivated intrinsically I'll tell you another example. I'm diabetic and For years my wife my family my endocrinologist have all tried to get me to change my eating habits and This type of thing and be more aware of these things and test my sugar more often I just haven't been about it doesn't really have been something wasn't something that really interests me even though it should But then I got this glucometer the continual glucose monitor Right one of those things that sticks on you and tells you your Luke monitor your glucose level It tells you like every five minutes where it's at That to me has been more effective in controlling my diabetes in anything mostly because I want to beat it I want to beat my glucometer and not beat diabetes, but I want to beat my glucose monitor I don't want it to get about that. I'm so internally motivated by this that it really has I've dropped my my you know my Overall glucose levels my my a1c is the call has dropped significantly since I got that Because of that I'm much more aware now when I reach for something to eat or something to drink I think okay in 10 minutes. What's my glucometer gonna say?  So I make a different choice a lot of times So I'm intrinsically motivated now that doesn't mean I don't like extrinsic rewards. I do I like being paid I like the little gadgets that my organization sends me and I like the little you know Extras that come along with that, but I'm also very intrinsically motivated We don't want to forget that we want to balance those things out people take pride in their job and people You don't want to work hard a lot of times. So let's let's honor that and let's focus on that as well Okay in general we need to have a holistic view of performance appraisal And not see it as a chance for and not let our employees and team members see it as a chance for us to just You know break out that stick and you know tell them everything that you're doing wrong performance appraisal should be an opportunity for us to Honestly evaluate that person's performance to tell them these are areas for improvement But also these are areas where you're doing well and this is a why it's important that you do these things well We need to balance all of that in there and use this as a time for honest reflection and Motivation for that person and encouragement for that person and and keep those things in mind There was different considerations then okay So I hope you will continue on with performance appraisal in a new light now If you have questions about performance appraisal or anything else related to Communication and leadership, please feel free to email me. I'd love to chat with you in that way But in the meantime, I hope you will get out there and that you will have a new perspective on performance appraisal as both the person receiving that appraisal and receiving that feedback and the person providing it and that you'll keep these things in mind When you're in that seat as well


The closure.core namespace contains many functions for working with collections, here we'll cover the most essential. First, the count function returns the number of elements or key value pairs in a collection. The list question mark function returns true if the argument is a list, otherwise it returns false. Vector question mark returns true if the argument is a vector, otherwise it returns false. And map question mark returns true if the argument is a map, it otherwise returns false. The contains question mark function returns true if the collection contains a specified key or index and otherwise it returns false. So, here for example, the first call to count returns to because the map argument has two key value pairs. The second call returns five because the vector argument has five elements. The third call also returns five because the list argument here has five elements. Notice that we quote the list so that it is not evaluated but instead just passed to count as itself. The first call to contains here returns true because the map argument does have a key which is the number three. The second call to contains returns false because the map argument does not have a key which is the string high. The third call to contains returns true because the vector does have an index two, but the fourth call to contains returns false because the vector has no index negative seven. This last call to contains also returns false because contains always returns false for a list argument. Here are four more functions. The cons function short for conjoin returns a new collection with an added element or key value pair. The asoak function short for associate returns a new collection with an added or modified value for a particular key or index. The asoak function short for dissociate returns a new map in which a particular key has been removed. And the merge function returns a new map that combines the key value pairs of one or more maps. Looking at some examples, the first call to cons returns a new map just like its map argument but with the addition of the key value pair specified in the other argument to cons. In the second call, the original map already has a key high and so cons returns a new map in which the key high has the value seven. For vectors, conge appends the new element to the end, but for lists conge prepends the new element to the front. So the third call to conge returns a new vector with the value true appended to the end and the fourth call here returns a new list with the value true prepended to the front. Used on a map, the asoak function is just like conge except the key and value are passed separately instead of together in a vector. Used on a vector, the asoak function expects an index and a value to put at that index. In this first example, asoak returns a new vector in which the value true replaces the value at index three. In the second example, the index five equals the original vectors count, so asoak returns a vector that is one element longer. In the third example, the index six is greater than the original vectors count and so is considered out of bounds. As the last example shows, asoak does not work on lists and so will throw an exception when passed a list argument. The first dissoak call here returns a new map that removes the string key high. The second dissoak call returns the original map because that original map contains no string key by. Despite what you might expect, dissoak does not work on vectors and so will throw an exception when passed a vector. The first merge call here has only one map argument and so simply returns the original map. The second merge call returns a new map in which the key value pairs of the second are added to the first, overriding existing values for keys as necessary. Notice that the returned maps key high has the value seven, not eight. The third merge call returns a new map in which the key value pairs of the successive maps are added to the first, left to right, overriding existing values for a key as necessary. So notice that the returned maps key, yo, has the value five, not four. Here we have three more collection functions, get returns the value of a particular key or index in a collection, pop returns a new collection that omits the first element or key value pair in a collection, peak returns the element or key value pair that would be removed by pop. So here in the first call to get, the map has the value eight for the key high. In the second call to get, the map has no key by and so get returns nil. In the third call to get, the vector has the value nine at index two. In the fourth call to get, the vector has no value at index six and so we get back nil. The last call to get returns nil because get always returns nil when passed a list. For vectors, pop removes the last element, but for lists, pop removes the first element. Again, this difference stems from the structural differences between vectors and lists. For vectors, it is most efficient to remove a trailing element, but for lists, it is most efficient to remove a leading element. So peak here on this vector returns 11 because pop would remove that element of the vector and peak on the list here returns seven because pop would remove that element of the list. Neither pop nor peak work on maps.


Hello and welcome to our Google Hangout for Eliminating Tacoma MOOC and today we're joined by Professor Alan Foster who's seated right here next to me and we're waiting for Dr. Anthony Solomon to join us and from Geneva in WHO and due to some technical problems we've had a small pause in trying to get him onboard and we have Dr. Paul Emerson he is at an airport in Johannesburg and he's going to try and join in from there but to get us started I guess Alan perhaps we could start by you telling us how come you got involved in Tacoma. Thanks thanks and hello to everyone joining in. So when I was a young doctor I always had the interest to go and work in Africa and I had the opportunity to go to Tanzania and I've done some training in ophthalmology, fairly limited training but knew something about ophthalmology and when I went to Tanzania I ended up working in central Tanzania near a town called Dodoma and it was an area with severely endemic Tacoma. So really almost from the first week of being there I was faced with lots of patients coming with interned eyelashes, trichitis and entropion and so that was my first exposure to Tacoma and subsequently I got more and more interested in it over the next 10 years. Excellent. So over the last three weeks while we've been doing this MOOC we've had over 2,600 participants and from over 100 countries and many of you have sent in a range of different questions so to get us started I think I'll just highlight some of the questions that that they've started at us off to while we wait for Sol to join us. So one of the questions that came up was Tacoma is an ocular infection so why are we treating an ocular infection with a systemic antibiotic? Okay so if we kind of go back 15 years or so and look at what the treatment recommended treatment for Tacoma was at that time it was a tetracycline eye ointment and it was twice a day for six weeks and it had been shown in various trials that were conducted in the 1970s that if you gave tetracycline ointment twice a day correctly for six weeks then you did eliminate trachoma, chlamydia trachomatis agent on the eye you treated the trachoma. The difficulty was putting that actually into practice in a public health program because it meant one had to give out tubes of tetracycline to mothers and then show mothers how to treat their children and the tubes of tetracycline often in hot climates as soon as you open them all the ointment would flow out everywhere. It was messy, it was difficult, the children were small so what all that came down to was although theoretically and in a research situation ointment worked in practice compliance was poor and it was difficult to make this ointment work. What then happened I think in the early 1990s it was worked by Robin Bailey maybe in the Gambia and they conducted a trial where they compared tetracycline with one dose of azithromycin given by MERS. Now azithromycin at that time wasn't available as an ointment or as a drop hence they used the systemic formulation and the pediatric formulation to go with it and they basically showed that it was as effective as the ointment even when the ointment was given perfectly and of course in a practical point of view a one-time dose was much easier to get good compliance than six weeks of twice daily ointment so that was really the study that showed a systemic treatment as a public health program would be better than the ointment. I should point out that in the meantime drops are now available of cithromax and they are actually used for small children where you should not give the systemic treatment but in the meantime of course a donation program has become available and that's why the tablet is used. There is one other reason I mean that's that's the kind of practical reason of what happened but the other reason is is that in children who do have chlamydia trichomatous in the eye they usually have chlamydia trichomatous in the nose and the ear and in that sense it's not just an ocular infection it's elsewhere in the body as well. The systemic one has many other beneficial benefits. So something else that has been repeatedly being raised during this period is the use of systemic antibiotics of course raises the concern for antibiotic resistance and this remains a concern so have we seen something on resistance with azithromycin? Right so there's two different parts one has to understand to this first of all is we're using the azithromycin to treat chlamydia trichomatous so the question is does chlamydia trichomatous develop resistance and the answer to that is there is as far as I'm aware anyway no evidence of that and basically the macrolide group of antibiotics which is tetracycline erythromycin and azithromycin is one of those they have been used since the 1950s to treat chlamydia and as far as we know there has been no resistance so I think we're on a fairly safe ground to kind of say chlamydia develop resistance to the macrolides including zeta max however there's another side to this which is used in the treatment of other infections such as streptococcus pneumonia etc and therefore would widespread use of azithromycin in a trichoma program pneumonia and I think in that situation there is some evidence that that doesn't care I don't have all the kind of exact facts but yes other agents can develop resistance to azithrom other bacteria can develop resistance to azithromycin whether whether the public health program against trichoma is encouraging that or not we're not so sure right and we have to remember this is a single dose that we're talking about one time single dose here and in some places where you've only given the single dose you're not even going back to give another dose unless the prevalence is high so I guess this that you know we'll have to watch the evidence as it comes through yeah it's certainly been looked at ever since the donation program started which was around late 1990s so I think if if it was a problem we would have seen it by now and as I say yeah and well we're still still waiting to see if if Dr Solomon can join us but just to keep keep the momentum going um we've got certain questions here on have you ever come across the idea of of using anti-inflammatory treatment such as topical steroid drops particularly in the secretricial phase of managing early trichiosis yeah so this this has been proposed and if you think about the pathogenesis of chlamydia infection and then the immune response in the body and then moving on to fibrous scarring there would be a logic to suppress the inflammatory response from the fibrous scarring with steroids yeah a kind of logic in that sense the issue really is again we're dealing with a public health problem and one would not use steroids topical steroids in any way in a public health campaign in in the case of an individual then of course the danger is in using it in an individual with severe inflammation putting steroids in the eye you're leaving them susceptible to other infections particularly herpes simplex and therefore one would say probably the benefits of reducing the scarring are outweighed by the potential problems that you would get with steroids having said all that I remember a case which I saw myself when I was working in Tanzania which was actually an adult who came with severe bilateral panacea right so a real kind of acute an invasive of the cornea panacea which I believed was due to trachoma and was really threatening his vision in the acute stage and I treated him with topical tetracycline because that's what we had at that time I think I also gave him doxycycline the systemic thing and in a hospital situation I did put some steroids in his eye but that's anecdotal whether it helped or not I don't know and certainly I would say it's not something that is to be recommended I think it's sort of highlights the decision making that has to happen at a clinical level and what policy and guidance you need to prepare for public health and you know the logistics of the two of course the role of the clinician will always remain and like you've shown that sometimes you do need to make that decision it might be right in that scenario but in the public health we cannot give out steroids in a free way so I think that that was a point that was raised by Rosalind Schott in Alice Springs in Australia for this course so it is it seems to be still remaining as a problem to try and get both our experts from these firing light places together and just to keep us going on on the topics that we can still cover we've we've got a few questions here regarding mapping and and the use of trachoma action plans shall we go on to those questions so one of the questions that has been raised after you've finished doing the mapping exercise how soon after that do you need to develop or can you realistically develop the national plan and put that into into place and what is what is the timeline and what are the challenges of the potential to then reach that 2020 target that we want for elimination so I mean this is a very important question and it's not that there's one white answer I mean it can vary from place to place but really the mapping exercise itself should already be part of a national plan because the national plan should be saying we believe that we have a trachoma problem in this country we need a plan to address it and the first question in that plan is which are the endemic districts in the country where we need to focus the safe strategy so in that sense the first action in a national plan is the mapping process and the mapping should be done at district level and now particularly in the last four to five years there's been a huge mapping project around the world which was led by Anthony Solomon and I think most countries the maps are now available there are some worse work still needs to be done but for most countries it's now known these are the endemic districts and and these other districts are clear so once that that mapping is known once you know okay in our country there's 20 districts and 10 of them have got endemic trachoma then as soon as possible one wants to implement the safe strategy and to be honest sometimes the safe strategy has even started before the mapping process because it was just known that this is a very bad area so as soon as possible one then wants to start on the implementing the safe strategy and for that that's what's called the action plan comes in the tap which is to really look at what are we going to do about surgery what are we going to do about mda for azithromycin and what are we doing about f and e in terms of personal hygiene health education water and sanitation and that is done district by district so you may not be able to start everywhere at once you may want to prioritise the worst districts and start in those but certainly the s and the a should be going and closely quickly backed up with the f and e components with a plan of we're going to start in these three districts and from the learnings in those three districts we're then going to expand to the next seven just in terms of the longer term timeframe when it comes to mda if you have districts where the the prevalence of tf trachoma follicular trachoma in children one to nine is more than 30% you will need at least five rounds of mda whereas if it's less than 30% but more than 10 you'll need three rounds so naturally once you've done the mapping you want to start with those districts that have the higher prevalence because they are going to need the more years of the safe strategy right um it's very funny using the google hangout to say something and then not say are there any questions i'm sure there are lots of questions online um so this is an interesting question that's been raised on taps and it's a practical one um where they say taps have to be owned by national programs the challenge in many places is that this is often the stumbling block where certainly there's not enough guidance or leadership in place at that national level to get the process moving or keep it moving um so we in our course we certainly demonstrated how well it worked in kenya and because they have a strong leadership they've been able to manage that process and keep the momentum going um since many of our participants have raised this this so how does one overcome the challenges of leadership when trying to roll out a good tap so first of all leadership is critical and i think many people will say you know if you look at the good programs around the world you can often say you know that national program is good because of that person who's been a leader and developed it and so but there is another side to this which is also it it does relate to structure within the ministry of health so historically trokoma programs were usually part of national prevention of blindness programs so they came under eye care and usually eye care within a ministry of health was led by an ophthalmologist and so there would be the national prevention of blindness coordinator an ophthalmologist hopefully a committee with that person and working with the government and within the framework of the blindness program one should one could embed the trokoma control program and the tap the trokoma action plan however over the last probably five years or so there have been changes and increasingly now trokoma comes within the remit of neglected tropical diseases and very often now within ministries of health there will be a focal person for neglected tropical diseases in that country and within that the mandate will be trokoma and that then is the leadership through which to work and for example if you're an eye care worker an ophthalmologist interested in blindness prevention the country you want to then work with the NTD program to look at how trokoma is integrated within the NTD program of the country so it varies some countries are prevention of blindness and eye care leadership others are NTDs and of course like you say sometimes it falls in between and one just has to try and push as well as possible and to find that advocate within the government who will kind of say yes I'm going to take this on and make sure it happens and then work with that leadership but that's anything that have we got oh we have Dr Solomon who is online excellent thank you Anthony hello can you hear us we are doing sign language right now so we can't hear you no he's certainly saying something but we can't have we got I think we carry on and then we'll try and get solved so as we work on the audio side of it we've got visual but no audio now and so within the TAP programs one of the things that has come up is sadly when trying to set up trichiasis programs and the issues that many people don't seem to be faced with is the lack of resources and without the resources they cannot deliver the services they require so what are these challenges and how can these challenges be addressed in order to get to our elimination targets okay so obviously resources are critical I think one has to say right at the beginning that generally the safe strategy certainly S&A and add F to it as health education that is a very cost effective intervention so one's not looking at huge amounts of money there to do yes and yeah and yes if one thinks of health generally the e-component more than sanitation particularly the hardware that goes that's an expensive intervention but let's just take an F and think about what the resources are that are required and the first critical one is people so are the people trained in chakras are ophthalmic assistance available and can be trained and again that's relatively low cost to be able to do that the A obviously the drug is free of charge it's a donation but it's the distribution program yeah if the distribution program again can be part of other distribution programs like NTDs and that's lower than the cost right because one can do several treatments at the same time and within that I'm going to be doing that at the same time you can do the health promotion which is the F component so just go to that what what may look as you know significant resources in actual practice are not very expensive probably the most important things are the cost of the instrument and the trichiasis and each cost to either take the surgery to the village or to take the MDA to the villages now where is that money going to come from of course ideally from the government it should be a commitment by the government that this is part of the program I'm going I just go back to it it's not a lot of money but one needs to do it if literally the government can't afford to do it or if it's a question of getting some seed money in to get it started then often there has been external donors that have been all this be it NGOs or be it other international donors that have given money USA and the Quiddus with Diamond Jubilee Trust have all given funding for safe implementation hello Dr Solomon hi Dexter hi Alan sorry about the delay no problem I can hear you now and it sounds like you can hear me too which is great yeah that's excellent but I'm I'm going to let Alan start you off on a few questions that we've got lined up for you so it's it's almost like an exam panel that you've got sitting here and so just to let you know that we have most of we have over 2,600 participants from more than a hundred countries that are involved in the MOOC at present and once the recording goes out on YouTube there will be a transcript also provided for those who can't get the audio to download okay great thank you so Sol I'm gonna I've been quizzed for the last half an hour by Daxa I won't ask you the same questions because you made it everybody different answers sure and maybe just to start and to kind of kind of warm things up Sol how did you get involved in trachoma work well it was you Alan as you probably remember you gave us a lecture as baby well David Davis was there as well obviously but you were the first person who I can recall ever hearing anything about trachoma from as part of the ophthalmology day on the diploma in tropical medicine and hygiene course in 1999 I think it's fair to say that changed my life in all sorts of useful ways so what was your what was your first kind of field work with trachoma I was lucky enough to get involved in a project in northern Ghana in which we worked with the Ghana Health Service to take a group of Guinea worm volunteers to see if we can work with them to diagnose and treat trachoma with zithromycin and that was in 99 that was just at the stage that Pfizer was warming up towards starting a donation program they started the program to donate the drug to trachoma elimination programs in that year and several people including yourself were looking for sensible ways to make the distribution possible and the opportunity of having a program that was functioning well in the Guinea worm program and that was functioning so well that it was starting to run out of cases was a really good idea and as you probably remember that was a successful trial that we did in Ghana and has led in part to Ghana's success in eliminating trachoma which they seem to be very close to you now yeah so can you briefly just tell the people who are joining what your job and role is today sure as of the last two years I'm responsible for the global trachoma program at the World Health Organization in Geneva so I'm based here with trying to provide support to trachoma different countries and their partners around the world okay thanks so so we've just been talking a little bit about national programs and trachoma action plans and kind of how some countries do that very well and other countries struggle and I was giving a little bit the background that historically often trachoma control came under prevention of blindness but more recently it tended to come under neglected tropical diseases could you could you tell us a little bit now from the side of WHO but also working with member states with countries a word trachoma fits in terms of the NTD programs of countries and plans going forward sure I think it's it's entirely up to countries in in how they arrange the administrative responsibility for a trachoma within WHO has moved from prevention of blindness to the neglected tropical disease department but it doesn't have to be that way at national level and whatever works administratively is is that is the thing that should be taken forward I think good so changing kind of topics quite a bit you led the global trachoma mapping project can you update us on where that project is now quickly kind of what has been achieved and what is still left to do we're cutting up in and out a little bit there Alan in terms of mapping what's been achieved and what's still left to do correct that's right yeah so the global trachoma mapping project started with the goal of completing the baseline trachoma map worldwide we we thought we had about 30 countries in which to work and we ended up doing mapping in in 29 we thought we had around 1238 districts I think it was to map and we ended up mapping 1546 districts so for the most part the project which ran over three years fulfilled its mandate and and a little bit more but the in the course of having conversations with health ministries about what needed to be mapped which districts were suspected pandemic we discovered a lot more than we knew about at the beginning and so there are still some districts that need mapping either because they came into the conversation rather later or because they were insecure at the time when we wanted to map them with with the support of health ministries and and so they couldn't be done at that time trachoma is obviously not not an emergency intervention and collecting data about it is even less an emergency so we took the view and this was a view supported by health ministries that putting field teams in danger because insecurity was not something that we wanted to so sol if somebody joining us now wanted to know whether mapping is complete in the country and where the endemic districts are how would they find that information out well the international trachoma initiative hosts a very nice resource called the global trachoma which is available online and that has district by district prevalence category data for for the whole world and usually it also includes an indication of where districts are suspected to be endemic but don't yet have data so that that's I guess the first port of call but you know it's often the case that that health ministries may have reason to suspect trachoma to be a problem in places but they haven't yet necessarily had that categorization put on the atlas so making sure that there's a conversation with with the relevant ministry at national level is also often helpful and that's a process of conversation that we continue okay good so I'm changing topics away from mapping now to MDA and with MDA we've got this thing of five years and three years and one year depending on what the prevalence of EF is and we've had a few questions regarding what's what why do we recommend that is there any evidence forward what's the rational reasons for why we say five years for this prevalence and three for that and one for this can you give us some background to that sure the I guess it's mostly sorry I'm having to move because my battery's running low I wasn't expecting to do this on the mobile the evidence is in the form of of programmatic experience mostly rather than level evidence in a kind of randomized controlled trial format to kind of definitively establish that that five years was needed for a particular prevalence category and three years was needed for another you would need quite a large randomized controlled trial with literally hundreds of of communities and and probably quite a lot of of districts in quite a lot of countries but the experience that's been accumulated over the last 17 years of the donation program from Pfizer suggests that the higher the prevalence of of this inflammatory sign TF in one to nine children the more or the greater the duration of interventions that's needed in order to make a sustained impact in other words to to bring the the prevalence of TF down below the elimination threshold um the the sort of most recent addition to that that suite of guidance the fact that for districts in which the prevalence is between five and nine point nine percent that we should try one round that's a it's a quite recent addition to to to what we suggest to countries and we're only just beginning to see the impact of that and so far it actually seems very positive so sometimes that that pragmatic approach of needing to make a recommendation in the absence of good evidence can still generate something that that seems to work and I think the the Chamber of Expert Committee of ITI uh particularly helpful in that in that regard under your leadership in in coming up with the sensible suggestions that would seem to be born out in greatness okay thanks Sol um what one question that's come in is the the goal is elimination of Tacoma now control of Tacoma is a public health problem by the year 2020 maybe we should just make sure that we've got the wording right there but the question is um well if a country is not achieved that by 2020 what will happen regarding MDA will the donation program still be available will Tacoma control the carrying on yeah I hope so uh it's it's difficult to say and and perhaps it's a it's a more of a political question than a public health question um and and well politics is always fairly intricately intertwined with uh with public health um but I think that so far Pfizer has said that they they're committed to the donation until 2020 now I think that if we if we manage to show substantial progress towards going to Tacoma elimination by the end of 2020 that there will be enthusiasm to continue to the to the public health endpoint so I think it's it's my job and the job of others interested in seeing this thing done to get as far as we can as quickly as we can and to demonstrate that success in order to ensure that the political commitment is sustained beyond the the date of 2020 if that's required and it's certainly likely based on the prevalence data that we have that there will be a number of districts that will require surveys after 2020 and some of those districts are likely to require ongoing interventions after 2020 so this is a a political challenge that will need to to grapple with over the next few years um having said all that you know there's in in my view there's a a real need to continue to to kind of support the get 2020 target in order that we maintain as much positive momentum as we can between now and 2020 so that we can achieve and document the the success between now and then so I don't I don't yet want to back away from from that that target I think the harder we push to to try and achieve it whilst realising that it may not necessarily be 100 possible the better it will be for the program as a whole good thanks um so I think I've got three more questions and then we'll let you get back to your what I'm sure is a very busy day so it's fine and these are kind of fairly if you like general questions but kind of as all and the audience understand and what's going on the first would be as you look for the next four to five years up to 2020 what do you think are the biggest challenges that we face in elimination of trocoma by 2020 okay but I think number one would be issues related to trociasis uh and and two in particular what what do we do about uh postoperative trociasis uh what do we do about low electric ciasis what do we do about um uh you know those those sort of more complicated surgical problems where there's not good access to ophthalmologists or or even better good access to oculoplastic surgeons because even even uh fully trained medical ophthalmologists struggle a little bit with the with the problem of recurrent disease and no one's quite sure as to how to to deal with lower lip disease and that's going to become an increasing problem as we increase as we scale up programs um you know there'll be several several hundred thousand operations done in Ethiopia over the next 12 months if things go to plan and in in the best programs one expects 10 percent recurrence or 10 percent postoperative trociasis so that's 20 000 people who'll potentially need management by specialists who who just don't exist at the present time uh the trociasis case finding is another issue how to how to manage that and that becomes more and more difficult the lower the prevalence of disease becomes so the job becomes harder the closer you get to the endpoint uh for antibiotics I think the one of the principal problems is funds for distribution and I think I came in to the conversation at a point where you were talking about some of the funding that's available and talking about the need for increased domestic financing uh which I absolutely support and then on the fne side evidence for the critical things that work in fne is a is a major challenge for the program uh there's uh there's a clear need for programs to get involved in in good quality operational research to to better establish what needs to be done okay thank you and then perhaps more on the positive side what would you see are the the the encouraging things uh with regard to trocoma and again the future not necessarily the achievements of the past but going forward why should we be positive in our outlook um well I suppose momentum and trajectory and and perhaps that's not what you wanted to hear because that that comes in in part from looking at at where we were 10 years ago where we thought there were 8.2 million people who needed an operation uh for trichiasis and and now we think there are 3.2 million people who need that surgery so the the backlog's been reduced quite a lot uh and the momentum is there and and the the support is there so the kind of global community of of practice around trichoma is really energised at the moment to to go on and get this done so community and partnership I think is is a is a real key uh along with that is a group of very committed donors who are involved in the in the partnership uh who really want to see the work completed uh I think we're we're getting better and better at being evidence based in the program and and work that uh the London school's been involved in recently looking at at the best operation to do for trichiasis is a particularly encouraging thing the ongoing commitment of Pfizer to donate the drug I think is wonderful they would be the the main things that I'd identify there okay and this is my last question there Sol um we as as Daksha mentioned before the been very encouraging that more than 2,600 people have registered for this course and are participating um what would be your message to those people well I'm I'm extremely grateful to them for having taken the time showing the interest to join the course I think it's a tremendous time to be involved in trichoma elimination I think we can do an enormous amount together I think their their participation in the course will will hopefully help that I would just like us all to to work together as hard as possible for as long as possible to see as much progress as we can against trichoma in the in the next few years and if there's anything that I can do to help that then then I'm here thanks Sol if I can just add to that my my as I mentioned right at the beginning of this my first contact or exposure to trichoma was in 1975 in Tanzania and if I think of what I saw a new then and what I see and believe is happening now I mean it's just incredible the amount of progress there has been and you can say well that's 40 years but I can assure you I think one couldn't have dreamed 40 years ago where we are today so I think realistically yes we all get worried about 2020 but I think certainly in the next decade this disease and hopefully before the next decade but in the next few years we are going to see this disease come under control around the world which is a very positive thing so Sol thank you for joining with us thank you for your precious time and thank you for all that you're doing at the World Health Organization to lead this global program and my thanks to Daksha who has put together the trichoma course and started off with this Google Hangout at this time and Sally who's our IT technician sat across the table from me who's been pulling her out trying to get people online for the last hour we hope you've enjoyed it we were sorry for the technical problems that we've had but it's been great and we wish you all well thank you and we have apologies from Dr Emerson who is stuck in an airport somewhere near Johannesburg okay bye now


By the Father of Allah, Subhanahu wa ta'ala, by God's grace, we are fortunate enough to have welcomed a new Gregorian year, a new calendar year in our lives. And of course we have our own calendar and the Hijri calendar and many of our obviously dates of importance and so on are governed by that. And nonetheless our lives day in and day out are governed by the Gregorian calendar. And nonetheless we have the opportunity to have experienced a new year. And as is the habit of some who are, as is often the case, people like to make new year's resolutions. And the idea of a resolution to resolve yourself or to resolve to do something or not to do something perhaps in some cases is also similar to the idea of intention or intentionality. Because truly one cannot have resolution or a resolution to do something or have resolve without intention, without intentionality. And we know that in our own tradition and what the Prophet, Sallallahu Alaihi Wasallam, taught us, Niyah or intention is fundamental. And it is at the very core of what we do. Inna mal'a'malu bin Niyat, the Prophet, Sallallahu Alaihi Wasallam, reminds us that indeed actions are determined or measured by their intentions. And we also know though that while intentionality is fundamental and Niyah is crucial to every action that we do, it is not the end-all, be-all of everything. It is of course by God's grace, by Allah's mercy, by His forgiveness, by His rahmah, His love and His fadl, His blessing. That we can in some instances get the reward for doing something simply by having the pure intention behind it. But that must come with purity of intention and sincerity. So yes, intention is fundamental. But for an action to be truly rewarded by Allah SWT, that is the exception to say that you will be rewarded for your intentions. The norm is that intentionality is important, but so is following through. But so is actually committing the action. And one may even question whether or not we are being sincere if we have no intention to actually, or a game plan as it were, or a strategy, or an approach, or a means to perform the action that you are intending to do, or to fulfill the intention that you have. And so yes, intention is fundamental, but so is actually following through and committing yourself to the actual thing that you are intending to do. And so whether or not you are one of those people who have made, who have consciously made New Year's resolution, let us for a moment think of something in our lives that we intend to, or that we have resolution to, change. Now that could be something that you want to change as in a good habit you want to develop, or perhaps it's the leaving off of bad habits. You intend not to do something anymore. Regardless, those are both resolutions as it were, or intentions that we can have. And so let us for a moment, this is an active exercise. This isn't just hypothetical or this isn't just rhetorical. I'm asking you individually to think about something in your life that you want to change. Now once you have thought about that thing that you want to change, you make Nia to do so. You have the intention, the volition, the resolution as it were, the resolve to want to do that. And then you must develop a game plan, follow a blueprint or a recipe for success. If you want to intend to do something, what are the best practices to achieve those goals? To achieve that intention, to achieve what it is that you intend to do. That's how we approach, that's how we solve problems. That's how we approach things in our day to day lives. And so when it comes to intending to do something or resolving to do something, we should approach it very much that same strategic way. So yes, you have the intention, you have the mindset, but then what is the game plan as it were? What is the recipe that you want to follow? What are the best practices to achieve those results? And Allah Subhanahu Wa Ta'ala, in the book of Allah, in the Quran and in the prophetic teachings of our beloved Prophet Sallallahu Alaihi Wasallam, we find that recipe. We find that game plan to how we change. In fact, according to some, the entire book of Allah, the Quran and its engagement with us is to teach us, is to instill in us that recipe, that blueprint for change. How can we as human beings change in our obedience to Allah? How is it that we can be open to the guidance that comes from Allah Subhanahu Wa Ta'ala? So the book of Allah is a book of guidance and recipes and strategies and a blueprint by which you can change your lives. And so what is it then that we can find in these resources? In our tradition, in the book of Allah and in the sunnah of the Prophet Sallallahu Alaihi Wasallam, in his practice that lays for us the groundwork that gives us and provides for us the best practices, the game plan, the blueprint to change. And certainly as Allah Subhanahu Wa Ta'ala describes in the Quran and one of the things that we have to be aware of when we talk about change, we're not just talking about something that is just theoretical or something that is not something that we have to intend to do and unless we intend to do it, it doesn't happen. Because whether or not we know this, whether or not we're conscious of it, we are constantly in a state of change. We as human beings, day in and day out, we are changing. You're maturing. You're growing or you're not growing. You're reversing. You are improving or you're not improving. You are constantly in a state of change. In fact, change is all around us. The seasons change. The weather changes. The earth changes. The universe changes around us. And so change is, as they say, the one constant in the universe. The one constant all around us and the one constant within ourselves is that we are changing. And so it behooves us, it makes sense then that we become mindful of those things that we are changing as or as a result of or be mindful of the fact that we are in fact changing to begin with and then to resolve ourselves and to have the intention to change for the better. Let next year find you in a better position and in a better state than you are today. And as I said, whatever it is that you have intended to do, it could be spiritual, but it could be personal. It could be something in your lives. It could be something physical. You want to be healthier. You want to eat right, eat better. You want to exercise more. You want to enjoy the outdoors more. You want to change something. You want to improve financially. You want to improve at the workforce. And you want to improve job performance. It could be any of those things. And yet all of them follow these blueprints. And these blueprints in the Quran, according to Allah, Subhanahu wa Ta'ala, are the sunnah of Allah. These are what Allah refers to as those natural laws, those sunnahs, plural of change. And the sunnah of Allah. And Allah, Subhanahu wa Ta'ala says, that indeed Allah does not change or there is no alteration in the sunnah of Allah. That is to say that these are immutable natural laws. And if we want to change, then we have to live a life that is in harmony or that is in synchronicity with those natural laws that Allah has placed in creation. And so what are those sunnah of Allah that Allah speaks of? And of course there are too many and abundant of these sunnah. And we don't have the time to go into them in any length, but to leave you with but a few of those strategies, as I said. Those blueprints or that blueprint or those recipes for how we can change ourselves. How it is that you can achieve what you have set out with regards to a resolution or an intention to achieve. The first and the most important of these sunnah brothers and sisters is that when we talk about change, change that is profound, change that is meaningful, change that is long lasting, right? Change that is not just superficial, change that is not just on the surface level. If we're talking about real change, then that change has to be brought about gradually. It has to be what? Brought about gradually. And hence the first sunnah of Allah that I want to remind ourselves about is the sunnah of gradualism. Is that change that is profound, that is deep, that is beyond the surface level. It happens gradually. And you have to ease into that change. Allah subhanahu wa ta'ala as we know, God Almighty has no limitations. We know that Allah subhanahu wa ta'ala kun fayakun. He simply wills something into existence and it happens. And yet, Allah subhanahu wa ta'ala also tells this in the Quran, Alladhi kharaqa samawati wal ardi wa ma bainahum fi siddati aayam. Here it is. He is Allah. He is the one who has created the heavens and earth and all that lies within fi siddati aayam in six days, in six stages of creation. Why? Allah is not limited. Allah does not need a day of rest. Allah is not limited in what he can do to fulfill his irada, to fulfill his will. He can simply kun fayakun, wills something and it comes into existence. And yet, Allah is reminding us here that he created all that we see around us. He created us. He created the universe that lies within us. Fi siddati aayam in six stages. Why? To remind us of this idea, if you will, of gradualism. Is that things happen in a systematic and systemic fashion. And that is how you can change most profoundly and most deeply. Is that by changing gradually, bringing about change on a gradual level, oftentimes when we resolve ourselves or when we get excited about something that we want to change in our lives, we try to go from zero to sixty immediately, right away. And that's why, what happens in December and January, right? Gym membership goes through the roof. People join their gym because oftentimes these resolutions around the new year are related to lifestyle, are related to exercise, fitness, physical well-being. And I don't have the metrics, but people seek help of coaching and counseling and therapy and things that they have neglected because they seek the advice of experts or a space where they can grow and where they can change. And so, these are the months where these type of membership and services are optimized and utilized. But what starts to happen in March or say April or as the spring approaches?  People stop going to the gym as regularly. Why? Because while you have that zeal and that energy initially that begins to wane. And that's because you haven't approached change systematically. You haven't approached change gradually. You can't go from zero to sixty immediately. There is a process that you can change. And this isn't just limited, as I said. And there are abundant examples that we can find in the tradition of our Prophet, in the Quran, in which we find this idea of gradualism. Aisha radiallahu anha she once remarked that had the first verse ever been revealed to that community. The first revelation had it been do not consume alcoholic beverages. If that was the first commandment as it were. If that was the first thing that God revealed then Aisha radiallahu anha she said that assuredly most certainly that community, the community would not have accepted it. Would not have been able to fulfill that command. Why? Because you hadn't created a foundation. You hadn't done so gradually. Now I'm not saying that if you have haram in your life and you're doing something that is prohibited, that you approach it gradually. What I'm saying is that there are examples within our tradition that underscore this idea this importance of approaching things gradually and profoundly. And so if you want to change you change gradually. And this is why the Prophet said what? He said that the actions that are most beloved in Allah's sight that is most beloved to Allah with Allah are those actions that are small but that are done consistently. Small actions or they may be small as compared to other actions but small and consistent is better than large than performative and is not as frequent or infrequent or doesn't happen consistently. And so the actions that are most beloved are those that are small but we do them consistently. Why? Because again, this idea of gradualism. You're creating a foundation. You're creating something that is meaningful and that is profound. But yes, since of time the second sunnah and this is related that's why I want to leave us with this is the idea that if you want to truly change you have to change attitude first. You can't go about changing behavior automatically or changing behavior first. You approach things by changing attitudes and mindset. You change attitudes and mindset and that behavior follows that. And this is why intentions is fundamental because you have to have the proper mindset to change.  What is it that you want to achieve? What is it that you're intending to do and then to be strategic about how you achieve it, right? That is why you change attitudes first and that behavior follows and this is something we find throughout our tradition. One example. In the days of Mecca when the community was being oppressed by the forces of the Quraysh and those who wished that community ill those that were adverse to that community when they were suffering that community was suffering under the yoke of oppression and subjugation and tyranny by that Meccan community elite society Allah SWT says within that context Refrain your hands establish the prayer and pay the charity. Why? Because the urge when you're being oppressed when you are living under the yoke of oppression and suffering is what? To bear arms against your oppressors to take up arms to engage in them physically to engage in them militarily but yet Allah SWT and the Prophet's approach is what? Concentrate on that prayer Are you paying the charity? Are you doing the farayat? Are you doing those things that are obligatory to you? Focus on that and so you live within a period of 13 years of Mecca wherein that community establishes this foundation is changing attitudes and mindset first so that when Madina arrives or that they arrive to Madina when the context of Madina happens when the openings in Madina begin to happen and the community is now strong enough has the foundation has the the building blocks for being able to engage in their oppressors militarily engage in them physically engage in them by engaging in that struggle that military combat and struggle with their oppressors they're able to do so in a fashion that is discipline that is within the boundaries and that fulfills the needs of that community and doesn't go beyond it does not cross the boundaries they form they engage militarily but they do so with discipline they do so with discipline because the foundation had already been established in Mecca they do so because the mindset had already been changed it was it was here and obey you don't get that from the go you get that after years of development where you can be that discipline and so if we want to change to do so gradually take small actions approach our change that way and first and foremost change attitudes and that behavior will follow the change in attitude because your body yourself, your being cannot exist in a state of dissonance it cannot exist in a state of what therapists and psychologists call a state of cognitive dissonance where your beliefs you feel on the inside what you believe internally are not in harmony are not in congruity with your actions with what you're doing if there's a disconnect between what you believe and what you're doing that eventually one thing will fall off because there has to be harmony there has to be congruence in our state and this is again why changing attitudes will result in changing behavior but you can't go about it the other way around I pray that Allah subhanahu wa ta'ala gives us all tawfiq gives us all success and the ability to fulfill our intentions to fulfill that which we have intended to do today in our minds to have the intention to do so and then to have a game plan and a success plan to make yourself successful in your endeavor I pray that Allah subhanahu wa ta'ala blesses this community and keeps us safe and healthy and secure I say this to you may Allah bless you and your family All praise be to Allah All praise be to Allah and we ask forgiveness and I seek refuge with Allah from our evil deeds who guides us and does not harm us and we bear witness that there is no god except Allah and we bear witness that Muhammad his servant and his messenger says Allah subhanahu wa ta'ala in the Noble Quran Allah says Allah says Allah says


Now, we will discuss the adults role in play and instruction. So, adults can control the play or they can plan the play. For example, adults play an important role in early childhood. There are three roles that adults can play in child's play as identified by Michigan State University Extension. Look, it depends on where children will play, where they will play. Assadzah or Walden needs to be taken care of. So, when laws were being made for ECE in Michigan State University, then Assadzah was given the training to plan a good play. If children are playing outdoors, then which play will they play and what little equipment they need, what ball they need or what other objects they need. And then if they are playing indoors, then what kind of equipment they need in indoors and what kind of equipment they can play. And then if they are playing together in a group, then the teacher can initiate and teach them how to play well and then the children can start playing. And then when they are playing, then they need to give support. Support means that the teacher will be able to play. And if a child faces any problem or feels any problem or any wrong interaction, then he supports them and sometimes he needs to give some equipment. Because what we are talking about here is especially about ECCC Assadzah. That our Assadzah can support children in any way. And then the last and most important thing is that there are a lot of equipment that can harm children in some way or another. Like sharp edges. Now obviously blocks are connected to children, but if a child falls on them, then his legs or hands can be injured. And no knife or knife or a fire extinguisher, no kind of stove or anything like that is nearby. And then when they are playing, then no one falls or falls completely. And if God forbid falls, then how should he be given immediate support. So this observance and surveillance is very important. The role of adults in this matter is that like parents tell their children to play, but mother is present in this game. Similarly, when they are in school, Assadzah will give permission to play with them. But they will keep playing with them so that the children can play in a safe environment. And then according to the book Active Learning for Fives, it says that there are three things that adults can do to plan for activities. The first is to plan and set up centers or interest areas. We talked about that in the talks. That some places should be given to us in the classroom where children can get some sort of material which they can play with. And secondly, their interest, like we mentioned the theory of Howard Gardner, that some are inter-personally better learners, some are more verbal learners, some are more numerical learners, so what is their interest? And then according to their interest, we should give them a place in the corner or in the corner so that they can do their satisfaction. The last is what scale level the children have that you are working with. Look, the thing is that the child should play the game according to his age. Sometimes it happens that you know that the child is a child, he can play a big game like this or he can play equipment like this which is not suitable for him. So we cannot say that we will let the child play so freely that he will make a loss. Free play means that his hands, feet, mind are free, whatever he wants to touch, but his interest should not be something which can harm him. For example, if there is water in a lake, there is water, or there is fire, or there is too much heat, the weather is very hot, or the weather is very cold, then in such a situation we call the children to play with some protective instruments. So the thing is that our resources are their responsibility which is the ECCK, that they will not only plan, they will also support, they will also do surveillance, and they will remove any dangerous equipment. We have shared a video with you in this series. Do watch it. You will like it very much because how children learn during the game and what needs to be kept in mind. You will get all that in it, InshaAllah.