The issue of Personal Protective Equipment (PPE) provision for healthcare workers was a vexed and politically-charged issue during the COVID-19 pandemic. In the early stages there were serious shortages, causing significant stress for those who were providing health and social care in the front-line. The pressure on supply chains led to prices soaring globally as governments around the world attempted to bulk-buy masks, gowns and related items. Eventually the supply and demand pressures eased, and large amounts of PPE were provided for healthcare workers, including dental professionals. However, with a reversion from the extreme transmission-based infection control guidelines for COVID-19 to procedures that are closer to standard infection control precautions, the volume of certain types of PPE that are required in clinical practice has reduced considerably.
Clearly, this is good news, but the law of unintended consequences has a habit of intervening. Earlier this year, my good friend Nigel Milne, who with his wife Vicky set up the charity Smileawi, was contacted by Paul Cushley, who is the Head of Procurement for Dental Services at National Services Scotland. Nigel and Paul were classmates at Glasgow Dental School, hence the connection. Paul explained that with the easing of COVID-19 infection control measures in dentistry, many practices were storing large volumes of FFP3 masks and protective gowns that had been provided through the NHS, but were now surplus to requirements. He wondered whether these items may be of value in Malawi and, if so, whether Smileawi could identify a means of collecting and transporting them. There was an underlying concern that many of these items would end up in landfill sites or incineration facilities if a suitable alternative use could not be identified. This backdrop triggered discussions between Smileawi and The MalDent Project, a partnership that has previous and ongoing collaborative activities linked to oral health improvement in Malawi.
Following a Zoom call with Paul, an SBAR was written followed by a string of meetings and discussions, including interaction with Dr Martha Chipanda, the Oral Health Coordinator at the Ministry of Health in Malawi, who confirmed that she was keen to receive any PPE that could be provided. It was agreed that we should establish a joint Smileawi – MalDent Project exercise to collect at least some of the excess PPE and ship it to Malawi. The items would be of value not only to the dental therapists and dentists delivering clinical care, but also to the dental therapy students and dental students in training at the Malawi College of Health Sciences and the Kamuzu University of Health Sciences respectively.
The organisation of this exercise turned out to be very challenging, but we are extremely grateful to our many colleagues in multiple sectors who allowed us to turn the concept into a reality. I will tell the story first, and then acknowledge the magnificent contributions of our supporters at the end.
The exercise itself started on Friday 26th August, with delivery of the 40 foot high cube container to the University of Glasgow Storage Depot in Govan.
Once unloaded by the extremely skilled and friendly driver, David, the container looked huge and when the doors were opened it was like staring into an abyss. I suddenly had a panic that we would be unable to fill it with the materials available – in retrospect I realise how naive I was at that stage.
Grant Suttie is the Logistics Manager for the University of Glasgow and was exceptionally helpful as we planned and executed the exercise. He joined us at the crack of dawn on the Friday morning when the container arrived to ensure everything ran smoothly – even hopping onto the forklift truck to move some pallets and ensure we had ample working space.
In addition to providing us with the space and 24/7 access to the yard, the University also gave us the use of a long wheelbase van for the duration of the exercise. This van is normally used by the University of Glasgow Hunterian Museum and is suitably decorated. Hopefully our visits to destinations across Scotland will have provided some long-range publicity for the Hunterian Museum. Alan Stewart, a trustee of Smileawi and a motor engineer who established Smileawi Spanners, would be my partner in the van while Nigel and Vicky would drive a second van.
Paul Cushley had been interacting with the Scottish health boards to arrange venues where dentists could drop off their excess PPE to facilitate collection by ourselves. For NHS Greater Glasgow & Clyde (NHS GG&C), all donations ultimately arrived at the Procurement Central Stores in Dava Street. Conveniently, this was only a short drive away from our container site in Govan and we made our first visit to the NHS Central Store on the Friday morning.
Once inside the facility, we were shown two long aisles completely full of donated PPE, and set about loading the vans for the first time, with help from John who oversaw the NHS GG&C operation at Dava Street.
This was the first time I had seen Trevor Haye packing boxes. Trevor, the fifth volunteer member of our team, is a friend of Nigel and Vicky, and has a long history of working in the transport and logistics business. He has collaborated with Smileawi before and also works with the volunteer organisation The Bananabox Trust, based in Dundee, which regularly ships containers of materials to Malawi. Trevor’s ability to pack boxes with such accuracy that virtually no spaces remain was something that I would continue to marvel at over the next few days.
After the short journey back to the University warehouse, the vans were unpacked, a routine that we would repeat on multiple occasions over the next few days until we found ourselves dreaming about it at night!
Each box had to be labelled and numbered so that a manifest could be prepared for the shipping and customs clearance. Vicky had produced hundreds of pre-numbered labels which were placed in plastic wallets that were self-adhesive once the backing sheet was removed. The number was also written directly onto the box in case any labels became dislodged during the packing and unpacking of the container.
Here is an example of the labelling:
The container was so long that initially we were able to process the boxes inside it, which was fortunate since there were frequent rain showers on the Friday. Meanwhile, at the front of the container, Trevor was busy packing the labelled boxes as tightly as though he were doing a three-dimensional jigsaw – very impressive.
In total, five van-loads of boxes were shifted from Dava Street to the container on that first day, and it was filling up very quickly, dispelling any earlier fears that we would struggle to reach its capacity.
On the Saturday, we headed to Alloa to collect excess PPE from NHS Forth Valley. Gordon Morson, a Glasgow dental graduate, had kindly offered storage space in his practice and we were able to load up easily from an access point at the rear of the building. With the help of Gordon and his young son we were soon loaded and heading back to Govan for more off-loading, labelling and packing.
The Sunday was a day of rest, although Nigel and Vicky had to return to Dunoon to print more labels, as we were projected to run out based on the volume of materials we were collecting.
On the Monday morning, it was agreed that Alan and I would meet at 8am and take our van to Kilmarnock to pick up donated PPE from NHS Ayrshire & Arran. Martin Wishart (Portland Dental Practice) had kindly agreed to store the items in his garage. By the time we arrived, Trevor (who lives in Ayr and travelled independently) had already started transferring the boxes onto the driveway for loading.
Once loaded, we decided to stop at a Greggs shop in Kilmarnock for a quick breakfast. Whilst we were there, a lady found herself locked into a toilet cubicle. Luckily Trevor, who heard her calls for help, had a tool kit in his car and set to work on the broken door mechanism. After a few minutes there was a cheer as the lady was released and Trevor returned to our table to celebrate his good deed for the day with a breakfast roll and coffee.
It was a quick run up the road from Kilmarnock to Govan. We then realised that Trevor had packed a significant number of boxes in his car before Alan and I had arrived in Kilmarnock, just in case we were going to be short of space in the van. On several further occasions we would see just how much can be packed into a Renault Clio if you know what you’re doing!
Whilst Alan, Trevor and I had been in Kilmarnock, Nigel and Vicky had taken their van to Polmont to pick up a further load from NHS Forth Valley that was deposited at Brightons and Polmont Dental Practice. We had unloaded the Kilmarnock boxes at the container before Nigel and Vicky returned from Polmont, but we still needed to collect boxes from NHS Borders, all of which had been centralized at Coldstream Dental Centre. It was decided that Alan and I should head there immediately, leaving Trevor at Govan to pack the container. This would allow us to decide whether Nigel and Vicky also needed to visit Coldstream with the second van.
It was a beautiful drive down to Coldstream on a bright sunny day. On arrival, we were shown the assembled boxes of PPE and were immediately able to alert Nigel and Vicky that a second van was definitely required. Alan and I packed as much as we were able, with great help from Aileen Richardson, Brian Hall and Gary Ward, all of whom worked at the Dental Centre.
Once we had closed up the van and taken a team photograph …
… Aileen kindly drove us to The Hirsel Estate, so that we could grab a quick late lunch in its Tea Room before driving back to Glasgow. Once we had finished eating, Aileen picked us up again and drove us back to our van – exceptional Borders hospitality.
Once back in Glasgow, we left both vans loaded with the Coldstream pick-ups overnight and decided to spend the Tuesday processing and packing all the items we had collected. It was becoming clear that even with Trevor’s meticulous packing we were close to, if not already exceeding, the capacity of our container.
Luckily the weather was dry and since we no longer had space inside the container to label and process the boxes, much of the work took place outside.
As the afternoon drew on, we were getting very close to a full container. One door was closed to allow packing right to the back of the container on that side and before long Trevor was nearing the end of his task.
In recognition of his packing wizardry, we invited Trevor to label the last box (number 1056) before he fitted it into the final remaining space.
It was then a case of brute strength to close the door for the last time – the container was ready for collection.
Whilst this was cause for celebration, our minds now turned to the ‘excess excess PPE’. From the boxes that we had already collected, there were eighteen that had not fitted into the container. Furthermore, NHS Highland had already collected PPE and assembled it at the Public Dental Service Clinic in Nairn, which we were scheduled to visit the following day.
Luckily we had a plan. Joanna Keating at Scottish Government International Development had put us in touch with KidsOR, a charity based in Dundee which supplies and installs state-of-the-art operating theatres for paediatric surgeons working in hospitals in low income countries. KidsOR has extensive experience of the logistics around transportation of medical equipment to countries such as Malawi. Dave Tipping, the Director of Global Operations for KidsOR, could not have been more helpful when we explained the situation. He agreed that KidsOR could accept some of the PPE we were collecting, as they have a large warehouse and would be able to include boxes of PPE with sets of operating theatre equipment that were being dispatched over the next few months. The destinations would include a range of low-income countries, spreading the benefit to nations other than Malawi.
On the Tuesday evening, we packed the eighteen excess boxes into Nigel and Vicky’s van. They drove up to Dundee, offloaded the boxes at the KidsOR’s warehouse, then stayed overnight in a Dundee hotel before setting out for Nairn on the Wednesday morning.
Alan, Trevor and I set out at 7am on the Wednesday from Govan to drive to Nairn in time to liaise with Nigel and Vicky on arrival. En route we stopped at Ballinluig Motor Grill for a hearty breakfast, which set us up for the rest of the day.
On arrival at Nairn, it transpired that some of the donated items were out of date and could not be uplifted for use by KidsOR. As a result, a second van was not required. Nigel, Vicky and Trevor took their loaded van to Dundee to drop off the boxes at KidsOR en route home, whilst Alan and I returned directly to Glasgow.
Such was the volume of PPE that had been deposited at Dava Street from dentists in NHS Greater Glasgow & Clyde, we realised that we could fill both vans once again and, with their agreement, provide an additional consignment for KidsOR. On the Thursday, therefore, we returned to Dava Street and re-loaded.
We travelled in convoy to Dundee, taking in a coffee break at Stirling Services, before arriving at the KidsOR facility in Dundee in the early afternoon.
Dave, the Director of Global Operations, gave us a tour of the facility to provide a flavour of the amazing work undertaken by KidsOR. All the equipment that is donated is brand-new and KidsOR remains in contact with all the hospitals into which it has installed theatres, to provide ongoing support around maintenance of the kit.
Currently work is underway to examine the feasibility of using solar power for the operating theatres, an activity which was of great interest to Nigel and Alan, who are considering this type of technology in the context of a truck-mounted mobile dental surgery in Malawi.
All members of the KidsOR team were incredibly cheerful, helpful and enthusiastic – clearly totally invested in the fantastic work they do. The unloading was greatly simplified by a ready supply of wooden pallets and use of the KidsOR forklift truck.
The boxes were segregated into types and carefully counted – 255 boxes in total.
Many thanks are due to the whole team at KidsOR. We were made to feel very welcome and think that there are opportunities for further interactions moving forward.
We rounded off this very successful day with a late lunch at The Horn Milk Bar en route back to Glasgow.
The collection of the filled container was scheduled for 7am on the Friday morning. The container was sealed by the driver and then hoisted onto the trailer. For those who are interested in seeing how this is done, you can watch the video below.
The loaded container weighed 15 tonnes, of which 3.7 tonnes was the weight of the empty container, so we were shipping 11.3 tonnes of PPE. Once everything was checked and secured, the driver gave us a cheery wave and headed off into a bright Glasgow sunrise.
During the few days we had spent at the University storage yard in Govan, we had made several trips to Wee Paul’s Snack Van in Helen Street. It is advertised as a ‘family run business with great food, prices and banter!’ The establishment lived up to all those claims, especially the banter, and so once the container had left, we visited ‘Wee Pauls’ for a last round of egg rolls and coffees, enjoyed whilst sitting on stacked pallets in the yard.
After locking the yard gate for the last time, Nigel and Vicky returned their van to the hire company in Greenock. I had dropped our trusty Hunterian Museum van back at the University Transport Hub the previous evening.
From a personal perspective, it was a physically hard but very rewarding week, working with a tremendous team that truly demonstrated the power of collaboration. Once the container arrives in Malawi, that partnership working will continue with our colleagues there, ensuring that the maximum benefit is gained from the PPE that has been donated. You will be hearing about that phase in a later post.
Acknowledgements
This was a very busy week of activity that had required extensive pre-planning and we are indebted to a number of colleagues without whom this exercise would not have been possible.
Many thanks are due to Joanna Keating (Scottish Government International Development), who authorised a minor re-profiling of our Scottish Government MalDent Project grant to cover the cost of the container rental and shipping. The introduction made by Joanna to KidsOR also allowed us to extend the value of our exercise beyond our own oral health projects in Malawi.
The University of Glasgow played a central role in providing access to its facility at Govan for the storage and filling of the shipping container, and by providing us with a van and fuel. Gary Stephen, Head of Security & Logistics at the University of Glasgow, and Grant Suttie, Logistics Manager at the University, could not have been more helpful and we are very grateful for the generous support that both provided. I am also grateful to Con Church and Linda Easton in the College of Medical, Veterinary & Life Sciences Procurement Team for their advice and help.
Thanks are due to those in each of the Health Boards that we visited, who provided space for the collected materials to be collated and / or assisted us with loading.
Dave Tipping and his colleagues at KidsOR provided a route for us to extend the original scope of the exercise. We are very grateful for the very positive and warm interaction we had with them and look forward to further conversations.