The annual College of General Dentistry Study Day, held on the first Friday in December at Glasgow Science Centre, is always a very stimulating and enjoyable event. It brings together a large number of dental professionals from across Scotland, including all the Vocational Trainees. It is a great opportunity to catch up with colleagues and also to hear from recent graduates as they start out on their professional journeys.

This year, the MalDent Project team was invited to deliver the Caldwell Memorial Lecture. Robert Craig Caldwell was born in the United States but raised in Millport. He graduated from the University of Glasgow in 1950 and embarked on a career in dentistry that saw him return to America as Dean of the School of Dentistry, University of California, Los Angeles (UCLA).

While there, he introduced the comprehensive patient care programme and encouraged the recruitment of minority and female students so that all segments of the population could be represented in the student body. He also encouraged students to seek advanced training and considered students to be his junior colleagues. After just three years in post Bob died, at the age of 46, of chronic myelogenous leukaemia. His classmates at the University of Glasgow established the Caldwell Memorial Lecture in his memory and it is delivered every year as the final session at the Study Day.

This was a tremendous honour for us. A small group was assembled to present an update on the MalDent Project’s progress and to demonstrate the benefit that collaborations and partnerships are playing in the venture.

We are very grateful to Robbie and Patricia Thomson, key players in the organisation of the Study Day, who had invited our participation. Following highly successful and influential careers in general practice, both are now Clinical Teaching Fellows at Glasgow Dental School, providing students with the benefit of their many years of experience in the profession.

The team comprised Stuart Bassham from Dentaid, Nigel and Vicky Milne from Smileawi, Andrew Paterson representing Bridge2Aid, and myself representing the broader MalDent Project. Stuart had to fly up from near Southampton that morning, but for the rest of us the venue was close to home.

The lectures at the Study Day are delivered in the iMax Theatre at Glasgow Science Centre. This is a large capacity venue, easily capable of holding the 350 delegates at the meeting:

There is always a trade show running in parallel with the rest of the event and we were grateful to the Study Day organisers for providing us with a ‘volunteering’ stand free of charge:

This was a great opportunity for Nigel, Vicky and I to discuss some of the joint projects we’re involved with in Malawi and which we would be talking about during the lecture that afternoon. Later, we were also joined by Andrew.

Stuart arrived from Southampton just in time to enjoy lunch with us, which was a very civilised sit-down meal…

… before we headed off to the iMax Theatre to check through our slides and then back to the trade show ahead of the afternoon lectures:

Just before we were due to deliver the Caldwell Memorial Lecture, awards were presented to a number of Vocational Trainees, including Martin Laird who had been one of the University of Glasgow students who had visited Malawi in 2019 with Smileawi and participated in the pilot child oral health survey, as well as spending some time at the University of Malawi College of Medicine.

The Caldwell Memorial Lecture was introduced by Conor O’Malley. Conor played a pivotal leadership role over many years in developing and building up the Study Day in its original guise as the FGDP Scottish Day, before the FGDP itself was replaced by the College of General Dentistry. Conor has also been a great friend to the Glasgow Dental Alumnus Association, helping to raise large sums of money over the years. It was, therefore, a particular pleasure that he had been chosen to introduce us.

I opened the lecture by describing the background to the MalDent Project. The two initial principal partners were the University of Glasgow and the University of Malawi College of Medicine (now Kamuzu University of Health Sciences) who, in 2018, were jointly awarded a Scottish Government International Development grant of £1.3m over 4.5 years. The principal objectives were to establish a BDS degree programme, the first in Malawi, and to develop an Oral Health Strategy for Malawi through close working with the Ministry of Health and other key stakeholders, including the World Health Organisation.

From the outset there were multiple partners across the academic, healthcare, charitable and commercial sectors: 

This presentation focused on the role played by three UK charities, Bridge2Aid, Dentaid and Smileawi and the dental supply company Henry Schein, working in collaboration with the two university partners.

The first of these partners to speak was Stuart Bassham, Dentaid’s Workshop Manager:

Dentaid covers multiple functions, both national and overseas, in its portfolio of activities. One of these is the servicing and installation of donated dental equipment and it was this particular skill that it has brought to bear on the MalDent Project. Stuart described to delegates the work that he and his team had done to replace 22 dental chairs and install 12 A-Dec phantom head units in the Dental Department at Kamuzu Central Hospital. During both installation visits to Malawi, Henry Schein had provided an engineer, free of charge – Jonathan Langley in 2018 and Chris Cox in 2022. The result of all this work was a transformation of the Dental Department with upgraded equipment, providing a suitable clinical teaching environment for the BDS students, improved working conditions for staff and an enhanced patient experience.

Following Stuart’s talk I spoke briefly about the work that had been undertaken to develop a National Oral Health Policy for Malawi. This took place between February 2020, when an Oral Health Policy Task-force was established, and the launch of the policy on 14^th April 2022. Twenty-two meetings were held on-line and there were a small number of face-to-face meetings of the Malawian Task-force members. Attention has now turned to implementation of the policy, and the Study Day provided a wonderful opportunity for Nigel and Vicky Milne, the founders of the charity Smileawi, to tell the audience about the variety of activities their organisation undertakes in Malawi which support the implementation of the new policy:

As a small Scottish charity whose main aim is to help improve oral health services in Malawi, much of the work Smileawi has carried out aligns very closely to the seven pillars of the Oral Health Policy. Key to their operation is providing very important support for the existing dental therapists and by funding many of the student therapists at the Malawi College of Health Sciences. This vital sector of the dental workforce will  grow in strength and confidence and be equipped to play a major role in the Oral Health Policy implementation. The joint work of Smileawi with Bridge2Aid, described by the next speaker, provided another example of engagement with dental therapists to strengthen oral disease prevention, a key policy objective.

Bridge2Aid is another key charity partner of the MalDent Project. Andrew Paterson, one of the charity’s trustees, has been involved as a clinician with the successful emergency dentistry task-shifting programme that Bridge2Aid has delivered in Tanzania for over 15 years, and a similar model is planned in Malawi. However, Bridge2Aid, together with Smileawi and other UK and Malawian partners, has also embarked on a programme of community Oral Health Promoter training in Northern Malawi, which again maps onto the Oral Health Policy implementation plan, as Andrew described:

Phase one was a modular course delivered to Northern Malawi dental therapists remotely using the ProDental CPD platform, to upskill their oral health knowledge and to give them teaching skills to cascade key oral health messages to remote and rural areas and to disadvantaged groups. Working with the Malawian Ministry of Health and the Dental Association of Malawi ensured messages were culturally appropriate and community led. Phase two empowered the therapists to use newly acquired teaching skills to cascade train rural Oral Health Promoter volunteers who are now actively engaged in promoting oral health in schools, churches, and other community settings rurally. The course will be run in Central Malawi in 2023 and thereafter Southern Malawi to create a national network of rural Oral Health Promoters.

The presentation finished with my summarising three further ongoing work streams. These were the design and construction of a new dental clinical teaching facility on the Blantyre campus of Kamuzu University of Health Sciences, the development of a Malawian version of the Scottish Childsmile programme that would be applicable to the local environment, and a National Child Oral Health Survey planned for 2023:

In closing, I stressed again how important the multi-sectoral collaborations had been to the progress made by the overall project and, finally, thanked the audience for their attention.

Before we all left for the drinks reception, Conor presented the conference secretariat, Andrew Miller and Patricia de Vries, with gifts to thank them for yet another brilliantly organised event. Andrew has been involved with the Study Day for many years and is a great friend to many of us, myself included, so it was very sad to hear that he is retiring from his activities in organising dental meetings to focus on work at his family farm. Andrew will be greatly missed by all in the Scottish dental community and we are grateful for his many years of service.

As is the custom, the event finished with a drinks reception. Nigel is captured here catching up with his friend from University of Glasgow days, Dr Ian Mills, former Dean of the Faculty of General Dental Practice …

… and I had opportunity to meet some of the current final year students at Glasgow, who told me how much they were enjoying their outreach dental teaching and looking forward to their turn in VT next year:

It had been an excellent event for all of us. We were very grateful to the organisers of the Study Day for the opportunity to speak to such a large audience about the MalDent Project and welcome any who may be interested in joining us to get in touch.

Acknowledgement

Many of the photographs in this post were taken by Jason Kimmings, the official photographer for the event. Thanks are due to Jason for kindly granting permission to reproduce his images.

The week of 14th-18th November 2022 was a very busy one for the MalDent Project. As the two previous posts describe, we held a workshop on the dissemination and implementation of the National Oral Health Policy on 14th and 15th November, and a workshop to review and discuss BDS curriculum content and delivery on 16th and 17th November.

The final day of the week was spent with the BDS 3 students, delivering face-to-face teaching. It was a very uplifting experience.

As had become normal practice during the week, the Scottish and Zambian team members met early for breakfast, which allowed time for some relaxed informal discussion and preparation for the day ahead. At dinner on the previous evening there had been some discussion between Niall and Dr Sayela about ties. As it happened, I had a University of Glasgow tie with me which I was delighted to present to Dr Sayela as a memento of a highly collaborative week which we hope will lead to further partnership working.

En route to Kamuzu Central Hospital we had an opportunity to visit the adjacent Lilongwe Campus of Kamuzu University of Health Sciences. The blossoms on the flowering trees were beautiful:

Whilst on the campus we took the opportunity for a quick photograph at the entrance into the main building:

Following the very short drive from the university campus to the Dental Department at Kamuzu Central Hospital we met with the BDS 3 students who had attended the curriculum workshop held the previous day.

The teaching commenced with a case-based discussion focusing on a 14 year old teenager who had presented with a fractured upper incisor tooth. Every aspect of the patient’s management from history taking and examination through gaining consent and determining a treatment plan were covered.

Next on the agenda was an introduction to dental veneers. This was in preparation for the next stage of the morning which would be spent in the pre-clinical skills simulation facility.

The engagement of the students was superb and their eagerness to learn was demonstrated by their willingness to participate in the discussions and their recording of copious notes.

The level of knowledge displayed by the students was outstanding for their stage on the course, especially considering that their first two years and a significant part of Year 3 had focused on biomedical and medical subjects. We congratulated them on their achievements to date, which were truly impressive.

Following this initial session, the students moved to the pre-clinical skills facility to participate in a practical session that entailed preparing an anterior tooth to receive a veneer. Niall and Andrew demonstrated the method of preparation ….

….before the students took up their own dental handpieces to practise the skill:

Andrew looked after a second group of students:

It was good to see the tablet computers that had been purchased with Scottish Government MalDent Project funding being put to good use by the students …

… and this was a great opportunity for Lorna and I to have some informal conversations with the students:

One issue we identified was that the compressor which drives the twelve simulation units overheats quickly when all are being used simultaneously. We plan to overcome this problem in the New Year by the installation of two new compressors which will have the additional power needed for simultaneous use of all the simulators.

Outside the pre-clinical skills facility was the poster that had been printed and displayed for the visit by Ben Macpherson MSP in 2018. At that stage none of the A-dec simulators or the new cabinetry were in place. Seeing the equipment in use by the students was a wonderful experience and put into perspective the critical importance of the progress made by the MalDent Project in collaboration with Dentaid and Henry Schein in May 2019 and March 2022.

Whilst Niall and Andrew continued to work with the students, Lorna and I spent some time in the office of Dr Jessie Mlotha-Namarika, the Dental Surgeon in charge of the KCH facility, who also coordinates the BDS 3 programme. Lorna and I were working our way through the spreadsheet of actions that had been drafted by Wisdom and Brian following the National Oral Health Policy implementation workshop earlier in the week. It was extremely useful having Jessie close by when we had questions to ask about local issues or needed explanations of acronyms that are commonly used in the Malawian healthcare system.

At about 2.30pm we were joined by Niall and Andrew. In addition to their time with the students Andrew had also delivered some CPD for the Assistant Lecturers.

The Flying Faculty activities continued in the afternoon, with teaching delivered by our Zambian colleagues. This was a good example of the type of South-South collaboration that could be mutually beneficial for all of the dental schools moving forward.

There had already been a number of instances throughout the week where the inter-relationship between the National Oral Health Policy and the BDS course was evident. Another example was the polo shirts that have been designed for the students to publicise the policy. One of the students, Felix Nandolo, wore the shirt to the teaching session and it was too good an opportunity to miss a photo shoot!

Once the teaching was concluded, we returned to the hotel, where Andrew and I had one final task to complete. We are both Trustees of the charity Bridge2Aid, which has been one of the partners with Smileawi, ProDental CPD, the Dental Association of Malawi, and the Malawi Government Ministry of Health in the ongoing project to train Oral Health Promoters in rural Malawi. One of the main areas of feedback from the Oral Health Promoters is that they would be able to share their new knowledge far more widely if they had bicycles to transport them between villages. In seeking a way forward, we had come across the charity World Bicycle Relief, which includes Malawi in its sphere of operation.

Following initial enquiries by the Bridge2Aid staff team, it was agreed that Anthony Kinnaird, the Malawi Country Director for World Bicycle Relief, would be able to meet Andrew and I that Friday evening in Lilongwe. It was a great chance for the three of us to share in detail the activities of the organisations involved and to discuss possibilities for a partnership project. We had an excellent conversation and the outcome is that a Zoom meeting with Anthony and the CEO of World Bicycle Relief, Allison Dufosee, will be scheduled for early 2023.

On this last evening in Lilongwe, we all shared a very enjoyable meal and mulled over the events of the past week. It had been busy and intense, but much had been achieved and we had established a strong working relationship between the four universities represented. The foundations for collaboration have been firmly established and it is now up to us as the partners to ensure the good work continues.

Andrew, Lorna, Niall and I had a relatively relaxed start to Saturday, as our flight from Lilongwe was not scheduled until early afternoon. At the allotted time our bus arrived to take us on the short journey to Kamuzu International Airport.

Our passage through security and passport control was very efficient and our plane arrived on time, allowing punctual boarding and departure.

Our routing to Addis Ababa was via Lubumbashi in the Democratic Republic of Congo…

… where we spent an hour on the tarmac while some passengers disembarked, others joined and the plane took on fuel.

As a result, our trip back from Lilongwe to Addis Ababa took considerably longer than it had on the direct outward journey a week earlier.

We had some time to kill in Addis Ababa but again boarded on time for the flight to Frankfurt, where we arrived very early on Sunday morning. Weary from the overnight flight, we found a lovely restaurant called Goethe which rustled up a wonderful breakfast that soon had us feeling human again:

The final short flight from Frankfurt to Glasgow passed swiftly and we were soon back home in Scotland.

I commented in the previous post about the dedication and commitment of the staff in both Malawi and Zambia, who were delivering the best educational experience they could for the dental students in their charge. What the Flying Faculty activities on the Friday had confirmed for me was that the BDS 3 students at KUHeS are also exceptional. Despite the challenges that have been faced over the past year, including delays in access to textbooks and consumable materials for use in the pre-clinical skills teaching, the knowledge they displayed was remarkable. Furthermore, their mature, professional approach on both the Thursday afternoon and Friday was a credit to themselves, to their teachers and to KUHeS. With this combination of staff and students there is every reason to be very optimistic for the future.

Following the National Oral Health Policy Dissemination and Implementation Workshop on 14th and 15th November, the MalDent Project team convened a two-day BDS Curriculum Workshop on 16th and 17th November that included representation from Kamuzu University of Health Sciences (KUHeS), the Copperbelt University (CBU), Zambia, Levy Mwanawasa Medical University (LMMU), Zambia and the University of Glasgow (UofG). As the KUHeS BDS programme, launched in 2019, prepares for its pioneer cohort of students to enter BDS 4 in early 2023, it is time to begin reviewing curriculum content and structure. The CBU is currently undertaking a review of its own programme and LMMU will be accepting its first students into the clinical part of the programme (BDS 3) in 2023. There are many opportunities for joint learning and collaboration between these three organisations, with potential for links with UofG and other international dental education providers.

The first session was chaired by Dr Peter Chimimba, the MalDent Project Lead at KUHeS. After introductory comments, he invited Drs Mchenga, Majambo and Sayela to provide summary overviews of the existing BDS curricula at KUHeS, CBU and LMMU respectively.

Dr Mchenga gave a very full account of the admissions process, the course structure, and the teaching and assessment methods that were employed at KUHeS, together with a summary of the various challenges that the fledgling programme was facing.

Dr Majambo followed, and delivered a similarly comprehensive presentation. The BDS course at CBU was the first in Zambia and launched in 2011, graduating its first dentists in 2016. To date, the course has delivered more than 120 dental graduates. The course runs for six years, excluding internship, and the students do not begin their formal dental teaching until the Fourth Year. Dr Majambo also highlighted some of the challenges in course delivery, revealing a number of parallels to those identified by Dr Mchenga

We next heard from Dr Sayela about the new BDS programme at LMMU. Construction of the LMMU building began in 2016, funded by the Zambian Government, with an ambition to resolve the deficit of 50,000 members of the healthcare workforce in the country. The university has five schools (Institute of Basic & Biomedical Sciences, School of Nursing, School of Health Sciences, School of Medicine & Clinical Sciences, and School of Public Health & Environmental Science). The six-year BDS degree programme sits within the School of Medicine & Clinical Sciences and its curriculum was developed in 2020. Formal dental teaching starts in BDS 4 with an average of 30 students per year. However, there is some integration and introduction of dental topics in the earlier years. The first intake of clinical students is due in 2023. As reported in the two earlier presentations, there were challenges in relation to equipment, staffing and costs of dental materials.

Whilst there were some significant differences between the three BDS curricula, there were also obvious synergies, suggesting that joint working could potentially help to ease some of the challenges being faced individually. These would be examined and discussed in detail the next day.

We had been joined for this session by Dr Emma Thomson, who has been a great friend to the KUHeS BDS programme since its inception. In her previous role as Director of the College of Medicine Education and Training Office, Emma was involved in the first and second BDS curriculum conferences, when the course was being created, and has since provided much behind-the-scenes support. In the new KUHeS structure, Emma is Acting Director of the Teaching and Learning Development Centre and she had kindly agreed to deliver a session on Clinical Assessment.

Emma’s talk provided an excellent grounding in assessment across all of the learning domains – knowledge (cognitive), skills (psychomotor) and attitudes (affective) – including specific advice on chair side assessment. The value of feedback, delivered in a constructive and positive manner, was stressed as a way of helping students to be the best they can.

It had been a very full morning, with much food for thought, and following Emma’s lecture we were able to continue our discussions over lunch:

Before Emma departed to join an on-line meeting in her schedule for that afternoon, we had a group photo.

The afternoon session, chaired by Dr James Mchenga, was devoted to a workshop on Restorative Dentistry teaching in the context of Malawi and Zambia, led by Andrew Paterson and Niall Rogerson from UofG. Despite the infrastructural challenges in Malawi for delivery of dental care, as described during the Oral Health Policy Workshop earlier in the week, the ambition is to train dentists who are ‘globally competent and locally relevant’. Ensuring that curriculum content is appropriate to this aim is very important and Restorative Dentistry is perhaps the clinical discipline which makes such decisions most difficult.

Andrew delivered an excellent presentation which covered all aspects of teaching in Restorative Dentistry, including biodental sciences, pre-clinical skills, laboratory skills, clinical skills and integrated care.

Following the presentation, we enjoyed an informal discussion session:

One of the most valuable elements of this workshop was the interaction that took place during refreshment breaks. With colleagues attending from multiple universities, disciplines and career stages, there were rich opportunities for joint learning and establishment of academic links.

By close of play on the first day of the workshop we had all absorbed a lot of information and were ready to return to the hotel for a rest before dinner. As I came out to our trusty bus I caught a cameo view of Niall already seated and ready to go:

One of the joys of this week of activities in Malawi was the opportunity to meet four of the six Assistant Lecturers who were able to join us. In order to thank them for their excellent input to the workshops and to acquaint ourselves better, we had invited them to join us for dinner that evening.

The food was obviously a highlight of the event …

… but there was also an opportunity to establish some informal mentoring for the Assistant Lecturers. Don, who is specialising in Dental Public Health, sat next to Lorna whilst Yusuf, who is specialising in Prosthodontics, sat with Andrew. As a result, both Lorna and Andrew have agreed to become external mentors for the period of Don’s and Yusuf’s specialist training. Similar external mentoring arrangements will be set up for the remaining Assistant Lecturers.

The next morning, while we were waiting for the bus, Niall spotted that one of the events scheduled in the hotel for later that day was a ‘Coca-Cola Malawi Meeting’. Lorna Macpherson, one of the UofG team, was due to deliver a lecture on the importance of preventive dentistry as a component of the BDS curriculum during our workshop, so this was an excellent photo-opportunity in real-time!

On arrival at Duncan’s Lodge, we launched into the morning session, which was chaired by Dr Majambo. I had agreed to lead a workshop on identifying collaborations between the parties present that could help to overcome some of the challenges in BDS course delivery identified on the previous day.

We structured the conversation around five initial themes, but by the end of the session that list had grown to seven:

In all of the areas listed above it was possible to identify practical, feasible and often relatively inexpensive ways in which we could all support each other to develop and deliver the three respective BDS curricula.

The morning finished with an excellent lecture by Lorna exploring the relationship and tensions between the need for teaching of preventive dentistry against a traditional historic emphasis in dental schools on operative procedures (curative dentistry).

Having described the preventive focus of the WHO document Promoting Oral Health in Africa and the aspirations of the 2021 World Health Assembly, Oral Health Resolution Lorna examined how these should be reflected in BDS curricula:

Upstream and downstream interventions, the concepts of Universal Health Coverage, the Basic Package of Oral Care, and the Common Risk Factor approach to prevention of Non Communicable Diseases (including common oral diseases) were all covered.

Lorna’s final slide tied the whole subject of the BDS curriculum back to the content of the National Oral Health Policy, since it would be the young dental graduates who would be playing a major role in policy implementation. Prevention of oral and dental disease is a corner-stone of the recently launched policy, hence its importance in the undergraduate programme.

Following Lorna’s talk we broke for lunch, when we were joined by the BDS 3 students from KUHeS. They enjoyed eating with us before attending the afternoon session.

The afternoon proceedings were chaired by Dr Sayela, who welcomed the BDS students before introducing Andrew and myself to lead the first session.

The purpose of this first session was to consider innovative ways in which the capacity to deliver oral and dental care in Malawi could be augmented in the short- to medium-term and how undergraduate dental education could prepare students for playing a leadership role upon graduation.

In his presentation, Andrew described the task shifting model that has been used in Tanzania for many years by the charity Bridge2Aid, through which Clinical Officers in very rural environments are taught to deliver emergency dentistry, including uncomplicated dental extractions. Plans are underway to pilot this model in Malawi to train Medical Assistants in a similar fashion. The task shifting approach is approved by the WHO as a mechanism to improve access to care in situations where there are severe shortages of trained workforce, a condition that is certainly fulfilled currently in relation to delivery of emergency dental care in rural Malawi. However, the concept triggered a vigorous discussion, as it had earlier in the week during the Oral Health Policy workshop, and the outcome of the pilot programme will be important to the acceptance and possible adoption of the model in Malawi.

The final event of the workshop was entitled ‘The Student’s Voice’ and was an open discussion with the BDS 3 students about their experience of the course. It was hosted by Dr James Mchenga in his role as Head of the BDS degree course at KUHeS:

James spoke of the importance of the students as the future dental workforce in Malawi and how critical it was that they were equipped to take forward the activities required to implement the National Oral Health Policy:

However, he also made the point that the staff team cares passionately about the welfare of the students – something that was very evident just from watching the minute-to-minute interactions between James and this pioneer group of students under his tutelage.

The open discussion provided some valuable feedback…

… and the Student President, Patrick Moses, concluded the session with a very well delivered short speech.

The workshop concluded with a summary of the activities of the past two days and a note of thanks to all involved. Once again, Annie Mwapasa and Madalitso Kaphamtengo had organised everything perfectly.

We also told the students how much we were looking forward to spending time with them on the following day at the Dental Department in Kamuzu Central Hospital, for delivery of some teaching as part of the MalDent Project Flying Faculty programme. That story will be told in the next post.

On reflection, the overwhelming memory of this two day workshop is of the passion and dedication of those entrusted with teaching the future young dentists of Malawi and Zambia. Dental education is an expensive enterprise, requiring clinical staff, complex equipment and a ready supply of dental materials, all of which are challenging to deliver reliably in low resource environments. Nevertheless, there was a palpable determination to provide the best possible opportunities for the students and to care for their welfare, particularly at this time as the cost of living crisis is impacting so significantly. It is well summed up in the following quote:

One looks back with appreciation to the brilliant teachers, but with gratitude to those who touched our human feelings. The curriculum is so much necessary raw material, but warmth is the vital element for the growing plant and for the soul of the child.

Carl Jung

Regular readers of the blog will be aware that Malawi’s National Oral Health Policy, created by a Ministry of Health-led Task Force established in February 2020, was launched officially by the Deputy Minister of Health, the Honourable Enock Phale MP, on 14th April 2022.

This was a milestone event for the MalDent Project but, as everyone knows, the true value of a policy lies not in its creation but in its successful implementation. Accordingly, the next step in the process took place on 14th and 15th November 2022 at Duncan Lodge, Lilongwe, where an Oral Health Policy Dissemination and Implementation Workshop was held. The meeting was organised jointly by the Ministry of Health and Kamuzu University of Health Sciences (KUHeS), with input from the University of Glasgow (UofG).

Over 40 delegates attended, including dentists and dental therapists from across all sectors of the profession in Malawi, Lorna Macpherson, Andrew Paterson, Niall Rogerson and myself from the University of Glasgow, Dr Mudhihiri Majambo from the Copperbelt University Dental School in Zambia and Dr Nalumino Sayela from the Levy Mwanawasa Medical University in Lusaka.

The chairperson for Day 1, Brian Nyasulu from Kasungu District Hospital, opened the proceedings.

The meeting started with a prayer, before delegates introduced themselves briefly.

Brian then asked Dr Martha Chipanda, Oral Health Coordinator at the Ministry of Health, to say a few words. Martha referred to the policy launch in April and stressed the importance of implementation, which had triggered this workshop of managers and other dental professionals from across Malawi. She spoke to the importance of the dental profession ‘owning’ the policy and working together to overcome the many challenges that were faced by oral healthcare in Malawi.

The context for oral health improvement at a global level was set out by Professor Lorna Macpherson, who is a member of The Lancet Commission on Oral Health team. Lorna was a co-author of a two-part Series of papers in The Lancet that highlighted the huge global health burden of oral diseases and the difficulties caused in tackling the problem because of isolation of oral health from other branches of healthcare. Lorna was able to lay out at first hand the key findings from The Lancet Series, identifying many principles that were directly relevant to implementation of Malawi’s new Oral Health Policy. For those who are interested, the two papers in The Lancet Series can be found here.

Following Lorna’s excellent presentation on the high-level principles for achieving oral health improvement, Martha took the delegates through the seven key pillars of Malawi’s Oral Health Policy. In her very authentic presentation it was striking that many of the points being made by Martha chimed perfectly with Lorna’s earlier comments. The Policy Task Force had certainly followed, as far as possible, WHO recommendations for the global response to oral health challenges, to ensure that the policy would be in line with current thinking.

One of the main objectives of the workshop was to seek engagement of the delegates with the detail of the policy and, through discussion, to identify the activities that were required for its implementation. All delegates were provided with a copy of the policy, the summary document, paper, pen and water – we were expected to work, not just listen!

Martha laid out the rules of engagement. We were divided into three groups, each of which was allocated two or three of the policy pillars to discuss in detail, then to identify activities that would support progress with implementation. Each group was asked to identify a Leader and a Rapporteur.

These were very energetic and spirited discussions which highlighted many challenges but also identified some novel approaches. It was an excellent learning experience for everyone.

A tea-break was very welcome following the first session of group work …

… after which we returned to pick up the discussions both before and immediately after lunch.

Towards the end of the afternoon, Group 3 was ready to report on Pillar 3 (Clinical Dental Practice and Patient Access) and Pillar 4 (Human Resources for Oral Health). Their rapporteur was Dr Nathan Lungu, an Assistant Lecturer at KUHeS who is specialising in Oral & Maxillofacial Surgery.

The feedback presentation, as would subsequently be the case for Groups 1 and 2, triggered lively discussion from the floor. The potential for introduction of a task-shifting initiative, through which Medical Assistants in rural areas would be up-skilled to deliver emergency dentistry, proved especially controversial.

Day 2 of the workshop commenced with introductory comments from Dr Martha Chipanda and from Dr Jessie Mlotha- Namarika, Head of the Dental Department at Kamuzu Central Hospital.

Following an opening prayer, the session commenced with a very informative talk by Emma Mathumula from Balaka District Hospital. Her talk was entitled Current Situation of Dental Clinics in Malawi. This excellent presentation highlighted many of the daily challenges in relation to equipment and consumables that are faced by dental staff in public healthcare facilities There is a focus on dental extractions rather than restorative dentistry, but even extractions can be challenging because of inadequate instruments and stock-outs of essential items such as lignocaine.

Subsequently there was a feedback presentation from Group 2, which had considered Pillar 2 (Dental Public Health) and Pillar 7 (Research, Data and Information Management). Very appropriately, the feedback was delivered by Dr Don Chiwaya, an Assistant Lecturers at KUHeS who has chosen to specialise in dental public health.

The morning session concluded with a joint presentation by Andrew Paterson and Martha Chipanda entitled Developing a Network of Oral Health Promoters in Rural Malawi. This ongoing work is a joint activity between the Ministry of Health and the two UK charities Smileawi and Bridge2Aid. The detail has already been described in an earlier post that was guest-edited by Andrew, and relates directly to Pillar 4 of the Policy (Human Resources for Oral Health).

After such an intensive morning, we were all ready for lunch and continuing discussions outside the confines of the conference room:

As lunch came to an end the clouds were beginning to gather and we decided to take a group photo before heading inside for the final session. Sure enough the rain started soon afterwards.

We still needed to hear from Group 1 following its deliberations about Pillar 1 (Leadership and Governance), Pillar 5 (Oral Health Financing) and Pillar 6 (Infrastructure and Equipment). This was the group in which I had participated and we had worked really hard on these three subject areas. We would have benefitted from more time, but our rapporteur, Wisdom Mkandawire from Blantyre District Hospital, produced an excellent set of feedback slides which summarised clearly the outcomes of our discussions.

Finally, Martha summed up the outcomes of the two-day workshop. A summary of the implementation activities suggested by delegates during the group work sessions would be created and circulated to all those present. In addition to local use by dental professionals in the field, it would also provide a valuable tool for discussions with the Ministry of Health and other key stakeholders identified in the Policy document. In fact, the first draft was produced the following day by Wisdom and Brian and passed to Martha for review, so no time has been wasted!

Martha thanked all present for their participation and the Scottish Government for supporting the workshop through the MalDent Project.

Massive thanks are due to Annie Mwapasa and Madalitso Kaphamtengo who organised the event and were a constant presence over the two days, ensuring that everything ran smoothly.

It had been a very busy two days but a great start on the journey of the dental profession towards ‘owning’ its new policy and improving oral health for the citizens of Malawi.

For those of us visiting from Scotland it was a wonderful opportunity to meet such a large number of dental team members from across Malawi and to learn so much about both the challenges and opportunities that exist for the profession and the population. The chance opportunities afforded by face-to-face events such as this cannot be over-stated. I met Tifley Thimba from Salima District Hospital who is not only a dental therapist, but also has a degree in biomedical engineering. Tifley has kindly agreed to work with Stuart Bassham (Dentaid), Chris Cox (Henry Schein) and I on the project we are undertaking to develop training materials on dental equipment maintenance and repair for therapists in the field with poor access to technical support.

Lorna had the opportunity to meet with Fred Sambani, the Country Director of Teethsavers International, who will be a very important contact as our workstream on child caries prevention develops:

There is much work to do as the MalDent Project progresses, but what was very clear during this workshop was the abundance of talent and enthusiasm among the dental professionals present to take forward the policy implementation. It will require additional, focused investment to ensure that this willing team is able to achieve the ambitions outlined in the Policy, but if that can be provided then the future holds significant promise for success.

November 2022 was a very busy month for face-to-face interactions between University of Glasgow staff and their partners at Kamuzu University of Health Sciences. Following the restrictions that had prevented such activities during the COVID-19 pandemic, it was wonderful to be able once again to enjoy the fellowship and informal academic interactions that are so much more difficult through video-conferencing. The subsequent two posts will reflect some activities of the MalDent Project during the week beginning 14th November. However, this separate introductory post provides an important preface.

In early November, the University of Glasgow Principal and Vice-Chancellor, Professor Sir Anton Muscatelli, visited Malawi, accompanied by Miss Rachel Sandison, Deputy Vice-Chancellor – External Engagement & Vice Principal – External Relations. During the busy itinerary at Kamuzu University of Health Sciences, Sir Anton delivered a public lecture entitled: The role of universities as drivers of sustainable development within communities and on a global stage. The support of the senior leaders of both the University of Glasgow (UofG) and Kamuzu University of Health Sciences (KUHeS) for development of the strong academic partnership that has developed between the two organisations reflects, in a very tangible way, the subject matter of the public lecture.

That relationship between the two universities was further strengthened by the signing of a formal MOU during the visit:

One of the main events during the visit was the official opening of the Blantyre-Blantyre Laboratory, the culmination of a joint UofG / KUHeS infrastructure project, which will deliver world-class biomedical laboratory facilities at KUHeS. This will support, in a sustainable way, future scientific collaborations with the University of Glasgow and other academic and industrial partners. The Blantyre-Blantyre project began just before the MalDent Project commenced, and the team has been extremely supportive to us, often helping us to problem-solve as we hit challenges that the Blantyre-Blantyre Project had already encountered and resolved! It is wonderful to see all their hard work coming to fruition and the joint official opening of the facility being shared by the Vice-Chancellors of both universities:

Whilst at KUHeS, there were also opportunities for Sir Anton to hear and see at first hand some of the ongoing work of the MalDent Project. He was able to meet with Dr Peter Chimimba, our Malawi Project Lead and Dr James Mchenga, Academic Head of the BDS degree programme:

There was opportunity for discussion of UofG / KUHeS collaborations …

… and time was included for a visit to the Dental Department at the Queen Elizabeth Hospital, Blantyre ….

… where Peter and James were able to provide information on our MalDent Project activities and progress:

For those of us engaged in collaborative projects between the UofG and KUHeS, this visit was a very powerful symbol of the support that exists for our work at the highest levels of each organisation. That support is of immense value as we go about our day-to-day partnership working.

This post would not be complete without some important acknowledgements. On behalf of the MalDent Project team, I would like to congratulate all colleagues involved in the Blantyre-Blantyre Project on the successful completion and opening of the laboratory. We have seen the immense efforts you have put into this complex project and have been the beneficiaries of much of your hard-won learning along the way! Particular thanks are due to Alex Mackay, who has not only provided us with many words of wisdom and encouragement, but also supplied me with some of the photographs for this post.

Finally, there are two common threads to the Blantyre-Blantyre project and the MalDent Project. The first is Dr Mwapatsa Mipando, a true visionary whose drive, determination and strategic thinking have been central to both projects.

Secondly, we are immensely grateful for the generous funding from the Scottish Government, which has transformed both projects from dreams to reality. Moving forward we will work hard to ensure that the legacy of the financial support is sustainable and in keeping with the Scottish Government’s International Development Principles.

Guest blog written by Lisa Taylor and Edward Hara

The MalDent Project has drawn together many people since its inception.  Below is a brief overview of the web of connections which brought about this exciting visit to the UK for Edward Hara, a very hard working dental therapist, now based in Chitipa, in the north of Malawi.

• Lisa undertook an MSc with Jeremy Bagg in his Cardiff days (1983-1991).
• Lisa also spent two years in St John’s Hospital, Mzuzu, Malawi as a VSO volunteer from 1992 to 1994 where she met Edward.
• Jeremy has been instrumental in setting up the MalDent Project and has met Edward Hara on several occasions.
• Edward and Jeremy are friends of Nigel and Vicky Milne, who founded Smileawi, a Scottish charity which operates in the North of Malawi and has worked closely with the MalDent Project.

Lisa always hoped to be able to bring one of her Malawian colleagues to the UK for a visit and given Edward’s many friends in the UK, a plan was made for him to visit both Scotland and England.  Smileawi hosts an annual fundraising Ceilidh in October and Lisa is involved with the annual British Dental Association Community Dental Service Conference and so this was chosen as the time for his visit. 

The initial hurdle to overcome was getting a passport and a visa.  This necessitated letters of invitation and support and brought with it a lot of stress and visits to Lilongwe for Edward.  Finally, the documents were all sorted which brought relief all round.  The excitement really began when he received his tickets. 

Edward would very much like to share with you his photo diary and thoughts about his visit:  

27.9.22.  I was supported by my family to get to the airport in good time – I arrived 4 hours ahead of time, I really did not want to miss this plane!

I boarded the Ethiopian Airlines flight – the trip was really on!  The flight was smooth with a touchdown in The Congo and a stopover in Addis Ababa.

28.9.22.  I finally arrived in Heathrow early the next day.  Lisa met me at the airport and drove me home on a sunny autumnal morning.

29.9.22.  After a relaxing first day we visited the Abbey Ruins in Reading and looked round Lisa’s home town by the Thames:

30.9.22.  On the Friday, we headed off towards The North and spent a lovely evening with Chris’s mum, Teresa, in Gateshead.  Chris, Lisa’s husband, had spent 3 years as a VSO in Lilongwe training laboratory technicians, and Teresa and Chris’s late dad Bob, had visited him in Malawi.  It was lovely to meet Teresa who was pleased to see us and to chat about her time in Malawi.

1.10.22.  The next day we started up to Scotland.  En route we visited The Angel of the North, and I found it hard to imagine how this huge structure could stay upright.

We then visited Hexham and went for a look round the Abbey, which was beautiful.  It was the first time I had seen a tomb within a church; it also seemed strange that they had a café in a church.  We looked round the town and my love of charity shops began.

We travelled on to Dunoon passing some beautiful English and Scottish countryside en route.  I did not like the idea of the ferry crossing as I cannot swim.  However, it was a very steady trip over and we arrived safely on the other side.

We easily found the Milne’s home and received a warm welcome.  A large group was gathered and we all ate a lovely meal together before heading off to the Ceilidh by coach.  The Ceilidh was great fun and I threw myself into this famous dance!

2.10.22.  Lisa and Chris headed back home the following day and my Scottish adventure began.  Thank you to Nigel and Vicky’s friend, John Challis, for taking me to the church service today and for his company after the service.

3.10.22.  An interesting visit to the David Livingstone Museum, just outside Glasgow, accompanied by good friends. 

I felt lucky to see the beautiful Loch Lomond:

4.10.22. I enjoyed looking around the University of Glasgow campus.

I also had an informative visit to Glasgow Dental Hospital and Postgraduate Centre:

5.10.22.  We had a great trip on the open top bus tour of Edinburgh.  Here I am on Waverley Bridge shortly after we arrived at Edinburgh Waverley Station:

I was also shown a lovely view of the city from Calton Hill:

6.10.22.  En route from Glasgow to London.  I was seen off by Vicky and met by Chris.

7.10.22.  More walking beside the Thames at Pangbourne.  I was very lucky with the weather!

8.10.22.  An insight into the work of the Berkshire Community Dental Service at the Royal Berkshire Hospital.  Thank you to those who made this experience possible and enjoyable.  What a great selection of cakes we had!

9.10.22. An introduction to the National Trust at Basildon Park:

10.10.22.  Lisa and I took a walking tour of Oxford.  We saw lots of the colleges and also people punting on the river:

11.10.22.  I visited all the local Community Dental Service Clinics – it was lovely to meet so many of those who have assisted me over the years.  The day also included a trip to Dinton Pastures Nature Reserve:

13.10.22 and 14.10.22.  British Dental Association Community Dental Service Conference.  There were some great lectures – I learnt so much:

13.10.22.  Meeting an old friend at the Conference dinner.  Jeremy gave an interesting after dinner talk about the MalDent Project.

15.10.22.  The parks, pomp and pubs of London – cheers to Chris for the guided tour:

It was inspiring to see the statue of John Chilembwe, who fought for Malawian independence, which is now on a plinth in London’s Trafalgar Square:

16.10.22.  Church in the morning and then my first cinema trip to see The Woman King, a film based on a true story of an old African kingdom.  Very enjoyable.

17.10.22.  I spent a day at Dentaid with Lisa who was working in a mobile clinic supporting the homeless.  Here I am with Stuart Bassham outside Dentaid HQ in Southampton:

19.10.22.  Portsmouth – my first time to see the sea and to experience the invigorating sea breeze!

20.10.22.  Windsor.  What an amazing castle!

21.10.22.  A visit to the London Museums – Natural History and The Science Museum:

22.10.22.  Reading FC – they won 2:0.  I enjoyed cheering on the team with the supporters:

23.10.22.  The day I flew home to the warm heart of Africa.

Thoughts from Lisa

It has been a pleasure to have Edward visit and to introduce him to my dental colleagues.  Over the years these colleagues have ‘adopted’ Edward and have generously supported him in his endeavours in Malawi.  They were so pleased to meet him and found it interesting to hear about his life and dentistry in Malawi.  I think they could not quite comprehend the amount and complexity of the work he undertakes.  I was so proud to call him my friend and at how well he coped with meeting so many new people.

I do hope Edward has enjoyed his visit.  As the photo diary confirms, he has certainly seen a lot!  I do wonder how such an experience will affect him on his return.  To see all we have here through the eyes of someone from Malawi has been challenging at times.  He has commented on the number of skips outside peoples’ houses with so many reusable items thrown away.  Upcycling is clearly embedded in Malawi.

Thank you to Edward for taking time away from his home and family to visit.  Thank you also to Nigel, Vicky, Jeremy and their friends for giving Edward such a wonderful experience of Scotland.

Yewo chomene for your visit Edward.  See you soon!

Thoughts from Edward

All in all, my coming to UK has been a dream changer.  Being on a plane, trains, wide green open rolling hills, all looked new to me and a strange experience.

One example is the payment systems; most of them are electronic, which is not existing in most systems in Malawi.

The historical structures and places I have seen and touched have also really complemented what I had learnt previously in school.  A worthwhile experience. Museums, famous rivers, universities and many other beautiful, attractive places have significantly changed my general perspective of life.  I’m no longer the same person.  A trip worth coming on.

The general friendliness of people and the spirit of willingness to assist wherever possible has taught me the spirit of sharing in times of need.

I have been to several different hospital and dental clinics in which I have experienced and gained lots of knowledge and ideas.  The systems and set ups have been worth learning from, for example the management of mental health patients in a dental setting.  The change from using metal dental syringes to disposable plastic ones has also been new and worth copying.

Acknowledgements

I would be very unfair in my conclusion if I don’t thank Chris and Lisa for making it possible for me to come out here to the UK.  A long-time dream come true.  I again would like to thank them for using their resources to take me around to different places and leaving their commitments.  I dearly thank God and feel very proud of them.  May I also extend my sincere thanks to Lisa’s friends for their continued support.

Let me further thank the family of Vicky and Nigel and that of Jeremy in Scotland for their time and for showing me many places.  Also for the invitation to a Scottish dance, a fund raising event for Smile North in Malawi.

There are many friends both new and old whom I have not mentioned here, but I dearly thank them too for the donation of different dental items.

My family and friends back home, I would like to thank them too.  In a special way, my thanks go to my dear wife Jean for allowing me to take up such an adventurous trip whilst she is left alone with very poor communication between us while here.

I love you all and may God bless us all.

Thank you.

The issue of Personal Protective Equipment (PPE) provision for healthcare workers was a vexed and politically-charged issue during the COVID-19 pandemic. In the early stages there were serious shortages, causing significant stress for those who were providing health and social care in the front-line. The pressure on supply chains led to prices soaring globally as governments around the world attempted to bulk-buy masks, gowns and related items. Eventually the supply and demand pressures eased, and large amounts of PPE were provided for healthcare workers, including dental professionals. However, with a reversion from the extreme transmission-based infection control guidelines for COVID-19 to procedures that are closer to standard infection control precautions, the volume of certain types of PPE that are required in clinical practice has reduced considerably.

Clearly, this is good news, but the law of unintended consequences has a habit of intervening. Earlier this year, my good friend Nigel Milne, who with his wife Vicky set up the charity Smileawi, was contacted by Paul Cushley, who is the Head of Procurement for Dental Services at National Services Scotland. Nigel and Paul were classmates at Glasgow Dental School, hence the connection. Paul explained that with the easing of COVID-19 infection control measures in dentistry, many practices were storing large volumes of FFP3 masks and protective gowns that had been provided through the NHS, but were now surplus to requirements. He wondered whether these items may be of value in Malawi and, if so, whether Smileawi could identify a means of collecting and transporting them. There was an underlying concern that many of these items would end up in landfill sites or incineration facilities if a suitable alternative use could not be identified. This backdrop triggered discussions between Smileawi and The MalDent Project, a partnership that has previous and ongoing collaborative activities linked to oral health improvement in Malawi.

Following a Zoom call with Paul, an SBAR was written followed by a string of meetings and discussions, including interaction with Dr Martha Chipanda, the Oral Health Coordinator at the Ministry of Health in Malawi, who confirmed that she was keen to receive any PPE that could be provided. It was agreed that we should establish a joint Smileawi – MalDent Project exercise to collect at least some of the excess PPE and ship it to Malawi. The items would be of value not only to the dental therapists and dentists delivering clinical care, but also to the dental therapy students and dental students in training at the Malawi College of Health Sciences and the Kamuzu University of Health Sciences respectively.

The organisation of this exercise turned out to be very challenging, but we are extremely grateful to our many colleagues in multiple sectors who allowed us to turn the concept into a reality. I will tell the story first, and then acknowledge the magnificent contributions of our supporters at the end.

The exercise itself started on Friday 26th August, with delivery of the 40 foot high cube container to the University of Glasgow Storage Depot in Govan.

Once unloaded by the extremely skilled and friendly driver, David, the container looked huge and when the doors were opened it was like staring into an abyss. I suddenly had a panic that we would be unable to fill it with the materials available – in retrospect I realise how naive I was at that stage.

Grant Suttie is the Logistics Manager for the University of Glasgow and was exceptionally helpful as we planned and executed the exercise. He joined us at the crack of dawn on the Friday morning when the container arrived to ensure everything ran smoothly – even hopping onto the forklift truck to move some pallets and ensure we had ample working space.

In addition to providing us with the space and 24/7 access to the yard, the University also gave us the use of a long wheelbase van for the duration of the exercise. This van is normally used by the University of Glasgow Hunterian Museum and is suitably decorated. Hopefully our visits to destinations across Scotland will have provided some long-range publicity for the Hunterian Museum. Alan Stewart, a trustee of Smileawi and a motor engineer who established Smileawi Spanners, would be my partner in the van while Nigel and Vicky would drive a second van.

Paul Cushley had been interacting with the Scottish health boards to arrange venues where dentists could drop off their excess PPE to facilitate collection by ourselves. For NHS Greater Glasgow & Clyde (NHS GG&C), all donations ultimately arrived at the Procurement Central Stores in Dava Street. Conveniently, this was only a short drive away from our container site in Govan and we made our first visit to the NHS Central Store on the Friday morning.

Once inside the facility, we were shown two long aisles completely full of donated PPE, and set about loading the vans for the first time, with help from John who oversaw the NHS GG&C operation at Dava Street.

This was the first time I had seen Trevor Haye packing boxes. Trevor, the fifth volunteer member of our team, is a friend of Nigel and Vicky, and has a long history of working in the transport and logistics business. He has collaborated with Smileawi before and also works with the volunteer organisation The Bananabox Trust, based in Dundee, which regularly ships containers of materials to Malawi. Trevor’s ability to pack boxes with such accuracy that virtually no spaces remain was something that I would continue to marvel at over the next few days.

After the short journey back to the University warehouse, the vans were unpacked, a routine that we would repeat on multiple occasions over the next few days until we found ourselves dreaming about it at night!

Each box had to be labelled and numbered so that a manifest could be prepared for the shipping and customs clearance. Vicky had produced hundreds of pre-numbered labels which were placed in plastic wallets that were self-adhesive once the backing sheet was removed. The number was also written directly onto the box in case any labels became dislodged during the packing and unpacking of the container.

Here is an example of the labelling:

The container was so long that initially we were able to process the boxes inside it, which was fortunate since there were frequent rain showers on the Friday. Meanwhile, at the front of the container, Trevor was busy packing the labelled boxes as tightly as though he were doing a three-dimensional jigsaw – very impressive.

In total, five van-loads of boxes were shifted from Dava Street to the container on that first day, and it was filling up very quickly, dispelling any earlier fears that we would struggle to reach its capacity.

On the Saturday, we headed to Alloa to collect excess PPE from NHS Forth Valley. Gordon Morson, a Glasgow dental graduate, had kindly offered storage space in his practice and we were able to load up easily from an access point at the rear of the building. With the help of Gordon and his young son we were soon loaded and heading back to Govan for more off-loading, labelling and packing.

The Sunday was a day of rest, although Nigel and Vicky had to return to Dunoon to print more labels, as we were projected to run out based on the volume of materials we were collecting.

On the Monday morning, it was agreed that Alan and I would meet at 8am and take our van to Kilmarnock to pick up donated PPE from NHS Ayrshire & Arran. Martin Wishart (Portland Dental Practice) had kindly agreed to store the items in his garage. By the time we arrived, Trevor (who lives in Ayr and travelled independently) had already started transferring the boxes onto the driveway for loading.

Once loaded, we decided to stop at a Greggs shop in Kilmarnock for a quick breakfast. Whilst we were there, a lady found herself locked into a toilet cubicle. Luckily Trevor, who heard her calls for help, had a tool kit in his car and set to work on the broken door mechanism. After a few minutes there was a cheer as the lady was released and Trevor returned to our table to celebrate his good deed for the day with a breakfast roll and coffee.

It was a quick run up the road from Kilmarnock to Govan. We then realised that Trevor had packed a significant number of boxes in his car before Alan and I had arrived in Kilmarnock, just in case we were going to be short of space in the van. On several further occasions we would see just how much can be packed into a Renault Clio if you know what you’re doing!

Whilst Alan, Trevor and I had been in Kilmarnock, Nigel and Vicky had taken their van to Polmont to pick up a further load from NHS Forth Valley that was deposited at Brightons and Polmont Dental Practice. We had unloaded the Kilmarnock boxes at the container before Nigel and Vicky returned from Polmont, but we still needed to collect boxes from NHS Borders, all of which had been centralized at Coldstream Dental Centre. It was decided that Alan and I should head there immediately, leaving Trevor at Govan to pack the container. This would allow us to decide whether Nigel and Vicky also needed to visit Coldstream with the second van.

It was a beautiful drive down to Coldstream on a bright sunny day. On arrival, we were shown the assembled boxes of PPE and were immediately able to alert Nigel and Vicky that a second van was definitely required. Alan and I packed as much as we were able, with great help from Aileen Richardson, Brian Hall and Gary Ward, all of whom worked at the Dental Centre.

Once we had closed up the van and taken a team photograph …

… Aileen kindly drove us to The Hirsel Estate, so that we could grab a quick late lunch in its Tea Room before driving back to Glasgow. Once we had finished eating, Aileen picked us up again and drove us back to our van – exceptional Borders hospitality.

Once back in Glasgow, we left both vans loaded with the Coldstream pick-ups overnight and decided to spend the Tuesday processing and packing all the items we had collected. It was becoming clear that even with Trevor’s meticulous packing we were close to, if not already exceeding, the capacity of our container.

Luckily the weather was dry and since we no longer had space inside the container to label and process the boxes, much of the work took place outside.

As the afternoon drew on, we were getting very close to a full container. One door was closed to allow packing right to the back of the container on that side and before long Trevor was nearing the end of his task.

In recognition of his packing wizardry, we invited Trevor to label the last box (number 1056) before he fitted it into the final remaining space.

It was then a case of brute strength to close the door for the last time – the container was ready for collection.

Whilst this was cause for celebration, our minds now turned to the ‘excess excess PPE’. From the boxes that we had already collected, there were eighteen that had not fitted into the container. Furthermore, NHS Highland had already collected PPE and assembled it at the Public Dental Service Clinic in Nairn, which we were scheduled to visit the following day.

Luckily we had a plan. Joanna Keating at Scottish Government International Development had put us in touch with KidsOR, a charity based in Dundee which supplies and installs state-of-the-art operating theatres for paediatric surgeons working in hospitals in low income countries. KidsOR has extensive experience of the logistics around transportation of medical equipment to countries such as Malawi. Dave Tipping, the Director of Global Operations for KidsOR, could not have been more helpful when we explained the situation. He agreed that KidsOR could accept some of the PPE we were collecting, as they have a large warehouse and would be able to include boxes of PPE with sets of operating theatre equipment that were being dispatched over the next few months. The destinations would include a range of low-income countries, spreading the benefit to nations other than Malawi.

On the Tuesday evening, we packed the eighteen excess boxes into Nigel and Vicky’s van. They drove up to Dundee, offloaded the boxes at the KidsOR’s warehouse, then stayed overnight in a Dundee hotel before setting out for Nairn on the Wednesday morning.

Alan, Trevor and I set out at 7am on the Wednesday from Govan to drive to Nairn in time to liaise with Nigel and Vicky on arrival. En route we stopped at Ballinluig Motor Grill for a hearty breakfast, which set us up for the rest of the day.

On arrival at Nairn, it transpired that some of the donated items were out of date and could not be uplifted for use by KidsOR. As a result, a second van was not required. Nigel, Vicky and Trevor took their loaded van to Dundee to drop off the boxes at KidsOR en route home, whilst Alan and I returned directly to Glasgow.

Such was the volume of PPE that had been deposited at Dava Street from dentists in NHS Greater Glasgow & Clyde, we realised that we could fill both vans once again and, with their agreement, provide an additional consignment for KidsOR. On the Thursday, therefore, we returned to Dava Street and re-loaded.

We travelled in convoy to Dundee, taking in a coffee break at Stirling Services, before arriving at the KidsOR facility in Dundee in the early afternoon.

Dave, the Director of Global Operations, gave us a tour of the facility to provide a flavour of the amazing work undertaken by KidsOR. All the equipment that is donated is brand-new and KidsOR remains in contact with all the hospitals into which it has installed theatres, to provide ongoing support around maintenance of the kit.

Currently work is underway to examine the feasibility of using solar power for the operating theatres, an activity which was of great interest to Nigel and Alan, who are considering this type of technology in the context of a truck-mounted mobile dental surgery in Malawi.

All members of the KidsOR team were incredibly cheerful, helpful and enthusiastic – clearly totally invested in the fantastic work they do. The unloading was greatly simplified by a ready supply of wooden pallets and use of the KidsOR forklift truck.

The boxes were segregated into types and carefully counted – 255 boxes in total.

Many thanks are due to the whole team at KidsOR. We were made to feel very welcome and think that there are opportunities for further interactions moving forward.

We rounded off this very successful day with a late lunch at The Horn Milk Bar en route back to Glasgow.

The collection of the filled container was scheduled for 7am on the Friday morning. The container was sealed by the driver and then hoisted onto the trailer. For those who are interested in seeing how this is done, you can watch the video below.

The loaded container weighed 15 tonnes, of which 3.7 tonnes was the weight of the empty container, so we were shipping 11.3 tonnes of PPE. Once everything was checked and secured, the driver gave us a cheery wave and headed off into a bright Glasgow sunrise.

During the few days we had spent at the University storage yard in Govan, we had made several trips to Wee Paul’s Snack Van in Helen Street. It is advertised as a ‘family run business with great food, prices and banter!’ The establishment lived up to all those claims, especially the banter, and so once the container had left, we visited ‘Wee Pauls’ for a last round of egg rolls and coffees, enjoyed whilst sitting on stacked pallets in the yard.

After locking the yard gate for the last time, Nigel and Vicky returned their van to the hire company in Greenock. I had dropped our trusty Hunterian Museum van back at the University Transport Hub the previous evening.

From a personal perspective, it was a physically hard but very rewarding week, working with a tremendous team that truly demonstrated the power of collaboration. Once the container arrives in Malawi, that partnership working will continue with our colleagues there, ensuring that the maximum benefit is gained from the PPE that has been donated. You will be hearing about that phase in a later post.

Acknowledgements

This was a very busy week of activity that had required extensive pre-planning and we are indebted to a number of colleagues without whom this exercise would not have been possible.

Many thanks are due to Joanna Keating (Scottish Government International Development), who authorised a minor re-profiling of our Scottish Government MalDent Project grant to cover the cost of the container rental and shipping. The introduction made by Joanna to KidsOR also allowed us to extend the value of our exercise beyond our own oral health projects in Malawi.

The University of Glasgow played a central role in providing access to its facility at Govan for the storage and filling of the shipping container, and by providing us with a van and fuel. Gary Stephen, Head of Security & Logistics at the University of Glasgow, and Grant Suttie, Logistics Manager at the University, could not have been more helpful and we are very grateful for the generous support that both provided. I am also grateful to Con Church and Linda Easton in the College of Medical, Veterinary & Life Sciences Procurement Team for their advice and help.

Thanks are due to those in each of the Health Boards that we visited, who provided space for the collected materials to be collated and / or assisted us with loading.

Dave Tipping and his colleagues at KidsOR provided a route for us to extend the original scope of the exercise. We are very grateful for the very positive and warm interaction we had with them and look forward to further conversations.

This is a guest post written by Lewis Olsson

Introduction

It is 3rd August 2022 and I am currently on the first of three flights which comprise the return leg of my trip to Malawi. As I write this, I am getting myself as comfortable as possible for almost 24 hours of travel and taking advantage of this free time to provide a contribution to the MalDent Project Blog – a real honour given the fantastic work that has been and is being done by the project.  I probably have not fully processed the wide array of experiences which this adventure has afforded me – but I shall attempt to share and reflect on what I have done and seen over the last four weeks.

Background

My name is Lewis, I am (about to be) a final year medical student at the University of Glasgow, and I am also a dentist, having graduated from the same university in 2016. Oral & Maxillofacial Surgery (OMFS) and Oral Medicine are two fields in which I am particularly interested. As part of my medical degree there is the option to undertake an elective project in the summer between fourth and fifth year. I have closely followed the MalDent Project over the last few years and have been impressed by the impact that it was having in improving oral health in Malawi. There was clearly momentum and energy behind the project and I felt that there was an opportunity for me to witness the work that was being done first-hand and be involved in some way – in order to satisfy the learning objectives of my medical elective. There were two main elements to my elective: (1) observing and being a part of the OMFS service in Malawi and (2) providing some teaching to the dental students at Kamuzu University of Health Sciences (KUHeS) in line with their curriculum.

Planning started in late 2021 following informal chats with Prof. Bagg and later liaison with Dr. Peter Chimimba and Dr. James Mchenga. Fast forward to early July 2022 and I was sitting on a flight bound for Blantyre, Malawi.

Week One

On arrival I made my way to Kabula Lodge, which was to be my main accommodation for the coming weeks. The busy roads and bustling market stalls flanking the streets made for excellent people-watching as I attempted to quickly adapt to the Malawian way of life. That evening I got myself settled in, making friends with some other residents at Kabula Lodge, and enjoyed the mountainous scenery which made the Lodge such an enjoyable place to stay. I had a day to settle in before clinical duties started on the Monday.

Week one began at the Queen Elizabeth Central Hospital (QECH), where the Dental Department and OMFS services are located. I arrived at around 8am and was met by a queue of patients spilling out of the waiting room. I quickly learnt that patients travel from far and wide (often at a significant personal financial cost) in pursuit of dental treatment. A number of dentists and dental therapists make their way through the unrelenting stream of toothaches and abscesses, children and adults, relaxed and anxious patients. In addition to these acute issues, several more complex pathologies also present via the dental clinic. By the end of my first day I had seen more non-malignant tumours of the jaw than I would typically see in a year in Scotland, with these patients destined for the OMFS service. It was impressive to see the way in which the dental staff efficiently manage the large volume of patients, always maintaining a good atmosphere in the department with smiles on their faces.

Other elements of my first week included time in theatre with Dr. Mchenga for elective operations; time discussing the BDS curriculum development; Wednesday morning case presentations and literature discussion with the assistant lecturers; and my provision of an Oral Medicine CPD lecture to a group of local dentists. I also had the pleasure of the company of Dr. Peter Chimimba, Malawi Project Lead of MalDent. Having read many previous blog entries where Dr. Chimimba is a main character, it was great to finally meet. We discussed – amongst other things – his illustrious career and tireless efforts in all dimensions of the MalDent project. He outlined the ongoing efforts to establish a programme for prevention of dental disease in children, based upon Scotland’s Childsmile model, and highlighted the requirement to tailor this to the unique needs and challenges of Malawi.

A fairly busy week was rounded off by enjoying local cuisine and seeing some animals at a nearby safari reserve. Sunday was spent journeying north to Lilongwe (where the BDS  3 students are based) for the following week’s work. The 5-hour car journey was broken up with a brief break at the famous Chikondi stopover – where I was pleasantly surprised by my first time trying goat meat.

Week Two

Week two was dedicated to providing OMFS/Oral Surgery/Oral Medicine teaching by way of a symposium which I had mapped against the BDS 3 curriculum, in conjunction with Dr. Mchenga (see timetable of teaching).

	Monday	Tuesday	Wednesday	Thursday	Friday
Morning	Exodontia Principles (lecture)	Basics of OMFS (lecture)	Oral Mucosal Lesions (lecture)	Exodontia Clinic	Suturing Workshop
Afternoon	Exodontia Instruments and Technique (phantom head lab)	Maxillofacial Examination Skills (lecture and practical)	–	Exodontia Clinic	–

I felt really privileged to be working with these dental students – they are, after all, trailblazers in being the first cohort to study dentistry in Malawi. As a general rule, dental students are fairly high-achieving people the world over – but as I reflect on the fact that these 10 students were selected in a country with a population of 19 million people, I feel it is important to emphasise that BDS 3 are the crème de la crème.  These enthusiastic individuals were welcoming, engaged and entertaining from the get-go. I found myself constantly impressed: their knowledge for the stage that they are at is excellent and they displayed a mature and conscientious approach to their learning over the course of the week.

Particular highlights of the week for me included the Thursday clinic where nine of the ten students successfully removed their first tooth (with one student beaming when he was the first – definitely one for the history books!). Additionally, the Friday morning suturing workshop was a fun way to conclude the week, with a big thanks to the Glasgow Dental Hospital Oral Surgery department for kindly donating sutures (banana peels provided courtesy of the local market).

In addition to my time with the students, I was also invited to provide CPD to the local dentists in Lilongwe. Again, the topic was Oral Medicine, with a quiz to boot and some Scottish prizes for the winning participants. Following this session, we had an insightful discussion about the services and facilities available locally for oral pathology. Furthermore, the dentists expressed their wish for more local in-person CPD events and recognised the importance of being a cohesive workforce in a country where the number of dental professionals is so small.

Being at a relatively early stage in my career, I feel I benefitted immensely from the opportunity to deliver teaching (both lectures and clinical) and gain feedback from the students, which they helpfully provided. Whilst I was teaching about pathology familiar to me in Scotland, I was able to also pick up some knowledge about pathology that is mostly exclusive to Sub-Saharan Africa. Also, in preparing teaching material I had reason to read the local literature and learn a little about the differing epidemiology of head and neck cancer in Malawi. Furthermore, much of the international literature and educational resources around oral pathology is very Western: clinical images are rarely of black patients – and this proved quite a challenge to sourcing relevant images for teaching purposes. I would suggest that underrepresentation in medical/dental education resources may be an important contributor to health inequalities across different ethnic groups.

Overall, my time in Lilongwe was a definite highlight of my trip. I cannot thank the students enough for their engagement with the teaching. Having seen their attitude to learning and to their patients, I came away from Lilongwe knowing that the future of dentistry in Malawi is in good hands.

I returned to Blantyre and spent the weekend unwinding at the excellent Satemwa Tea Plantation with Nelson – a pharmacy lecturer at KUHeS, who recently completed his Masters degree at the University of Glasgow.

Week Three

The next week I worked with the OMFS team in Blantyre. I was involved in two acute trauma cases and gained experience of the skillset required to use wire in the reduction and fixation of bony fractures – a technique which is less commonly used in Scotland. On the Wednesday I was involved in the resection and reconstruction of a large mandibular ameloblastoma. It was a lengthy procedure with some equipment limitations, but the operation was successful.

During this week I made the most of the local cuisine, having by this point acquired a taste for nsima – the staple food of any traditional Malawi meal. I visited restaurant Pamudzi (Chichewa for “home”) several times during my trip as it served the best Malawian dishes in Blantyre. It was very popular with local people at lunch and dinner time and near the KUHeS campus and QECH. Food was fresh, delicious, wholesome and very filling!

Another weekend of R+R was spent at the stunning Cape Maclear, where I enjoyed a boat trip, delicious freshly caught chambo and some sunshine. Here I met a group of Dutch medical students – we were able to share our stories and experiences from our time so far in the Malawian health service.

Week Four

My final week in Malawi was again spent with the OMFS team at the QECH. Monday’s list was dedicated to resection and reconstruction of another large mandibular ameloblastoma. This was a 7-hour long procedure and provided a number of learning points – particularly observing the harvest of a rib graft to replace the mandibular condyle and ramus.

Conclusion

There is a plethora of things which I will take away from my elective – some of them will not likely dawn on me till later – but a few have already made their mark.

What really struck me about the OMFS service (with one specialist for the entire country – Dr. Mchenga) is that despite the lack of personnel, equipment and resources, “the job still gets done”. There is adaptation and flexibility in how things are done, which is essential when, for example, a particular screw or instrument is not available. The UK is not considered a resource-poor country, so by witnessing the situation in Malawi I was forced to reflect on just how good the OMFS service back home is. Despite years of financial cuts to healthcare, we have a free system that remains the envy of most nations around the world. By the end of my elective, I felt gratitude for the NHS like never before.

This trip also demonstrated to me the power of involving the right people when delivering a service or developing a project. Malawi is a country which has multiple hurdles and challenges to things such as healthcare provision, foundation of a dental school or implementation of a national oral health strategy. Despite this, a small group of leaders have successfully made inroads in all three of these areas – and this is testament to their skill, commitment and passion to ultimately serve Malawians. I fully expect there were many roadblocks and much frustration in getting to this point, but what I saw was individual flair and collaborative effort at all levels of the system.   

Finally, it would be remiss to not consider the growing problems facing Malawians at present: soaring cost of living, political unrest, and frequent power blackouts to name a few. Yet, despite these, I was made to feel welcome and safe for the duration of my trip.  Certainly living up to its title as “the warm heart of Africa”, Malawi displays many of the best bits of humanity. It was inspiring to see such motivated and skilled healthcare professionals investing their energy and careers into improving the lives of the population. Also, by way of high-quality dental education, the MalDent Project is absolutely sowing the seeds for major improvements in oral health for the country.

I would like to record my thanks to the many people who helped contribute to making my trip to Malawi so worthwhile: Prof. Bagg, Dr. Mchenga, Dr. Chimimba, the local dentists in Blantyre and Lilongwe, BDS 3 students, Nelson Nyoloka, the theatre staff at QECH, Precious (KUHeS driver), and all the patients. I really learnt a lot.

Those who are regular readers of our MalDent Project blog will be well aware of the very large role being played by our charity partners Bridge2Aid (B2A) and Smileawi in the work strand to spread messages in rural areas of Malawi about the importance of good oral health and how to achieve it. This forms an important part of the implementation plan for the new National Oral Health Policy which was launched in April this year.

In a recent post compiled by B2A Trustee Andrew Paterson, which you can read here, he explained the programme of cascade training of community-based Oral Health Promoters by Dental Therapists which has now commenced as a joint venture between B2A, Smileawi, the Malawi Government Ministry of Health, the Dental Association of Malawi and the Malawi Red Cross. As part of the ongoing work-stream Shaenna Loughnane, until very recently the CEO of B2A, visited the programme in Malawi and spent several days with Martha Chipanda, the Oral Health Coordinator at the Malawi Government Ministry of Health, who is very involved with, and committed to, the cascade training model.

Immediately after returning from Malawi and with customary energy and enthusiasm, Shaenna was driving north to represent B2A on their stand at the Scottish Dental Show in Glasgow.

As I was also at the Scottish Dental Show working with the Smileawi team on their stand, which by chance was next to the Dentaid display (another demonstration of the unity among Maldent Project partners!), Shaenna and I had the opportunity for a long chat about her recent visit to Malawi. It was a very uplifting, positive account and since Shaenna has written a blog about her experiences, you can too can share in the story by reading it here. Enjoy!