Those who are following the blog will recall that following the joint meeting with Dentaid, Henry Schein, Bridge2Aid and Smileawi on 25th February, it had been agreed that I should travel to Malawi whilst the dental chairs donated by Glasgow Dental Hospital were being installed.
The chairs had now been delivered safely and the team from Dentaid and Henry Schein arrived in Lilongwe on Wednesday 8th May to begin their work.
As a result, on Thursday 9th May I set out from Glasgow to catch a mid-afternoon flight to Heathrow for an onward connection with South African Airways to Johannesburg and then to Lilongwe. In the morning I received a British Airways text message about a strike by French air traffic controllers, which was impacting on a significant number of flights crossing Europe and causing ‘knock on’ delays.
Sure enough, the shuttle flight to London was an hour late, necessitating a spirited dash from Terminal 5 to Terminal 2, arriving at the gate just as my seat row for the SAA flight was being called. I cooled off and relaxed in my seat – a first time for me on an Airbus A330. It’s a long overnight flight to Johannesburg, but the ATC strike made it even longer because we had to head a long way east and route over Munich before heading south for our destination:
Despite this dog leg and extended journey time it was smooth flying with a wonderful sunrise to watch over the winglet of the A330.
The connecting flight up to Lilongwe was on time, with some impressive turbulence en route. After completing visa and immigration formalities I was delighted to be met at the airport by Peter Chimimba and a College of Medicine driver, David. Peter had already arranged a meeting for me with the Medical Council of Malawi that afternoon, so after dropping my suitcase and a quick shower and shave, it was off to meet Richard Ndovi.
I had met Richard previously at the two dental curriculum conferences and I was keen to understand how the Medical Council registration system works for those volunteering on dental treatment and training camps, with particular relevance to forthcoming activities by Smileawi and Bridge2Aid. We concluded our discussions in about 30 minutes and then headed to the Dental Department at Kamuzu General Hospital, where the dental chair and phantom head unit installations had already begun.
I am now very familiar with the building and as we walked into the central atrium area Peter and I were greeted with the sight of a wooden structure, previously part of the old phantom head facility, which had been removed to make way for installation of the new kit.
Much of the wood had been ravaged by termites – a stark lesson of the need to treat the new wooden support structure with an anti-termite agent.
The open space in the phantom head room was now ready for the next phase:
We next headed across to the dental surgeries where Stuart Bassham and Terry Bristow from Dentaid and Jonathan Langley from Henry Schein had already started work on the dental chair replacements, of which they had completed three. They had established a ‘Standard Operating Procedure’ after the first two chairs and now had a sequential system which was efficient.
The other important issue was the supporting infrastructure, particularly the compressors and suction pumps which were housed outside the Dental Department in separate sheds.
Last December, Stuart had put a virtually un-used compressor that had been donated to Dentaid into the shipping container with the dental chairs and phantom head units, and in due course this would be installed before the team left for the UK.
We left the hospital at 4.30pm and were driven back to our respective hotels. In the evening we met for dinner, which was an excellent opportunity to get to know one another and to discuss strategy for the next day. That afternoon I had offered my services as a labourer and this had been accepted, so it was agreed that we would all meet the following morning at the Dental Department.
When Peter and I arrived at about 9am the following morning, Stuart, Terry and Jonathan had already started. Stuart had gone off in the car with Ken, their driver, to source anti-termite agent and some other items, returning shortly after we arrived with some of the goods, but no preservative. I joined Stuart and Ken in the hunt for anti-termite agent, which we tracked down at Deekay Suppliers Ltd:
The interior of Deekay Suppliers was an Aladdin’s Cave of building, construction and hardware goods.
Whilst on our way back, Terry phoned to request some additional items, which we found in the Phalombe Hardware store, very close to Kamuzu Central Hospital:
Terry identified all the goods we needed and we were set up for the day’s work.
By the time we arrived back, the hospital carpenters had started work on construction of the support structure for the six new phantom head units, generously donated by Dentaid. They were using the old structure that had been removed as a workbench – instant re-purposing!
As the day progressed, the structure began to take shape. The central support spars are black as a result of application of the anti-termite preparation.
Terry and Stuart worked closely with the carpenters to ensure that the compressed air lines, which fed along the centre of the structure, were installed at the appropriate time, before the plywood panels were finally secured.
This facility would not be finished today, but would be fully functional before the team left for the UK.
The other main activity of the day was continuing installation of the replacement dental chairs. For much of the day Stuart, Terry and I worked as a three man team, installing the old chairs and replacing them with the new ones. This was the really heavy part of the work, because the dental light, spittoon and bracket table had to be unbolted from the old chairs then re-attached to the new. Whilst two of us were holding the (very heavy and unwieldy) light assembly the third was lying on the floor with a socket wrench, either undoing or tightening the bolts. Jonathan would follow us to do the electrical and service connections.
With this approach, we installed 9 chairs, so that by close of play all 12 replacements were in situ.
It had been agreed that the four remaining donated chairs would be transported to Blantyre for the Dental Department at the Queen Elizabeth Hospital. The small amount of superficial ‘road dirt’ from their travels between Dentaid’s HQ and Lilongwe were removed …
… and the chairs are now pristine for their final journey to Blantyre:
We left the hospital at 4.30pm, after a very busy day during which far more had been achieved than anticipated.
The following day, Sunday, the hospital carpenters were keen to complete their work in the phantom head room. Stuart, Terry and Jonathan carried on with the equipment installation and then, later in the day, Ken took them for a few hours of well-deserved rest and relaxation to a local wildlife park. I spent the day at the hotel catching up on written work and in the evening had dinner with Peter.
On the Monday morning, a meeting was convened at the College of Medicine Lilongwe campus to discuss the strand of work in the MalDent project that is concerned with developing a national oral health policy. Strong engagement with the Ministry of Health is essential and we were delighted that Dr Nedson Fosiko (Deputy Director of Clinical Services) and Mr Masauko Dzingomvera (Assistant Director of Clinical Services, with responsibility for oral health) were able to join us. In addition to Peter and I, Dr Jessie Mlotha-Namarika (Head of the KCH Dental Department) and Dr Wiston Mukiwa (Secretary of the Dental Association of Malawi) were present. Dr Mwapatsa Mipando, Principal of the College of Medicine, joined by teleconference, from Blantyre.
This was an extremely positive meeting. In summary, it was agreed that the work to establish a multi-partner Oral Health Policy Working Group should commence as soon as possible and that the policy work should proceed in parallel with developing a strategic direction for oral health in Malawi. Furthermore, the concept of ‘task shifting’ emergency dentistry in rural areas by training Clinical Officers as an interim measure to address some of the current workforce issues, as proposed by Bridge2Aid, was also favourably received and a follow-up meeting with Paul Tasman and I has been arranged for 10 June in Lilongwe.
After this meeting, Peter and I headed back to the hotel to collect Dave Rodacanachi (Equipment Specialist with The Dental Warehouse (Pty) Ltd – a Henry Schein Company) who had flown up that morning from Johannesburg. Dave had been in regular contact with Stuart and had been able to source a number of spare parts that were required for the dental chair installation. Dave has worked in the dental industry for many years and has a wealth of experience. The three of us then headed back to the College of Medicine for a meeting to discuss procurement of dental equipment and consumables, as well as equipment maintenance and repair services. These are all crucial elements of the jigsaw if the MalDent Project is to succeed. The meeting included Mr Matiya, the Head of Procurement for the College of Medicine and Mr Chakholoma from the Finance Office, both of whom had travelled from Blantyre. Mr Dzingomvera from the Ministry also joined us, as did Stuart from Dentaid, and Lucy Msiska, the Principal’s PA, who took a note of the meeting. The valuable discussions will all feed in to the next phase of developing a formal Procurement Plan.
One of my additional tasks whilst in Lilongwe was to submit the ethical approval application for the pilot epidemiological study of child oral health in Northern Malawi that Smileawi is planning for June, with the collaboration of elective students from Glasgow and Dundee Dental Schools. The first step was to pay the $150 application fee at the Ministry of Health Headquarters and collect a receipt to accompany the submission. When Peter and I arrived, we were told that the payment had to be in local currency (110,000 kwacha), so we headed back into town, collected the necessary money and then returned to make payment. As it was close to the end of the working day and the following day (Tuesday) was a national holiday I was becoming concerned, but all went well and the receipt was duly issued.
We returned to the hotel and enjoyed a relaxing evening meal with Dave.
The next morning, Peter had arranged for us to deliver the ethics application to the National Health Services Research Council office. We drove to a complex of buildings in Old Lilongwe that housed a number of research units. Whilst we were looking for the correct building, I spotted a University of Glasgow logo on a sign and walked across to investigate. These were the offices of the Malawi Epidemiology and Intervention Unit, of which I had heard much in Glasgow, both in meetings and via e-mails. I also knew that Professor Mia Crampin, a fellow University of Glasgow member of staff, was the Director and so I took a chance and asked at the Reception whether Mia was in the office that day. We were in luck and were able to meet for the first time.
Indeed, we were in luck on more than one count. First, it was lovely to have the opportunity, purely by chance, to meet Mia. We had an enjoyable conversation and both recognised the potential research possibilities that exist between the MalDent Project and MEIRU. Secondly, Mia was able to inform us that we were in the wrong place to submit the ethics application! We were in Zone 3, but needed to be in Zone 2, which would entail another car journey to a different part of town, across the river, and Mia was able to furnish us with directions.
After bidding farewell to Mia, we followed a convoluted route to the Ministry of Health Research building to make the submission.
Peter had previously been put in touch with Billy Nyambalo, the officer who would accept the submission. The handover was complicated by the fact that the template I had been using had been superseded and that the number of copies required had been reduced from 20 to 5! However, most of the documents required were present, with one exception which we will forward separately, and it was with considerable relief that the submission was finally completed.
Peter and I next headed back to Kamuzu Central Hospital, where work was continuing with equipment installation and repair.
The phantom head room was changed beyond all recognition:
Jonathan was still busy repairing the dental delivery units and it was tremendous to find that he had an audience of four students who were on attachment to KCH as part of their studies towards a BEng degree in Biomedical Engineering at the Malawi University of Science and Technology (MUST).
Over the course of the day, the students were given tasks to complete, under supervision, and it was great to see how prepared they were to become part of the team.
They were also keen to road-test the installation:
It cannot be stressed enough how important it is for the success of the MalDent Project to develop a cadre of highly trained biomedical engineers with specialist knowledge in dental equipment maintenance and repair. Not only is this required for the Dental School project, it is a necessity for all dental treatment facilities in Malawi. The enthusiasm of the students was obvious and bodes well for this strand of the project, which will provide initial training, delivered by Dentaid and Henry Schein, for two Malawian engineers who will visit the UK in the coming months.
On the Tuesday, Leigh Spamer (Sales and Marketing Director, The Dental Warehouse (Pty) Ltd – A Henry Schein Company) flew up from Johannesburg to join us. Leigh was given a tour of the Department and shown the progress that had been made.
By close of play on the Tuesday, the planned work was finished. Although there is much still to do, the Department has been transformed in terms of its functionality, both for clinical service delivery and teaching.
Now that Stuart and the team have visited once, they have a clear view of additional equipment repairs and replacements that could further enhance the Dental Department. Stuart has a long list of required items, some of which he has available from donations in stock at Dentaid Headquarters, and we are already looking at ways of raising the funds to send across another container of equipment, focused on identified needs, for a future visit.
That evening, Dr Mwapatsa Mipando, Principal of the College of Medicine, hosted a working dinner at the Four Seasons Katmandoo Restaurant:
This choice of venue had a very particular significance for Mwapatsa and I, because it was where we had our very first meeting, in September 2017, with Ian Nicol from Scottish Government:
At that working lunch, we conceived the idea of a refurbishment of the Dental Department at KCH and were subsequently awarded a small pump-priming grant of £60K by the Scottish Government. That work had now come to fruition so it seemed very appropriate that we should celebrate in this spot and toast Ian and the Scottish Government for their support, without which none of this would have been possible.
After a lovely evening, with everyone in high spirits, we gathered for a group photo which exemplified the partnership working that had made possible the success. The University of Malawi College of Medicine, Ministry of Health, Dental Association of Malawi, Kamuzu Central Hospital Dental Department, Henry Schein, Dentaid and the University of Glasgow had all played key roles and established a strong collaboration which will continue as the MalDent Project progresses.
On the Wednesday morning, Lucy had arranged for a press conference at Kamuzu Central Hospital.
Before the press conference began, the Principal enjoyed a guided tour and demonstration of the new equipment.
He was keen to test out the replacement dental chairs for comfort and functionality:
Once the members of the media had arrived, the press conference was opened with a welcome from Dr Jessie Mlotha-Namarika, the Head of the Dental Department at Kamuzu Central Hospital.
After Jessie’s introduction, Peter chaired the conference and invited comments for the press from those present, starting with the Principal. Leigh Spamer and Stuart Bassham spoke for Henry Schein and Dentaid respectively and Wiston Mukiwa commented from the perspective of the Dental Association of Malawi. It was an excellent opportunity for all the partners in the project to describe the highlights of the last few days and to signpost the way forward.
Following the press conference, the members of the media were shown the newly installed equipment, to contextualise the earlier comments.
I was asked to do a piece to camera, which provided a good opportunity to discuss the breadth of the MalDent Project, including the importance of developing a disease prevention model which would be embedded within a national oral health policy.
Immediately following the press briefing, we headed back to the hotel to collect our bags and then travel onto Kamuzu International Airport to start the journey home.
The flights back passed uneventfully, and this time did not entail a diversion over Germany, since the French air traffic controllers were back at work.
This had been a remarkable few days. Stuart, Terry and Jonathan had worked exceptionally hard and with great skill to ensure that the final stage of this phase of the project came to a successful conclusion that surpassed all our expectations.
Massive thanks are due to Dentaid and Henry Schein for their amazing commitment and to the Scottish Government for financial support. Many thanks also to NHS Greater Glasgow & Clyde for their generous donation of the 16 dental chairs which all now have many years of useful working life ahead of them to the benefit of patients, students and staff at Kamuzu Central Hospital.
In conclusion, here is a photo montage of some of the steps in the journey of the dental chairs from the basement of Glasgow Dental Hospital to their new home at Kamuzu Central Hospital. Many thanks to all who have helped along the way!
- POSTSCRIPT: Shortly after returning home we heard the very sad news that Mr Masauko Dzingomvera, the Assistant Director of Clinical Services at the Ministry of Health, had been taken ill and died suddenly. He had shown great enthusiasm during our visit for the work we are planning with the Ministry to develop an oral health policy. He was a very gentle person with a particular passion for caring for the rural communities of Malawi and we were very much looking forward to working with him. Our thoughts are with his family, friends and colleagues at this very difficult time.