A warm MalDent Project welcome to friends from Malawi and Zimbabwe

We have recently had the pleasure of welcoming Nelson Nyoloka to Glasgow. Nelson is a Lecturer in Pharmacology at the University of Malawi College of Medicine and has enrolled on the MSc in Clinical Pharmacology at the University of Glasgow. He works closely with Peter Chimimba’s wife Frider, who is also an academic member of the pharmacology staff team at the College of Medicine. Lorna Macpherson and I had been able to meet Nelson in Blantyre in February 2020, when we visited Malawi for the national Oral Health Policy Workshop.

First meeting with Nelson Nyoloka in Blantyre in February 2020

As a result of the COVID-19 pandemic, the start of Nelson’s MSc programme had been deferred to November. I was delighted to hear that he had arrived in Glasgow, but for the first two weeks he had to quarantine according to the COVID-19 regulations. Shortly after his quarantine period ended, we agreed to meet on a Saturday morning for a socially distanced outdoor coffee, a chat and a walk around the University.

Nelson at his new residence for the next year

After a very enjoyable catch up over our coffee, we set out for the main University of Glasgow campus.

Getting to know the beautiful University of Glasgow campus

We were lucky to catch a dry spell before rain arrived later in the day and Nelson was excited to see the beautiful buildings around the campus – lots of photographs were taken!

Our walk back to Nelson’s hall of residence took us through Glasgow’s Botanic Gardens. The many squirrels were a novelty for Nelson, and I recounted how the equivalent novelty for me in Malawi had been to see monkeys running around a conference centre near Mangochi which we were visiting for one of the early BDS curriculum development meetings.

In Glasgow Botanic Gardens – with a squirrel!

It is unfortunate that Nelson has arrived in Glasgow during this period of COVID-19 restrictions. However, he is very positive and determined to make the most of his time in Scotland. We look forward to sharing that experience with him.

Our other recent meeting was with Cleopatra Matanhire, who has joined the University of Glasgow from Zimbabwe to complete an MSc in Global Health. Cleopatra is one of three postgraduate students (one each from Malawi, Zambia and Zimbabwe) in Glasgow funded by the Beit Trust on their Joint University Partnership scheme. Cleopatra trained as a dentist in Zimbabwe and in view of this, our good friend Alex Mackay from the Wellcome Centre for Integrative Parasitology, who is closely involved with the Beit Trust-funded students, passed on Cleopatra’s details. However, even before I had made the connection, Charlotte had been in touch with us at Glasgow Dental School, demonstrating her commitment to developing partnerships and pushing forward with her professional ambitions.

Cleopatra gained a Bachelor of Dental Surgery degree with Honours in 2015 from the University of Zimbabwe College of Health Sciences. Whilst undertaking her internship at Harare Government Dental Centre, she completed a Masters of Business Administration degree at the National University of Science and Technology in Zimbabwe. Since 2018, Cleopatra has been undertaking multiple roles as a Government Dental Officer with the Ministry of Health & Child Care, responsible for coordination of Dental Surgery Assistant training, a Volunteer Lecturer at the Ministry School of Dental Therapy and Technology and, since 2019, a Part-Time Lecturer at the University of Zimbabwe College of Health Sciences, Department of Dentistry.

Lorna and I meet with Cleopatra for an introductory Zoom chat – lots of common interests

It was a great pleasure for Lorna and I to catch up with Cleopatra over Zoom recently. It is clear that Cleopatra is highly motivated to make a significant difference to the oral health of those living in Zimbabwe, particularly children, patients in hospital care and those with psychiatric illness. Her list of achievements to date is very impressive and shows a passionate determination to improve public sector dentistry in Zimbabwe.

The MSc in Global Health at the University of Glasgow requires each student to complete a research project and dissertation. Cleopatra is interested in studying the role of dental associations and academia in establishing oral health policies. We have pointed out that a current work stream for the MalDent Project is the development of a national oral health policy for Malawi, with major input from the Dental Association of Malawi, the University of Malawi College of Medicine and the University of Glasgow. On that basis, we would be a real-time subject for study!

It has been a real privilege to meet Cleopatra and we will be continuing our conversations and, hopefully, joint activities into the future. The challenges for oral healthcare in Zimbabwe, as related to us by Cleopatra, are common to many African countries. If we collaborate and share our ideas, working with impressive young professionals like Cleopatra, we will be able to make a real difference to the lives of many of those who currently have little or no access to either preventive measures or oral healthcare.

MalDent Project / Smileawi collaboration with the Water Futures Programme sheds light on groundwater fluoride risk

‘Networking’, ‘partnerships’ and ‘collaboration’ are words that are used frequently in the context of international development. Those of us in Scotland who are engaged in projects with Malawian partners are extremely fortunate that there are many initiatives to support joint working. In addition to the direct and generous leadership of Scottish Government in this arena, the Scotland Malawi Partnership and its sister organization the Malawi Scotland Partnership play a pivotal role. Their input is evidenced by this story of a collaboration which is starting to bear fruit and shows great potential in two important areas of the Sustainable Development Goals – safe water supplies (SDG 6) and good oral health (SDG 3).

In October 2018 I attended the Annual General Meeting of the Scotland Malawi Partnership, held in the Student Union of the University of Glasgow.

Where it all started – the Scotland Malawi Partnership AGM at the University of Glasgow Student Union

Whilst there, I met Ieuan Isaac from the Rotary Club of Ayr, who discussed with me the work of the club on a water borehole project at a Malawian village, delivering sustainable water to over 700 residents. Their project had received valuable assistance from Professor Bob Kalin, based at the University of Strathclyde. Ieuan asked if I would be prepared to address the Ayr Rotary Club members about the MalDent Project, which I was delighted to do.

Purely by chance, on the date that was set for my brief address (26th February 2019), Dr Mwapatsa Mipando, Principal of the University of Malawi College of Medicine, was in Scotland and he accompanied Niall Rogerson and I to Ayr, where we gave a joint presentation and answered questions.

Bob Kalin was in the audience. Bob is the Director of the Climate Justice Fund: Water Futures Programme (WFP), which is funded by the Scottish Government. Following the formal part of the evening, Bob, Mwapatsa, Niall and I had a very interesting discussion about potential synergies between the MalDent Project and the Water Futures Programme in the context of the fluoride content of water.

With Mwapatsa, Bob and Niall, after our fledgling discussions about mutual interests

For readers who don’t have a dentistry background, fluoride is of great importance to dental health. At appropriate concentrations (0.7 – 1.2 parts per million), fluoride in drinking water strengthens tooth enamel and reduces the risk of dental decay. Some places have sufficient fluoride in natural water sources whilst in some geographic locations fluoride is added to the water supply. If the drinking water is low in fluoride, then regular brushing with fluoride-containing toothpaste has been shown to provide added protection. However, excessive fluoride in drinking water interferes with the formation of enamel when children’s teeth are developing, resulting in an appearance of the teeth which can be unsightly.

Dental fluorosis in a Malawian school pupil. Photo courtesy of Nigel & Vicky Milne

In an unrelated series of discussions, Nigel and Vicky Milne, the founders of Smileawi, had approached Glasgow Dental School for support with a child oral health survey which they were keen to undertake in some of the schools based in Malawian villages that they visited regularly to support dental healthcare. Furthermore, they wondered whether any of our senior students may be interested in participating. As regular readers of the blog will know from previous posts, this all went ahead, and as part of the preparations we linked the Smileawi team with Bob Kalin and one of his PhD students, Marc Addison, who is studying fluoride in groundwaters in Malawi.

Nigel and Vicky enjoying a training session delivered by David Conway and Lorna Macpherson in preparation for their child oral health survey

Marc provided the Smileawi team with fluoride-measuring kits to assess the water in the boreholes at each of the six schools they visited, though it is important to recognise that it is the fluoride content in village water supplies where the children live during the period of tooth formation that is of critical importance. At one of these schools, in Dedza District in Central Malawi, they identified a higher level of fluoride than in the others. In this same school they also identified a significant number of children with dental fluorosis, quite unlike the clinical picture in the other five schools.

Vicky Milne and Paula Houston testing borehole water for its fluoride content in one of the schools

Once all the epidemiological data collected by the Smileawi team had been checked for accuracy, they were passed in anonymised format to Marc, to consider in the context of his work to predict groundwater vulnerability to geogenic fluoride risk. Recently, Marc contacted us to review the outcome of his cross-referencing, which has proved very exciting.

The Glasgow Dental School team is briefed by the Strathclyde team – exciting news

In summary, the school in Dedza is located in an area where Marc’s work has predicted that an underground hot spring is buried beneath sediment. The relevance of this is shown in the whisker plot below, because the water that emanates from hot springs contains very high levels of fluoride.

Geogenic fluoride risk classification

At present, the Malawi drinking water standard is 6 mg/l, a concentration which can cause both dental and skeletal fluorosis. In due course, through a staged process, the ambition is to reduce that standard to the WHO drinking water standard of 1.5mg/l.

In light of the hard work put in by the Smileawi team to gather the epidemiological data, Bob and Marc kindly agreed to repeat their presentation for Nigel and Vicky Milne on the evening of 28th October 2020.

Nigel and Vicky Milne see the results of their labours

It was as exciting for the Smileawi team as it had been for us to see how these separate pieces of work in two distinct disciplines had come together in a complementary way.

Marc demonstrates and discusses a geological map of Malawi

Gaining an understanding of how the underlying geology could impact on fluoride levels in drinking water, which in turn has a very significant effect on dental health (for good or bad, depending on concentration), was extremely enlightening.

A cross-sectional map of the geology in the area of the school whose pupils showed a high prevalence of dental fluorosis

Despite the fact that Bob and Marc had already provided a presentation summarising these results on two occasions for us, there was to be a third time! A major strand of ongoing work for the MalDent Project is its involvement in the development of a national Oral Health Policy with the Government of Malawi Ministry of Health & Population. The fourth meeting of the policy task force was scheduled for Thursday 5th November, and with the agreement of the chair, Dr Nedson Fosiko, we invited Bob and Marc to deliver a presentation to the task force members. At Bob’s suggestion, we also invited Modesta Kanjaye, who is the Director of Water Resources at the Ministry of Forestry and Natural Resources.

Bob gave an initial, brief overview of the Climate Justice Fund: Water Futures Programme, to provide context for the task force members

He showed a series of slides, including an illustrated description of the extensive mapping of water points that has been completed.

Following Bob’s introduction, Marc described his PhD studies on fluoride levels in the Malawian water supply.

What is striking, as we had heard in Marc’s previous presentations, is the very wide variation in levels of fluoride across the country, which are totally dependent on the underlying geology.

Marc has very recently published a paper on his work, entitled Predicting groundwater vulnerability to geogenic fluoride risk: a screening method for Malawi and an opportunity for national policy redefinition, which interested readers can download here. Further papers are in preparation.

The relevance of these wide fluoride level fluctuations to dental health is substantial. There will be areas of the country where the natural fluoride level is optimal for dental caries prevention, others where additional fluoride (eg from regular supervised toothbrushing with a fluoride-containing toothpaste) would be recommended and some areas in which excessive levels are causing dental fluorosis. We have now added geographic distribution of drinking water fluoride levels to the situational analysis the Oral Health Policy Task Force is currently undertaking, to inform the policy content.

To illustrate the complexity of the problem, Bob showed a graph of the various water points in the villages surrounding the school in which children with fluorosis were identified by the Smileawi team. All of these points are now being tested for their fluoride content, in an attempt to identify the specific water sources that are responsible for the fluorosis in the children.

Multiple sources of drinking water in the villages surrounding the school

In summary, this joint work is mutually supportive. From the perspective of the MalDent Project, our increased understanding of the geographic distribution of the varying fluoride levels in drinking water will inform both the design of the forthcoming national child oral health survey and the content of the oral health policy. From the perspective of the Water Futures Programme, epidemiological data that we gather from the national child oral health survey and related dental research programmes can act as a proxy to help the team focus its efforts on fluoride reduction in water supplies to those water points most likely to require attention. Furthermore, the engagement of both the Ministry of Health & Population and the Ministry of Forestry & Natural Resources in ongoing discussions provides key central links within the Government of Malawi.

Since this story started with the Ayr Rotary Club and the kind invitation from Ieuan Isaacs to one of their meetings, we should perhaps close on the same theme. I took a photo of this plaque in the Savoy Park Hotel on the evening that Mwapatsa and I spoke to the members there.

Those initial discussions with Bob Kalin have turned into a substantial and valuable collaboration. In line with Rabbie Burn’s exhortation – we caught the moments and we’re putting them to good use.

A pot-pourri of recent MalDent Project activities

Despite the challenges of the COVID-19 pandemic, many of the core activities of the MalDent Project continue to make good progress. This post provides an update on some of the recent developments.

Refurbishment of the Dental Department at Kamuzu Central Hospital

One of the projects that has been delayed by the pandemic is Phase 2 of the refurbishment of the Dental Department at Kamuzu Central Hospital in Lilongwe. Following the success of Phase 1, financial support from Scottish Government and the Royal College of Physicians & Surgeons of Glasgow HOPE Foundation has funded the collection and refurbishment of more dental chairs and dental simulator equipment which Dentaid has serviced ahead of transportation and installation in Lilongwe. We have purchased a shipping container and it was loaded just before lockdown. On 23rd September I had a call with my friend and colleague Stuart Bassham, Dentaid’s Warehouse and Engineering Manager.

Enjoying a conversation with Stuart – we’re moving forward with Phase 2

We have decided to arrange for shipping of the container from Dentaid’s depot in Southampton in the next few weeks. This should ensure it arrives in Lilongwe in early 2021, when it will be placed permanently on a site in the grounds of the College of Medicine campus, adjacent to Kamuzu Central Hospital. We will unload the equipment when we visit Lilongwe to undertake the installation, which is tentatively scheduled for June 2021.

Scotland Malawi Partnership Meeting Annual General Meeting, 3rd October 2020

Throughout the COVID-19 pandemic, the Scotland Malawi Partnership (SMP) has done a fantastic job of keeping partners in both countries connected and updated on the progress of the infection in our respective homelands. The regular Zoom meetings, which commenced on 31st April 2020, have been informative and, despite the challenges of the pandemic, inspirational in many ways. The COVID-19 hub on the SMP web-site is an excellent source of up to date information.

The SMP Annual General Meeting, held virtually on 3rd October 2020, was a highlight of this year’s activities. One of the centrepieces was the keynote speech from the President of Malawi, Dr Lazarus Chakwera:

In his uplifting speech, Dr Chakwera outlined the priorities he saw for the relationship between Scotland and Malawi in the coming years.

One presentation that was of particular interest for me was the update on the COVID-19 case numbers in Malawi, delivered by Dr Mwapatsa Mipando, Principal of the University of Malawi College of Medicine and a driving force behind the MalDent Project. The data he presented were very encouraging:

Dr Mwapatsa Mipando gave a very clear and positive presentation on COVID-19 in Malawi

However, fingers remain crossed that the pattern of disease seen in many other parts of the world, and currently presenting a major challenge in Scotland, is not repeated in Malawi. As I write this post on 23rd October, things remain hopeful, as demonstrated in the figure below, tweeted by the Government of Malawi Ministry of Health yesterday:

Other details of the SMP AGM are all available to interested readers on the Scotland Malawi Partnership web-site.

Participation in WHO Africa webinar on COVID-19 impact on oral health care service

Regular followers of this blog will have read previously of the MalDent Project links with Dr Yuka Makino, who is the WHO Africa Technical Officer for Oral Health, based in Brazzaville. Yuka played a central role in the National Oral Health Policy Workshop in Lilongwe held on 13th and 14th February 2020.

We were approached by Yuka to ask whether we would contribute to a webinar that she was organising entitled ‘Continuity of essential oral health service in the context of COVID – WHO African Region’. The event was run on 28th and 29th September.

Yuka introduced the objectives of the webinar:

Objectives of the webinar

Yuka had invited speakers from around the globe, including Dr Benoit Varenne who is the Dental Officer at the World Health Organization, based in Geneva:

The programme for Day 1

The presentation on the situation in Scotland and the broader UK was scheduled for Day 2:

The programme for Day 2

It was a privilege for the University of Glasgow to participate in the event.

In addition to speaking about the UK context, Yuka had asked me to provide an update on the MalDent Project, and the challenges that had arisen from COVID-19. I focused on the challenges of delivering on-line learning to students in Malawi because of issues around accessibility of digital devices, WiFi and affordable data bundles. It was good to be able to report on how joint working between Scotland and Malawi had been able to overcome some of these difficulties at the University of Malawi College of Medicine.

This was an excellent webinar, very well organized and run by Yuka. It finished with two concluding slides:

As I read the second of these slides, which focused on the now well-known phrase ‘Build Back Better’, it struck me how many of these recommendations are feeding directly into the ongoing work of the Government of Malawi Oral Health Policy Task Force. In a future blog post we will update on the work of that group, which aims to publish a finished policy document by the middle of 2021.

Recordings of both days of the webinar are available on YouTube and are recommended to all interested readers.

Day 1: 28th September 2020
Day 2: 29th September 2020

Progress with design of the integrated dental teaching facility and student hub

Further to the earlier post, the Stage 1 Report has now been finalised and presented to the MalDent Project team by Paul East and his colleagues at the Edinburgh offices of John McAslan + Partners. The final page of the report includes a rendering of the concept for the building at this stage of the design process.

An exciting vision of how the future may look

Following the initial presentation of the Stage 1 Report, Mwapatsa Mipando shared the draft document and the recording of the design team discussions with key stakeholders at the College of Medicine. He hosted a formal feedback session, to ensure inclusivity of all players who would benefit from this exciting enhancement to the campus infrastructure:

Subsequently, that feedback was shared with Paul East and the design team, followed by a Zoom meeting in which Mwapatsa Mipando and Peter Chimimba clarified queries raised by the local responses.

Following up on the points raised by the feedback session held in Malawi

Paul and the design team have now commenced on Stage 2 of the design process, which is scheduled for completion by the end of November 2020.

Developing a childhood caries prevention programme for Malawi

Ronald Manjomo, the recently appointed PhD student based at the College of Medicine, has made an excellent start on his study programme. He provided an update at a meeting held on 20 October with his two main supervisors, Professors Ken Maleta (College of Medicine) and Lorna Macpherson (University of Glasgow).

Ronald and his supervisory team enjoying a discussion on the current work plan

Since Ronald’s work feeds directly into the activities of the Oral Health Policy Taskforce, he is now joining the meetings of that group as an Observer in the first instance.

In addition to funding from the Scottish Government MalDent Project, Ronald is partly funded by the Borrow Foundation. The Borrow Foundation has recently updated its web-site, which now includes a link to the MalDent Project and specifically mentions the work that Ronald is undertaking as part of our overall programme.

In conclusion, we are maintaining momentum for the MalDent Project despite the COVID-19 challenges. Once again, it is the very strong partnership working at all levels, and the enduring support of our funders, that is enabling us to make progress.

In the very first post I wrote for this blog on 1st September 2018, I quoted Helen Keller, who said: “Alone we can do so little; together we can do so much”. That has proved so true for the MalDent Project to date and has laid the foundations that will see us through the COVID-19 challenges towards achieving our aim of ‘Oral health for all

Stage 1 building design concepts revealed to the MalDent team – great excitement!

At the third meeting between the design team members and the MalDent team, held recently on Zoom, Paul East of John McAslan + Partners, together with his colleagues, presented the work they have been undertaking to complete Stage 1 of the design process for the new Dental School / Student Hub Building on the Blantyre campus of the University of Malawi. It was an exceptionally exciting and eye-opening two hours. Little did we know what was to follow after the opening slide of the presentation.

Paul initially reminded us of the phasing of the project and associated timeline. The team is working to a very tight schedule but at present it is all on track, which is a fantastic achievement:

The time-line

For the the first part of the presentation, Sophie Burgess provided a description of the site analysis that had been undertaken. Of the three possible locations that had been previously identified, Site B was chosen as the one that best satisfied the design brief.

Consideration of the site selection – Site B proved the winner

This choice was superimposed on a photograph of the campus, which illustrates its position on the perimeter of the existing buildings but bordering open space for potential future developments.

Site B in the context of existing campus buildings

The site was also considered from the perspective of photographs taken from different locations. These pictures also serve to illustrate the stunning backdrop for the new building.

Photo survey of the site from different vantage points

We were next given information on the topographic analysis that has been completed. There is a significant slope to the site, which it later transpired would be very relevant to the design process.

Analysis of the topography of Site B

Paul and Sophie next handed over to Sam Haston from Buro Happold, to discuss the climatic analysis that has been completed. It was fascinating to hear how impactful the climate data are in relation to the design process.

Weather data were available from Chileka International Airport

Every aspect of the climate, including temperature, relative humidity, wind speed and cloud cover were considered at each time of the year.

Parameters of the local climatic conditions throughout the year

Sam explained how combined use of shading and air-flow could have massive impacts on levels of comfort for those using buildings and how relevant consideration of these factors were critical to the design process.

The importance of shade and airflow for human comfort

To explain this in more detail, Sam gave a description of what are known as passive design principles

He showed a diagram illustrating how overhangs can be used to provide shade to the North and South elevations, but that vertical structures are more efficient on the East and West:

There are also rules governing building designs that will increase the efficiency of cross ventilation:

The priority for this building is to use passive design principles as much as possible to reduce the amount of mechanical ventilation required. This improves natural efficiency, reduces power usage and enhances the green credentials of the building.

Prioritise natural over mechanical ventilation

In addition to natural ventilation, there are many other design features that can improve the overall efficiency of buildings and which are environmentally friendly. These are all being considered during the design process:

The final slide in this section summed up the opportunities provided by Site B and why it had been chosen over Sites A and C.

This image has an empty alt attribute; its file name is Screenshot-68-1024x576.png
The multiple opportunities provided by Site B

Paul then moved on to the brief, to explain the progress of the team through Stage 1.

One of the first considerations had been to consider how the functional elements should be organized within the structure, to ensure appropriate adjacencies.

Consideration of adjacencies

Having considered the adjacencies, the next step was to consider how the various elements should be organised. On their next slide, we were treated to the first set of architect’s hand drawings which then morphed into three possible organisational options – ‘organic’, ‘slices’ and ‘spine’.

Organisation of the functional components of the building

Paul then proceeded to take us through a series of slides which illustrated how each of these three organizational options could begin to translate into a concept for the building. The design team had come to the conclusion that Option 3 – Spine, worked best.

The building would extend over three floors and this is where the topography of the site became relevant to the design.

The distribution of facilities across the three floors of the ‘spine’ design

We were then treated to a series of pen and wash sketches, through which the design was developed and emerged. I have always loved this type of illustration, and to see the design concept appearing out of the page was incredibly exciting.

Early development of the spine design

In this sketch, the use of the lie of the land is becoming clear.

Further refinement of the initial sketches

Another sketch provided an illustration of how the entrances to the building and surrounding landscaping could be envisaged.

Landscaping and surroundings

Suggested floor plans were illustrated for each level of the building

An example of one of the floor plans

The design then emerged through a series of sketches …

… followed by computer simulations based upon those sketches:

Paul explained that some of the components of the design had stemmed from considering features of other buildings that had similar requirements in the brief, so-called precedents:

At the end of the two hour presentation, there was general discussion about progress and the vision for the building design that had been shared with the MalDent team. In summary, we were both astonished at the amount that had been achieved and delighted with what was being proposed.

It was agreed that Dr Mipando would share the recording of the presentation with other key stakeholders in Malawi, to garner their views and feedback. Paul agreed to send the printed Stage 1 report to all present.

Reflecting on the workshop held in Blantyre in September 2019, led by Professor Chris Platt, it is now extremely exciting to see the design appearing, based upon principles that flowed from those stakeholder discussions held a year ago. The benefits to the entire campus will be legion, quite apart from providing a teaching focus for the new BDS programme. Thanks to John McAslan + Partners, together with the design team they have established, we are off to a flying start!

On-line clinical examinations now a possibility at the College of Medicine

In an earlier post we reported on the generous support of Scottish Government International Development which allowed the purchase of digital devices to allow students at the University of Malawi College of Medicine to participate in remote on-line learning.

We were subsequently contacted by Dr Emma Thomson, the Director of the College of Medicine Education and Training Office, to ask whether we had any experience of delivering clinical examinations using on-line platforms. At Glasgow Dental School we have been very fortunate that a small team of academic staff has perfected a method for running Virtual Objective Structured Clinical Examinations (VOSCEs) via the on-line platform Zoom.

Recently my three colleagues James Donn, Alun Scott and Craig Mather delivered an excellent presentation for Emma, which demonstrated the methods they have developed. In addition to the VOSCE format, they also gave a demonstration of how the same on-line platform has been used recently to run the Case Presentation examination for our Fourth Year BDS students.

James Donn, Alun Scott, Craig Mather, Emma Thomson and I enjoying some informal conversation at the end of the presentation

The presentation was recorded and the video file made available to Emma so that she can share it with Prof Nyengo Mkandawire, the Dean of Medicine, and with other interested colleagues in Malawi.

Sharing ideas and novel methods for teaching and assessment during the COVID-19 era are an essential part of life for all higher education institutions. The potential for delivery of on-line examinations also provides added value to the investment made by Scottish Government in the purchase of the digital devices. A great example of collaboration and innovation!

First meeting of the Malawi National Oral Health Policy Task Force

The National Oral Health Policy Workshop held in Lilongwe last February resulted in the establishment of a task force to take the policy development work forward under the aegis of the Ministry of Health and Population (MoHP).

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Delegates at the National Oral Health Policy Workshop, Lilongwe, 13th and 14th February 2020

After the workshop, the Ministry drafted Terms of Reference for the task force, but by March we were being challenged both in Malawi and the UK by COVID-19. Inevitably this placed significant pressures on all parties to manage the pandemic, resulting in some delay, but on Thursday 27th August the first meeting of the task force was held via Zoom, chaired by Dr Nedson Fosiko, Deputy Director of Clinical Services in the MoHP.

Screenshot 20 Group photo cropped
Participants in the first meeting of the Oral Health Policy Task Force

The main purposes of the meeting were to confirm acceptance of the Terms of Reference and then to map the way forward for developing the policy.

Brian Chaima, from the Policy Development Unit, Department of Planning & Policy Development at the MoHP, took us through a brief presentation on the standard process used for policy development by the Malawi Government.

The initial step is to develop a concept paper:

Screenshot 1 croppedMuch of the content required to create a concept paper was covered at the Policy Workshop in February and this stage will be relatively straightforward.

Once the concept note has been approved by the Principal Secretary, the next stage is to develop a Policy Analysis Document (PAD):

Screenshot 2 cropped

This phase of the process requires a situation analysis. One element will be a rapid review of relevant literature, which Lorna Macpherson and I have agreed to lead on, with involvement of Ronald Manjomo. We will also create a list of key questions relating to the local environment e.g. up to date statistics for the oral health workforce in Malawi. This will involve consultation with a wide range of stakeholders and we will work closely with Peter Chimimba and Wiston Mukiwa on this part of the programme.

On the basis of the situation analysis, policy options will be generated, followed by a process of policy impact assessment:

Screenshot 3 cropped

Ultimately a recommended option will be generated together with an accompanying implementation plan:

Screenshot 4 cropped

Finally, the Policy Framework Document will be developed, for review and approval by senior Ministry and Government officials up to the level of the Cabinet:

Screenshot 5 cropped

This is a complex and ordered process, but being led by Nedson Fosiko and Brian Chaima from the Ministry of Health & Population will ensure we keep on track. A series of regular meetings is now being scheduled to ensure we also keep to time!

 

Scottish Government support for digital devices unlocks on-line teaching at University of Malawi College of Medicine

The COVID-19 lockdown has affected all areas of our lives. The impact on higher and further education has been no exception. In the UK and many other high income countries the availability of internet based platforms such as Zoom has played a major role in helping to mitigate the cessation of face to face teaching on campuses. In the Dental School at Glasgow we were able to rapidly transition to on-line teaching and assessment methods which allowed us to complete the 2019/2020 academic session for all of our students in May / June 2020. The steep learning curve for both staff and students was challenging, and it is remarkable what has been achieved.

Mock BDS 3 VOSCE cropped
Glasgow Dental School staff preparing for a Virtual Objective Structured Clinical Examination (VOSCE)

Whilst it may have been challenging we were fortunate to have access to the necessary digital technologies. Sadly, the same cannot be said for many low- and middle-income countries. At the University of Malawi College of Medicine the campuses were closed to students from the middle of March 2020, with no delivery of undergraduate teaching since then and no assessments undertaken. 

There have been two major challenges. One of these is the wide geographic variation in WiFi availability within Malawi. Many of the students have gone home to their villages in rural areas and are without readily accessible WiFi. Purchase of data bundles is relatively expensive and beyond the means of many students. The second major challenge is that many students do not have access to suitable digital devices on which to download teaching materials and undertake their studies. It would be very unfair for any university or college to deliver on-line teaching if some of the students were unable to access it, merely adding to inequalities within the student body.

The College of Medicine identified that 267 of its 1076 students did not have access to suitable digital devices for on-line teaching. In mid-June it therefore launched an appeal called #267forCOM to “bridge the digital divide”.

267 for COM Twitter

This digital access issue and appeal were of immediate relevance to the MalDent Project. The students on the BDS 1 course, which had commenced in August 2019, were severely affected along with all the other undergraduate programmes, including the foundation course which also included students keen to join the next cohort of dental students. However, regardless of their course of study, this challenge of digital access was impacting all students across the College of Medicine, and required an urgent partnership response.

By chance, I had been speaking about digital delivery of education to health care workers with my good friend Shaenna Loughnane, who is CEO of the charity Bridge2Aid, with whom we are working on the project to up-skill Medical Assistants in Malawi to deliver emergency dentistry. Shaenna is engaged in projects that use digital delivery for education of healthcare workers in Tanzania, and she was instantly keen to help.

We set up a Zoom meeting with Dr Mwapatsa Mipando, Principal of the College of Medicine and Dr Emma Thomson who leads the College of Medicine Education & Training Office, to consider possibilities. A number of options were discussed including fund-raising in the UK, an approach to the Turing Trust by Shaenna and an approach by myself to the Scottish Government to enquire whether some re-purposing of a small amount of the MalDent Project budget may be possible.

It soon became clear that fund-raising would be too slow to provide the urgent support needed to bring teaching back on track. Shaenna had a very productive discussion with the Turing Trust which raised the possibility of  purchasing, at low cost, up to 50 laptop computers from a consignment which, at the time, was in a container en route to Malawi and bound for distribution to schools via their partnership organisation the Centre for Youth and Development.

For my part, I worked with Deirdre Kelliher, our MalDent Grant Manager, and identified that in the 2020/2021 budget estimate we had costed in £20K for ‘Flying Faculty’ teaching which would not be used because of the travel restrictions, which are anticipated to be in force until at least 31 March 2021. However, much of that education and instruction could be delivered in a modified way by the ‘Flying Faculty’ volunteers if all the students had access to on-line teaching. Accordingly, we prepared a short briefing paper which was followed up by a very positive Skype call with the Scottish Government International Development Team. Our request was to re-purpose the £20k towards purchase of 100 suitable digital devices, as a contribution to the #267forCOM appeal. It was agreed that this request would be taken to the Minister for International Development, Ms Jenny Gilruth MSP.

I was delighted when we were informed recently that our request to re-profile the £20K towards the purchase of digital devices had been approved. What I had not been prepared for, nor was expecting, was the offer of additional funding from the Scottish Government of up to £33K to support purchase of 230 of the digital devices required. I was completely overwhelmed by this generous response, the impact of which will be immense.

Through their own local fund-raising, the College of Medicine had sufficient monies to cover the cost of an additional 37 devices. The following photograph shows the Principal receiving MWK 6,000,000 (approximately £6000) from one of its supporters, NICO Holdings plc, which is helping with purchase of devices.

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The Principal (left) receives the donation from a senior executive of NICO Holdings plc

Reaching this milestone, which now enables purchase of the 267 devices required to satisfy the #267for COM appeal, in effect unlocks the delivery of on-line learning and, potentially, assessment for 1076 healthcare students in Malawi. It represents a massive step forward and will have a lasting impact even beyond the COVID-19 pandemic.

Following the award of this additional funding, Malawi’s Public Procurement and Disposal Authority (PPDA) allowed the University of Malawi College of Medicine to use an emergency but transparent procurement process. The advert was floated on the PPDA website and two companies tendered their bids. Subsequently the College’s Internal Procurement and Disposal Committee met to identify the preferred bidder and it is anticipated that the devices will be delivered within a matter of days.

The other piece of the jigsaw is the access to affordable data bundles and there has been success on this front too. The Principal, DrMipando, has been interacting with the Malawi Government and with telecommunications companies to identify a way forward.

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The Principal, at a meeting with the Malawi Government Minister of Information, the Honourable Gospel Kazako

Through negotiations involving the Malawi Government and Telekoms Network Malawi (TNM),  Dr Mipando has secured a reduced rate on data bundles, which the College of Medicine will purchase on behalf of the students.

For the MalDent Project, there is relief and excitement that we can now move forward with delivery of on-line learning and once more engage fully with the students on the BDS and foundation programmes. However, on a much broader scale this outcome provides the opportunity for all the students at the College of Medicine to revert to their studies and, we hope, obviate the need for them all to face lengthy extensions to their degree programmes. The generosity of the Scottish Government and Malawian sponsors in facilitating this major step forward will have a lasting impact on the lives of many young healthcare workers and, ultimately, the patients they look after, for many years to come.

The last word should come from Dr Mwapatsa Mipando, Principal of the University of Malawi College of Medicine, who established the #267for COM appeal and has worked tirelessly to see it succeed:

“ As a Principal of COM and as a Malawian, I am thankful for the support that we have received from Scottish People, our local companies and our alumni. This support will allow us to purchase Tablets for all our needy students. This is really the spirit of UBUTHU!!  This UBUTHU has surmounted the digital divide that was amongst our students.  The cherry on top, is the partnership that the COM has entered with Telekom Networks Malawi PLC (TNM) resulting in the College providing 10Gbs of internet data every month to every student.  COM is a trailblazer in Malawi  through the above support and we hope to release more health care workers into our already overstretched health system!”

 

 

Design team members visit Glasgow Dental Hospital & School

At the recent Zoom meeting of the design team for the new dental teaching facility / student hub building on the Blantyre campus of the University of Malawi College of Medicine, it was agreed that a visit to Glasgow Dental Hospital & School could provide useful contextualisation for the architects and engineers involved.

On Thursday 30th July, Niall Rogerson and I were delighted to host a visit by Paul East and Sophie Burgess, from John McAslan + Partners, together with Sam Haston from Buro Happold. We are very grateful to Andy Hamilton, the NHS Greater Glasgow & Clyde Dental Hospital Estates Manager, who kindly accompanied us for the whole duration of the visit.

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Sophie Burgess, Paul East, Niall Rogerson, Maryanne Ferguson, Sam Haston and Andy Hamilton in the pre-clinical skills (‘phantom head’) facility

We spent the first 45 minutes in a socially distanced face-to-face meeting, which set the scene for the subsequent walk round.

One of the main issues which was discussed related to ventilation and air changes in the clinical teaching areas. Dentistry as a profession is currently suffering badly because many of the procedures undertaken involve use of instruments, such as high speed handpieces, which generate aerosols. In the COVID-19 era this poses wicked problems in relation to safety of patients, staff and students. Additional infection control procedures are required, for example fallow times in surgeries between patients who have been treated with aerosol generating procedures  (AGPs) to allow sufficient air changes to dilute aerosol particles, and the use of additional personal protective equipment (PPE). The problem is even greater in many dental schools because the students undertake patient treatment in open-plan multi-chair clinics, to allow close supervision by clinical tutors. Control and management of aerosols in such spaces is very difficult.

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Niall Rogerson with Glasgow dental students in a multi-chair polyclinic

The timing of the MalDent Project building design project will allow us to develop and build in features which will help to overcome these challenges around air-flow and ventilation.

The design team members were able to visit all the key elements of a dental school building and learnt a significant amount from Andy about some of the specialised technical aspects linked to dental equipment and associated infrastructure. Andy has kindly provided his contact details to the design team members so that they can liaise with him directly as necessary – another willing partner is welcomed into the MalDent Project team!

 

Inaugural meeting marks the beginning of the student hub / dental teaching facility design programme for CoM

As reported in an earlier post, the contract to design the new student hub and clinical dental teaching facility at the University of Malawi College of Medicine Blantyre campus was awarded to a consortium led by John McAslan + Partners.

The first meeting of the project team was held on Friday 17th July by Zoom.

First John McAslan meeting screen shot
Project team members from the John McAslan + Partners design consortium, University of Malawi College of Medicine and the University of Glasgow, after the first successful meeting

This initial meeting, chaired by Paul East, established administrative, working and communication methods.

A variety of surveys are required in the early stages of the programme. Quotations for a topographical survey and geotechnical site investigations are currently awaited and a number of other items of information are being sought, as outlined in the following screenshot.

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Work has begun on the surveys required for the design project

It was exciting to see a plan of the College of Medicine site with a cross hatched area which identifies where the new building is to be sited – suddenly this part of the project is coming alive!

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Exciting to see the site of the planned new building (arrowed) on the campus plan

Lines of external communication have been set up through John McAslan + Partners, the University of Malawi College of Medicine Communications Team and the University of Glasgow Communications Office. An initial press release has been drafted for distribution to media outlets in Malawi and Scotland.

Weekly meetings will be scheduled for the foreseeable future as the work to develop the design brief and the subsequent stages of the project progress. We will keep readers updated!

Ronald Manjomo, PhD student, joins the MalDent Team

One element of our successful MalDent grant application to the Scottish Government was to appoint a PhD student to collaborate with us on the work stream to develop a model programme for prevention of dental disease in children that would be applicable in Malawi. Subsequently, this element of the project has received a major boost with additional funding of $75,000 from the Borrow Foundation.

The PhD studentship was advertised in 2019 and interviews for the short-listed candidates took place by Zoom on 19th December 2019. Professor Lorna Macpherson and I took part from Glasgow and the process was chaired by the Dean for Postgraduate Studies at the College of Medicine, Dr Fanuel Lampiao.

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Lorna Macpherson and I in Glasgow, with Dr Fanuel Lampiao in Blantyre, as we prepare for the interviews.

Following the interviews, we identified Ronald Manjomo as the preferred candidate, and he was duly recommended to the Vice-Chancellor for approval .

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Smiling faces after the interviews – Dr Fanuel Lampiao, Ms Siphiwe Lino
(Assistant Registrar – Academics) and Ms Annie Mwapasa (Maldent Project Administrator)

We are very excited about Ronald’s appointment, as his skills and experience fit very well with the work that is required for this oral health improvement project. Ronald graduated with a Bachelor of Social Science degree from the University of Malawi, Chancellor College in 2010. He majored in sociology, economics and psychology, and completed a dissertation entitled ‘Assessing the socio-economic impacts of a resettlement scheme on a local community in Machinga District’ as part of his course-work. From 2012 he worked for the Baobab Health Trust and in 2018 completed his Master of Public Health degree at the University of Malawi College of Medicine. His MPH project was entitled ‘Assessing the integrated management of non communicable diseases at Area 25 Urban Health Centre in Lilongwe, Malawi: experience from a human resources limited setting’.

Lorna Macpherson and I were able to meet Ronald in person when we visited Lilongwe in February this year for the National Oral Health Policy Workshop. We were joined by James Mchenga, the Academic Head of Dentistry at the College of Medicine, and enjoyed a very productive discussion.

Restaurant with Ronald
With Ronald Manjomo at the Sunbird Capital Hotel, Lilongwe

The various administrative procedures that have been necessary for Ronald to take up his studentship have now been completed and on Monday 13th July we held the first Zoom meeting with Ronald and his supervisory team. Professor Ken Maleta, who is Professor of Public Health at the College of Medicine School of Public Health & Family Medicine, is the Lead Supervisor in Malawi and Professor Lorna Macpherson will co-supervise from the Community Oral Health Research Group at Glasgow Dental School. Dr James Mchenga will provide the academic link to Dentistry within the Faculty of Medicine. Other academic colleagues will link into the project as it develops.

Supervisor meeting
Ronald and his supervisory team – ready for the off!

Many thanks are due to the Scottish Government and to the Borrow Foundation for the funding that supports the studentship to which Ronald has been appointed. The work to develop a dental caries prevention programme for children in Malawi is a crucial strand of the MalDent Project. We look forward to working closely with Ronald and with the other stakeholders, including the Ministry of Health & Population and WHO Africa, in this project to develop a sustainable prevention model based upon the principles of Scotland’s successful Childsmile programme.