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.
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.
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.
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.
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.
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.
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.
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.
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 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).
Exodontia Principles (lecture)
Basics of OMFS (lecture)
Oral Mucosal Lesions (lecture)
Exodontia Instruments and Technique (phantom head lab)
Maxillofacial Examination Skills (lecture and practical)
Timetable of teaching
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.
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.
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.
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!
This is a guest post from my friend and colleague Colin Larmour, Consultant Orthodontist and Senior Lecturer, Aberdeen Dental Hospital and Institute. Many thanks to Colin for his great support of the MalDent Project and for compiling this post describing his recent visit to Malawi.
As part of the MalDent Project ‘flying faculty’ program I travelled to Malawi in May to provide introductory clinical orthodontic teaching to the third year BDS students. This group of students are the ‘pioneer’ students at the new Dental School of the Kamuzu University of Health Sciences (KUHeS). My wife Pauline, a Psychiatrist, also made the journey to Malawi to provide clinical teaching in psychiatry at the medical school in Blantyre and Zomba Hospital through the Scotland Malawi Mental Health Education Project (SMMHEP).
In the months preceding our trip I was given a lot of advice from Jeremy in Glasgow about what to expect with a trip to Malawi from both a practical perspective and also in relation to the Dental School set up and the curriculum for the BDS course. I was also in close contact with James Mchenga, the academic lead for Dentistry at KUHeS, and Peter Chimimba, the lead for the MalDent Project in Malawi. This included discussions about the orthodontic curriculum and the content of the introductory programme in orthodontics and exchanges of reading material and learning outcomes for the students.
Following a request from Malawi for some orthodontic instruments, including examination kits and rulers, Christian Burdess from DB orthodontics in West Yorkshire was kind enough to donate the orthodontic instruments requested, as well as lip retractiors and mirrors for orthodontic photographs. Many thanks again to Christian and his team in West Yorkshire for their support of the MalDent Project.
As far as travel arrangments in the COVID era, I had lots of advice from Jeremy who had made a recent trip with Chris Cox and Stuart Bassham. Mandatory vaccination and a negative PCR before arrival were still required. As far as COVID is concerned, having seemingly escaped the virus for more than two years I started to develop symptoms two weeks before we were due to travel. Luckily my symptoms were mild and I stopped testing positive after 8 days. I had a PCR test around day 12 which was also negative so travel plans were still on course…
The journey began on Wednesday 18th May and the first leg of the journey was with British Airways from Aberdeen to London Heathrow, connecting with an overnight flight to Addis Ababa with Ethiopian airlines.
An early morning connecting flight to Chileka airport in Blantyre saw us arrive in the early afternoon on the Thursday, almost 20 hours after leaving Aberdeen. Successful negotiation through the COVID clearance tent, where vaccination and PCR status are checked, and onto passport and visa checking at the border control and then, thankfully, reunited with all our luggage including the dental equipment.
We were staying at the Kabula Lodge, a guest house about five minutes from the city centre, situated in an elevated position with panoramic views of the city and surrounding mountains.
After a couple of days settling in over the weekend I was picked up by a University driver, Richard Jumbe, who brought me for an early morning meeting with James Mchenga and Peter Chimimba at the Kamuzu University of Health Sciences, close to the Queen Elizabeth Hospital.
We were also joined by a new part-time faculty member, Yusuf Maundala. We had a very productive discussion about the orthodontic curriculum and plans for the orthodontic teaching that would be delivered over the next few weeks while I was in Malawi. We also organised the instruments donated by DB orthodontics so that those required over the next few days in Lilongwe with third year BDS students on clinic could travel with James and myself. One of the challenges at present is having the students split over two campuses with the early phase students (foundation year and first and second year BDS) being at present based in Blantyre and the third year BDS students in Lilongwe, while the team await the completion of the building of the new Dental School in Blantyre.
Late morning I left Blantyre and travelled to Lilongwe. This was a very interesting road trip travelling north through Malawi with the road running along the border with Mozambique, reaching Lilongwe around 5 hours later at the Sunbird Capital Hotel in the centre of the city. James was travelling separately with his wife and arrived slightly later. We met for a very pleasant Malawi-style buffet dinner in the hotel, with a chance to catch up around plans for the week ahead.
Early next morning James and myself were picked up by our driver Richard and were taken across the city to the Dental Department at Kamuzu Central Hospital, where we had a short meeting with Jessie Namarika, the Senior Dental Surgeon at the clinic.
Following this we went to the seminar room to meet a group of local general dentists for a CPD session on orthodontics. We had a lively and interactive session which included a presentation on ‘Dental and Occlusal Anomalies’, including intercepting problems in the mixed dentition.
The following day we met the third year BDS students at the Kamuzu Central Hospital for introductory sessions on Orthodontics, including an update on facial growth and occlusal development.
The students were very enthusiastic and keen to make the most of the sessions, with lots of lively discussion and intelligent questions. We were joined for the session by a local dentist, Dr Samonte, who is based at the clinic and is involved with student teaching.
A full day of lectures and a ‘virtual’ new patient assessment session followed, with the students completing two virtual new patient assessments.
All the students were happy to contribute to the discussions around each virtual patient and proved confident enough to present their thoughts on the diagnosis of each malocclusion type and development of a problem list. Fuelled with a tasty snack of Scottish shortbread they still had energy to have a go at a short quiz at the end of the day and left with a spring in their step, feeling that it had been a worthwhile day.
On my last day at Kamuzu Central Hospital in Lilongwe we met the students early for a preparatory tutorial before moving to the clinical areas, where the students carried out orthodontic assessments on each other.
Dr Samonte, a local dentist who has an interest in orthodontics, was also present and the students worked very enthusiastically through the orthodontic assessments before presenting their ‘patients’. In the early afternoon we had a debrief and final session for the students with James and myself so they could feed back and ask questions about all they had been learning that week on their introduction to orthodontics course.
Following final photos and goodbyes we travelled back to Blantyre. The roads were much busier on the return journey and it took us more than an hour to get out of Lilongwe onto the Blantyre road. We arrived back in the early evening after five hours of driving, enjoying a beautiful African sunset on the way.
With a weekend free, Pauline and I went on a camping trip with the local hiking club which allowed us to travel to the Chikala hills to the north east of Blantyre. This involved a couple of hours travel on rough dirt roads through local communities. This overnight trip turned out to be a highlight of our time in Malawi with a hike through the rainforest and an overnight camp on the summit, with views to Mount Mulanje in the south and the Shire valley in the east.
The following week, back in Blantyre on the Monday I had a meeting with James and Yusuf, with further discussions around the orthodontic curriculum for the BDS students going forwards. We were also visited in the afternoon by a retired dentist from the U.S., Dr Clifford Daines, who was in Malawi with his wife as missionaries with the Mormon church.
Dr Daines had brought with him a batch of donated dental instruments which were enthusiastically opened by James and Yusuf.
The following day James and I had organised a CPD day for local dentists. Accordingly a group of nine dentists, based in both private practice and government health clinics, met in the board room in the medical college. We had a good interactive discussion around a presentation on dental and occlusal anomalies, including interception and management of problems in the mixed dentition. Several dentists have an interest in orthodontics and were very enthusiastic and happy to contribute to the day.
Later in the afternoon Wellington Chikuni, one of the local dentists on the Queen Elizabeth Hospital site, gave me a very informative tour of the Dental Clinic.
Several paediatric patients were in the clinical areas having extractions under local anaesthetic and Wellington discussed how this can be difficult, with many very anxious children presenting with toothache and acute dental infection. There is currently very little access to extractions under general anaesthesia and we discussed the potential advantage of introducing inhalation sedation as an option for younger and more anxious patients. Plans were hatched, with both of us agreeing to take a look at options for developing this service in the future.
My final few days in Blantyre were busy with further meetings with James, Yusuf and Peter. I was also given the opportunity to speak to the preclinical first and second year BDS students and it was great to see their enthusiasm as they set out on their studies in Dentistry.
They proved a lively bunch and asked lots of questions about orthodontics, especially after I let them into the secret that it is the best speciality in dentistry!
On my final afternoon I was given the opportunity to accompany James and Yusuf to the Plastic Surgery department at Queen Elizabeth Hospital and attend an educational meeting on maxillofacial trauma, presented by the plastic surgery registrars with clinicians at other hospital sites in Malawi linking in via ‘Zoom’. It was a well attended meeting. James and Yusuf contributed to the discussions with it being apparent how much general dentists and dental therapists are involved in managing facial trauma in Malawi with most being proficient at placement of inter-maxillary fixation.
Our final weekend was spent exploring the Mulanje mountain area south of Blantyre, before saying our goodbyes and heading back to the UK. The return trip was uneventful with a reverse of the outward journey travelling from Blantyre to Addis Ababa and then onto London and finally Aberdeen.
On reflection it was a very stimulating and rewarding trip both personally and professionally. I felt privileged to join the MalDent team and make a small contribution to the on-going journey to improve dental health for the people of Malawi. The enthusiasm of the local team including James and Peter is immense and they are very upbeat about the positive changes in dental health and clinical capacity that are slowly starting to take root in Malawi. They have understandably great pride in their ‘pioneer’ BDS students and new faculty members who are the bright future of dentistry in Malawi.
This is a guest post that has been compiled and edited by Jonathan Miller, Education and Data Analysis Manager at Medical Aid International. It describes the ongoing programme undertaken by Medical Aid International, in partnership with Martha Chipanda, the Oral Health Coordinator at the Malawi Government Ministry of Health. The programme was funded by the Scottish Government through the MalDent Project. It aims to ensure the sustainability of healthcare equipment investment in the region by providing holistic Biomedical Engineering training for students in Malawi.
Contributors: Martha Chipanda, Jonathan Miller, Tim Beacon, and Jeremy Bagg
Our journey starts over 20 years ago when Tim Beacon noticed the desperate need for medical equipment in low- and middle-income countries (LMICs). Tim, being driven and having a can-do attitude, set about utilising his contacts to make a difference. He built Medical Aid International from the ground up to focus on this aim.
Tim has a varied background across a number of different fields including roles as an Operating Department Practitioner, outdoor adventure trainer, running personal development courses, university and military healthcare lecturing, and more. He completed his Post Graduate Diploma in Travel Health at Glasgow School of Medicine and is also the author of The Gap Year Handbook. An Essential Guide to Adventure Travel (available for free download here).
In all of his previous jobs and his life in general, Tim has a history of responding to challenges with vigour and decisive action. When attending meetings addressing the healthcare situation in LMICs as part of his work at Medical Aid International, he noticed the topic of Biomedical Engineering and maintenance arising almost every time. No one seemed to be doing anything about this need, so Tim sought to address it himself.
At first, Medical Aid International partnered with Mercy Ships to deliver an on-the-ground 8-week course in Biomedical Engineering. Whilst this programme was extremely effective, the cost was prohibitively expensive to be rolled out to a wider audience; there were also the practical, logistical issues of getting to people! To create the solution that would be equally useful, but more cost effective, Medical Aid International invested over £150,000 to produce a comprehensive, online Biomedical Engineering Programme which is available in both English and French.
This multi-faceted programme includes a robust online training course, professional grade toolkit, a set of textbooks and a digital library of service manuals. The students are taught through a series of over 70 videos covering a wide range of topics, all tailored to the LMIC environment. Students must answer over 300 multiple choice questions throughout the course to pass, ensuring rigorous learning.
The course is designed for hospital “fixers” and estates managers who already have responsibility for looking after the hospital equipment, and upskills them to be more effective in their roles. By supporting their passion and enthusiasm with practical knowledge and resources, a huge day-to-day impact is achieved.
Research has been conducted into the effectiveness of the programme and found that students rate the course over 9.5/10 for course satisfaction and over 9/10 for course impact. A full data analysis report on the first 50 students that completed the course can be found here.
This brings us to the present day, where we have over 85 students across more than 12 countries with both the English and French versions of the course in use. Our impact in Malawi is particularly significant, a point of pride for us, with 27 students having either completed the programme or currently studying. These students are spread out geographically across the country, from Karonga in the North to Blantyre in the South (not forgetting Lilongwe in the Centre too). We’re proud to have worked with organisations both large and small, from governments to NGOs.
The textbooks and service manuals also allow for future study to further the students’ capabilities. By providing the professional grade toolkit we ensure the students are well resourced and can put into practice their newly acquired skills. Through the provision of this Biomedical Engineering training, the investments into new equipment are protected for the long-term and provide a lasting impact into the future.
Now to the MalDent project. Six students (five dental therapists and one biomedical engineer) across all regions of Malawi were selected to undertake our programme. The students have now all received their toolkits and have started the course. Here are some fantastic pictures of students receiving their toolkits; many thanks to Martha for arranging delivery and taking such great photos!
All six students have been working diligently and have completed the course in just a matter of weeks. We truly believe this hard work will pay off, benefiting the students, the healthcare facilities, and their patients. We will be sending out certificates to each of the students shortly to both congratulate them and celebrate their fantastic achievement. We look forward to hearing about the projects undertaken by our graduates and would like to thank the MalDent project, once again, for making this all possible.
The bespoke LMIC course (which focuses on equipment actually found in LMICs) teaches the students about:
Unit 0: Health and Safety
Unit 1: The Frequency Spectrum
Unit 2: Electrical Safety
Unit 3: Electrocardiogram (ECG)
Unit 4: Defibrillation
Unit 5: Patient Monitoring
Unit 6: Infusion Devices
Unit 7: Premature Baby Incubators (PBIs)
Unit 8: Ultrasound
Unit 9: Surgical Diathermy
Unit 10: Hygiene Guidelines
Unit 11a: Anaesthetics, Oxygen and Suction Devices
Unit 11b: The Operating Department and Sterilisation
Unit 12: First Aid
Unit 13: Train the Trainer
We are real advocates of the “Train the Trainer” approach. By this we mean that we train the students how to become trainers, so they can teach others and share their knowledge. This allows for best practice and benchmark standards to be developed hospital-wide – improving equipment maintenance and patient care.
We look forward to sharing the success stories once the students have been given the opportunity to put their training into practice!
Tim Beacon, CEO of Medical Aid International says:
“It is so wonderful to be working with MalDent on this project. Their long-term strategic vision, that we share, which encompasses this vital area of equipment support is to be highly commended. Giving these engineers the physical resources and foundational knowledge, which can now be built on as they develop their specialisation in dental work, is essential. It has also developed the communication infrastructure between them, which as the drive to develop dental services in Malawi continues, will be extremely beneficial.”
Martha Chipanda, the Oral Health Coordinator at the Malawi Government Ministry of Health says:
“I am very excited to see all of my students succeeding, many thanks to the Scottish Government, University of Glasgow and MalDent Project for the effort they have made to sponsor this program. I will fail in my job if I do not thank the Directorate of Health Technical Support Services (HTSS) Mr. Chimphepo, Ministry of Health Headquarters, for understanding the importance and granting us an opportunity to train dental therapists along with biomedical team in biomedical engineering. This is a development that is going to see our equipment being repaired and taken care of at district level where biomedical engineers are not easily available. It has started to implement our newly launched National Oral Health Policy on the area of infrastructure and equipment. It is my hope that another cohort is on the way to be trained. I am very confident that my team will do a great job on the emergency repairs of our dental equipment. A big congratulations to the students. Tim, Jonathan, Prof. Jeremy you are a blessing.”
Medical Aid International would like to thank the MalDent Project, the University of Glasgow and the Scottish Government for their involvement with this fantastic project.
On Thursday 14 April 2022 the Malawi Government Ministry of Health launched its first National Oral Health Policy. This represented the culmination of two years of work and twenty two meetings of the Oral Health Policy Taskforce, which had been established at the Oral Health Policy Workshop held in Lilongwe in February 2020. It was a big day for all concerned and a significant event on Malawi’s journey to ‘Oral Health for All’
The launch was held at the Sunbird Capital Hotel in Lilongwe – in exactly the same venue as we had convened the initial Oral Health Policy workshop in February 2020.
Whilst the guests were assembling, they were treated to entertainment from the Health Education Band, whose members sang songs which included messages about the importance of good oral health. The following video, which will give readers a feel for the music, was provided by Dr Mwapatsa Mipando, whose role in establishing and delivering the MalDent Project, including the Oral Health Policy development, has been so crucial from the outset.
Thanks to the modern wonder of Zoom, those of us who could not attend the event in person were able to join by videoconference from our bases around the world. Dr Yuka Makino, WHO Technical Officer for Oral Health in Africa, had contacted Chief Dental Officers from a number of other African countries, who joined the launch via Zoom. Thanks are due to the technical team at Kamuzu University of Health Sciences (KUHeS), who set up the Zoom link and made it possible for a further thirty of us to join those who were present in person.
The launch was facilitated by Mr Adrian Chikumbe, who is the Ministry of Health Public Relations Officer. The event started and ended with a prayer .
The first speaker was Dr Janet Kayita, who is the WHO Country Representative in Malawi. Dr Kayita commented that she was impressed with the standard set by the policy and that Malawi’s Oral Health Policy was running ahead of the imminent WHO Global Oral Health Strategy.
The next speaker was Dr Peter Chimimba, who had been invited to provide feedback from the perspective of the MalDent Project.
As Malawian lead for the MalDent Project, Peter has been closely involved with all aspects of its work, including the establishment of the new BDS degree at KUHeS.