It’s a century – the hundredth post on the MalDent Project blog!

During a recent discussion with Nigel and Vicky Milne, co-founders of the charity Smileawi, I mentioned that we were coming up to the hundredth post on our blog. Vicky suggested that I focus on the many collaborations that we have established and the multiple sources of support that underpin the project as a way of reflecting on where we are and where we are heading. It was an excellent suggestion and I’ve taken up the challenge. Where appropriate I have added web-links to earlier posts and included some photos of key events.

First and foremost, the MalDent Project is a partnership between the Kamuzu University of Health Sciences and the University of Glasgow, which is now well established and based upon trust and mutual respect. The progress made by this partnership since 2017 has been made possible through generous funding from the Scottish Government Malawi Development Programme. The photo below illustrates the beginning of this tripartite basis for the MalDent Project which occurred during a working lunch in Malawi in September 2017 between myself, Dr Mwapatsa Mipando and Mr Ian Nicol from Scottish Government International Development.

Two other organisations that have provided very valuable support are the Corra Foundation and the Scotland Malawi Partnership. Chrissie Hirst provided exceptional support with the log-frame development for the MalDent Project and to my colleagues at Smileawi with their Scottish Government grant relating to task shifting of emergency dentistry in Malawi.

The Scotland Malawi Partnership has helped us to publicise the MalDent Project and been responsible for introducing us to a number of our current collaborators, which has been a tremendous support for our efforts.

The NHS Scotland Global Citizenship Programme has also been a valuable resource and we have established a MalDent Project web domain on its main website.

One of the earliest supporters of the MalDent Project was the Royal College of Physicians & Surgeons of Glasgow (RCPSG), through its Global Health Group chaired at the time by Mr Mike McKirdy. My initial scoping visit to Malawi in September 2017 was partly funded by the College and when a delegation from Malawi visited in March 2018, the College generously hosted a dinner for our visitors. The HOPE Foundation of the RCPSG has also provided funding in support of our work to refurbish the Dental Department at Kamuzu Central Hospital.

Another early and continuing supporter has been the journalist and author Susan Dalgety who I met with her husband in Malawi whilst she was living in the country for six months to research her wonderful book, The Spirit of Malawi.

Not only did Susan mention the Maldent Project in her book, which was a tremendous thrill, but also covered us on several occasions in a weekly column she writes for The Scotsman newspaper, which gave us a great boost.

The university sector plays a major role in the MalDent Project. The challenges posed by poor oral health and delivery of dental care in Malawi were initially brought to the attention of the University of Glasgow in 2016 by the Principal of the University of Malawi College of Medicine (now Kamuzu University of Health Sciences), Dr Mwapatsa Mipando. This was the beginning of the partnership from which the MalDent Project arose. We have benefitted greatly from the high level partnership between the two universities.

This partnership has also resulted in a very exciting biomedical research programme based around a new state of the art laboratory known as the Blantyre Blantyre Research Facility. The MalDent Project team is very grateful to colleagues involved in the Blantyre Blantyre laboratory development for advice, encouragement and support.

Discussions in the Marketplace at one of the the Scotland Malawi Partnership Annual General Meetings led to an invitation to speak about the MalDent Project at the Rotary Club of Ayr. Professor Bob Kalin from Strathclyde University was in the audience that evening and that meeting in turn triggered a very valuable study with Bob’s team on fluoride levels in groundwater in Malawi and dental fluorosis that has recently been published.

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The University of Dundee has involvement with the Maldent Project on several fronts. Its Centre for Medical Education (CME) has been working with the Kamuzu University of Health Sciences for several years and when we invited a delegation of colleagues from Malawi to visit Glasgow Dental School in March 2018, we arranged a visit to to the CME which was hosted by Dr Neil Merrylees.

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We also engage frequently with colleagues at Dundee Dental School, particularly Professor Peter Mossey, who introduced us to the FDI (International Dental Federation), resulting in the MalDent Project being used as an exemplar in its recent 2030 Vision document, and Mr Andrew Paterson who is a Trustee of the charity Bridge2Aid (see later). Very recently Olivia Welch, a Dundee dental student, completed a dissertation for her intercalated BMSc in International Health based on a study of the design work currently underway for the new dental teaching facility / student hub on the Blantyre campus of KUHeS, which is also funded through the MalDent Project (see below).

Collaboration across universities and with local partners was key to success of the curriculum development for the new BDS course. Two curriculum conferences were held involving KUHeS, the University of Glasgow, the University of North Carolina and Wits University. Professor Simon Nemutandani, Dean of the Dental School at Wits, provided valuable support to the local team in Malawi and played a pivotal role at the Second BDS Curriculum Conference in November 2018. The curriculum conferences were also attended by representatives of the Dental Association of Malawi, Medical Council of Malawi and the National Council for Higher Education to ensure that the relevant official and regulatory bodies were involved from the outset.

Wits University is also hosting the four Assistant Lecturers as they undertake Masters degrees in a range of dental specialties before returning to their teaching roles at KUHeS.

Chance encounters which have brought great opportunity have been a feature of the MalDent Project. It was one such encounter at a gathering in a Glasgow coffee shop for discussions with Professor Phil Cotton, Vice-Chancellor of the University of Rwanda, that resulted in my introduction to Professor Chris Platt, Mackintosh Professor of Architecture at Glasgow School of Art. Chris had been working on plans for student hostels in Rwanda and when I explained that we had funding to design a dental teaching facility in Malawi the conversation rapidly became very animated – it was fantastic. By chance, Dr Mwapatsa Mipando, then Principal of the University of Malawi College of Medicine, was due in Glasgow shortly afterwards and a meeting was hastily arranged.

It was agreed that Chris would lead a design workshop with key stakeholders in Blantyre, which would also provide opportunity to view potential sites on the campus. Two senior architecture students from the Glasgow School of Art agreed to join us to help organise the event – Breffni O’Brien and Ciara Durkin.

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It was a whirlwind few days but very successful. We had invited the Head of Architecture, Ike Phiri, and some of his students from the University of Malawi Polytechnic to join the workshop and we visited their department the day before to brief them on the project, which provided a great piece of experiential learning for the students. Also in attendance were architects Patrick Calisse and Peter Creaser from MOD Architects, a local practice with previous experience of building on the Blantyre campus.

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This very successful workshop provided sufficient information to establish an initial project brief and schedule of accommodation to incorporate in a procurement process to appoint a design team. Following a formal process through the University of Glasgow Procurement Office, a consortium led by John McAslan + Partners was appointed. The consortium included Studio KAP, Buro Happold, Quant Consult Associates and David Narro Associates. The design process is well underway and a bid by KUHeS led by Dr Mwapatsa Mipando to the World Bank for $5.2m towards the capital cost of the project was recently agreed and has been approved by the Malawi Parliament.

At the interface of education and clinical service, NHS Education for Scotland (NES) is a formal partner of the MalDent Project. There are two dental educational programmes, managed by NES, that are of particular value for both undergraduate and postgraduate dental education. The first of these is the suite of clinical guidance document produced by the Scottish Dental Clinical Effectiveness Programme (SDCEP). The second is the repository of learning materials, developed in partnership by academics and learning technologists in Scotland’s dental schools, known as Scottish Dental Education Online (SDEO). Both of these resources are freely available online to dental students, academic staff and other dental professionals in Malawi.

A number of Scotland’s NHS boards have supported the MalDent Project through donation of dental equipment, particularly dental chairs. These have included NHS Greater Glasgow & Clyde, NHS Lothian, NHS Highland and NHS Tayside. We have also benefited through donations from general dental practitioners.

Donation of medical equipment to low income countries is a complex area, riddled with potential pitfalls. In particular, the donated equipment must be in good working order and robust but it is also important to ensure that there is engineering expertise for installation in the recipient country and biomedical engineers available who can service and maintain the equipment in the long term. Unfortunately, such expertise is in short supply in many low-income countries such as Malawi. In order to address these issues, the MalDent Project has been very fortunate to number the charity Dentaid and the international dental supply company Henry Schein among its closest and most active partners. Both organisations are a key part of the chain of ‘donation – transportation – installation in country’, working with local engineers and tradesmen, in the refurbishment of the Dental Department at Kamuzu Central Hospital, which currently delivers training of dental therapists from the College of Health Sciences and, from February 2022, will also be used for pre-clinical and clinical teaching of BDS 3 students.

To address the longer term need for skilled dental equipment engineers in sub-Saharan Africa, the development of a module in dental equipment technology is currently underway to be offered as part of the Biomedical Engineering BEng degree at the Malawi University of Science and Technology (MUST). This is a partnership within the MalDent Project between MUST, KUHeS, Henry Schein, Dentaid and a large American dental supply company DCI.

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The charity sector continues to play a major role in the Maldent Project. In addition to Dentaid, the two dental charities Smileawi and Bridge2Aid are key players, with all three of these organisations bringing different skills and experiences to the MalDent Project work streams. Furthermore, there is great cooperation and communication between all the parties

Bridge2Aid introduced me to the programme of task-shifting of emergency dentistry to Clinical Officers in Tanzania, that they have been running for over 15 years. It was a model that was clearly applicable in Malawi and in collaboration with the Dental Association of Malawi and Smileawi, with full support of the Ministry of Health, Bridge2Aid planned a pilot course for Malawi in June 2020. Unfortunately the COVID-19 pandemic resulted in postponement but as soon as conditions allow, the pilot will proceed.

Smileawi instigated the pilot child oral health survey which they undertook in June 2019 with a group of senior dental students from Glasgow and Dundee Dental Schools. This study turned into the largest child oral health survey ever undertaken in Malawi and has provided valuable learning for the national child oral health survey planned for 2022 in which Nigel and Vicky Milne have already agreed to participate.

Very recently, with Scottish Government funding through the Small Grants Scheme, Smileawi has collaborated with Bridge2Aid, the Dental Association of Malawi and ProDental CPD to produce twelve on-line training modules for dental therapists in Malawi. Twenty six therapists in the North have been provided with tablet computers and pre-purchased data bundles and are completing the full course, for which they are awarded CPD. The therapists have provided comprehensive feedback on the course content and therapists in other districts are now keen to participate.

The close involvement and constant support of the Dental Association of Malawi, particularly from its Secretary Dr Wiston Mukiwa, has opened many doors for the Maldent Project and continues to be a vital partner.

Another key partner from the charity sector is the Borrow Foundation, which is providing significant funding for the work on prevention of dental caries in children. Ronald Manjomo, our PhD student at KUHeS, receives a bursary and the funding will also help to support the forthcoming national child oral health survey.

Many of the activities underway in conjunction with charities are closely aligned with priorities that have been identified in the ongoing work to develop a national Oral Health Policy. This package of work is led by the Malawi Government Ministry of Health and commenced with a two day workshop in Lilongwe in February 2020.

Subsequently an Oral Health Policy Task Force was established with representation from the Ministry of Health, Ministry of Education, Science and Technology, Office of the President and Cabinet, Dental Association of Malawi, Medical Council of Malawi, WHO Africa, KUHeS and the University of Glasgow.

The close involvement of Dr Yuka Makino, WHO Technical Officer for Oral Health in Africa, has been especially valuable in the policy work to date and has provided an excellent interface with oral health activities in other sub-Saharan African countries.

The policy and implementation plan are due for official launch in late Summer this year. In addition to providing a route-map for oral health improvement activities in Malawi, we hope that much of the content will be generalisable to neighbouring countries with whom we are developing links, including Rwanda, Zambia and Zimbabwe.

This blog post has concentrated on highlighting the input of more than 50 organisations to the work of the MalDent Project. In addition, there are many other individuals and small groups who make a highly significant contribution. The on-line Christmas Concert put together by Glasgow Dental School’s Big Smile Big Band to raise money for Smileawi and the contribution to the recently established MalDent Student Aid charity by my class mates at our 40th Reunion are just two examples. Others such as Deirdre Kelliher who looks after the grant management and Annie Mwapasa our Project Administrator in Malawi work with total commitment and dedication on the project. Many thanks to them all.

I’d like to finish with a photo of the three men whose vision and hard work lit the blue touch paper to ignite the MalDent Project and who have then continued to provide the support needed to maintain progress, despite multiple challenges such as COVID-19.

They deserve the last word as we look forward to the next 100 posts!