My fourth and final week in Malawi coincided with a visit by five dental colleagues from the UK who would deliver an intensive week of clinical teaching for the BDS 4 and BDS 5 students at Kamuzu University of Health Sciences (KUHeS). Significant preparations for the visit had been underway by the UK team in the run-up to their arrival, led by Andrew Paterson, Senior Lecturer / Honorary Consultant in Restorative Dentistry at the University of Glasgow Dental School. Andrew has significant experience of working in Africa with one of our partner organisations, Bridge2Aid, and had previously engaged in a BDS curriculum conference in Malawi in November 2022, together with one day of student teaching. Andrew was accompanied by Niall Rogerson, Lecturer in Restorative Dentistry at Glasgow Dental School, who was on his third visit to KUHeS, Madeleine Murray, an Honorary Senior Lecturer in Restorative Dentistry at Glasgow Dental School, Abisola Asuni, also an Honorary Senior Lecturer and NHS Consultant at Glasgow Dental School, and Kathy Wilson, an Associate Specialist and Clinical Lecturer in Sedation and Special Care Dentistry at Newcastle School of Dental Sciences. Like Andrew, Kathy has been heavily engaged with Bridge2Aid and has worked on multiple occasions in Tanzania.
Peter, James and I headed to Kamuzu International Airport in good time on Sunday 18th February 2024 to meet the team off their flight. It was great to see them appear with smiles across their faces, despite the long journey from the UK.
After a quick stop for a welcoming photograph …
… we loaded everything up into the two vehicles we had brought to the airport and headed to the President Hotel, our base for the week.
In addition to their personal cases of luggage, the team had brought three bags full of dental instruments and other teaching aids, which would support their activities during the Flying Faculty week. These items would stay in Malawi for continued use by the KUHeS staff and BDS students once the team had left.
After checking into their rooms and freshening up, the team re-emerged to take our Toyota Coaster bus to the Dental Department at Kamuzu Central Hospital with the dental bags, to unload and arrange the materials ready for an early start to the teaching on the Monday morning.
The three cases contained a bewildering array of dental items which James and Peter were delighted to receive.
After the unpacking we returned to the hotel and that evening enjoyed a ‘welcome dinner’ arranged by KUHeS. It was a lovely event and the team members were all in good spirits!
On the Monday morning we arrived early at the Dental Department and greeted Dr Jessie Motha-Namarika, the Dental Surgeon in charge of the facility. Jessie is also a part-time Lecturer on the BDS degree programme and is Course Coordinator for BDS 3.
We then moved to the Board Room, which serves as a classroom for the BDS students. The visitors were welcomed by James before I introduced the team and Andrew addressed the students to explain how the week would run.
The students were divided into suitably sized groups, with the BDS 4 and BDS 5 students taught separately to take account of their different levels of knowledge. In addition to the Board Room , we had access to a large office, an open plan area and the phantom head facility, allowing the smaller group teaching to proceed. Andrew’s teaching would focus on advanced restorative dentistry, law, ethics and professionalism.
Madeleine’s teaching was focused on periodontology:
Kathy’s teaching was focused on Special Care Dentistry, but she would also provide content on ‘how to teach’, bearing in mind the importance to dentists of being able to communicate oral health messages to the community and potentially deliver teaching for other cadres of health care workers.
The teaching delivered by Kathy on Special Care Dentistry was very novel to the students and they were extremely engaged with this new subject area.
Use of spectacles that mimic visual disturbances such as tunnel vision was a valuable educational experience both in the classroom …
… and in the clinic …
The teaching delivered by all the Flying Faculty team members was highly interactive and the students soon became very accustomed to participating:
In addition to the simulation of visual disturbances described above, Kathy also taped up some of the students’ fingers to simulate impairment through arthritis and then set them the task of opening a new toothbrush from its packaging – the case was made quickly!
Later in the week Kathy would deliver sessions on how to teach, which would also be highly interactive:
Abisola, known to her friends and colleagues as ‘Bis’, focused on delivering teaching on endodontics.
Each day there was a lovely spread of finger food for lunch. There was also a constant supply of coffee, tea, water and fruit juices to keep the team going.
My role in delivery of the teaching was limited, but I had some other activities to attend to that week. Professor Heather Cubie, who is currently the Chair of the Scotland Malawi Partnership, was also in Malawi at that time. The Scottish Government funding for the MALSCOT cervical cancer screening and mentoring project, led by Dr Caroline Campbell from the University of Edinburgh with Heather and colleagues, finishes at the end of March 2024 – just like our MalDent Project funding. On the Monday afternoon I met with Heather, together with Peter Chimimba, at the President Hotel. We had a very enjoyable and useful conversation over tea and coffee.
Each evening the team fell into the habit of meeting in the bar at 6pm for a de-brief on the day’s activities. This was an excellent way of focusing attention on particular areas of teaching for the next day. The first day had been partly to gauge the level of knowledge of the students and the experienced team members were able to adapt their teaching very flexibly and at short notice to satisfy perceived need.
The timetabling was done on a day-by-day basis, based to some degree on the de-briefing sessions.
Following dinner, when we all retired to bed, Andrew would type up the timetable so that when we awoke in the morning a very clear schedule would have been sent to us all by WhatsApp. That’s what I call a leader!
On Tuesday 20th February Peter, James and I took time out to attend a meeting at the Ministry of Health with Dr Lilian Chunda, the new Chief of Health Services (Technical). Dr Chunda is an Internal Medicine doctor and is known to James through shared membership of the Board of the Medical Council of Malawi. We had also invited Dr Ayid Patrick Shepard to join us from Mzuzu, following his appointment as the Ministry of Health Oral Health Coordinator, succeeding Martha Chipanda who has left Mzuzu for three years to train as a Paediatric Dentistry specialist in Tanzania. The Chief of Health Services had arranged for Mr George Chitope-Mwale, Director of Clinical Services and Mr Godfrey Kadewere, Director of Health Technical Support Services, to join her for the meeting.
We provided hard copies of the National Oral Health Policy and its summary document, together with the action plan created during the policy implementation meeting held in November 2022.
The agenda included a wide range of subject areas relevant to oral health improvement in Malawi, all of which were linked directly to the content of the policy:
There were some initial technical difficulties related to the projection facilities, but thanks to intervention by the Chief of Health Services an alternative laptop was identified which solved the problem.
I gave a 15 minute presentation about the MalDent Project and the challenges moving forward:
I was keen to stress at the end of the presentation how important the Scottish Government funding and the various cross-sectoral partnerships had been to the success of the MalDent Project to date:
There was an extended discussion following the presentation. We stressed the importance of ensuring that there were suitable facilities available for the new dental graduates who would be finishing their degrees in a year’s time, and for the subsequent cohorts in future years. We also pushed the need for a full-time Chief Dental Officer based at the Ministry of Health in Lilongwe, if meaningful progress were to be made with policy implementation. The Chief of Health Services was very engaged and receptive to our comments. She has asked for monthly written updates and quarterly meetings with the team.
Peter, James and I had a follow-up meeting with Dr Shepard at the President Hotel before we all travelled back to Kamuzu Central Hospital. Over the lunch break, Andrew and Kathy briefed Dr Shepard about the ongoing work of Bridge2Aid, Smileawi and ProDental CPD, in collaboration with the Dental Association of Malawi, to roll out the cascade training of therapists and Community Oral Health Educators, which has been successfully piloted in Northern Region, into Central and Southern Regions.
The teaching aids that have been developed for the Community Oral Health Educator programme have now been translated into both Tumbuka and Chichewa from the English originals.
Within the three bags of dental items that had been brought across by the Flying Faculty team were some brand new scaling instruments that had been purchased from the MalDent Project budget and which will remain in Malawi for BDS student teaching. They were accompanied by some 3D – printed tooth models (thanks to the Glasgow Dental Hospital Dental Technology Lab) around the gum margins of which was red acrylic paint. Hand scaling can be practised by removing the paint. A supply of paint was left with the teachers in Malawi so that the models can be re-used on multiple occasions in the future.
Here, two of the BDS 5 students are practising hand scaling with the instruments and models provided:
One of the aspects of the Flying Faculty week that the students really enjoyed was the ‘hands on’ nature of much of the teaching, including in endodontics. Endodontics was a completely new subject for the BDS 4 students so they were very attentive!
Towards the middle of the week Niall, who had a major role in delivering the simulation training, lost his voice completely and was feeling quite under par. Undeterred, however, he continued to participate, often demonstrating practical clinical procedures whilst Andrew gave a running commentary on the process. It was a great double act!
Following the demonstrations, the students were able to practise and develop their own skills in cutting crown preparations:
On the Thursday evening, Jessie kindly invited the whole team to dinner with her family at their home. I had already arranged, through the Scotland Malawi Partnership, to meet with Drs Ken Jeffrey and Peter Mtika that evening. Ken and Peter were visiting Malawi from the University of Aberdeen to scope out the possibility of establishing a formal partnership with the University of Livingstonia, and were interested in our existing partnership between Kamuzu University of Health Sciences and the University of Glasgow. The three of us enjoyed a wide-ranging discussion over dinner, whilst the rest of the MalDent team had a great evening at Jessie’s house. It was an extremely kind gesture by Jessie and greatly appreciated by the team.
The final day of the Flying Faculty week commenced with a short session on research, delivered to BDS 4 and BDS 5 jointly. I led the session …
… but the main event was a pre-recorded presentation by Professor Shauna Culshaw from the University of Glasgow. This session yielded significant interest from the students, some of whom wish to follow up opportunities with us.
There followed three half-hour sessions on adhesive bridges, classification of periodontal disease and an introduction to implant prosthodontics.
After a break for refreshments, we split the students back into their year groups and spent the next couple of hours talking through a series of cases that Andrew had put together in a fantastic workbook which the students had received at the beginning of the week. The twist here was that we asked the students to present the cases and we sat in the audience. This exercise generated some very valuable discussions.
Finally, when the workbook cases were completed, we all met up again in the Board Room, where our week had begun. There were brief presentations from James, the BDS 4 and BDS 5 Class Representatives, Andrew and myself. All agreed that it had been an immensely valuable and successful week.
As some of us knew, in their youth Peter Chimimba and Wiston Mukiwa had run an outfit called ‘Super Disco 75’ which operated at a range of social functions. Peter had very kindly provided us with a flash drive containing a large number of the Malawian songs that the disco used to play. At the end of the speeches, we played out to one of Peter’s favourite numbers. It was a very joyful Malawian way to close an exceptional week:
Following the frivolities, we headed out to the entrance of the Dental Department for a group photo:
As the group dispersed there were lots of small group huddles and additional photos being taken:
It had been a very intensive and tiring week for both the students and the staff but there was definitely a ‘family feel’ in the air and there is no doubt some long-term professional links have been forged.
Once we returned to the hotel a small number of the team headed back out to the shops, courtesy of our wonderful bus driver, Kennedy Jeputala, whilst the rest of us took it easy and attended to packing.
However, I had one more meeting to go, as I had arranged to meet Natasha Mwenda, WASH and Health Programme Manager for Water Aid in Malawi. I had first met Natasha at a Cross Party Parliamentary Group meeting at Holyrood and she had subsequently attended the workshop held in February 2020 which resulted in establishment of the Task Force that drafted the National Oral Health Policy. Lorna Macpherson and I are keen to examine potential collaborations between the WASH agenda, nutrition and oral health in the context of developing interventions to reduce the incidence of dental caries in children. Natasha was accompanied by her partner Thoko Kapalamula, who is Dean of the Faculty of Veterinary Medicine at Lilongwe University of Agriculture and Natural Resources (LUANAR). The faculty had graduated its first cohort of veterinary surgeons in 2019, so like the BDS programme it is relatively new.
I had a very fruitful discussion with Natasha, before introducing her and Thoko to James and the Flying Faculty team members.
Natasha and Thoko were able to stay on and join us for our final dinner. it was a very nice way to round off the week’s events.
On the Saturday morning we had a relaxed breakfast before some of the team headed back to the shops. James and Peter accompanied us to the airport mid-morning where we took the final group photo and said our farewells.
Once we were through security there was an opportunity for a last team shot. We had enjoyed a tremendous week and I suspect the poster held more than a grain of truth. Some of us at least will definitely be back!
It was at this point my own travels took a different direction from the Flying Faculty team. As they headed for their flight to Addis Ababa and onward to the UK, I picked up a flight to Johannesburg to connect with a second flight to Cape Town. I had business at the University of Western Cape, which will form the substance of a future blog post.
In closing, I would like to thank all who made this week of intensive teaching such a success. First, the clinical teaching staff at KUHeS including James, Peter, Wiston, Jessie, Mirriam, Tasneem and Nathan, who have the ultimate and heavy responsibility of running the BDS degree programme. Particular thanks are due to the administrative team of Annie Mwapasa and Madalitso Kaphamtengo, who did so much to organise every aspect of the Flying Faculty week, from hotel and transport bookings to the food and refreshments that kept everyone going.
Thanks are also due to many colleagues at the University of Glasgow Dental School who, through Andrew, contributed greatly to the preparations for the visit.
The BDS students at KUHeS worked hard and diligently during the week, participating enthusiastically in all the activities and providing valuable feedback that will help to structure future Flying Faculty visits.
Finally, a massive thanks to Andrew, Kathy, Bis, Madeleine and Niall who put their absolute all into delivering an incredible week of very high quality teaching. They will share some of their personal reflections in a future blog post. On behalf of the team a very special thanks to Andrew, who masterminded every aspect of the operation and who demonstrated what leadership is all about. Zikomo!
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