One of the work streams in the MalDent Project that has been most impacted by the COVID pandemic is the completion of the re-equipping of the Dental Department at Kamuzu Central Hospital, which we commenced with our partners Dentaid and Henry Schein in 2018. Since then, many items of donated equipment had been delivered to Dentaid in Southampton for refurbishment and servicing by Stuart Bassham and his team. The shipping container that we purchased with financial support from the RCPSG HOPE Foundation had been loaded and transported across to Malawi last year, ready for Phase 2 of the refurbishment. The one missing part of the jigsaw was a visit by our team to install the equipment.
As travel restrictions began to ease, we were able to plan this last step. On Sunday 13th March I made my way to London Heathrow Airport to meet Stuart and our latest recruit to the MalDent Project, Chris Cox from Henry Schein Dental. This was to be the start of a very busy, successful and memorable working visit to Blantyre and Lilongwe.
Jacqueline James at Dentaid had looked at several options for our travel and, after consultation with Stuart, we decided to take a new route via Addis Ababa with Ethiopian Airlines.
After a very comfortable seven hour overnight flight on an airbus A350 we arrived safely in Addis Ababa.
As you will see from the photo above, Stuart is wearing a boot on his left foot and walking with crutches. He had broken his foot earlier in the year but did not allow this to deter him from travelling to Malawi. It also did not hold him back once the hard work started!
We had a two hour stopover in Addis Ababa and found a lovely coffee shop. I had already realised that Chris was a very keen coffee drinker and a cup of the strong black liquid soon had him smiling after the overnight flight.
Ethiopia is widely believed to be the birthplace of coffee. Apparently Ethiopia is the only place that coffee grew natively. According to a story written down in 1671, coffee was first discovered by a ninth century Ethiopian goat-herder called Kaldi. Allegedly he noticed the energy his goats received from eating the cherries! Whatever the veracity of the legend, we were very grateful for the energising we received that morning!
Our second flight, aboard a Boeing 737 to Chileka Airport in Blantyre, took only four hours.
On arrival at the airport, our first visit was to a large tent, in which our COVID tests and vaccination certificates were checked.
We then headed into the terminal building to purchase our visas and clear immigration. This took a while, and when we were finally through to the baggage reclaim area, I was delighted to see that Peter Chimimba had come to meet us. Our airline baggage tags were checked by security before going through the X-ray scanner:
It was fortunate that Peter was present, because one of the security staff operating the scanner wanted to understand why Chris was bringing in the large tool bag. There was a discussion in Chichewa, which did the trick, but I think we might have struggled to explain had we been on our own!
Once into the airport car park, our bags were loaded into a Toyota Hilux pickup that would be our steed for the duration of our visit.
We also met our driver from the Kamuzu University of Health Sciences, Sibande Balaka, who would become a very trusted and loyal friend during our stay and who is pictured here a few days later at Kamuzu Central Hospital:
After a 20 minute drive we reached the Sunbird Mount Soche Hotel at about 1.45 pm. I was so pleased to see the familiar surroundings and many familiar hotel staff after the COVID-enforced two year absence from Malawi.
We quickly checked in and whilst Chris and Stuart headed to their rooms, I travelled to the KUHeS campus with Sibande for a meeting with Professor Ken Maleta. We discussed some aspects of our work in the area of prevention of dental caries in children, which aims ultimately to establish a Malawian model that is akin to Scotland’s Childsmile programme. I was grateful to Professor Maleta for his valuable advice and guidance, providing suggestions to pursue once back in Scotland.
After the meeting I headed back to the hotel and to the red sofa in the bar where Peter and I have had so many meetings and discussions in the past. We had arranged for Stuart and Chris to meet with Professor Wilson Mandala, Executive Dean of the Academy of Medical Sciences at Malawi University of Science and Technology. In addition to making introductions, we were also keen to update Prof Mandala on the plans for the training of Malawian dental therapists and biomedical engineers in dental equipment maintenance that have recently evolved. Ever since our visit to MUST in 2019, we have been keen to work with staff in its Biomedical Engineering programme on delivery of teaching around dental equipment maintenance. We had a very positive meeting and look forward to further joint working.
Following the meeting with Prof Mandala we enjoyed dinner in the hotel and after a good night’s sleep were up promptly on the Tuesday for meetings at the Blantyre Campus of KUHeS. Our first set of discussions was held with Professor Johnstone Kumwenda, the Dean of Medicine, who has been very supportive of the new BDS programme. After introductions, we briefed Prof Kumwenda about the purpose of our visit and then enjoyed a general discussion about the new course and how things were progressing.
After our meeting with the Dean, we walked across the campus to meet the Acting Vice-Chancellor, Professor Macpherson Mallewa and the Registrar, Mr Stuart Chirambo. We had a very positive set of discussions, after which Stuart, Chris and I were presented with gifts to mark our visit.
For me it was a great pleasure to meet Lucia Msiska, formerly the PA to Dr Mwapatsa Mipando when he was Principal of the University of Malawi College of Medicine, and now supporting the AVC. Lucia played a very important role in the early days of the MalDent Project, before Annie Mwapasa was appointed as our Administrator. Lucia reminded us that exactly four years ago she had been in Glasgow with the CoM delegation that visited, and was part of the team that wrote the successful MalDent Project grant application to the Scottish Government. After the formal meeting we had a chance for a quick catch up, which I really enjoyed.
Our next engagement was with the BDS students in Foundation Year and in BDS 1 and 2. We met them in the same auditorium as the BDS Programme launch had been held in 2019 and it was quite emotional to see the large cohort of budding young dentists as the course gathers momentum.
After introductions by James and Peter, Chris, Stuart and I each took our turn to address the students. It was a great opportunity to update them on the broader aspects of the MalDent Project, including the forthcoming launch of the National Oral Health Policy and the progress being made with the design of the new teaching facility on the Blantyre campus.
In the afternoon we headed across to the Dental Department of the Queen Elizabeth Hospital.
When I had first visited this facility in 2017 it was in a dreadful state. Since then, with funding from the Ministry of Health and KUHeS, a significant amount of refurbishment and re-equipping has been undertaken, bringing about great improvements. However, there were still a number of equipment issues that remained to be addressed and Stuart and Chris soon had the tool kit out and set to work:
Whilst Chris and Stuart were busy, I left them to head back to the KUHeS campus for a meeting with Joyce Gondwe, the Dean of Students and Collins Chiliwawa, the Scholarships Officer. We had a very fruitful discussion about MalDent Student Aid and the Dentist to Dentist scholarships that are being established at KUHeS.
I returned to the Dental Department at the Queen Elizabeth Hospital later in the afternoon, expecting Chris and Stuart still to be working. However, they were at the entrance chatting with staff, having completed all the repairs required:
The next few photographs illustrate some of the improvements that have been made recently to the clinical facilities. First, a panoral radiography set up has been installed:
New dental chairs have been fitted in re-decorated areas of the building and the dividers between each unit have been replaced with new fittings that feature oral health messages:
Here, some of the dental therapists who work in the Department are posing in a surgery that has colourful painted murals:
It was fantastic to see these significant improvements, all of which had taken place outwith the funding from the MalDent Project itself, and which bring tremendous added value to the work being undertaken to improve oral health in Malawi.
We returned to the hotel for dinner and I was delighted that my good friend Nelson Nyoloka, Lecturer in Pharmacy at KUHeS, was able to join us. Nelson had spent the previous year in Glasgow completing his MSc in Clinical Pharmacology, and it was great to see him again and introduce him to Chris and Stuart.
The following morning we were up early for the long drive to Lilongwe. I have now completed this journey on a number of occasions and always enjoy it. For Chris and Stuart, it was their first time on this road, and they both found the variety of views and beautiful countryside fascinating. En route I spotted a private dental clinic in one of the towns and managed to take a photograph as we passed.
We checked into our hotel in Lilongwe and had a light lunch before heading across for a reconnaissance of the work to be undertaken at the Dental Department in Kamuzu Central Hospital. Whilst we were enjoying our lunch there was a very heavy rainstorm, which lasted for a matter of minutes before abating:
On arrival at KCH, and after greeting the team there, we headed straight to the pre-clinical skills facility, since a priority for the visit was to install the second group of six A-dec 4810 phantom heads to complement the six identical simulators we had installed in 2018.
Whilst the existing cabinetry looked in a reasonable state from the outside…
… a quick look inside revealed exactly the same problem we had encountered in 2018 – massive destruction of the composite board by termites, which had reduced much of the internal structure to a brown dust:
It was clear that the structure needed to be removed, so Chris, Stuart and I set about removing the fittings, breaking up the wooden structure and removing it completely
The ‘moth-eaten’ appearance of the wood is clearly evident in this photo…
… as are the piles of termite dust in these photos:
By close of play, covered in dust and wearing sweat-drenched clothes, we were very pleased to have completed this part of the work on our first day in Lilongwe, to allow the hospital carpenters to start building the new cabinetry the following day.
After showers, a decent meal and a good sleep at the hotel, we were up early to head back to KCH. On arrival I enjoyed a chat with Jessie Mlotha-Namarika, the senior dentist at the facility, who I have known since my first visit to Malawi in 2017. Jessie was delighted with some tooth models and teaching materials that Stuart had donated to her on behalf of Dentaid.
Shortly after our arrival, we were joined by the hospital carpenters. Stuart and Chris explained what was required, referring to the structure built in 2018 for the first six simulation units, which provided a template for what we needed. Wood was ordered and once it arrived the carpenters set to work.
A little later, the equipment from the shipping container arrived on a truck…
… and unloading commenced
The chairs were placed in the circulation space in the centre of the building …
… and the six phantom head units lined up outside the pre-clinical skills facility:
The shipping container from which the equipment had been delivered to the Dental Department that morning is now permanently stowed at the Lilongwe campus of KUHeS. It is available to ourselves and all our partners, including Smileawi and Bridge2Aid, as a storage facility and staging post for all our various activities associated with oral health improvement in Malawi.
Just as the truck with the equipment was arriving, I had to leave for a meeting at the Ministry of Health with Dr Jones Masiye, Deputy Director Clinical Services – NCDIs and Mental Health. On arrival I apologised for my ‘working clothes’, before we started our discussions, including the detailed planning for the launch of the National Oral Health Policy, which had just been re-scheduled for 14th April. It was a very valuable meeting.
I returned to Kamuzu Central Hospital, where the carpenters were busy constructing the cabinetry for the phantom head units. In light of the termite issue, the structure was liberally coated with an anti-termite preparation, which should help to preserve it.
These views show the metal manifold from which the compressed air is directed to each of the simulation units
The carpenters were happy to pose with Chris, once their work was done:
We returned to the hotel in the evening and enjoyed a dinner in Vincent’s Restaurant with colleagues from the Ministry of Health. We were honoured that Enock Phale MP, Deputy Minister of Health, was able to join us, along with Martha Chipanda, the Oral Health Coordinator at the Ministry and Jones Masiye, who we had met earlier in the day. Jessie, Peter and James also joined for a truly memorable evening.
Enock Phale and Martha Chipanda had been classmates at the College of Health Sciences when they initially trained as dental therapists. We were able to capture this lovely photo of Enock and Martha (seated) and Jones and Jessie (standing) – all key players in the journey to improve oral health for the citizens of Malawi
On a previous visit to Malawi I had sampled crocodile tail, which I had really enjoyed. On my recommendation, Chris (and I!) chose the crocodile for our main courses and both thoroughly enjoyed it.
The next day turned out to be highly significant. As explained in the previous blog post, Martha Chipanda has identified five dental therapists and one biomedical engineer who will complete the online training programme on equipment maintenance delivered by Medical Aid International. We had arranged for these six candidates to attend at KCH Dental Department on Friday 18th March to shadow Chris and Stuart as they were installing the replacement dental chairs. Martha and I spent an initial twenty minutes with the group, explaining how their involvement fitted into the broader MalDent Project. They then joined Chris and Stuart for the rest of the day. Their enthusiasm and willingness to become closely involved in the work was inspirational. Chris and Stuart were fantastic teachers, such that after a fairly short time the team of trainees was doing much of the work under supervision:
This photo was probably our favourite of the trip – the most positive image you could wish for:
When Stuart had been packing the shipping container at Dentaid headquarters, he had included an Oxford hoist, which had previously been used to care for an elderly relative. His intention had been to donate it to the main hospital, but we then realised that it could be used to lift and transport the dental chairs and other weighty items. Anyone who has tried to move dental treatment units will know how heavy and awkward they are. Moreover, the base is designed to be non-slip for stability, making sliding the chair very difficult. We were very grateful for Stuart’s brainwave in packing the hoist, which made our lives much easier.
Mid-morning on the Friday I walked across to the Lilongwe KUHeS campus to meet with the pioneer cohort of dental students, who have now commenced BDS 3. Our extensive discussions were accompanied by refreshments. It was an opportunity for James, Peter and I to update the class about a number of developments underway on the MalDent Project and for the students to air some of their feedback and concerns.
At the conclusion of our meeting, we enjoyed lunch together …
… and then moved to the steps at the front of the building for a photograph.
Grateful thanks are due to Madalitso Kaphamtengo, Administrator at KUHeS, for organising the venue and refreshments.
Following the meeting with the BDS 3 students, I returned to KCH. The trainees were still busy working with Chris and Stuart. At one point they were divided into two teams and each given a chair replacement to complete under the watchful eyes of Chris and Stuart. They were extremely fast learners and this experience bodes well for the Medical Aid International training they are about to commence.
On the Saturday, we returned to KCH to continue working on the equipment. Chipi, one of the therapists from the group of six who had visited the previous day, joined again voluntarily on the Saturday and the following Monday, as he lived locally
On the Saturday evening, as we were enjoying a drink in the bar, Peter recognised an acquaintance of his, Professor Francis Moto, who is Chairman of the KUHeS Council. Formerly Professor Moto was the Malawian High Commissioner to the UK (2005-10) and subsequently Malawi’s first Ambassador in Brazil (2011-15). Peter greeted him and he kindly came across to join us for a fascinating discussion on a wide range of subjects. It was a memorable evening. I was especially interested in the tartan scarf that Professor Moto was holding. It turned out to be the official Malawi tartan – designed at his instigation whilst High Commissioner in the UK!
On Sunday, Chris and Peter were away for the day visiting a charity (the Chinthowa Development Trust) outside Lilongwe – Chris’ family has close involvement with this organisation.
I stayed in the hotel and completed some academic work that required attention. In addition, it was World Oral Health Day 2022, and we were able to publish a series of tweets about the work we were doing in Malawi, including the following three:
On the Sunday evening we were all joined by Dr Mwapatsa Mipando, who had travelled to Lilongwe that day from Blantyre, having only just arrived back from a visit to Zambia. We enjoyed a working dinner together, ahead of a visit on the Monday by Mwapatsa to see the results of the work at the KCH Dental Department.
Whist at the Dental Department, he was able to meet with the BDS 3 group who were waiting to have a lecture in the Conference Room there. It was good to see the tablet computers that we had helped to fund being put to good use by the students.
By this stage, the installation work was largely complete, with small details being attended to before we left. The phantom head unit was transformed into a first class training facility:
In total, six refurbished dental chairs were installed and five existing chairs serviced and repaired…
… and seven chairs were prepared to be transported and installed in district clinics. The therapists who are undergoing the biomedical engineering training will be able to support these installations.
By the end of our visit, we had accumulated a ‘graveyard’ of termite-ravaged cabinetry and scrap equipment which will be disposed of by the local team:
Word got out that it was my 65th birthday on Monday 21st March and I was very touched that the BDS 3 class presented me with a birthday card! The success of the trip itself was a fantastic birthday gift, and it’s an occasion I won’t forget.
On the Monday afternoon, Chris brought the BDS 3 students into the pre-clinical skills unit to run over some of the ‘dos and don’ts’ of using the equipment. Chris previously worked for A-dec before joining Henry Schein, and what he doesn’t know about these simulators isn’t worth knowing – the students were learning from a true expert.
Just before we left KCH for the last time, we had a photo with Chipi, who showed great enthusiasm and aptitude for working on dental equipment – he had rapidly become part of the team.
Chris donated the extensive tool kit to the Department, together with a large bag of spare parts, to support the local team with maintenance moving forward.
After leaving KCH for the last time our driver, Sibande, took us to a local market. Chris and Stuart were keen to buy some artwork and artefacts to take home.
When he returned to the car, Stuart handed me a birthday gift – a beautiful wooden model of a Land Rover Defender. Stuart is a great fan of Land Rovers and knew I share an interest in cars – it was a lovely surprise and will join my collection of Malawian items from earlier trips.
We returned to the hotel to commence our packing and decided, as it was our last night, to have dinner in Vincent’s Restaurant. Chris opted for crocodile yet again and I started with the fantastic mushroom soup they serve.
The next morning we had a leisurely start, leaving the hotel at 11.15am for Kamuzu International Airport.
Our COVID PCR tests had all been negative and we were quickly through the necessary checks.
The flight to Addis Ababa was on time and uneventful. However, we had a six hour stopover before our flight to Heathrow. We settled down in a cafe called ‘Cravings’, next to a power point, and enjoyed a nice meal followed by laptop time using the excellent free airport WiFi.
Whilst we were waiting, we received a message from Chipi, the dental therapist turned biomedical engineer! He wanted us to take a selfie and send to him, which we duly did. His message indicated how much he and his colleagues had learnt and that he would be in contact through WhatsApp with any issues that Chris and Stuart could help to resolve. It was a lovely message and along with the enthusiasm of the six involved has confirmed that the concept of training dental therapists to maintain their own clinical equipment is worthy of examination.
We boarded on time and the overnight flight to London was smooth and punctual.
Once we had cleared immigration and collected our bags, Chris and Stuart headed to the car park to retrieve their vehicles and I headed for central London and the train home from Euston.
This had been a tremendous visit. As always, our Malawian colleagues showed us great warmth and hospitality and our partnership working continues to reap rewards on all fronts. My good friend Peter Chimimba was always on hand to help and guide us, and I was particularly pleased to capture this very happy photo of him with Stuart at breakfast in the hotel.
Big thanks are also due to James Mchenga, Annie Mwapasa and Mwapatsa Mipando for their help in organising our visit and ensuring it ran smoothly. We are also indebted to Sibande Balaka, our driver, who always greeted us with a wide smile and for whom nothing was too much trouble.
Thanks are also due to the many individuals and organisations who donated the equipment in the UK for onward transport to Dentaid and then to Malawi. Many thanks also to Scottish Government International Development and the Royal College of Physicians & Surgeons of Glasgow HOPE Foundation for generous financial support.
Personally, I would also like to thank Andy Evans, Chief Executive Officer of Dentaid, and Patrick Allen, Managing Director of Henry Schein UK, for supporting Stuart and Chris respectively to participate in this visit. Both Stuart and Chris worked tirelessly to extract the maximum benefit from our time in Malawi, utilising their expert knowledge to not only complete the installations, but also provide training, advice and a set of tools so that the local team can maintain the equipment far more effectively moving forward. All of this was achieved with both humility and a great sense of humour. I could not be more impressed or more grateful to them – they deserve the last word and final photo in this post! Zikomo!