Chilomoni Dental Clinic is now fully equipped, courtesy of AMECA, Fondation Eagle and Henry Schein South Africa

Regular readers will be familiar with the construction work undertaken earlier this year by the charity AMECA to establish a two-surgery dental clinic at Chilomoni Health Centre as part of the overall renovation of the healthcare complex. One of the strategic reasons for establishing a high quality dental clinic at health centre level was to provide a model primary care dental facility that could act as an exemplar for replication elsewhere in Malawi. Now that Malawi is graduating its own home-trained dentists, the requirement to provide functional clinics where they can work is a significant priority.

Two good quality dental chairs were available for the new clinic, but there was a long list of additional equipment that was still required to render the new dental clinic fully functional. Initially, AMECA and The MalDent Project launched an on-line appeal, which raised a small sum, but the major breakthrough came with a grant application to the Swiss organisation Fondation Eagle, which provided a grant of £21,900 to purchase the equipment that was required.

In May this year, Peter Chimimba and I travelled to Johannesburg to meet with the team at Henry Schein South Africa. We discussed the equipment requirements for the Chilomoni clinic, and also had valuable discussions relating to the dental chair requirements for the new Dental School building at Kamuzu University of Health Sciences (KUHeS). Andre Wessells, Team Leader at Henry Schein South Africa, was present for those discussions and has subsequently been an exceptionally efficient and valuable contact for both projects, as this post will attest.

The order for the dental equipment at Chilomoni Health Centre was placed by AMECA, the items shipped to Malawi, and installation was scheduled for the week beginning Monday 1st December. We were delighted that Andre would visit us to personally undertake the equipment installation, and he duly arrived on Sunday 30th November. He was able to stay in a guest room at the complex where both I and Ruthie Markus, CEO of AMECA, rent our apartments.

First stop: KUHeS – Dental School construction site

Although the primary purpose of Andre’s visit to Malawi was to install the equipment at Chilomoni Health Centre, in discussion with the architects (JMP) for the new Dental School building at KUHeS we arranged for him to visit the site on his first day and meet with Lloyd Ndau, the Building Services Engineer sub-contracted locally to the project.

We are experiencing rains every day now and the skies were looking threatening as we headed towards the building, but the weather stayed dry for our walk around the site.

Once inside the structure, Andre and Lloyd entered into detailed discussions about the installation of the services for the 26 dental chairs on the clinical floor. The discussions were timely, including issues such as the order of installation of services and the gradient on drainage pipes.

Andre also walked across the clinical floor with the team and checked the positions of all the service portals that had been cast into the concrete slab, checking carefully with a measuring tape that they mapped to the planned positions of the dental chairs.

This would be the first of two visits that Andre would make to the KUHeS site, as he would return later in the week to meet with the plumber who would be installing the pipework.

Chilomoni Health Centre Dental Clinic: equipment installation

After our visit to KUHeS, attention turned to the main project of the week, the installation of the dental equipment at Chilomoni Health Centre. Malawi Revenue Authority clearance of the goods, and storage after their arrival, had been managed by Combine Cargo, whose truck was due to make the delivery at 1.00pm on Monday 1st December. Exactly on time the truck duly appeared, negotiating the rutted, un-metalled road to Chilomoni Health Centre.

Performing the tight reversing manoeuvre into the health centre required considerable skill on the part of the driver, but it was negotiated without incident. In all respects, the service we received from Combine Cargo was exemplary.

Once parked, there was no shortage of volunteers to help with unloading of the vehicle. Many of those involved were members of Dzuka Chilomoni Community Group (DCCG), a community-driven, non-profit organisation that was established in 2019 by Maliko Paul Chikaonga. It exists to uplift the most vulnerable populations in Chilomoni and surrounding areas through humanitarian support, youth empowerment, environmental protection, and community development. Thanks to the strong and meaningful relationship that has been built between Ruthie Markus of AMECA and DCCG, partnership working at this grass-roots level can achieve great things. Furthermore, a Health Centre Management Committee (HCMC) strengthens collaboration between the health facility and the community it serves.

Maliko led the charge with unloading the truck:

There were no mechanical aids to help with the unloading, so it was heavy work:

Once the equipment had been offloaded, the volunteers and staff carried the items to the dental clinic:

On arrival at the clinic, there was much unpacking to do. Here, Maliko is removing the suction motor from its container under the watchful eye of Andre:

The beautiful new Cattani compressor had been bolted to a pallet for safe transportation – this had been the heavy box coming off the truck!

Once the initial unpacking of the large items was complete, work began to arrange them in the appropriate rooms and commence installation. A significant amount of equipment had been purchased for the Decontamination Room, which had been purpose-designed as part of the construction work earlier in the year. Cleaning and sterilisation of dental instruments is a critical part of safe clinical practice and, as you will see as this post unfolds, the Decontamination Room will become a central feature of the entire health centre.

Much of the equipment was made in Italy and supplied with European plugs. In due course, we purchased and fitted UK style plugs to match the sockets that had been installed during the construction of the building.

Thorough cleaning of medical, surgical and dental instruments after use is a key element of the decontamination cycle. Here, Andre is setting up the ultrasonic bath which will form part of the cleaning process:

A further innovation for the dental clinic at Chilomoni Health Centre is the availability of a mobile digital X-ray unit, which was assembled by Andre with help from Maliko and his team of volunteers.

The assembled unit, together with the laptop computer that has been configured with the appropriate software, will bring dental imaging to Chilomoni Health Centre for the first time.

On Day 2 of the installation process, the main challenge was to identify the most appropriate way of installing the services that would connect the compressor and suction motor to the two dental chairs. Mr Jan Sonke, the architect and engineer who had overseen the Chilomoni Health Centre refurbishment, together with Chikondi Chawinga, the technician who had assisted with putting the chairs in place earlier in the year, were part of the discussions which identified the best way forward.

After identifying the connectors and tubing required …

… we headed into Blantyre and visited an amazing store called Toppers, which was stocked with every conceivable item of hardware you can imagine.

Andre explained our needs and we left with all the items required:

One of the items on the shopping list was piping which would house the services travelling along the back wall of the dental clinic. As we needed long runs there was a reluctance to cut the pipes we purchased into smaller sections for transportation. Traffic regulations in Malawi permit a 1.5 metre overhang at the front and back of a vehicle, so we were able to lash the pipes to the roof bar on the passenger side of the Prado and transport them safely back to Chilomoni Health Centre.

Once back at the health centre, Chikondi very efficiently cut and assembled the piping with appropriate connectors to the architecture required. In due course the pipes and connectors were glued together.

The final configuration of the exterior pipework containing the relevant components was very neat …

… linking the two dental chairs to the suction motor and compressor that were now fully installed in the plant room:

Establishing a full dental treatment service at Chilomoni Health Centre is a step-wise process and we are on a journey. The first step was the construction work led by AMECA to establish the physical infrastructure, which has provided the perfect home for the equipment which we have now been able to purchase, as step 2, with the funding from Fondation Eagle. An important next step is provision of training for those who will use the equipment. On Day 3 of Andre’s visit, he began the process of providing training on use of the equipment in the Decontamination Room. Prince, the dental therapist at Chilomoni, was a recipient of the training, but we also invited two nurses from Maternity, Mary and Hannah, for reasons which will become clear soon.

The autoclave and ultrasonic bath can only be operated using distilled water. One of the items of equipment we had purchased and which Andre had installed was a water distiller. Andre explained the operation of the distiller, before all had a practice opportunity.

It is important that the reservoir in which the water is heated is cleaned regularly and de-scaled, using citric acid, a process explained by Andre.

You will be wondering why Mary and Hannah from Maternity had been invited to the training. The reason is that Henry Schein UK had previously donated another autoclave for use at Chilomoni Health Centre. I had collected it from the depot at Gillingham in Kent, driven it back to Scotland and then arranged for it to be sent to Malawi by shipping container through the BananaBox Trust. This second autoclave had arrived in Malawi recently and we had agreed that it should be used by the Maternity Unit. It had been placed in the laundry room next to the Maternity ward and Andre instructed Mary and Hannah in its operation …

… following which they both practised the procedure.

In discussion, Andre suggested that the maternity autoclave would be much better sited in the Decontamination Room at the dental clinic, an observation with which we all agreed immediately. The distiller would then be co-located with both autoclaves, each of which require distilled water for operation. In effect, the Decontamination Room could function as a Central Sterile Services Department (CSSD) for the health centre, including for instruments used in the Out Patient Department.

In a subsequent meeting on 11th December at Chilomoni with Dr Gift Kawalazira, the District Health Officer, and members of his team …

… this recommendation was accepted and both autoclaves are now installed side by side in the Decontamination Room:

This panoramic photograph shows how all the components together provide a small CSSD for the entire site:

As part of his training, Andre spent time with Prince to take him through a full decontamination cycle with a set of dental instruments.

The value of the ultrasonic bath was evident from the colour of the cleaning solution after use.

One of the challenges for healthcare generally in Malawi is the cost of consumable materials. As part of the consignment of goods from Henry Schein South Africa, a large stock of ultrasonic cleaning solution and sterilisation packing material was generously provided, which will allow a consistent and reliable supply for many months to come.

Standard Operating Procedures are being drafted for each item of equipment to ensure that manufacturer’s instructions are followed by trained staff at all times.

It had been a very busy but exceptionally successful three days, during which all the new equipment was installed, and we felt that a celebration was due! It is generally recognised that citizens from South Africa are very skilled at braai (barbecuing). At the end of Day 3 of Andre’s visit, we decided to capitalise on his native skill and hold a celebratory barbecue in the beautiful gardens where we have our apartments. Our landlord, Giorgio Losacco, joined us together with our friends Sue Cabon and Moses. Just as the braai-ing was coming to an end, a strong wind blew up and we rushed everything inside before a fierce storm arrived. The food was tremendous and the storm (and power cut!) added to the general excitement!

As mentioned previously, we arranged for Andre to have a further visit to the KUHeS construction site so that he could hold a detailed face-to-face discussion with the plumber who would be installing the pipework for the dental chairs. It is a complex procedure and we hope that the combination of the earlier walk round with Lloyd and this follow-up meeting with the plumber will ensure a good outcome.

All too soon it was time for Andre to return to Johannesburg:

Andre had been a complete star and achieved all the objectives of the visit. Working in a resource-poor environment like Malawi can be challenging and during the week we faced a number of unexpected obstacles – including rodents and scorpions! With experience, skill and amazingly good humour Andre dispatched every challenge, usually culminating in what became his catchphrase “It’s gonna be great” – and it was! In a recent post on LinkedIn, Stan Bergman, Chairman of the Board and CEO at Henry Schein, talked about ‘Team Schein’ spirit and sense of purpose – Andre exuded that spirit in bucket-loads.

Next steps

I wrote earlier of the journey we are on with Chilomoni Health Centre Dental Clinic. The facility is now set up and equipped to a high standard that will allow a dentist to perform the full range of clinical procedures for which he or she is trained, including restorative dentistry. The costs of running such a facility and maintaining a regular supply of consumables require careful consideration and a public / private funding model is being explored.

A case has been written and submitted to the District Health Officer to support the appointment of a dentist, who can work with a dental therapist in this two clinic facility. There are fantastic opportunities for interaction with the local community, already exemplified by the activities of Anna Smith that have been reported in an earlier post and which would be amplified by Beehive Centre for Social Enterprise and the Dzuka Chilomoni Community Group. Furthermore, Chilomoni is readily accessible from KUHeS and could be used as an outreach teaching facility, allowing senior BDS students to experience dentistry within the community. The availability of a dentist on-site will also provide an opportunity for inter-professional learning and patient management with staff from Maternity and the Out Patient Department, both of which encounter many patients with oral and dental problems.

In summary, the Chilomoni Dental Clinic can function as an oral health node within the health centre and community, providing both preventive and curative care

Malawi now has its own home-trained dentists

Chilomoni Dental Clinic would provide an excellent working environment for one of them!

Acknowledgements

The journey to this stage has been made possible by the engagement and generosity of many partners and organisations. Particular thanks are due to:

• The Board of AMECA, for the insight and courage of the CEO and Directors to invest in the capital works required to establish a state-of-the art two surgery dental clinic at Chilomoni Health Centre.
• Fondation Eagle for the generous grant that was awarded to fund the equipment needs of the dental facility.
• Leigh Spamer, Andre Wessells and Robin Petersen at Henry Schein South Africa for their willing advice, support and provision of a free installation service for the equipment purchased.
• College of General Dentistry Scotland for a donation towards purchase of hand instruments for the dental clinic.
• Those who contributed to the online appeal earlier in the year.
• Dr Peter Chimimba, for his tireless interest in the project and wise counsel.