During the course of the Maldent Project we have received a large number of donated dental chairs and related items of equipment, including phantom head units, destined for the Dental Departments at Kamuzu Central Hospital in Lilongwe and Queen Elizabeth Hospital in Blantyre. This work stream has been strongly and generously supported, particularly from a technical perspective, by our partners Dentaid and Henry Schein Dental.
In May 2019 we completed Phase 1 of the re-equipping of the Dental Department at KCH and on arrival back in the UK began collecting additional items to allow completion of the work in a second phase. That work is about to begin as the container of equipment dispatched last year has arrived safely in Lilongwe. I will be heading out to Malawi on 13th March with Stuart Bassham from Dentaid and Chris Cox from Henry Schein to complete the installation. In addition to the materials that have already arrived in the container, we will take out a number of additional spares which will support the installation and any maintenance required on the chairs installed previously.
There are many potential pitfalls surrounding medical equipment donations. In one study of 112,040 pieces of equipment, 38.3% of items in developing countries were found to be out of service, with the three main causes of equipment dysfunction being lack of training, health technology management, and infrastructure (Perry L, Malkin R. Effectiveness of medical equipment donations to improve health systems: how much medical equipment is broken in the developing world? Med Biol Eng Comput. Jul 2011;49(7):719-722). One of the common pitfalls, especially for donated pre-used equipment, is a failure to consider in advance the need for ongoing maintenance and repair of the equipment following installation, which requires appropriately trained biomedical engineers. In many sub-Saharan African countries, including Malawi, there is a shortage of trained biomedical engineers. As a result, medical equipment which breaks down often lies idle for extended periods, or is discarded, when a trained and well-resourced engineer could resolve the problem relatively easily.
We have been acutely aware of these challenges since the MalDent Project was established and we included a funding stream to begin addressing this issue with dental facilities in Malawi. The COVID-19 pandemic hindered the start of this element of the project but an exciting and innovative start has now been made on what we are calling the ‘MalDent TechAid‘ programme.
Recently, Stuart Bassham at Dentaid became involved in another global health project with the Social Enterprise Medical Aid International, which is led by Tim Beacon. Medical Aid International’s stated goal is ‘to improve healthcare across the developing world through supplying medical equipment and accessories, training and biomedical support that is context-appropriate, fit for purpose and tailored to the individual project’.
Stuart subsequently introduced Tim to a group of partners we had been assembling to develop on-line training materials in dental equipment maintenance and repair. Patrick Allen, our long-term partner and supporter from Henry Schein, set up a conference call with Stuart, Tim, Tony Royston (Medical Aid International), Jason Spencer (DCI), Aldo Eagle (axiUm) and myself to examine how our shared expertise could be pooled to address the need for enhancing dental equipment maintenance and repair skills in Malawi. The meeting resulted in exciting developments which will likely prove a turning point.
Following introductions and a short summary of the scope of the MalDent Project, Tim delivered a presentation about Medical Aid International and how its work could support and interface with our own ambitions.
His opening slide included a photo of two Malawian engineers at the Beit Cure Hospital in Malawi who have already completed the on-line Medical Aid International training programme.
Tim then described very clearly the various ways in which his organisation approaches the delivery of support for medical equipment procurement, installation and after-care in low-and middle-income countries:
The procurement of equipment appropriate to the environment, and high quality education for engineers and estates teams, are central factors which will also be key to addressing the challenges surrounding dental equipment in Malawi:
One particular slide illustrated a surgeon who, with minimal equipment but some knowledge was able to effect a repair on an operating light. I was delighted to recognise the surgeon as Steve Mannion, an orthopaedic surgeon who is renowned for his work in global surgery, particularly in Malawi, and a fellow member of the Royal College of Physicians & Surgeons of Glasgow Global Health Group:
What was of particular interest to the group was the educational package that Medical Aid International has developed on biomedical engineering for those in low- and middle-income countries:
The training package comprises three components, the first of which includes the supply of a set of tools:
The second component is an on-line training programme. There is an extensive monitoring and student support process delivered by staff at Medical Aid International:
The final component, COVID-19 permitting, is an on-site face-to-face follow-up:
The next slide stimulated a very interesting conversation which has fundamentally altered our approach in terms of the target group for the training:
We had previously only considered the up-skilling of qualified biomedical engineers, by delivering specific training on dental equipment installation, maintenance and repair. However, Tim suggested that we should perhaps consider training a cadre of dental therapists, who would then have additional skills and could provide extended duties in the field. I had never considered this previously, but the more we discussed the concept, the more sense it made. Many of of the equipment challenges arise in parts of Malawi (particularly more rural areas) where there is no access to a biomedical engineer. If there were dental therapists on the ground who had some knowledge and understanding, then they could undertake routine maintenance and attempt repairs themselves when necessary.
After the call, I spoke with Martha Chipanda, the Oral Health Coordinator at the Ministry of Health in Malawi. Martha was very enthusiastic about this concept and, as a result, we have enrolled five dental therapists and one biomedical engineer on the Medical Aid International programme.
In parallel, Stuart, Patrick and Chris Cox, together with their other colleagues at Dentaid and Henry Schein respectively, will design a series of on-line training modules specific to dental equipment, which the six individuals who complete the Medical Aid International course will then undertake as a follow-up programme. The first face-to-face planning meeting has already taken place:
It is very exciting that this part of the MalDent Project is now underway and that we have added another partner to our team in the shape of Medical Aid International. If this proof-of-concept pilot training programme is effective, then we can examine ways in which it can be extended, potentially linking with further- and higher-education institutions in Malawi. It is also clear that there may be applicability to other countries in the region which face similar challenges to Malawi with dental equipment maintenance and repair.
The American New Thought writer Wallace D Wattles (1860-1911) wrote: “It is essential to have good tools, but it is also essential that the tools should be used in the right way”. Our aim is to ensure we do both.
Having worked as a Dentist at Zomba General Hospital in Malawi, I am in complete agreement with the project of
training the dental therapists to attempt repairs especially to equipment they use frequently. The corridors in the hospital were littered with so called “broken down” equipment which nobody had attempted to repair. I hope this works but the Therapists may demand an uplift in their pay packets.