Introducing The MalDent Project’s newest friend: The AMECA Trust

In early December 2023 I received an e-mail from Ruthie Markus, who is the CEO of a charity called The AMECA Trust. Ruthie founded the Trust in memory of her son, Alex, a British Army doctor who died in 2006. Since 2008 The AMECA Trust has been undertaking many projects in Malawi, largely in liaison with the Blantyre District Health Office, to implement sustainable initiatives in healthcare. The Trust also sponsors many medical students at Kamuzu University of Health Sciences to support them through their studies. The website of The AMECA Trust provides a comprehensive overview of its activities and can be accessed here.

Ruthie wrote to me because at a recent visit she had made to Chilomoni Health Centre, just outside Blantyre, she had been approached by the resident dental therapist, Wisdom, who explained that a new dental chair had been provided to the health centre three years previously, but because of a lack of appropriate materials and engineering expertise it had never been installed. He wondered whether The AMECA Trust could help. By chance, Ruthie had just been reading our MalDent Project blog after it was cited in a recent Scotland Malawi Partnership newsletter, and contacted me to see whether we could help. To cut a long story short, after some follow up e-mail correspondence and a WhatsApp call I visited Ruthie in the UK whilst she was home for the festive season. We had lunch and a five hour conversation during which it became clear we had many common interests and could potentially work together on a variety of activities. It was agreed that when I reached Malawi at the end of January we would meet and look seriously at the possibilities.

As I mentioned in the previous post, Thursday 1st February and Friday 2nd February included visits, organised by Ruthie, that marked the start of our collaboration. I had explained to Peter Chimimba the possible benefits of joint working between The AMECA Trust and the MalDent Project, especially in relation to the enhancement of dental facilities outwith the central hospitals. Peter was fully in agreement and on Thursday 1st February we set off to visit the AMECA Clinic at Chilaweni, which was funded, designed and built by The AMECA Trust. By chance, Paul Thomas, a retired UK surgeon who is the Medical Director of AMECA, had also recently arrived in Blantyre and he travelled in Ruthie’s car whilst I went with Peter Chimimba in his vehicle. Unfortunately the most direct route is not currently available because the bridge over a river was destroyed by Cyclone Freddy. We therefore had to take a more circuitous route along a rough, non-metalled road, surrounded for the most part by maize fields. The following video clip will give you a feel for the terrain.

On arrival at the clinic it transpired that Ruthie and Peter had met previously at KUHeS. We were shown around the facilities which were truly remarkable. The building had been designed by a Malawian architect called Jan Jaap Sonke, who we would meet later in the morning. The facility was very well maintained and there were beautiful touches such as the murals painted on many of the walls.

The large number of patients present showed just how valuable this health centre is to the local community.

Great efforts have been made in the maternity wing to ensure that all the staff are well trained. The mothers are cared for in a dignified manner and the building design affords them appropriate privacy.

In addition to the health centre buildings themselves, there are also well-appointed boarding facilities for the healthcare workers employed there.

One structure of note was the very tall water tower, beneath which a deep bore hole provides a water source. The pump which brings the water to the surface is powered by a bank of solar panels arranged adjacent to the tower. This water tower supplies not only the health centre but also the nearby village, providing additional value to the community.

Following our tour of the clinic, Peter and I headed back into Blantyre to attend to other activities. On the journey we passed an Airtel and TNM station nestling among the maize fields…

… and once we were back on the main road passed both chickens and charcoal being transported into the city on motorcycles.

On Friday 2nd February we had an early morning meeting at the Blantyre District Health Office.

Ruthie had arranged for me to meet with her colleague and friend Dr Gift Kawalazira, who is the District Health Officer for Blantyre. We had an excellent meeting. I was able to provide Dr Kawalazira with a summary of the MalDent Project’s activities to date but, more importantly, our ambitions for the future. With the prospect of Malawi graduating its first ever home-trained dentists in one year’s time, it is critical that we start to upgrade some of the dental facilities in the district hospitals and health centres so that the young dentists will have surgeries that are fit for purpose. Initially we would like to start by upgrading a clinic in Blantyre District that could act as an exemplar and set the standard for other health centres across the country. The plans described by Dr Kawalazira for the establishment of Community Hospitals in Blantyre District, operating in concert with health centres, could fit this model perfectly. We agreed to maintain contact and liaise on possibilities moving forward.

Following our meeting at the District Health Office, we headed off for Chilomoni Health Centre. Once again, Peter kindly gave me a lift. Like the road to Chilaweni, the surface was tricky…

… but we finally arrived at our destination:

Once we were out of our cars, the team assembled. In addition to Ruthie, Paul, Peter and I, we were joined by Chikondi Chawinga, a dental equipment technician who had been invited by Peter, and Jan Jaap Sonke, the well-known Malawian architect mentioned earlier who is a friend of Ruthie’s and who had designed the AMECA Clinic. Shortly after our arrival, Wisdom appeared. I recognised him instantly as one of the dental therapists who had attended the symposium held in November 2022 to develop an action plan for the National Oral Health Policy.

Wisdom led us to the building where his clinic was situated. Even before entering the health centre building, the lack of maintenance of the fabric of the structure was evident.

Once inside, we saw the new dental chair that had been supplied three years previously and to date had not been installed. It is a very good quality Belmont chair which could provide the centrepiece of an exemplar dental surgery within a health centre.

Sadly, the delay in installation of the dental chair was not the only problem. The roof above the room leaked and much of the ceiling had fallen down. There would be little point in moving ahead until the roof had been repaired.

Jan Sonke explained with a diagram how the problem with the roof related to the way in which the bolts were placed through overlapping metal sheets without using a fitment between the rafters and the undersurface of the metal. He told us that this was a common problem in Malawi, but that it would be relatively inexpensive to render the roof watertight.

Wisdom then informed us that he had been offered an alternative, larger room to use as a dental surgery, if we could install the chair. This was a much better proposition…

… but this room also suffered from a leaking roof:

We decided to develop a project plan to strip out, refurbish and decorate the larger room, repair the roof and ceiling, and install the dental chair. The MalDent Project and AMECA Trust teams will work with partners to identify the resources needed to provide this exemplar dental surgery at Chilomoni Health Centre. Once completed, the work would provide a blueprint for other health centres.

Following the visit to Chilomoni, Peter had work to attend to but Ruthie kindly invited me, together with Paul and Jan, to her house for coffee on the khonde. In addition to further reflections on the work to be done at Chilomoni, we had a very wide-ranging conversation. Jan, who is Dutch but has lived in Malawi for almost 50 years, trained as both an engineer and architect. He has also been involved in Malawian politics and was at one time the Finance Minister for Malawi. Unsurprisingly he had many fascinating stories to tell. There is a very interesting interview he gave in 2022 which is available on YouTube for interested readers.

Peter Chimimba, James Mchenga and I had a meeting with the Vice-Chancellor at KUHeS on the Friday afternoon, but that evening I joined Ruthie and Paul for dinner at the Bistro in Blantyre. It was an excellent opportunity to reflect on all that we had seen over the past two days and to continue to firm up our plans for the future.

One of the hallmarks of the MalDent Project has been the massive benefit that has accrued from partnership working with organisations across multiple sectors. The link that has now been established with The AMECA Trust holds great promise as we move our attention to identifying clinical dental facilities in which both dental therapists and dentists can deliver high quality treatment. These facilities will act as oral health nodes within the community from which many of the ambitions reflected in the National Oral Health Policy can be realised. This, in turn, will contribute to the mission of The AMECA Trust to improve Malawian health care facilities in a sustainable way.