This is a guest post from my friend and colleague Colin Larmour, Consultant Orthodontist and Senior Lecturer, Aberdeen Dental Hospital and Institute. Many thanks to Colin for his great support of the MalDent Project and for compiling this post describing his recent visit to Malawi.
As part of the MalDent Project ‘flying faculty’ program I travelled to Malawi in May to provide introductory clinical orthodontic teaching to the third year BDS students. This group of students are the ‘pioneer’ students at the new Dental School of the Kamuzu University of Health Sciences (KUHeS). My wife Pauline, a Psychiatrist, also made the journey to Malawi to provide clinical teaching in psychiatry at the medical school in Blantyre and Zomba Hospital through the Scotland Malawi Mental Health Education Project (SMMHEP).
In the months preceding our trip I was given a lot of advice from Jeremy in Glasgow about what to expect with a trip to Malawi from both a practical perspective and also in relation to the Dental School set up and the curriculum for the BDS course. I was also in close contact with James Mchenga, the academic lead for Dentistry at KUHeS, and Peter Chimimba, the lead for the MalDent Project in Malawi. This included discussions about the orthodontic curriculum and the content of the introductory programme in orthodontics and exchanges of reading material and learning outcomes for the students.
Following a request from Malawi for some orthodontic instruments, including examination kits and rulers, Christian Burdess from DB orthodontics in West Yorkshire was kind enough to donate the orthodontic instruments requested, as well as lip retractiors and mirrors for orthodontic photographs. Many thanks again to Christian and his team in West Yorkshire for their support of the MalDent Project.
As far as travel arrangments in the COVID era, I had lots of advice from Jeremy who had made a recent trip with Chris Cox and Stuart Bassham. Mandatory vaccination and a negative PCR before arrival were still required. As far as COVID is concerned, having seemingly escaped the virus for more than two years I started to develop symptoms two weeks before we were due to travel. Luckily my symptoms were mild and I stopped testing positive after 8 days. I had a PCR test around day 12 which was also negative so travel plans were still on course…
The journey began on Wednesday 18th May and the first leg of the journey was with British Airways from Aberdeen to London Heathrow, connecting with an overnight flight to Addis Ababa with Ethiopian airlines.
An early morning connecting flight to Chileka airport in Blantyre saw us arrive in the early afternoon on the Thursday, almost 20 hours after leaving Aberdeen. Successful negotiation through the COVID clearance tent, where vaccination and PCR status are checked, and onto passport and visa checking at the border control and then, thankfully, reunited with all our luggage including the dental equipment.
We were staying at the Kabula Lodge, a guest house about five minutes from the city centre, situated in an elevated position with panoramic views of the city and surrounding mountains.
After a couple of days settling in over the weekend I was picked up by a University driver, Richard Jumbe, who brought me for an early morning meeting with James Mchenga and Peter Chimimba at the Kamuzu University of Health Sciences, close to the Queen Elizabeth Hospital.
We were also joined by a new part-time faculty member, Yusuf Maundala. We had a very productive discussion about the orthodontic curriculum and plans for the orthodontic teaching that would be delivered over the next few weeks while I was in Malawi. We also organised the instruments donated by DB orthodontics so that those required over the next few days in Lilongwe with third year BDS students on clinic could travel with James and myself. One of the challenges at present is having the students split over two campuses with the early phase students (foundation year and first and second year BDS) being at present based in Blantyre and the third year BDS students in Lilongwe, while the team await the completion of the building of the new Dental School in Blantyre.
Late morning I left Blantyre and travelled to Lilongwe. This was a very interesting road trip travelling north through Malawi with the road running along the border with Mozambique, reaching Lilongwe around 5 hours later at the Sunbird Capital Hotel in the centre of the city. James was travelling separately with his wife and arrived slightly later. We met for a very pleasant Malawi-style buffet dinner in the hotel, with a chance to catch up around plans for the week ahead.
Early next morning James and myself were picked up by our driver Richard and were taken across the city to the Dental Department at Kamuzu Central Hospital, where we had a short meeting with Jessie Namarika, the Senior Dental Surgeon at the clinic.
Following this we went to the seminar room to meet a group of local general dentists for a CPD session on orthodontics. We had a lively and interactive session which included a presentation on ‘Dental and Occlusal Anomalies’, including intercepting problems in the mixed dentition.
The following day we met the third year BDS students at the Kamuzu Central Hospital for introductory sessions on Orthodontics, including an update on facial growth and occlusal development.
The students were very enthusiastic and keen to make the most of the sessions, with lots of lively discussion and intelligent questions. We were joined for the session by a local dentist, Dr Samonte, who is based at the clinic and is involved with student teaching.
A full day of lectures and a ‘virtual’ new patient assessment session followed, with the students completing two virtual new patient assessments.
All the students were happy to contribute to the discussions around each virtual patient and proved confident enough to present their thoughts on the diagnosis of each malocclusion type and development of a problem list. Fuelled with a tasty snack of Scottish shortbread they still had energy to have a go at a short quiz at the end of the day and left with a spring in their step, feeling that it had been a worthwhile day.
On my last day at Kamuzu Central Hospital in Lilongwe we met the students early for a preparatory tutorial before moving to the clinical areas, where the students carried out orthodontic assessments on each other.
Dr Samonte, a local dentist who has an interest in orthodontics, was also present and the students worked very enthusiastically through the orthodontic assessments before presenting their ‘patients’. In the early afternoon we had a debrief and final session for the students with James and myself so they could feed back and ask questions about all they had been learning that week on their introduction to orthodontics course.
Following final photos and goodbyes we travelled back to Blantyre. The roads were much busier on the return journey and it took us more than an hour to get out of Lilongwe onto the Blantyre road. We arrived back in the early evening after five hours of driving, enjoying a beautiful African sunset on the way.
With a weekend free, Pauline and I went on a camping trip with the local hiking club which allowed us to travel to the Chikala hills to the north east of Blantyre. This involved a couple of hours travel on rough dirt roads through local communities. This overnight trip turned out to be a highlight of our time in Malawi with a hike through the rainforest and an overnight camp on the summit, with views to Mount Mulanje in the south and the Shire valley in the east.
The following week, back in Blantyre on the Monday I had a meeting with James and Yusuf, with further discussions around the orthodontic curriculum for the BDS students going forwards. We were also visited in the afternoon by a retired dentist from the U.S., Dr Clifford Daines, who was in Malawi with his wife as missionaries with the Mormon church.
Dr Daines had brought with him a batch of donated dental instruments which were enthusiastically opened by James and Yusuf.
The following day James and I had organised a CPD day for local dentists. Accordingly a group of nine dentists, based in both private practice and government health clinics, met in the board room in the medical college. We had a good interactive discussion around a presentation on dental and occlusal anomalies, including interception and management of problems in the mixed dentition. Several dentists have an interest in orthodontics and were very enthusiastic and happy to contribute to the day.
Later in the afternoon Wellington Chikuni, one of the local dentists on the Queen Elizabeth Hospital site, gave me a very informative tour of the Dental Clinic.
Several paediatric patients were in the clinical areas having extractions under local anaesthetic and Wellington discussed how this can be difficult, with many very anxious children presenting with toothache and acute dental infection. There is currently very little access to extractions under general anaesthesia and we discussed the potential advantage of introducing inhalation sedation as an option for younger and more anxious patients. Plans were hatched, with both of us agreeing to take a look at options for developing this service in the future.
My final few days in Blantyre were busy with further meetings with James, Yusuf and Peter. I was also given the opportunity to speak to the preclinical first and second year BDS students and it was great to see their enthusiasm as they set out on their studies in Dentistry.
They proved a lively bunch and asked lots of questions about orthodontics, especially after I let them into the secret that it is the best speciality in dentistry!
On my final afternoon I was given the opportunity to accompany James and Yusuf to the Plastic Surgery department at Queen Elizabeth Hospital and attend an educational meeting on maxillofacial trauma, presented by the plastic surgery registrars with clinicians at other hospital sites in Malawi linking in via ‘Zoom’. It was a well attended meeting. James and Yusuf contributed to the discussions with it being apparent how much general dentists and dental therapists are involved in managing facial trauma in Malawi with most being proficient at placement of inter-maxillary fixation.
Our final weekend was spent exploring the Mulanje mountain area south of Blantyre, before saying our goodbyes and heading back to the UK. The return trip was uneventful with a reverse of the outward journey travelling from Blantyre to Addis Ababa and then onto London and finally Aberdeen.
On reflection it was a very stimulating and rewarding trip both personally and professionally. I felt privileged to join the MalDent team and make a small contribution to the on-going journey to improve dental health for the people of Malawi. The enthusiasm of the local team including James and Peter is immense and they are very upbeat about the positive changes in dental health and clinical capacity that are slowly starting to take root in Malawi. They have understandably great pride in their ‘pioneer’ BDS students and new faculty members who are the bright future of dentistry in Malawi.
