This is a guest post edited by Andrew Paterson, with contributions from Abisola Asuni, Madeleine Murray-Kerr, Niall Rogerson, Kathy Wilson, and Jeremy Bagg
One of the key challenges in the learning of the first cohorts of dental students in Malawi is to provide specialist teaching for them whilst Malawian assistant lecturers are away training abroad to upskill themselves as specialists, so that this can later be provided by Malawians when they return. “Flying Faculty” support is an extremely valuable way to provide specialist teaching to both students and staff at the Kamuzu University of Health Sciences (KUHeS), plugging a gap short-term until there are sufficient specialists in Malawi so that all aspects of the curriculum can be covered by them.
Following a visit from KUHeS staff to Glasgow in December 2023, subject areas in need of “Flying Faculty” support were identified and a teaching week for BDS 4 & 5 students organised. This was to be at the start of their academic year in February 2024. We were given a wide remit to cover diverse and wide-ranging topics such as dental trauma, endodontics, periodontics, advanced restorative dentistry, management of fluorosis, ethics & professionalism, disability, and teaching the students to teach and cascade key oral health messages to others in their communities. All these topics would assist KUHeS in having ‘locally relevant and globally competent’ dental graduates. The last topic aimed to empower the BDS students to have the tools to cascade key oral health messages and key health messages on non-communicable diseases widely in whatever communities they would work following graduation, this being a key component of Malawi’s National Oral Health Policy.
Jeremy Bagg was already in Malawi prior to the teaching week so five of us arrived heavily laden in Malawi, carrying much donated equipment to facilitate the teaching week and to provide sustainable resources that could be reused by the KUHeS students in subsequent years. Four of us were from the University of Glasgow, with Kathy Wilson having been smuggled across Hadrian’s Wall from Newcastle!
We hit the ground running, arriving on a warm Sunday afternoon, and after a quick shower went straight to Kamuzu Central Hospital (KCH), Lilongwe to unload and set-up for an 8am start the following day.
We would like to thank the many people who donated equipment for the visit including University of Glasgow Dental School, many dental staff, the dental nursing team and laboratory technicians, and Dentaid. Our visit would have not been possible without the organisational support and assistance of Frank Bonner, Mary-Anne Ferguson, Linda McMichael, Amy Wylie and Yvette Hollywood of the University of Glasgow and our superb hosts James Mchenga, Peter Chimimba, Jessie Mlotha-Namarika, Wiston Mukiwa, assistant lecturers Nathan Lungu, Mirriam Chapinga and Tasneem Chikwatu, and administrators Madalitso Kaphamtengo and Annie Mwapasa. Finally, we would like to thank Amy McCabe, Graham MacDonald and many others in the NHS Prosthodontic laboratory at Glasgow Dental Hospital who used their time and talents to produce over forty 3D printed models that can be sustainably used for pre-clinical skills periodontal teaching at KUHeS for many years.
Finally, as James Mchenga, Head of the KUHeS Dental School, informed us at the welcome dinner, in Malawian culture an uncle is extremely important as an advisor and facilitator in any Malawian family. We would like to thank “Uncle Jeremy” who has and continues to be the pivotal force in the MalDent family.
Here are the reflections of the “Flying faculty”:
Abisola Asuni (Consultant in Restorative Dentistry, NHS Greater Glasgow & Clyde):
I don’t have experience of practising or teaching dentistry outside the UK, so this was a first for me. Luckily, growing up in Nigeria helped shape my expectation and even though I had never visited countries outside West Africa, it felt very nostalgic with so many similarities in fauna, flora and architecture.
My remit was to cover Endodontics and Trauma. We took a good array of equipment and materials, and immediately set to work preparing everything for the practical sessions. This included preparing the plastic endodontic teeth, which wouldn’t have been ready on time without Nathan’s help!
I was reassured by Mirriam and Tasneem in my first session, that the prepared topics aligned with and complemented the students’ existing knowledge. The students were enthusiastic and motivated, the ethos of ‘locally relevant and globally competent’ really came into play. The final year students had already received sessions in endodontics and had some experience treating patients. So, the teaching had to be adapted to make it more relevant to their clinical environment. The practical sessions allowed me to gauge their clinical skills and bridge the gap between their theoretical knowledge and practice. Despite long days, engagement did not waiver and the case presentations and discussions at the end of the week demonstrated the students’ commitment to making the most of our visit.
During the week, we also had mentoring conversations with 5th year students. It was clear that despite the usual anxiety around finals and graduation, they recognised the significance of their cohort and were proud to be the first ‘home grown’ dentists. The two students I mentored were resilient, ambitious and showed entrepreneurism, with one of them being in the process of making a locally produced toothpaste!
This was an incredibly rewarding experience for me. I’d like to think, in a very small way, that I have been given the opportunity to reinforce teaching and training, and contribute to the future of dentistry in Malawi. This experience has given me food for thought on intercultural teaching and the importance of adaptability, particularly in situations where resources may be limited. I am thankful to have been given the opportunity and to have worked with an incredible team. Thank you, ‘Uncle Jeremy’, for the invitation, and to Andrew who kept us all in order. Also thank you to James, Peter and Jessie for hosting us, and to Mirriam, Tasneem, Nathan and the rest of the team for looking after us. Jessie and her family also welcomed us into her home, and we experienced traditional Malawian cuisine which was so tasty! It has really been a privilege to have been part of the ‘Flying Faculty’ team.
Madeleine Murray-Kerr (Honorary Clinical Senior Lecturer, University of Glasgow):
I had never been in Africa and what a trip as an introduction. When I was lucky enough to be asked to go with the ‘Flying Faculty’ I knew to expect the unexpected and to be flexible in what happened on the trip.
I expected it to be hot, it was… I expected it to be wet and buggy, it wasn’t…. I expected hard work, we did indeed work hard… flexibility with lesson plans extended sometimes to the point that only when the words came out of my mouth in response to a question from the students did I know what was going to happen.
I didn’t expect such a warm welcome from the local team or such fun and camaraderie amongst the ‘Flying Faculty’ team. We as a Faculty learnt so much from the local team and hope we have introduced treatment concepts that can be used as building blocks for care. It’s hard to know what impact we could possibly make in a week, but I know I was left with an impression of incredible resilience and commitment amongst the Malawian staff and students to learn and improve oral health care provision locally and I feel hopeful, enriched and inspired.
Thank you MalDent.
Andrew Paterson (Education Lead Restorative Dentistry, University of Glasgow):
My role was coordination of the ‘Flying Faculty’ teaching and to teach a wide variety of subjects including ethics & professionalism, indirect restorations, management of dental fluorosis which is prevalent in Malawi, and to introduce students to dental implants.
There was much problem solving and readjustment after each day’s teaching to try and ensure content was relevant and at an appropriate level as we did not initially have a full understanding of where the knowledge gaps were. We learnt very quickly and so did the students which allowed for a very productive week.
I enjoyed facilitating ethics & professionalism teaching with the students. Sessions were very interactive with much student-led learning and debate. I was very fortunate to be joined at sessions by Peter Chimimba and Wiston Mukiwa, both of whom had formerly had significant roles with the Medical Council of Malawi from its inception in 1988 and helped formulate their ethical codes. Additionally, James Mchenga, the current dental representative on the Medical Council, attended some sessions so the students had excellent role models and gained a fuller understanding of how codes had developed in Malawi. Much debate was had on the difficulties of gaining appropriate consent in rural situations where there still remains a high illiteracy level and many cultural factors at play.
We created a culturally appropriate workbook for the students covering all the topics that they were learning in the ‘Flying Faculty’ week applied to a Malawian context. The engagement of the students was superb and their interest, self-directed and peer learning were phenomenal. I was very impressed with their attitudes and abilities. This culminated with the students presenting on the final day topics that they had learned. We asked them to lead a session, present, debate and discuss with virtually no notice in front of their peers, teachers and ‘Flying Faculty’. They all did this with high-quality presentations fielding many questions and showed growing confidence and leadership skills.
I asked a lot of the ‘Flying Faculty’ and it was a real joy to work in this setting with Bis, Jeremy, Kathy, Madeleine and Niall – they may feel differently! Days were long and much preparation took place in the evenings following a daily debrief. Their teamwork, humour and skills were amazing, and they all certainly went the extra mile to make a worthwhile positive learning experience for the students together with an exchange of mutual ideas and understanding. This was borne out by the positive feedback we received from students. It was an absolute pleasure and privilege to teach, mentor and learn from the KUHeS dental students and their hard-working and professional staff who were inspirational, had a great sense of humour and many hidden talents – I will treasure my newly acquired collection of Malawian 70s super disco music from one of the KUHeS faculty, a former DJ! I hope I have the opportunity again to be involved in teaching Malawian dental students. I have every confidence that these first cohorts of Malawian trained dental students will have all the tools required to improve oral health in their nation and in time to inspire others who follow them.
Niall Rogerson (Clinical Lecturer in Restorative Dentistry, University of Glasgow):
My overarching impression having co-facilitated tutorials and practical sessions covering a range of subject areas is that the expected level of knowledge for years BDS4 and BDS5 is evident and that the students’ enthusiasm to actively participate is apparent. This strongly indicates that the quality of their learning experience to date is a credit to their teachers at KUHeS. This achievement is remarkable considering this is a newly developing BDS programme with many constraints and challenges that require to be carefully managed.
One of the main objectives for the visiting faculty is to contribute to the programme in a manner that is likely to have a continuing positive effect. It is my view that through the many and various learning activities over five days and with opportunities for on-going collaborations with our KUHeS colleagues this will be achieved.
I reflect that it may not be straightforward to suddenly share your teaching spaces with five faculty from abroad, who arrive with a structured programme and a wide range of educational material. Therefore, I greatly appreciate the access, facilitation and support KUHeS and KCH staff have provided, enabling the effective delivery of all the sessions. This welcoming and calm environment with additional input from technical staff enabled the planned sessions to run smoothly, ensuring the students have the potential to gain maximum benefit.
To conclude, I have an enormous feeling of gratitude to all the Malawian staff for their gracious hospitality and kindness and to the students for their keen and courteous engagement.
Kathy Wilson (Associate Specialist, University of Newcastle-upon-Tyne):
I was delighted to receive an invitation to be part of the ‘Flying Faculty’ and accepted without hesitation. It was such a rich and rewarding experience to contribute to the 4th and 5th year BDS students’ wider education.
My role was twofold. Firstly, I introduced the students to the issues of impairment and disability in relation to oral health, a concept not previously addressed in the curriculum. The students fully engaged with the didactic and interactive components of the sessions. Practical activities enabled them to experience visual impairments and physical disability for themselves. The students were able to fully appreciate the barriers facing many individuals, in particular carrying out oral hygiene and accessing services. The exercises also emphasised the challenges they themselves will face in delivering oral health care to this group of patients.
Once qualified many of the students will be working in rural areas with a responsibility for promoting oral health messages to their communities; as such they need to have the skills to teach. I ran several sessions covering learning styles, teaching methods and how to plan a training programme. The students contributed throughout, firstly by suggesting what makes a good teacher.
I then demonstrated an effective teaching style, using an example of instructing them how to make a paper plane. In pairs the students then taught each other the same skill. They were completely absorbed in the task and clearly reflected on their experiences as both a teacher and a learner.
On the last teaching day, the students presented cases from their workbooks. It was rewarding to hear them discuss and debate treatment options, clearly illustrating the knowledge they had gained. The enthusiasm and participation of the students throughout the week was infectious
After an intense and busy programme, we were all very tired but exhilarated by the unique opportunity to be able to contribute to the development of the first cohort of dentists to qualify in Malawi – a true milestone.
My thanks to all the Dental Faculty at KUHeS for their kindness and hospitality during our stay and to Jeremy and Andrew for allowing me this tremendous experience.
Jeremy Bagg (Scottish MalDent Project Lead, University of Glasgow):
As I said in my preceding post, this had been an exceptional week working with exceptional people. I have been interacting now with this group of students, particularly those in BDS 5, for several years. In 2019, when I first met them, they were an excited group of freshman students embarking on not only a new path of study for themselves, but a completely new degree programme for their country. They have developed, over the intervening years, into mature, dedicated, knowledgeable and highly engaged young healthcare professionals. This is not just my opinion but a view that was shared by all of the Flying Faculty team members. As with any new course established from scratch, it is never plain sailing and massive credit is due to all of the KUHeS staff members and others on the ground who have supported these pioneer dental students to their current state of knowledge and understanding.
The trick now is to ensure sustainability, both of the BDS course and of the ongoing work to prepare the ground for these new young dentists, once they have graduated, completed their internships and entered the workforce as full registrants. There is a long way to go, but we need to take multiple small steps to get there. The Flying Faculty week was one of those steps and every opportunity will be taken into the future to maintain this model, until KUHeS has installed its full staffing complement and has an independent team of specialist teaching staff covering all areas of clinical dental practice.
It was a massive privilege for me and for all of the KUHeS MalDent Project team to welcome Andrew, Bis, Kathy, Madeleine and Niall to Malawi for this Flying Faculty week. I am delighted that it was such a success and I thank each and every one of them for their skill, hard work and wonderful good humour – an ‘A – Team’ if ever there was one!
We were all sad to leave Malawi but have many happy memories of a memorable week
