This is a guest blog post written by my friend and colleague Andrew Paterson. Andrew is a Senior Lecturer / Honorary Consultant at the University of Dundee Dental School, one of our partner organisations in the MalDent Project. The focus of this post, however, is Andrew’s work with the charity Bridge2Aid, another of the major partner organisations working on the MalDent Project. The post describes the excellent progress that is being made by Bridge2Aid, in partnership with the Dental Association of Malawi, to improve access to emergency dental care in rural areas of Malawi.

I am very fortunate to be a volunteer, trustee and site clinical lead for the UK charity Bridge2Aid which for the last 15 years has trained clinical officers in rural settings in Tanzania to provide safe, sustainable and simple emergency dentistry to their communities whilst delivering relevant oral health messages and appropriate referrals of more complicated cases to dental therapists and dentists in district health facilities.

During that time 570 health workers have been trained and around 20 District Dental Officers trained to be potential local trainers. The ongoing programme in Tanzania has treated 56,500 patients and provided 5.7 million rural Tanzanians access to simple emergency dentistry. Put in the words of Dr Mohammed Khalfan, Clinical Director of Bridge2Aid’s Tanzanian partner Education & Health for All (EH4all), “that’s access to the equivalent of more than double the population of Botswana due to the efforts, drive and collaboration of many”.

Bridge2Aid has more recently felt that the Tanzanian training model was applicable to other nations and Malawi was one of the countries in which it may provide benefit to the health system. Ongoing discussions in 2018 culminated in Professor Jeremy Bagg visiting Tanzania to see the model first hand during a programme I was privileged to lead (https://www.wordpress.com/post/themaldentproject.com/171). Many discussions were had and Jeremy’s sterling efforts brought partners together to investigate collaboration possibilities including the Dental Association of Malawi, Smileawi, Bridge2Aid and the Universities of Glasgow and Dundee towards a common goal of improving oral health in the rural periphery in Malawi. The concept has been  approached with a positive mindset by everyone

Bridge2Aid and the Dental Association of Malawi were successful in gaining a new projects start up grant from the Tropical Health Education Trust and in June 2019 Paul Tasman, Bridge2Aid’s Operations Manager, visited Malawi to assess the feasibility of the project with, amongst others, the Dental Association of Malawi, The Medical Council of Malawi, The Ministry of Health and the Chief Dental Officer (https://www.wordpress.com/post/themaldentproject.com/834). Responses of the Malawian Government and dental community to Bridge2Aid’s proposals were very encouraging as they appeared to dovetail well with the Government’s existing policies and their ongoing attempts to facilitate access to care in rural and hard to reach areas.

Underpinned by this goodwill, Bridge2Aid CEO Shaenna Loughnane and I travelled to Malawi on 10^th September 2019 to have further discussions with Malawian stakeholders and to try to put arrangements in place for a first Bridge2Aid programme to be delivered in 2020. September had been chosen as Smileawi were running a programme that provided emergency dental care near Mzuzu at that time, which gave us the opportunity to see first-hand the challenges of providing dentistry in rural Malawi. Smileawi had been instrumental in bringing together the Smile North Dental Therapists Group and they organised a conference in Mzuzu which gave a forum for discussion and CPD for therapists from all parts of the Northern Region. Smileawi and Smile North had kindly invited Bridge2Aid to present and discuss the training model to them at the conference. We would be joined on the visit by Dr Mohammed Khalfan who in addition to his role with EH4all is a Dental Therapist. Mo had had to travel independently from Mwanza via Dar-es-Salaam. The dental therapists would be at the heart of Bridge2Aid’s proposed training model in Malawi where the Medical Assistant cadre, rather than Clinical Officers, would be trained and later they would be mentored and supervised by dental therapists.

Shaenna and I arrived in Lilongwe on the 11^th September 2019 to be greeted by Dr Wiston Mukiwa, a proud alumnus of the University of Dundee (where I have my “day job”) and Secretary of the Dental Association of Malawi. Whilst I had lived in Malawi, many years before, more recently I had travelled frequently to Tanzania so it at first felt strange to not be landing in Dar or Mwanza.

Wiston’s welcome was warm and we were driven through the busy Lilongwe traffic to our hotel, the Korea Garden Lodge. After a quick freshen up, Shaenna and I joined Wiston for dinner during which many issues were discussed and solutions brainstormed.

Wiston would pick us up the following morning and fortunately the airport was on the road North so we picked up Mo and headed on the six hour drive to Mzuzu. Discussions continued in the car regarding the programme and many other subjects. I was beginning to understand that Wiston was both knowledgeable and engaging on many important issues ranging from hybrid mangoes to the problems of deforestation in Africa. It made the time pass quickly through the beautiful scenery, past familiar rural scenes but in a ‘more Scotland-like’ mountainous terrain (without the inevitable rain) than Tanzania

We arrived in Mzuzu at the glorious Umunthu camp and were joined by the founders of Smileawi, Nigel and Vicky Milne, during the evening. Our plan was to visit Smileawi’s training sites the following day as any first Bridge2Aid programme would require collaboration and cooperation with both local partners and Smileawi. Accordingly it was important to see the Smileawi model first hand, the potential logistic issues that may occur and to understand who to engage with within the local community. Nigel and Vicky were amazingly open and helpful offering great advice and local knowledge.

We followed Vicky and part of the Smileawi team early next morning to the Kambombo Health post, following her car flying the St Andrew’s cross up the rutted dirt road, a remarkably similar journey when accessing a Tanzanian dispensary.

The health post was in a beautiful setting with banana plantations and mountains in the distance. This multi-purpose building was used by villagers throughout the year mostly for childcare and had been funded by our late Scottish dental colleague and Smileawi volunteer Alan Walker and is a lasting legacy for the local rural community.

On entering the health post it became a bit of a reunion for me. Former colleagues from the Maxillofacial Unit at Crosshouse Hospital in Kilmarnock, Helen Patterson and Liz Leggate, were volunteering with Smileawi – a fairly surreal experience to bump into them here.

Shaenna, Mo, Wiston and I each had different roles in trying to make the most of our visit. Mine was largely to look at the logistics of Smileawi’s operation, so I spent time looking at their sterilisation facilities and how the clinic operates and flows. There were far more similarities than differences and indeed the sterilisation facilities were identical to those Bridge2Aid uses in Tanzania. Whilst Bridge2Aid concentrates on training and Smileawi concentrates on treatment much of the ethos of the organisations is remarkably well aligned. Smileawi have really engaged with a local youth organisation “Taarifa” led by the engaging and impressive Shupo Kumwenda who we met at our next Smileawi site. Taarifa provide local volunteers who facilitate waiting patients and act as interpreters and it was great to see the symbiotic relationship between Smileawi and the local community.

After meeting the local chief and holding further discussions with community headmen we travelled to another Smileawi site at Ekwendeni hospital near Mzuzu. Here Nigel was leading a team with large patient numbers waiting for treatment. Smileawi were running a slick operation and were working hand in hand with the local dental therapist. This was excellent collaboration but Mo, Wiston and I had to resist our urge to put on some gloves and assist in clearing the backlog of patients. We observed the desperate state of oral health in these rural areas with widespread dental decay in many, meaning there was a massive need for both safe emergency dentistry and oral health education exactly like Tanzania.

We left the Smileawi sites convinced that the Bridge2Aid model was both feasible and much needed in Malawi and that it would be possible to cascade-train health workers here which Wiston felt was such an important priority for Malawi.

It is imperative that NGO’s planning on putting programmes into new areas discuss and negotiate plans with senior local stakeholders so that the programmes appropriately meet the needs of the community. Wiston therefore arranged for us to meet Dr Don Chiwaya, one of the two dentists at Mzuzu Central Hospital. Wiston and Shaenna discussed Bridge2Aid’s plans and were met with a very positive response. I was able to send greetings to Don from his former colleague, Remus Chunda, a dental therapist and now a PhD student at the University of Dundee.

On leaving the hospital we bumped into Alan Stewart and his team from Smileawi Spanners, mechanics who repair local ambulances and train local people in vehicle maintenance. They had already managed to put two ambulances back into service – great work.

The following day Smileawi and the Smile North Dental therapists group had their conference at the St John of God Conference Centre, Mzuzu. Smileawi had been instrumental in bringing together the Northern dental therapists from a wide and remote geographical area to interact together and enhance their lifelong learning and continuing professional development. This was a very impressive group who would be pivotal as trainers during a Bridge2Aid programme and mentors and role models for trained Medical Assistants after any programme. Helen Patterson gave an inspiring talk on managing disability in rural Malawi and then Shaenna introduced the Bridge2Aid model to the therapists. I discussed the nuts and bolts of the Bridge2Aid model and the proposals of how it may work or be modified for Malawi and Mo discussed the benefits of the training model for a local dental therapist. We were, though, all merely warm up acts for Wiston who gave the audience one of the most inspiring talks I have ever heard in over 30 years as a dentist. His complete understanding of public health issues in rural Africa was inspirational.

Wiston concluded that he felt that the Bridge2Aid project would make a difference as it brings together many partners to buy into a sustainable programme that will systematically and consistently train Medical Assistants in rural areas in the provision of emergency dental care services and referral of difficult cases that are beyond their competency. He felt that this would in turn free some of the Dental Therapists time for them to deal with more complicated cases and importantly empower them with the opportunity to be the natural trainers, supervisors and mentors of the trainees.

I managed to surprise Wiston at the Conference by presenting him, on behalf of the University of Dundee, with some alumni memorabilia and as a member of staff there I was able to tell Wiston how proud the University is of his contribution to public health and dental public health in Malawi given his many roles and many years of excellent service.

After lunch Wiston, Shaenna, Mo and I facilitated a wide ranging discussion with groups of dental therapists regarding the Bridge2Aid proposals, exchanging ideas and jointly problem solving our way through potential barriers with the therapists to move the proposals forward.

That evening we joined the full Smileawi team for dinner prior to returning to Lilongwe the following day. As they say, a good time was had by all! Our route to Lilongwe involved stops in Mzimba and Jenda to scope out potential sites and accommodation for possible future programmes.

Mo had to return to Tanzania and for the next two days Wiston, Shaenna and I discussed and refined our thoughts on a potential programme based on what we had observed to ensure its relevance to Malawi. In addition we met a local NGO to discuss logistic support needs for Bridge2Aid programmes which is essential for their smooth running.

As Bridge2Aid has a sustainable model, a key aspect of its sustainability is its ability to work alongside local partners and within existing healthcare structures and priorities. To ensure that this is done effectively during our remaining time in Malawi we met key partners and stakeholders including Dr Nedson Fosiko, Deputy Director of Clinical Services at the Ministry of Health and Dr Jessie Mlotha-Namarika, Chief Dental Officer of Malawi. Both were entirely positive and we were reassured that the Bridge2Aid model was relevant to Malawian health needs and supported wholeheartedly by both Government and the dental community.

 

Finally it was sadly time to leave this beautiful country with its friendly hospitable people, but hopefully Bridge2Aid will return to Malawi very soon.

So what now?

Whilst there remains some administrative groundwork still to be done to ensure that both Bridge2Aid and Malawian stakeholders are in agreement over their respective roles, the first Bridge2Aid programme in Malawi has been planned for mid-2020 with tentative plans to further roll out the Malawian training model during 2021 following reflection on the first programme.

In the spirit of collaboration and continued partnership the trainers on the first programme will include Wiston, Nigel and Vicky from Smileawi and myself and EH4all will attend that programme to help train Malawian logistic partners based on their experiences in Tanzania.

I am honoured to be leading a Bridge2Aid programme in Mara Region, Tanzania in November 2019 and it will be a privilege then to have Wiston and a representative from the Malawian Ministry of Health visiting that programme to observe the Bridge2Aid training model in action so final lessons can be learned prior to the first programme in Malawi.

Just like the MalDent project, the Bridge2Aid Malawian project has so far involved the drive, positivity, collaboration and goodwill of many to attempt to build bridges between nations, partners and above all in a small way to try to bridge some of the rural health inequality gaps. I am confident it will be a success that will offer real sustainable benefits to oral health in Malawi.

 

Martin Laird is a dental student at the University of Glasgow. He undertook his elective project in Malawi between the fourth and fifth years of the BDS course. This is his reflection on part of that elective experience.

In the past, I had been to Malawi with my high school in 2014 and 2015. My time there was spent with local primary schools, orphans and prisons across southern Malawi. However, there were three people who I met on those occasions that have had such a profound impact on me that I made it my solemn duty to meet them again. As fortune would have it, I had the chance to return to Malawi for my elective after four years of waiting!

The first of these remarkable people I’d like to talk about is a lady called Deborah Nglande. She is a principal teacher at Mendulo School in Mulanje district.

Not only is Deborah extremely dedicated to the children she teaches, but she also runs an orphanage and a hundreds strong programme for disabled children out of her own home to provide a safe place for these estranged children and their parents. These families are often ostracised from their villages purely because of their child’s disability. It is through this project that I met the next person in my story. So without Deborah really none of the rest of this is possible – a special thanks to her.

The second person I would like to talk about is Regina Baulen.

I was paired with Regina five years ago as a sponsor. Take from this what you will, but the stars seemed to align somewhat with myself and Regina meeting each other, from our random allocation amongst the hundreds of children as part of the disabled project. Little did we know that we were both exactly the same age (despite our very obvious physical differences) and we both have scoliosis – a relatively common spinal deformity. Mine is very mild and I have more or less overcome it, but Regina’s is far more severe and she has suffered various repercussions from not receiving treatment. I was fortunate enough to be able to fund a degree of treatment and buy a pushbike for her that allows her to travel to school independently. Despite her mental acuity being normal, her disability has meant she has only reached Form 5 of primary school.

Thanks to Deborah, I was able to meet Regina again at Chindola Primary School where we were initially greeted by the head teacher and brought into his office. What was remarkable about this place was that there was a large tarpaulin sign of partnership between Chindola and Our Lady and St. Joseph’s Primary School in Glenboig which is not even 5-10 minutes drive from my home back in Scotland. To see this in one of the most remote places I had ever been in my life was not only immensely comforting but incredible too – saying that we live in a small world doesn’t do it justice.

It was at this moment that I turned to face the open doorway to see Regina herself. I could tell that despite my much more hirsute visage she recognised me straight away and we embraced each other warmly. That moment for me made all the travelling, stress and doubt disappear, and in that instant I knew my decision to come back to Malawi was the right one.

We then took Regina in the car to her village. I recognised her house straight away and we were greeted by her father and shortly after by her mother. Through Deborah, I spoke to her family about how grateful I was to see them again and then asked them what sort of things they needed. Unfortunately, their house had been damaged by flooding; their roof was very unstable with the metal sheeting that made it up being tethered down with bricks. I told them that I would help fix this as well as providing anything else they needed.

I then proceeded to give over some clothes and a new schoolbag I had bought for Regina. She also required new shoes but her current ones had no size on them – I had to take pictures of them next to my own size 11 shoes so I had a size comparison. Looking back on that photo it really hit me how vulnerable she is, and how impossible it seems that we are the same age and yet how different our lives are.

My sincere thanks to Professor Bagg for recording some of this interaction with Regina – I had no idea that he was filming so it was wonderful to see this meeting in such a pure and genuine way (View). Afterwards, we took Regina back to her school. I will be the first to admit I did get upset in the back of the car as we drove away after dropping her off, but I hope it won’t be long till we meet again.

The final person I was reunited with is nothing short of a modern day saint – Sister Anna Tomasi. Anna is a retired Catholic nun who has lived in Malawi for (I believe) around 20 years.

She started the C.C.C trust in Blantyre, an organisation which provides teaching and employment to former inmates of the numerous prisons in southern Malawi. Many of these inmates have been unjustly imprisoned and, from seeing the prisons for myself, they live in the most squalid and inhumane conditions. However, thanks to the work of this astounding woman, the prisons have slowly improved, and multitudes of inmates have been granted their freedom, an education and ultimately a job as a result of her tireless efforts. I was so happy to see her again after such a long time, and for the second time that day I received a hug I’ll never forget – one with the strength that belied her scarcely 5ft tall Italian frame! I could tell she was genuinely happy to see me which made me so relieved that she still remembered me after all these years. She sat and told us about the work she’d been doing, and from listening to her, she seems to be doing more than ever. If anything, she looked younger now despite being around eighty years old and working twelve hour days. I was delighted to hear that her work had finally begun to gain recognition in Europe, with the Catholic Church and Italian government awarding her €250,000 towards her efforts, which she has implemented to great effect – allowing the CCC trust to grow arms and legs and take some of the pressure off her, not that she’ll ever utilise any free time to rest!

To think that this was just one day in my elective is absolutely mind-blowing. To a degree, I’m still processing that one day and will do so for some time. The remainder of the elective project, spent at the College of Medicine in Blantyre with Rosie (my classmate), working at Kamuzu Central Hospital, Lilongwe and conducting data collection with Smileawi amongst so many other things, was tremendous. But for me, being able to say I got to see these three special women again allows me to be content that my elective experience will live with me forever. I was honoured to experience it with Jeremy and Rosie, and I hope they have an equally powerful memory of that special day too.

Katie Read-Challen is a dental student at the University of Glasgow. She undertook her elective project in Malawi after completing the fourth year of the BDS course. This is her reflection on that elective experience.

Spending 3 weeks in Malawi this June for my dental elective was such a fantastic experience, mostly thanks to the group of people we travelled with and those who we met along the way. Vicky and Nigel Milne knew so much about Malawi and had made many close connections from the time they had previously spent in the country. I was very inspired by all their efforts at making their charity more sustainable including the funding of local dental therapists through University, bamboo toothbrushes (donated by Humble) to reduce plastic waste and the Smileawi Spanners branch of the charity who helped local engineers fix hospital vehicles. It was great meeting Alan Stewart and Andy Lancaster, the two mechanics, as well as Heather Lancaster who did a great job at organising us dentists during the data collection. We had a good laugh the whole time and I would definitely recommend joining a Smileawi trip to anybody who is interested!

Starting this September, I will be studying an intercalated degree in Global Health which I am looking forward to even more since the Malawi trip. The oral health survey is an exciting project to be involved in and it was interesting and satisfying seeing it right through up to the input of the data on the laptops, despite the data input itself being tedious at times! Collecting the data at the selected primary schools was immensely fun as the children were so sweet, the teachers so welcoming  and the translators who helped us were brilliant at keeping the good mood going all day.

We set up in church halls or classrooms and used head torches, mirrors and cotton wool to carry out the dental examinations. The translators helped us to fill out the questionnaires and the children would then wait very patiently for their turn to see us and collect their toothbrush afterwards. We suspected that some older children told us that they were in the survey’s age range of 5-12 years in order to get a toothbrush, as there was a surprising amount of wisdom teeth seen for children that young! The fact that many children did not own a toothbrush was one of many poignant reminders of the poverty in Malawi and reinforced the need for a dental prevention programme there.

The School for the Blind in Ekwendeni and School for the Deaf in Embangweni were really inspiring and turned out to be very fulfilling experiences, after my initial nervousness about how we would communicate effectively with the children there. We were able to teach our visual prevention lesson to the children at the blind school by describing the pictures and we were able to sing our toothbrushing song in the school for the deaf using dance moves – which the children loved! The following two photos show some of the the children at Embangweni School for the Deaf after receiving their bamboo toothbrushes donated by Humble:

At Ekwendeni School for the Blind we handed out Days for Girls reusable period kits and taught a small class of girls in one of the dorm rooms, some of whom had albinism, how to use them.

The girls at Ekwendeni School for the Blind receiving their Days for Girls reusable period packs

Overall the experiences at these two schools were my favourite due to the challenges we were able to overcome in order to carry out our survey and brushing instruction as well as the admiration I had for the teachers and the pupils overcoming their own daily challenges, always with a smile.

There is so much more I could have written about Malawi – each day was packed full of experiences that would have easily filled an elective poster. Going forwards we hope to raise money to fund two feeding programmes at Dunduzu and Malivenji primary schools in the North in order to aid nutrition of the pupils as well as help the schools to increase the number of pupils that go. It would also be great to send mosquito nets to the residential schools (Ekwendeni School for the Blind and Embangweni School for the Deaf) as well as plastic teeth for the phantom heads at the School of Health Sciences which trains dental therapists. I have left extremely inspired by the work of Smileawi and the MalDent project and I look forward to seeing the results of the survey and the positive effects it could have on the oral health of Malawi.

Paula Houston is a dental student at the University of Glasgow. She undertook her elective project in Malawi between the fourth and fifth years of the BDS course. This is her reflection on that elective experience.

In June 2019 I was fortunate enough to travel to Malawi with fellow BDS students, dentists and volunteers with the charity ‘Smileawi’. We were conducting a survey of the prevalence of dental caries in children aged 5-12 years in rural primary schools across the country. We visited six schools in total and surveyed more than 2600 children’s teeth. I believe it will be the largest study of its type among children conducted in Sub-Saharan Africa and it was an invaluable experience.

As a group we discussed and strategized over the daunting task of charting 3000 children’s dentition within the narrow timeframe that we had. (It would require seeing a patient every 2 minutes on average).

We used basic fold down dental chairs (manufactured by the charity Dentaid), a plastic mirror, some cotton wool and a head torch. We took it in turns to assess the patient and to scribe the results and swapped roughly every 20-minutes when inevitable fatigue set in – in order to minimise human error.

In addition to gaining significant data, we were able to give the children of Malawi a positive impression of dental treatment. Unlike children in the UK, most (if not all) of the children that we looked at had no previous experience of dentistry and this survey stood as an opportunity to acclimatise them to dental treatment. It was so encouraging to see how cooperative the children were and how excited they were about our visit!

We had some local Malawian volunteers who helped the children complete the questionnaires and also taught us some useful local phrases.

‘Yasa Mula’ – Open your mouth

‘Yasa Mula Chomeni’ – Open your mouth very much

‘Tawonga chomeni’ – Thank you very much.

These basic words got us by, although admittedly on occasions we mixed up ‘thank you’ with ‘open your mouth’ and had children climbing off of the table post-exam, then jumping back on with wide open mouths in perfect obedience!

For each school that we visited we also spent some time teaching the children some basic oral hygiene and delivering tooth brushing instruction. With the help of our translators, we conjured up a song which reminded the children to brush their teeth twice a day. It wasn’t a chart topper, but it was certainly trending in Malawi! One of the moments that really stands out to me on this trip was hearing an assembly of children singing our song back to us in both Tumbuka and English.

It was an educational trip and checked a box in completion of our required university project, but in the end, it was so much more than that to all of us. Not only have I fallen in love with the beautifully kind people of Malawi, but I am left in awe of the incredible work that Smileawi conduct annually. This small charity, founded by Nigel and Vicky Milne, has made such a noticeable difference to the rural villages of Northern Malawi. They provide emergency dental treatment, in addition to funding dental therapy students to complete their education and provide materials to DCP’s working throughout the country. Furthermore, Smileawi has funded the construction of a kitchen at one of the schools we visited, in order for the children to be fed at school and encourage attendance.

I left Malawi with some great memories, great friends and a great desire to return and help as a dentist in the future.

This post relates to the second phase of a visit I made to Malawi last June. It has been delayed in publication and forms the first of a series of four posts which cover an exciting collaborative project that took place between the charity Smileawi and dental students from Glasgow and Dundee Dental Schools. Three of the students have written reflections of their experiences, which complete the ‘mini-series.’

My involvement started with a very early morning flight on Tuesday 11th June from Lilongwe to Blantyre, following meetings on the previous day with Paul Tasman from Bridge2Aid, Ministry of Health officials, Wiston Mukiwa from the Dental Association of Malawi, and the Christian Health Association of Malawi (https://www.themaldentproject.com/2019/06/23/with-the-scotsman-bridge2aid-and-malawian-partners-in-lilongwe-two-busy-days/). Chris, a local taxi driver, picked me up from my hotel at 04.30 and I caught the 06.15 flight south. We landed at 06.50 and I was picked up by a College of Medicine driver who delivered me to my hotel.  After some breakfast I headed straight to the College of Medicine and met with the Principal, Dr Mwapatsa Mipando, and his PA, Lucy Msiska. Following a variety of discussions during the day at the College of Medicine I returned to the Sunbird Mount Soche Hotel for some dinner and an early night.

On the Wednesday Peter Chimimba arrived after breakfast to pick me up and deliver me to the College of Medicine. He was accompanied by Martin Laird and Rosie Grimes, two Glasgow BDS 4 students who had arrived in Blantyre the previous Thursday and who, at the generous insistence of Peter and his wife, Frider, were staying at their house. With the impending enrolment of the first group of BDS students at the College of Medicine, I had been keen to engage students at Glasgow Dental School with the MalDent Project. Ultimately, we would aim to establish a  student exchange programme between the two schools. I was, therefore, delighted that Martin and Rosie had chosen to visit the College of Medicine for their elective project this year.

On arrival at the College of Medicine, we went straight to the office of Professor Nyengo Mkandawire, Dean of the Faculty of Medicine, where I was presented with a bound copy of the BDS curriculum and the signed certificate from the University of Malawi Senate confirming its approval. This was symbolic of the completion of the first milestone in the MalDent Project – partnership working to achieve an approved BDS curriculum.

Next, we headed to the other side of the Library Building to see Peter Chimimba’s new office. In addition to his office, Peter now also had an assistant, Annie Mwapasa, who had recently been appointed with support of the Scottish Government funding of the MalDent Project. This was great progress as Annie’s role would be essential when the first BDS students were enrolled, as well as the management of the other strands of the project linked with policy development at the Ministry of Health and the design of the new dental facility, together with its construction, on the Blantyre site.

That morning, Peter went with Martin and Rosie to visit a primary school in Blantyre, which they reported later to have been a great success. I had a significant amount of written work to complete linked to the elective students’ project with Smileawi, so I spent much of the day working in Peter’s new office.

At 12.30pm I decided to have a break and head to the Beit CURE Café for some lunch. By chance I met Martin, Rosie and Annie heading to the same venue and then, whilst there, we met the team from the University of Glasgow Institute of Infection, Immunity & Inflammation who were busy installing laboratory equipment as part of the Scottish Government-funded Blantyre Blantyre Project. Inevitably, we decided to have a group photo – far too good an opportunity to miss!

During the evening, Martin and Rosie treated Peter, Frider and I to dinner at 21 Grill, a very nice restaurant at Ryalls Hotel. It was a lovely evening and one way in which Martin and Rosie were able to show their appreciation for the exceptionally kind and generous hospitality afforded them by Peter and Frider during their stay in Blantyre.

On the Thursday, Martin, Rosie and I headed to Mulanje to visit some friends of Martin’s that he had got to know many years previously as part of a twinning project between his school in Lanarkshire and a primary school in Mulanje. You will be able to read Martin’s story in his own blog post which will be published shortly. For my own part, I would just wish to say that we met some utterly inspirational people on that day, including the most engaged and cheerful children I think I have ever met. My reflection, having met the teachers and children we came across, was that a caries prevention programme based upon the supervised toothbrushing model of Scotland’s  Childsmile programme would likely be adopted with enthusiasm.

On the Friday, Martin, Rosie and I, complete with our luggage, left the College of Medicine to head to Mzuzu. The College kindly provided us with a minibus and driver for the nine hour road trip north.

It was a long journey but by and large the roads were of good quality. We stopped and enjoyed lunch with our driver at Salima before the final push, arriving at Mzuzu just after dark.

Our home for the next two nights was ‘Joy’s Place’, a backpackers’ lodge which boasted a Korean Kitchen. There was a power cut as we arrived, so we checked in by candlelight, but shortly afterwards power was restored.

Just after we reached the lodge, Nigel and Vicky Milne, together with the rest of the Smileawi team, Conor O’Brien and our remaining elective students from Glasgow and Dundee arrived to greet us (see: https://wordpress.com/post/themaldentproject.com/621). They were staying nearby at Umunthu Lodge, and we agreed that we would all eat together there later that evening. An hour later the full team was assembled and we enjoyed a lovely meal together – an excellent introduction to Mzuzu for Rosie, Martin and I.

We were up early on the Saturday morning for breakfast, when we met Nathan Bradley, a Peace Corps volunteer who was a soil scientist from Virginia, USA. He was reaching the end of a two year visit to Malawi, and was working with a local group of beekeepers to put their honey through the various analyses and certifications necessary to allow them to export their product. He told us he frequently visited Joy’s Place, together with other Peace Corps volunteers, for relaxation at weekends.

After eating, we headed to the Saint John of God Conference Centre, where Smileawi had organised a conference for dental therapists. As part of the programme, Conor O’Brien, an oral surgeon from Glasgow Dental Hospital, had agreed to deliver a minor oral surgery update lecture and I was to provide a presentation on the problem of antibiotic resistance and the importance of antimicrobial stewardship. After lunch I had agreed I would provide an update on progress with the MalDent Project. The students from Glasgow and Dundee were also keen to speak about their background and  experiences to date.

One of the highlights of the day for me was meeting Edward Hara, who had worked in the area as a therapist for many years. I had heard a lot about Edward previously from my good friend Lisa Taylor who had worked as a VSO dentist in Mzuzu many years ago, shortly after she completed her masters degree at Cardiff Dental School. It was a great pleasure to meet him in person at the conference.

The Guest of Honour at the meeting was Dr Owen Msopole, from the Ministry of Health Directorate of Quality. We spoke at length during the morning coffee break and it transpired that he was a good friend of Dr Nedson Fosiko, with whom we had met in Lilongwe earlier in the week to discuss the Bridge2Aid initiative (see: https://wordpress.com/post/themaldentproject.com/834).

As with any self-respecting conference, a group photo was in order. It is hard to believe that by Malawian standards this was a winter scene!

Conor delivered an excellent presentation on minor oral surgical techniques, incorporating a significant amount of content on quality and governance issues.

More sun was lapped up during lunch, which was served outdoors.

Towards the close of the event, the four dental students who had been working with the Smileawi team delivered a first class presentation. They talked about their BDS course back in the UK and also described with great enthusiasm and clarity the work in which they had been engaged since arriving in Malawi. You can read more in their reflections that will be published immediately after this post.

The event finished with an excellent networking opportunity enjoyed over tea, coffee and snacks. It was fascinating and very valuable to hear from the therapists themselves about their day-to-day work. They were clearly very stretched because of the workforce challenges (nationally there are only 137 therapists in Malawi against a Ministry of Health establishment of 300). There was also great interest in the BDS programme which was due to commence at the College of Medicine in August 2019 and two of those present had submitted applications for entry.

After the conference, we all returned to Umunthu Lodge and turned to data entry from the hard copies of the clerking forms used for the dental inspections. This was a massive job, which the team had been tackling every evening until the sun set.  The industry and enthusiasm of the team was extremely impressive and by the time they left Malawi all of the data had been uploaded.

Once it became too dark to continue working, dinner was ordered and there was great conversation over a beer (or cider) or two! Adjacent to the eating area was a log-burning fire pit which was where the evenings ended, with a sense of time well spent and a tremendous team spirit.

Massive thanks are due to Nigel and Vicky Milne, the founders of Smileawi, for having invited our students to Malawi for this unforgettable experience. The joint working between Smileawi, the University of Glasgow and the University of Dundee has been an outstanding success and will hopefully continue long into the future.

On the Sunday morning, Martin, Rosie and I headed back south to Lilongwe – a drive of about five hours. There was some beautiful scenery and the following video clip gives an idea of the ‘road home’, which was not unlike some of our Scottish scenery:

That evening, I had invited Martin and Rosie to have dinner with me, as I was flying back to Glasgow the following day. As it turned out, Dr Mipando, the College of Medicine Principal, had arranged for Peter Chimimba and I to accompany him early on the Monday morning to deliver a presentation about the MalDent Project to the Senior Management Meeting at the Ministry of Health. As a result, Peter also had to come up to Lilongwe on the Sunday evening, so we all had dinner together.

It was a complete surprise when Steve Mannion, a well-known orthopaedic surgeon  (http://www.stevemannion.com), appeared in the restaurant. He had arrived that day with his team from the UK to undertake a series of operating sessions in Malawi. I know Steve as a result of sitting on the Royal College of Physicians & Surgeons of Glasgow Global Health Group (GHG). Indeed, it had been Steve who had stressed during my first attendance at the GHG in 2017 the importance of trying to develop dental services in Malawi, long before the MalDent Project had emerged. We had some excellent chat!

The following morning, the Principal, Peter and I had very positive feedback from those attending the Senior Management Meeting at the Ministry of Health. It was a most uplifting way to finish this visit to Malawi and as I headed to the airport I felt very buoyed by the enthusiasm and support that had been displayed.

I had a trouble-free journey back to the UK, arriving in Glasgow on the Tuesday morning. That afternoon we had our Dental School Prize Giving and the following day was BDS Graduation. Both were proud occasions for our students, relatives and staff. With Malawi still ringing in my ears, I reflected on what a great day it will be when the College of Medicine graduates its first cohort of dentists in Blantyre.

This is a guest post by Breffni O’Brien and Ciara Durkin from the Mackintosh School of Architecture, Glasgow School of Art

Earlier this month, two Mackintosh School of Architecture (MSA) stage 5 students, Breffni O’Brien and Ciara Durkin, took part in a stakeholders’ workshop at the University of Malawi College of Medicine, involving 25 senior academics, architecture students and architects.

This was a result of an invitation from Professor Jeremy Bagg, the Head of Glasgow University’s Dental School, to Professor Christopher Platt, MSA’s Chair of Architecture, to lead a workshop to inform the design process for a new building for the recently inaugurated Dentistry Degree Programme at the University of Malawi College of Medicine Blantyre campus.

Breffni and Ciara took a leading role in two of the workshop groups.

Ciara Durkin writes,

“The energy during the workshop was powerful and invigorating, with an holistic and beneficial exchange of ideas.  I enjoyed watching the Scottish and Malawian participants use this workshop to cement a common vision within a unique team of international and local collaborators.”

Breffni O’Brien writes,

“To be involved in such a collaborative and thought provoking design process was an incredibly unique experience. Being given the opportunity to contribute to such an exciting project and work alongside Malawian architecture students and the staff of the College of Medicine was an honour.”

Christopher Platt writes,

“Breffni and Ciara were hugely effective in how they worked closely with a range of academic and student stakeholders to explore the key issues which should inform the new building’s brief. They led some of the discussions, presented their group’s findings to the wider workshop body and used their architectural graphic skills to quickly sketch key ideas which could be easily understood to a lay audience. They were outstanding ambassadors for MSA and GSA and we all enjoyed the experience with Professor Bagg and his colleagues in Malawi enormously, which has established firm foundations for future collaborations.”

 

 

Partnership working is key to international development activities and we have been extremely fortunate with the MalDent Project to have established a network of enthusiastic, multi-skilled collaborators. That network developed another arm recently when Mwapatsa Mipando and I met Chris Platt, Professor of Architecture at the Mackintosh School of Architecture, Glasgow School of Art (https://wordpress.com/post/themaldentproject.com/966).

On Tuesday 3rd September I headed to Glasgow Airport to meet with Chris and two of his senior students, Ciara Durkin and Breffni O’Brien. We were heading to Blantyre for a site survey of the College of Medicine campus and a stakeholder workshop – all set up to inform a design brief and costing exercise for the new teaching facility that will house the clinical components of the Bachelor of Dental Surgery course.

We travelled via Dubai and Johannesburg.

Complications to our journey began after we landed in Johannesburg. First, the A380 from Dubai taxied too far towards the terminal building at the gate and we needed to wait for 20 minutes until a tug arrived to push us back to the correct position for the doors to be opened. We were seated at the back of the plane, so it took a long time to disembark and our connection was quite tight. After passport control we ran to the Malawian Airways desk, to be told that the flight on which we were booked was not available! After some extended phone calls by the ground staff, we were finally given boarding passes for a plane to Lilongwe and then an onward connecting flight to Blantyre.

As a result, we arrived at Blantyre Chileka Airport several hours later than planned, but remarkably so did our bags!

We were driven to the Sunbird Mount Soche Hotel by a College of Medicine driver, arriving at about 6.30pm. After a quick shower, I headed downstairs for a meeting with Dr Nedson Fosiko, Deputy Director of Clinical Services at the Malawi Government Ministry of Health, and Dr Peter Chimimba. We had a very positive discussion about the oral health policy development activities that are planned through the MalDent Project, and now have a clear way forward to commence the work.

Chris, Ciara, Breffni and I then had dinner together in the hotel and turned in early for some much-needed rest.

The next morning, after breakfast, we were collected by a College of Medicine driver and then headed to the College Library for a meeting with the Principal and Peter Chimimba.

The Principal laid out the history of the project and the need, now, to create a design and establish a costing for a new facility in which to deliver clinical dental teaching. Later in the morning we were joined by Peter Creaser, an architect from a local, well-established practice called MOD Architects. This company has worked on many projects at the College of Medicine through the years and Peter and his colleagues have extensive knowledge of the campus.

After these initial discussions in the Board Room, we enjoyed some refreshments and general discussion…

… a group photo

… then all headed outside to walk around the campus, armed with a site plan and Peter’s local knowledge. Chris, Ciara and Breffni took notes and many photographs for future reference.

Breffni and Ciara provided excellent support for Chris during the site survey.

Once the walk-round was complete, Chris, Ciara, Breffni and I went back to the hotel for a quick lunch. We were then collected and taken to the Polytechnic, which is part of the University of Malawi, to visit staff and students at the School of Architecture:

We were welcomed by the Head of the School, Ike Phiri, and introduced to a number of his staff colleagues and students. There was great enthusiasm for our visit and for their invitation to the stakeholder meeting the following day.

Chris presented Ike with a copy of the MacMag, which is an annual publication from The Mackintosh School of Architecture.

I was also delighted to meet Grace Phiri Zimba, the Estate and Development Officer for the Kamuzu College of Nursing, which is about to merge with the College of Medicine to establish the Kamuzu University of Health Sciences. Among her qualifications, Grace has a BSc in Architectural Studies from the Polytechnic. Grace is inevitably involved with the  establishment of the new dental teaching facility on the Blantyre College of Medicine campus.

Just before leaving we took a group photo and during the discussions that went on as people organised themselves for the shot, Ike mentioned that he had done his Masters degree in Dublin, Ciara and Breffni’s alma mater!

Just after the photograph was taken, Dave Rodocanachi from The Dental Warehouse in Johannesburg (a Henry Schein company) arrived. He would be providing expertise from a dental equipment perspective at the workshop the following day. Whilst Chris, Ciara and Breffni headed back to the College of Medicine to check out the venue for the workshop the following day, Dave and I headed back to the hotel and had a discussion in the bar based around a PowerPoint presentation on the equipping of a dental outreach teaching facility in South Africa which is currently in the final planning stages. There were a number of relevant learning points for the workshop the following day.

In the evening we were joined by the Principal for dinner at 21 Grill on Hannover. It was a good chance for many of us who would be participating in the workshop to get to know one another better. Peter Creaser from MOD Architects sat next to me and it was fascinating to hear about his career as an architect, starting in Lincoln but culminating in many years spent in Africa, particularly Malawi.

The following morning we set off from the hotel at 8.30am to set up for the workshop, which was held at the Research Centre at the College of Medicine campus.

Once the tables were laid out it was a matter of waiting for the many stakeholders to arrive and for the work to start. 

Whilst waiting for the event to commence …

… and Chris spent time speaking with Peter Creaser and his business partner Patrick from MOD Architects:

It was a very successful event. Chris first described how he had become involved in the MalDent Project and about his own background …

… before explaining the purpose of the workshop and how the day would be based around four tasks undertaken in small groups, with feedback delivered after each task.

The initial task aimed to identify the main themes that delegates believed to be important for consideration during the design of the building. These themes would then form the basis of the following three tasks, examining specific issues in increasing detail. The work undertaken is best described in pictures:

After each piece of group work, a spokesperson fed back for 5 minutes:

Chris made notes as each group fed back to the delegates:

After Task 1 was completed we broke for coffee and a group photograph:

During the coffee break, Chris identified and wrote up the main themes that had emerged from Task 1 on a flip chart. This was slightly refined following discussion with the delegates. The themes were then allocated to individual groups who would work on them during Tasks 2 and 3.

After Task 2 and feedback we enjoyed lunch, when the discussions continued on many fronts:

One of the advantages of the College of Medicine campus is the vista of the mountains and distant scenery, that can be viewed from so many angles. This was mentioned during the workshop as a feature that should not be forgotten when the new building was being designed.

For the final task we were asked to consider which of the three possible sites we would choose to erect the new building and to submit some relevant drawings. I found the latter particularly difficult, but Ciara was well versed in the concept and produced six drawings for Group A with no difficulty whatsoever.

By the end of the day, we had accumulated a very large number of feedback sheets:

When the meeting closed, Breffni and Ciara photographed all of the sheets. The hard copies were left with Ike who will use them for a design exercise with his architecture students at the Polytechnic. Chris, will work from the photographs of the sheets.

At the end of the event the Principal, Patrick from MOD Architects, Chris and I sat down to discuss the next steps. The outputs from the workshop would be used to inform a design brief, which in turn would allow a schedule of accommodation to be created and a cost estimate to be made.

We returned to the hotel, totally exhausted but very happy with the outcome of the day. After a couple of celebratory drinks in the bar, shared with Peter Chimimba, we had dinner and retired early in preparation for the start to our journey home at 5.15am the next morning.

Our driver arrived on the dot at 5.15am and everything went smoothly at Chileka Airport. It had been a whirlwind visit, packed with activity. As we headed out to the plane on the tarmac in the early morning light it was hard to believe how much had been achieved in just two days – an immensely successful outcome. 

 

 

 

On Thursday 15 August 2019, I set off from Glasgow to participate in the Induction Week for the first ever students to enrol on the recently approved Bachelor of Dental Surgery programme at the University of Malawi College of Medicine. It was a thrilling prospect! I was accompanied by my Glasgow Dental School colleague, Dr Petrina Sweeney, who would join me in delivering components of the Induction Week programme.

The journey was trouble-free and we spent the weekend completing the preparation of materials for our induction sessions. We also enjoyed time with Dr Peter Chimimba (Malawi MalDent Project Lead) and Prof Nyengo Mkandawire (Dean of the Faculty of Medicine), all of which helped to prepare us for the week ahead.

On Monday 19th August we met the students for the first of their induction sessions. Here they are, pictured with Dr Mwapatsa Mipando, Principal of the College of Medicine, in the centre of the group photo. The curriculum development and approval process had been arduous, but here was the result – and what a great result! It was the start of what would be a truly memorable week.

Following some initial introductory words from Prof Mkandawire, the Principal welcomed the students to the new BDS programme. In total, 10 students have been enrolled into BDS 1 (the Class of 2024) and 15 are commencing the Foundation Year before entering BDS 1 in 2020 (the Class of 2025).

Subsequently Peter, Wiston, James, Petrina and I introduced ourselves and spoke for a few minutes about our own careers in dentistry, to provide some background for the new students. We had a very broad range of experience between us, including primary care dentistry, hospital dentistry, academic dentistry and health services delivery, the latter of particular note since Peter and Wiston had both held very senior posts in the Malawi Government Ministry of Health at various points in their careers.

After a tea break, I delivered a presentation about the MalDent Project, to provide background context to the programme on which the students had enrolled, but also to stress the parallel work stream on oral health policy development and the need for prevention to form a core component of that policy.

The afternoon closed with a presentation by Petrina on some of the common oral disorders that the students would learn about over the course of their five year degree programme.

The following day, Tuesday, we were not required for Induction Week activities and instead we visited the Malawi University of Science and Technology (MUST) (https://www.must.ac.mw).

In a previous post I had described a recent meeting in Glasgow with Prof Wilson Mandala (https://wordpress.com/post/themaldentproject.com/988). Subsequently, Wilson, who is Executive Dean of the Academy of Medical Sciences at MUST, had arranged a very interesting itinerary for Peter, Petrina and I. Our first stop that morning was at MUST itself, which is about a 40 minute drive out of Blantyre in Limbe.

As described on its web-site, MUST was established by an Act of Parliament in 2012 “… with the aim of promoting the development, adaptation, transfer and application of science, technology and innovation for macro- and micro-economic development of Malawi”

Having passed through the entrance gates, the scale of this complex becomes clear immediately.

The first cohort of students was enrolled in 2014. MUST currently offers seven undergraduate and two postgraduate programmes in Engineering, Computer and Information Technology, Innovation and Entrepreneurship.

The Academy of Medical Sciences started its operations in 2018 with programmes in medical imaging, immunology and medical microbiology. This school also houses a large teaching hospital building, the operation of which is still undergoing development.

We were generously hosted by Professor Jonathan Makuwira, Deputy Vice-Chancellor, and we enjoyed a very productive meeting with him together with several other senior staff members. Two areas have emerged that may develop into collaborations with the MalDent Project:

• MUST runs a Bachelor of Engineering programme that focuses on Biomedical Engineering. There are possibilities for joint working in this area of training in the specialist field of dental equipment installation, maintenance and repair.
• There may be the possibility of developing a dental outreach ‘teach and treat centre’ in the hospital building which forms part of the Academy of Medical Sciences. Senior BDS students could work in this facility under the supervision of qualified dentists. The facility would also improve access to dental care for those living in and around Limbe, an area which is currently poorly covered by dental services.

After this very interesting and positive meeting we were treated to delicious refreshments, before heading back to Blantyre itself.

Following our meeting at MUST, Wilson took us to meet Professor Robin Broadhead who was Principal of the College of Medicine prior to Professor Maleta, who in turn was Dr Mipando’s predecessor. I had heard a great deal about the tremendous work of Professor Broadhead at the College of Medicine and it was a real privilege and honour to meet him over coffee in the lounge of his delightful house. Professsor Broadhead provided some very valuable advice on our plans to design and build a new dental teaching facility on the College of Medicine campus in Blantyre, based upon his extensive experience of other major construction projects for the College, including the associated fund-raising.

In addition to his medical and administrative knowledge and experience, Professor Broadhead is also a very talented artist and it was fascinating to visit his studio and see so many of his canvases, both completed and underway.

After bidding farewell to Professor Broadhead, Wilson drove us back to the Sunbird Mount Soche Hotel for a meeting with Mr William Mpinganjira, who is Deputy Managing Director of FDH Bank Ltd, based in Blantyre. We had a very valuable discussion during which Mr Mpinganjira provided clear advice on how to structure our proposal to potential funders in our bid to identify support for the construction of the new dental teaching facility on the Blantyre campus.

Wilson, Peter, Petrina and I then enjoyed lunch together at the Mount Soche Hotel. It had been a fantastic morning of meetings and I am very grateful to Wilson for setting them up for us.

That evening, the College of Medicine had arranged for all the MalDent team to have dinner at 21 Grill in Ryall’s Hotel, to celebrate the beginning of the BDS course. It was a lovely event and much appreciated by all present.

On the Wednesday morning we had a MalDent Project meeting. The many facets of the project resulted in a wide-ranging set of agenda items, but all linked and interconnected:

The Wednesday afternoon was filled with an induction session run by Peter, Wiston, Petrina and I for the BDS students. This included presentations and extensive discussions on the importance of prevention of oral disease, a description of the various specialties in dentistry, and some aspects of professionalism, with particular emphasis on the pros and cons of using social media channels in a professional context.

On the Thursday morning we were shown the preparations that were ongoing in the lecture theatre to prepare for the programme launch. The carpenters were hard at work and we were left to guess what was being built, because we were next due to participate in a third BDS student induction session.

This session had been billed as an opportunity for general discussion, providing an opportunity for the students to ask questions about dentistry as a profession and about the course ahead. Wiston, Petrina and I were joined for this session by Dr Jessie Mlotha-Namarika, the Head of the Dental Department at Kamuzu Central Hospital who, like Wiston, has been appointed as a part-time Clinical Lecturer for the BDS programme. It was a lively session with tremendous interaction from the students.

Petrina left this session slightly early to meet with Dr Joyce Gwonde, who is Dean for Students at the College of Medicine. This role carries significant responsibilities for the pastoral welfare of the students studying at the College of Medicine. Petrina has many years of experience as a Student Advisor at Glasgow Dental School and the two had arranged to meet to share experiences. It proved a very successful meeting and it was agreed that on return to Glasgow, Petrina would prepare some materials for me to deliver to Joyce during my next visit, scheduled for the near future.

I also left the induction session slightly early to meet Dr Susan Chichlowska, a Senior Lecturer in the Faculty of Public Health & Family Medicine at the College of Medicine. Susan was originally from the UK but has lived in Malawi for many years. Susan is involved in joint research projects with my colleagues Prof Peter Mossey and Mr Remus Chunda at the University of Dundee and I was keen to discuss some related issues with her. We had a very valuable discussion over a coffee at the Beit Cure Café and were subsequently joined by Petrina.

After lunch at the café, Petrina and I headed back to the main Lecture Theatre in the Library for the official BDS degree launch ceremony. It was a hive of activity as final preparations were underway. The carpenters had made a great job of decorating the stage and  the screen announced the launch of the BDS programme: 

A booth had been built which contained a sign announcing the new BDS programme behind a ribbon and bouquet:

A local band, The Melltones, was playing and singing to welcome guests to the event. I had heard this group previously on an earlier visit, when Peter and I were enjoying dinner at 21 Grill, and had commented then how great they sounded, so it was fantastic to hear them again.

We were ushered to seats in the front row and the hall slowly filled up. The BDS students had pride of place and were joined by other staff members from the College of Medicine, Mrs Papeye from the Ministry of Health and members of the national media.

The event was chaired by Dr Diston Chiweza, the College of Medicine Librarian, who welcomed us all and began proceedings with a prayer.

He then invited Dr Peter Chimimba to describe the background to the long-standing ambition to establish a BDS degree at the College of Medicine, which stretched back over many years. Peter described the launch of the programme as having a potential impact on oral health care in Malawi akin to the impact for mankind of Neil Armstrong landing on the moon. It was an emotional speech which illustrated very clearly the excitement that the BDS programme was finally a reality.

Professor Nyengo Mkandawire was the next speaker. He gave a very clear exposition of the mission of the College of Medicine and how the commencement of the BDS programme fitted into the overall structure. He followed with an outline of the course structure and some of the next steps in the development of the programme, including the need to design, fund and build a clinical dental teaching facility on the Blantyre campus.

It is tremendous at last to see Dentistry on the list of undergraduate programmes available in the Faculty of Medicine:

I was then invited to the stage to provide a brief overview of the MalDent Project. It was a pleasure to be able to acknowledge the support of the many individuals and organisations that were involved, both locally in Malawi and internationally, particularly the Scottish Government and UK partners. The importance of developing an oral health policy for Malawi, through close working with the Ministry of Health, was something I stressed as a critical parallel strand of work to ensure that the students who would be trained at the College of Medicine would have a suitable environment in which to work following graduation.

After a musical interlude by The Melltones the Principal, Dr Mwapatsa Mipando, spoke of his excitement that the BDS course had now been launched. He then invited Mrs Papyeye to speak on behalf of the Ministry of Health. In her very positive speech, Mrs Papeye issued an invitation to the Principal to update the Senior Management Group on the progress with the MalDent Project at one their forthcoming regular meetings.

Following the speeches, the official ribbon cutting took place to launch the BDS programme. I was very honoured to be invited to share the ceremony with Mrs Papeye. We were each provided with pair of scissors to cut either side of the central bouquet … 

… which was then held aloft by the Principal and one of the BDS students. 

After all the work that had gone into the development of the curriculum and its approval by the University of Malawi Senate, together with the many years of campaigning by colleagues like the Principal, Peter, Wiston and Jessie, this was an emotional moment of celebration.

Finally, the Principal accepted a donation of dental materials from Central Medical Stores Trust (DFID), which had been donated to mark the occasion.

The launch event closed with a prayer from Dr Chiweza, following which all the guests were then invited to move to the hallway behind the Lecture Theatre for refreshments and networking.

This photo of Dr Peter Chimimba, taken at the launch event, shows the elation and happiness that so many of us felt now that the BDS programme had finally been launched.

Colgate had a trade stand and provided everyone with a bag containing oral hygiene products and a commemorative mug: 

A number of us were interviewed by the journalists present and both Petrina and I spent a long time talking with the dental students. This culminated in the request for a photograph and we were delighted that Dr Joyce Gwonde, the Dean for Students, was able to join us.

The final photo is a tribute to the three men at the College of Medicine who have worked so hard to make this BDS programme a reality – the Principal, Dr Mwapatsa Mipando, the MalDent Project Lead in Malawi, Dr Peter Chimimba and the Dean of the Faculty of Medicine, Professor Nyengo Mkandawire.

Finally, the Principal kindly drove Petrina and I back to our hotel and shortly afterwards both Peter and Nyengo joined us for a celebratory drink together in the hotel bar. It was a lovely way to close off the day, spending a while with these two great friends and colleagues who have been on the MalDent Project journey from the outset.

Petrina and I were booked on an early flight out of Blantyre Airport the next morning and were to be picked up at 5am for the drive to the airport, so after dinner we both retired early to our rooms to finish packing and get some sleep.

Walking across the tarmac to board the waiting plane at Blantyre Airport the following morning, I reflected on what had been one of the most rewarding and exciting weeks of my professional career. We will undoubtedly face significant challenges over the next few years but the course is now up and running with a group of very impressive young students and a very determined team of staff and partners.

My colleague Petrina, having now experienced Malawi and the staff and students of the College of Medicine, is already looking forward to a future visit, as was Niall Rogerson after he accompanied me last November. I have no doubt that the many other colleagues who are offering their support as Flying Faculty, now that the programme is running, will experience the same pull to keep returning to the Warm Heart of Africa and to support this fledgling BDS programme through its early years.