It seems very little time since my initial visit to Malawi in September 2017 for the first curriculum conference to assess the feasibility of establishing a Bachelor of Dental Surgery degree programme at the University of Malawi College of Medicine (now Kamuzu University of Health Sciences [KUHeS]). The success of that meeting culminated in a second curriculum conference in 2018 and, ultimately, approval of the new BDS curriculum on 21st March 2018, with the first cohort of students enrolled in August 2018.

That first group of BDS students has now completed the course, signalling the requirement for a full curriculum review. The process to be followed is laid down by KUHeS procedures and begins with a stakeholder meeting. For the BDS curriculum, that meeting took place on 10th and 11th March 2025 at Chikho Hotel, Mponela.

Day 1: Chair – Dr Thandie Mwalukomo, Coordinator for Curriculum Activities & Strategic Direction, School of Medicine & Oral Health, KUHeS

Following an opening prayer and introductions of all present, Professor Wakisa Mulwafu, Executive Dean of Medicine at KUHeS, provided an overview of the programmes offered by the School of Medicine & Oral Health at KUHeS. He finished his presentation with some of the challenges presented by the BDS degree programme which the curriculum review should address.

One of the main stakeholders for the BDS degree programme is the National Council for Higher Education (NCHE). Dr Ishmael Nyirenda represented the NCHE and delivered an extensive presentation covering the basis of accreditation, the relevant standards, tools, guidelines and templates used, together with the implications and effects of accreditation. In summary, the basis of accreditation (Section 28, NCHE Act) requires acceptable standards surrounding:

• Physical, human, financial, teaching and learning resources
• Management and operational procedures
• Acceptable standards of academic life focusing on teaching, research, community service and expert service

Professional programmes, such as the BDS course, are accredited by NCHE after being approved by another of our main stakeholders, the Medical Council of Malawi (MCM). Dr David Zolowere, the Chief Executive and Registrar, of the MCM attended the stakeholder meeting and spoke next.

Dr Zolowere described the creation of the MCM through the Medical Practitioners and Dentists Act No. 17 of 1987, then spoke of the vision, mission and core values of the MCM and its functions:

The MCM is a critical stakeholder for the BDS programme because it is a legal requirement that the course is approved by the Council. Subsequently, the MCM will only register practitioners who have trained under courses it has approved. The existing BDS curriculum received MCM approval in 2018, but it will now be necessary to share a copy of that original curriculum with the planned revisions shown in track changes, so that the Council can consider the next version.

The next speaker was Dr Nitta Chinyama, Deputy Director of Clinical & Rehabilitative Services at the Ministry of Health. There were some technical issues with the projection when Dr Chinyama began to speak and George Kafera, one of the BDS 5 students who had just passed Finals, leapt to the rescue – a role he would repeat on several occasions over the course of the two days!

Dr Chinyama spoke about the relevance of the BDS degree programme to two key pillars of the Malawi Government Health Sector Strategic Plan III:

• Health service delivery pillar: Increase equitable access to, and improve quality of, health care services.
• Human resources pillar: Improve the availability of competent and motivated human resources for health, for quality health service delivery that is effective, efficient and equitable.

Dr Chinyama then moved on to speak about the high level of activity at a global level to improve access to oral health care for all, aiming for universal health coverage (UHC) for oral health for all individuals and communities by 2030. The six principles of this global oral health strategy are:

• Public health approach to oral health
• Integration of oral health into primary health care
• Innovative workforce models to respond to population needs
• People-centred oral health
• Digital technologies for oral health
• Oral health interventions across the life span

The role of the young dentists who will be graduating from KUHeS over the coming years will be key to achieving these local and global goals for oral health in Malawi.

The final speaker before the coffee break was Dr Peter Chimimba, who has been such a central figure, not only in establishing the BDS degree programme, but also in creation of Malawi’s National Oral Health Policy, delivery of the National Child Oral Health Survey and currently as a member of the Task Force that has been established to develop a National Child Oral Health Improvement Plan. Nobody could be better placed than Peter to talk about the history of the BDS degree, which was first conceived 27 years ago, but finally left the blocks in 2017 and has now reached the stage in 2025 of graduating its first cohort of students.

Before the coffee break, an official photo was taken of those attending the stakeholder meeting:

The first speaker after coffee was Dr James Mchenga, Acting Head of the Department of Oral Health Sciences, who provided an overview of the first five years of the BDS curriculum. As with any new course that starts from scratch, there are challenges in the early years. These have included staffing and physical infrastructure, both of which have been mitigated and for which long-term sustainable improvement plans exist.

Clearly, some of the most important feedback on the existing curriculum comes from the first group of students to successfully complete the BDS course. In the run-up to the stakeholder meeting, that group of students had completed a detailed questionnaire and the data were analysed for presentation to the delegates. Chifundo Banda, who had been the President of the Dental Student Society and George Kafera, who was the BDS 5 Class President, gave a joint presentation of the class feedback. The general consensus was that the curriculum was extremely engaging and that the staff were very approachable, but that elements of the administration and organisation of the course required attention. George finished his presentation by saying that despite challenges along the way, he and his classmates were nevertheless ‘globally competent and locally relevant’, the mantra adopted from the beginning of The MalDent Project when it was first used by Dr Mwapatsa Mipando!

I was due to speak next on progress with construction of the new clinical dental teaching facility and student hub for the Blantyre Campus of KUHeS. Unfortunately, repeated power cuts interfered with my presentation and I was unable to share the computer generated illustrations of the planned new facility. I have included one picture in this blog post to provide an impression for readers of the new building that is due to commence construction very soon:

The final presentation of the morning was delivered by Dr Wellington Chikuni on behalf of the Ministry of Health. Wellington is a dental surgeon who works at the Queen Elizabeth Hospital Dental Department in Blantyre and is engaged in clinical teaching of BDS undergraduates. Wellington spoke about the interface of the BDS programme with Malawi’s National Oral Health Policy and touched again on some of the points raised by Dr Nitta Chinyama earlier in the morning. It is critical that the BDS curriculum includes a substantial component that relates directly to the national policy, a key consideration for the forthcoming review.

After lunch, there were two sessions of small group work. The first was a SWOT analysis of the BDS programme and the second was a session addressing the challenges of the BDS programme. Once again, both George Kafera and Chifundo Banda played leading roles.

The day concluded with a general discussion led by Professor Wakisa Mulwafu.

Day 2: Chair – Dr James Mchenga, Acting Head, Department of Oral Health Sciences, KUHeS

The second day began with an excellent recap on the discussions during Day 1, delivered by Dr Peter Chimimba.

Peter’s recap session was followed by a presentation from Mr Emmanuel Chiphiko, who is based in the KUHeS Teaching & Learning Development Centre, on the KUHeS Curriculum Development Framework. This very technical presentation defined clearly the steps we will need to take as we complete the forthcoming BDS curriculum review.

Next up was an excellent presentation on the interface between the MB BS and the BDS curricula, delivered by Dr Lerato Mambulu, who is the MB BS Year 3 coordinator. The BDS and MB BS students are taught together in Years 1 and 2, but begin to diverge significantly in Year 3. Since the recent review of the MB BS Year 3 curriculum, there will be significant work to do when we review Year 3 of the BDS course.

The final session before the coffee break featured the return of Mr Emmanuel Chiphiko, who covered Intended Learning Outcomes and Bloom’s Taxonomy.

Immediately after coffee, we divided again into small groups to discuss ‘Assessing clinical competence and professionalism on the BDS degree programme’. Once again, George Kafera and Chifundo Banda, our two new alumni, showed great initiative in facilitating the group work and reporting back in the plenary session.

One of the elements of the BDS course that has proved particularly challenging is the research methodology component, which requires identification of a research question, writing a protocol, making a submission to the KUHeS Research Ethics Committee, collecting data and delivering a research report. This work is spread over Years 3 and 4. Dr Loti Nyirenda, from the School of Global and Public Health, oversees this module and gave some very clear, practical suggestions on modifications to its delivery that would facilitate its completion by the BDS students in a timely fashion.

The final session of the meeting on the last afternoon included one presentation on opportunities for outreach and community engagement for BDS students …

… and a heated discussion about multiple entry and exit targets for the BDS degree programme. The formal proceedings closed with a prayer.

The meeting concluded with a photograph of George Kafera and Chifundo Banda, our two alumni, with the BDS teaching staff who were present at the meeting. It was a very happy ending to a positive and fruitful BDS curriculum stakeholder meeting.

The hard work now begins. Once the notes from the stakeholder meeting are made available, an extended departmental meeting, held over several days, will be required to draft the suggested changes to the BDS curriculum for presentation to the School of Medicine & Oral Health. This will be followed by scrutiny from two further committees before final presentation to KUHeS Senate for approval.

There’s a lot to do, but the review process offers a great opportunity for further evolution and enhancement of what all present at the stakeholder meeting agreed is fundamentally a very sound curriculum.

Acknowledgements

The support of Ms Walusungu Nkhwazi, Ms Annie Mwapasa and Ms Madalitso Kaphamtengo with organisation and running of the meeting is gratefully acknowledged.

Regular readers of the blog will be familiar with the joint working that has emerged over the last year between The MalDent Project and the charity AMECA. In a previous post, we explained the nature of AMECA’s most recent project at Chilomoni Health Centre, that has included refurbishment of the Maternity and Outpatient Departments, establishment of a Physiotherapy Unit and the construction of a Dental Clinic. If you would like to read more about the work that has been completed by AMECA at Chilomoni Health Centre, you can read an in-depth description in AMECA’s excellent recently published newsletter here.

Over the first two weeks of March, there was significant activity to bring the works and fit-out to a conclusion, as excitement mounted for the official opening which was scheduled for Friday 14th March.

The evening before the official opening, a dinner was organised at the Sunbird Mount Soche Hotel by Dr Gift Kawalazira, Blantyre’s District Health Officer. The Deputy Minister for Health, Honourable Noah Chimpeni MP, was to join us for the opening ceremony, but unfortunately he was unable to reach Blantyre in time for the dinner. We nevertheless had a very enjoyable, informal evening which ended with some brief impromptu speeches:

We had been slightly worried about the weather for the opening event, as earlier in the week the south of Malawi had experienced heavy rain during the passage of Cyclone Jude. However, we need not have worried as Friday 14th March dawned dry and bright, staying that way throughout the day.

We were fortunate that St James Chilomoni Catholic Church is close to Chilomoni Health Centre and we were allowed to use the extensive car park for those attending the event.

Between the cathedral and health centre there is a large area of flat ground, which would be used for the speeches later in the afternoon. The tents that were erected would have provided protection from any rain, but in the event provided welcome shade from the sun for those attending:

The improvements that have been wrought by AMECA at Chilomoni Health Centre are outstanding. Much of this post will focus on the dental clinic, because of the relevance to The MalDent Project. However, AMECA must be hugely congratulated on the entirety of what has been achieved at Chilomoni Health Centre in recent months, covering maternity, outpatients and physiotherapy as well as the dental facility.

This photo shows the three main characters involved in the transition from a small, non-functional dental surgery in the original out patient department, to the spacious two-surgery clinic that has been developed by AMECA:

It had been Wisdom Maiza, the dental therapist at Chilomoni Health Centre, who spoke originally to Ruthie about the appalling state of his original surgery in the outpatient department. This conversation set in train the collaboration between Ruthie, Peter Chimimba, Wisdom and I, along with all of AMECA’s collaborators in Malawi, to deliver a state-of-the art dental clinic.

A notable feature of all the refurbished facilities at Chilomoni Health Centre is the beautiful hand-painted art work on the walls. All of these paintings are designed and applied by Young, a gifted local artist.

Before the official opening, there was an opportunity for local people and friends of AMECA to view all the facilities that have been refurbished at Chilomoni Health Centre. This included the dental clinic, for which Wisdom acted as Chief Guide!

An invitation to the opening event had been issued to members of the Bachelor of Dental Surgery teaching staff based at the Blantyre Campus of Kamuzu University of Health Sciences and the Queen Elizabeth Hospital Dental Department, all of whom were excited to see the new facility. In time, it is hoped that the dental clinic at Chilomoni Health Centre will provide an opportunity for outreach teaching of senior BDS students.

The nursing staff based at Chilomoni Health Centre also came to inspect the new dental clinic and their dance around the chair suggests that they were suitably impressed:

The imminent arrival of the Deputy Health Minister was heralded by the delivery of a red carpet and balloons strapped to the back of a motorcycle:

Suddenly the singing increased in volume and the Deputy Minister appeared:

The Minister was directed first to the refurbished and re-equipped Maternity Wing:

From Maternity he was ushered to the Outpatient Department ….

… then to the Physiotherapy Unit, before visiting us at the Dental Clinic:

The Minister spoke briefly with dental team members before being led into the two-surgery clinic.

Once again, Wisdom provided an excellent overview of the facility and described the difference it will make for both staff and patients.

On the way out of the clinic, the Minister enjoyed some further discussion with Ruthie and Trinity:

Once the Minister had been shown around the health centre, we all moved to the tents on the flat area of ground adjacent to the cathedral. En route, there was time for a quick dental selfie taken by Welington Chikuni, one of the dentists based at the Queen Elizabeth Hospital, who provides clinical teaching for the BDS students and has responsibility for overseeing dental interns there.

When we arrived at the area for the speeches, many local villagers had gathered:

Dr. Peter Chimimba delivered one of the early speeches …

… followed later by Ruthie …

… the Principal Secretary Administration for Health, Mr James Manyetera …

… and various other local dignitaries, concluding with a speech by the Deputy Minister …

Interspersed with the speeches were rousing shows by local dancers:

When the speeches had concluded, members of the national press were keen to interview the Deputy Minister …

… and, of course, Ruthie:

The run-up to the opening had been very busy for Ruthie and her team. I was heading back to the UK the following day, and once the event had concluded I enjoyed some snacks and a drink with Peter and our mutual friend Nelson Nyoloka, before heading home to pack.

In conclusion, I would like to congratulate Ruthie and all of the AMECA Trustees for an amazing transformation at Chilomoni Health Centre. Special mention is also due to the architect, Mr. Jan Sonke, and the contractor, Mr. Mbewe, whose skills and diligence made the project a successful reality.

The significance of the dental clinic cannot be over-stated. Once fully operational, it will be the only dental facility of its type at health centre level in Malawi. We urgently need additional facilities of this type in Malawi to provide suitable work-places for the new dentists now being trained at Kamuzu University of Health Sciences. Chilomoni Dental Clinic provides an exemplar for replication in other district hospitals and health centres across the country.

We are still raising money for some of the final items of dental equipment at Chilomoni and if you would like to contribute you can do so here. Thank you

In November 2024, I was honoured to be invited as one of two keynote speakers to the Third Global Citizenship event organised by the University of Dundee and NHS Tayside, with sponsorship from Global Citizens Tayside and Kids Operating Room (KidsOR):

This annual event is a great opportunity for both undergraduate and postgraduate students at the University of Dundee to showcase their global citizenship activities and to compete for prizes. The evening was a joyous celebration of the engagement of so many students in transformative projects.

My fellow keynote speaker was Dr David Cunningham, CEO of the Scottish charity KidsOR. David delivered an inspirational talk which demonstrated the massive impact of the state of the art surgical infrastructure delivered by KidsOR, which allows paediatric surgeons to deliver high quality care for children in low resource environments. Now operating in over 40 countries, the global impact of the charity is massive.

David and I had opportunity for some informal discussion during the evening about our respective activities. We touched on the fact that in many low resource settings, including Malawi, there is a desperate shortage of high quality, well-equipped, functional dental surgeries. As a result, dental therapists and dentists struggle to deliver care for children and adults alike, because they are unable to use the full range of skills within their scope of practice. This results in many unnecessary referrals to central hospitals for relatively minor procedures, causing additional costs and inconvenience to patients. Furthermore, the already busy central hospital departments become overwhelmed.

David’s wife Claudia graduated as a dentist from the University of Dundee and is now Head of Dentistry at the University of Central Lancashire. David and I engaged in some further discussions after the global citizenship event and early this year he informed me that he would be in Malawi on 10th and 11th February to participate in a regional meeting of Ministers of Health in Lilongwe. He planned to bring Claudia with him to allow her to assess the dental situation on the ground and asked whether The MalDent Project team would be able to organise a suitable itinerary for her. Peter Chimimba and I began planning and arranged a programme that included both Lilongwe and Blantyre.

Day 1: Lilongwe

On Monday 10th February, Peter and I collected Claudia from her hotel in Lilongwe and headed to Kamuzu Central Hospital (KCH) Dental Department. We met initially in the office of Dr Jessie Mlotha-Namarika, the Senior Dental Surgeon at KCH, who is also the Course Coordinator for BDS 3. Dr Wiston Mukiwa also attended who, like Jessie, is a part-time lecturer on the BDS programme. Following introductions, Claudia was taken on a tour of the clinical facilities and then we headed to the conference room, where five of the Final Year BDS students who live in Lilongwe had kindly agreed to join us and were waiting. These students had all sat their final examinations and were awaiting the results. We enjoyed some further discussion before leaving Claudia alone with the students so that she could glean their views without any staff members present!

At the end of the morning session we had a group photograph …

… before Peter and I took Claudia to the Sunbird Capital Hotel for lunch.

We returned to KCH at about 3pm to meet David, who was keen to view the paediatric operating theatre at KCH – one of the first that KidsOR had installed. Following his flying visit we had time for a group photo before heading to our respective hotels.

Day 2: Blantyre and Chilomoni

Early on the morning of Tuesday 11th February, Peter and I collected Claudia from her hotel and headed to Kamuzu International Airport, where we caught the 08.10 flight to Chileka Airport, Blantyre.

On arrival, we headed directly to the Blantyre Campus of Kamuzu University of Health Sciences, where we met Dr James Mchenga, Acting Head of the BDS degree programme, Dr Nathan Lungu, Lecturer and Dr Tasneem Chikwatu, Assistant Lecturer. After initial discussions we went across to the Dental Department at the Queen Elizabeth Hospital, where the BDS 5 students had undertaken their Integrated Dental Care programme over the past year. Here we met Wellington Chikuni, who will be overseeing the internship programme for the successful BDS 5 students who are allocated to the QEH Dental Department over the next year.

Our final stop was at Chilomoni Health Centre, where the charity AMECA is undertaking a major renovation of the infrastructure, including the establishment of a two chair dental surgery. Claudia was introduced to Ruthie Markus, the CEO of AMECA, who gave her a guided tour of the work underway.

The visit to Chilomoni concluded with a visit to the ongoing work on the dental clinic which, once completed, will be the first facility of its type at health centre level.

After bidding farewell to Ruthie and her team, Peter, Claudia and I had a light lunch in the city centre before returning to Chileka Airport for Claudia to catch her flight back to Lilongwe.

It had been a whirlwind visit by Claudia which has hopefully provided a real-life sense of the achievements to date but also the significant challenges that lie ahead. It has been partnerships that have helped us to this point and it would be wonderful if there were an opportunity for KidsOR and The MalDent Project to establish an element of collaboration moving forward.

I arrived back in Blantyre on 2nd February for the first of four blocks of six weeks each that I will be spending at Kamuzu University of Health Sciences (KUHeS) during 2025 as a Visiting Professor in the Department of Oral Health Sciences. One of the joys of the journey to Malawi is watching the African sunrise and this time I had a window seat on the Emirates Airbus A380 from Dubai to Johannesburg. It is impossible to capture the real beauty of the colours in a photograph, but this was the best of several attempts:

The story to be related in this blog began back in December 2024, when I received an e-mail from someone I had never previously met, called Jo Frencken:

The substance of Jo’s e-mail is self-explanatory. Jo had found my e-mail address through reading our MalDent Project blog and was keen to re-connect with Peter Chimimba, my long-term friend and colleague, and The Maldent Project lead in Malawi. I forwarded Jo’s e-mail to Peter and contact was restored!

Jo graduated DDS from the University of Nijmegen, the Netherlands, in 1975. He had worked as a Dental Officer at St Luke’s Hospital in Milosa, Malawi, between January 1977 and January 1980, which was where he had met Peter. In 1981 he completed an MSc in Dental Public Health at the University of London then moved to the University of Dar es Salaam, Tanzania, as a Lecturer in Preventive and Community Dentistry from January 1982-1986. He returned to the University of Nijmegen between 1986 and 1988 to complete his PhD, then from November 1988 – January 1992 was a Senior Researcher in the Department of Community Dental Health & Epidemiology, Netherlands Institute for Preventive Health Care in Leiden. In a further return to Africa, Jo spent January 1992 – July 1997 as Consultant in Dental Public Health at the Ministry of Health & Child Welfare, Zimbabwe, where he was also Acting Chief Dental Officer. Jo spent the remainder of his career in a variety of senior academic posts in the Netherlands until his retirement from academic dentistry in 2015.

Subsequently, Jo informed Peter that he would be visiting Malawi in late January / early February. By coincidence, his time in Blantyre coincided with the start of my own visit – and that was how I came to meet the inventor of Atraumatic Restorative Treatment (ART).

On Thursday 6th February, Jo spent the morning at the Blantyre Campus of KUHeS with Peter and I. We were joined by our junior teaching staff colleagues, Nathan Lungu and Tasneem Chikwatu. We provided Jo with a summary of the various components of The MalDent Project, our progress to date and aspirations for the future. Subsequently, Jo spoke about some of his own work and academic interests, especially in the field of minimal intervention dentistry and atraumatic restorative treatment. It was during his time delivering dental care in low-resource settings in Africa that he had developed the concept of ART, and it was such a privilege for us to hear from the originator himself about this technique which has become so well known in dentistry and is of such direct relevance to Malawi.

Jo had kindly brought a number of books with him which he donated to the Department:

Following a fascinating morning, Jo, Nathan and I enjoyed lunch together before dropping Jo back at his hotel

Later in the day, Peter and I were able to meet with Jo at his hotel to discuss how he might become involved in The MalDent Project. With his wealth of experience delivering clinical service and dental education in Africa, together with an extensive research record (214 peer reviewed journal articles, co-author of seven scientific books and 16 book chapters), we could not have wished for a more experienced adviser and collaborator. During his career he had also held senior positions in both the FDI (World Dental Federation) and WHO, adding further to his credentials for collaborating with us. We agreed that we would develop a proposal, incorporating training opportunities for the teaching staff as well as support for undergraduate training, that Jo could utilise in discussions with his many contacts and attempt to seek additional support for our work moving forwards. Before Peter and I left, Jo kindly presented us with copies of one of his books entitled ‘The art and science of Minimal Intervention Dentistry and Atraumatic Restorative Treatment’.

Jo left Blantyre on 7th February for a few days visiting his old haunts in Malawi, but we had opportunity to meet him once again on 11th February, before he travelled back to the Netherlands. On this occasion we were able to introduce him to Dr Mwapatsa Mipando who, in his former role as Principal of the University of Malawi College of Medicine, had been the initiator of The MalDent Project.

Our work with Jo is just beginning – another exciting chapter opens in The MalDent Project story!

This is a guest post written by Professor Lorna Macpherson, a core member of the MalDent Project team and a Trustee of The Borrow Foundation. Lorna attended the WHO Global Oral Health Meeting in Bangkok from 26th – 29th November and has provided this report of her experiences at the event.

The WHO Global Oral Health meeting was held in Bangkok, Thailand, from 26th – 29th November 2024. This large-scale meeting was hosted by the Government of Thailand.

The specific objectives of the meeting were:

• To promote the implementation of the Global Oral Health Action Plan 2023-2030 and negotiate a joint Bangkok Declaration on oral health.
• To develop national roadmaps that will accelerate the implementation of the Global Oral Health Action Plan 2023-2030.
• To integrate oral health into primary health care and universal health coverage packages.
• To discuss six strategic objectives, 100 actions, 11 global targets, and monitoring of the framework of Global Oral Health Action 2023-2030.

Approximately 300 individuals attended the meeting. Member states were invited to send up to two delegates, and ultimately representatives from 98 member states were present in person. 

The Borrow Foundation provided a grant to the WHO to enable the 45 countries classed as ‘least developed’ to travel to the meeting and 36 countries, including Malawi, were able to attend. It was, therefore, tremendous news for The MalDent Project that Dr Innocent Lanjesi, National Oral Health Coordinator and Dr Jessie Mlotha-Namarika, Chief Dental Surgeon at Kamuzu Central Hospital, were able to travel to Bangkok to represent Malawi:

The Borrow Foundation was represented by Professor Andrew Rugg-Gunn, Nigel Borrow and Lorna Macpherson: 

The meeting also attracted delegates from UN agencies, international organizations, philanthropic foundations, civil society organizations, and other stakeholders dedicated to advancing oral health, non-communicable diseases, and universal health coverage programmes.

The first three days of the meeting considered driving change in relation to the six strategic objectives of the Global Oral Health Action Plan:

• Oral health governance, leadership, and finance
• Oral health promotion and oral disease prevention
• Health workforce
• Oral health care – ensuring universal health care for oral health  
• Oral health information systems
• Oral health research agendas

Two topics were covered each day. In the morning, keynote presentations and case studies were presented from across the world, followed by panel discussions from Member State representatives outlining their experiences, including challenges and opportunities for advancing the strategic objectives under discussion.  

Dr Jessie Mlotha-Namarika participated in a panel discussion on workforce, outlining the issues and recent developments in Malawi:

Planetary health was also discussed and the role for oral health care in building climate resilient health systems and in phasing down the use of dental amalgam was covered.

In the afternoon sessions, Member State representatives were divided into groups, reflecting the six WHO Regions, to discuss the morning session and to work on developing national roadmaps to take forward the strategic objectives: 

This was followed by a series of side events from 5pm to 6pm. Topics included noma, sugar control, school oral health programmes, oral health interventions for the ageing population and shaping a contemporary oral health workforce.

Jessie contributed to a side-event that covered oral health workforce:

There were good opportunities for social events and informal discussions. The Borrow Foundation hosted an evening meal with Drs Kofi Nyarko and Yuka Makino (WHO/AFRO) and Member State representatives from the African countries associated with the Foundation.

On the final morning of the meeting, three key activities were delivered:

1. A high-level session with presentations from regional directors and ministers of health from several countries, declaring their commitment to advancing the Global Oral Health Action Plan and integrating oral health into their national NCD and UHC strategies.  
2. The potential to form a Global Coalition on Oral Health, to assist member states take their oral health strategies forward, was proposed by the WHO and representatives from ‘non state actors’ described ways in which their organisations could collaborate and help promote the implementation of the Global Oral Health Action Plan. Groups participating in the panel discussion included the IADR, FDI, International Dental Manufacturers, UNICEF, the NCD alliance and charities such as The Borrow Foundation.
3. The Bangkok Declaration was adopted. This Declaration outlines collective commitments from member states to accelerate the implementation of the Global Oral Health Action Plan. It seeks to guarantee oral health as a fundamental human right and recognizes that improving access to affordable oral health care cannot be achieved without integrating it into primary health care and universal health coverage packages.

The Bangkok Declaration will inform the Director General’s report for the 4th UN high-level meeting on NCDs due to take place in New York in 2025, to ensure better recognition and integration of oral diseases in the future global NCD agenda.  

Following the conclusion of this successful global meeting, delegates have returned to their home countries armed with new knowledge and a range of activities to pursue in ways that are locally relevant and applicable to their individual nations. Taken in concert, these actions at country level will contribute to taking forward the global oral health agenda.

Acknowledgement

Photographs 1, 3, 4-6, and 9 in this post are credited to WHO / Ministry of Public Health, Thailand, to whom the author gives grateful thanks.

Regular followers of the blog will be aware of the partnership between the charity AMECA and The MalDent Project to establish an exemplar dental clinic at Chilomoni Health Centre, just outside Blantyre. The development of the dental clinic is one component of a much larger programme of work by AMECA at Chilomoni Health Centre which also includes:

• A new physiotherapy clinic
• A complete refurbishment of the maternity unit
• Replacement of the roof and a refurbishment of the outpatient department

The physiotherapy clinic, beautifully decorated with hand-painted colourful murals by a local artist, is already completed and in use:

The following two photos show early stages of the construction work on the maternity unit, which has been making excellent progress:

The replacement of the roof of the outpatient department is also underway, ahead of the refurbishment work required inside:

The origin of the work to provide a functional dental clinic is described in an earlier post. What began as an initial request from Wisdom, the dental therapist, to assist with installation of an existing dental chair into a sub-optimal space has transformed into a much larger project to establish a two chair dental clinic that can act as an exemplar for other healthcare facilities in Malawi.

As a reminder, this was the original dental surgery with its un-installed dental chair and leaking ceiling:

A much larger structure was subsequently identified with sufficient floor space to develop a two-surgery dental clinic. Dr Gift Kawalazira, District Health Officer for Blantyre, gave his approval for the space to be re-utilised for this new purpose.

The establishment of this exemplar dental clinic at Chilomoni Health Centre will:

1. Deliver the first fully equipped dental clinic in a Malawian Health Centre, integrated with other co-located primary care facilities.
2. Provide a model for demonstration to the Ministry of Health and other key stakeholders, who could replicate the core components in other District Hospitals and Health Centres across Malawi.
3. Improve the working conditions for Wisdom Maize and his colleagues delivering dental care within Blantyre District.
4. Increase access to high quality dental treatment for the 63,000 Malawians living in the catchment area of Chilomoni Health Centre.
5. Deliver the potential for outreach teaching of BDS Year 5 students from Kamuzu University of Health Sciences, since it is located very close to Blantyre. This model is widely used in the UK to provide a ‘stepping stone’ for students from clinical practice in the Dental School to a more realistic primary care setting.
6. Provide a facility for collecting accurate oral health data.

Construction work

AMECA has generously agreed to fund the construction work required to convert the space, at a cost of £15,000. That work is currently in progress as shown in the following video and photos:

The outlines of some of the new spaces that are being formed are illustrated by this initial course of bricks:

This photograph shows the very significant changes to the existing structure to convert it into a functional, two surgery dental clinic:

The contractor, Mr Mbewe, produces items such as door frames, window frames and security doors at his own premises then transports them to the site:

Once the construction work is completed, the facility will be decorated and will then be ready for installation of equipment. A later blog post will provide an illustrated description of the facility at that stage.

The Chilomoni AMECA / MalDent Project Dental Clinic Campaign

The dental chair that lay un-used in the previous surgery is brand new and a second dental chair is also available for installation. In addition, Henry Schein Dental has donated a new autoclave for the decontamination room in the facility.

However, funding is required for additional equipment including a compressor, suction motor, ultrasonic cleaner, X-ray units, handpieces, scalers and hand instruments. We have, therefore, launched a fund-raising campaign for the purchase of these items, which are required to allow the clinic to become fully operational.

If you would like to contribute to the campaign and make a donation that will help us to equip the new Dental Clinic at Chilomoni Health Centre you can do so here

Many thanks in advance to those who decide to contribute to our fund-raising. Your donations will help us to make a further significant step towards our goal of ‘Oral Health for All‘ in Malawi.

Regular readers of the blog will recall that Peter Lee, Head of the Edinburgh Studio of John McAslan + Partners (JMP), visited Malawi in February this year. We had a busy week of meetings and visits, including the signing of the contract between JMP and Kamuzu University of Health Sciences (KUHeS) for the next phase of design work on the planned dental teaching facility and student hub to be built on the Blantyre Campus.

Since then, a massive amount of work has been undertaken by JMP, together with local Malawian partners, to produce the dossier of materials required for submission to the Project Implementation Unit (PIU), which acts as the intermediary between the Ministry of Education and the World Bank. The PIU has the main responsibility for project implementation, coordination and monitoring of projects – like this KUHeS building – that are funded through the Skills for a Vibrant Economy (SAVE) programme of the World Bank. The plans have also been submitted to Blantyre City Council for approval.

On Sunday 6th October, another of the JMP architects who is closely involved with our project, Leon Grobbelaar, arrived in Blantyre for a week of on-site work. The main ambition was to review the design with the local teams and contractors to validate it and confirm that it is all fully deliverable to the required standard.

Leon’s work commenced on the Monday morning by meeting with key members of KUHeS staff engaged in the project. It was confirmed that the dossier of documents and drawings produced by JMP and recently forwarded to KUHeS had now been submitted to the PIU. Leon intimated that he could speak directly with members of the PIU if this would be helpful and Chisomo Msefula, who is now the KUHeS academic link with the PIU, passed on that offer.

Leon then presented the various elements of the tender documentation to the team, and explained the key aspects of the final design. This was extremely helpful as the paperwork ran to hundreds of pages, much of which was highly technical. The amount of detail was extraordinary and very impressive.

The visuals of the exterior of the building were especially exciting for the lay audience present:

The exterior of the building is exposed brickwork and Leon enquired whether a small sample wall could be constructed for him to view before he left Blantyre on the Friday. You can read about the outcome of that request later in this post.

Following our meeting in the Board Room we moved to the proposed site for the building:

We were subsequently joined by Soobhas Sobnack, the engineer on the team, who has been involved in the construction of about 80% of the existing buildings on the campus, so he brings with him a wealth of local knowledge.

Soobhas was concerned that the site of the building identified on the plans would incur significant drainage problems on its southern perimeter and that by moving the building slightly north-east, these could be largely eliminated, also reducing the overall cost of construction.

As part of our walk around the site we identified the location for the proposed demonstration wall that Leon had requested at the initial meeting. This was marked out by producing a shallow trench – the first time any soil has been moved during our many discussions over the building design!

After the site meeting, Soobhas took Leon and I to see the new CREATOR Building, constructed for the Malawi Liverpool Wellcome Trust. It is a fantastic building which is now nearing completion:

Leon commented on the regularity of the bricklaying which was first class and a valuable benchmark for our planned new building on the KUHeS campus:

On the Monday evening, Leon, Peter Chimimba, Chisomo Msefula and I met for dinner in Vincent’s Restaurant at the Sunbird Mountain Soche Hotel. It was a very convivial evening which gave Peter and I an excellent opportunity to provide Leon and Chisomo with the back-story of the MalDent Project from its inception.

On Tuesday 8th October, Leon and I visited the recently opened St John Paul II Catholic College, which is part of the Beehive Social Enterprise. Our visit was organised and hosted by Jess Baily, who was the architect for the project. Since completion of this building Jess has recently been engaged by John McAslan + Partners on a part-time freelance basis.

Leon was keen to learn from Jess about any of the challenges that had been encountered during the design and construction of the St John Paul II Catholic College and to discuss in detail the materials employed, design features and sources of the various components of the building. As a lay person I was fascinated by the detailed technical discussions between Jess and Leon. Our visit lasted about an hour during which time we gained a significant amount of information relevant to our planned new building at KUHeS.

We enjoyed a guided tour around all of the facilities, during which Leon took multiple photos. It was a very vibrant building with large numbers of students in attendance. Both Jess and Leon described the thrill for an architect of seeing a completed building which they have designed being put to good use.

Following our tour of the College, Jess took us to visit some building suppliers in Blantyre. Our first stop was at the Universal Trading Company. This was a very large premises with multiple entrances:

Entrance 3 housed a massive array of pipes of different dimensions, angle iron, mesh and related metal items. Leon’s camera was red-hot!

In another part of the warehouse, Leon was able to view sanitary ware, taps, door handles and related fittings:

After ironmongery we moved to another store to view tiles:

By now it was lunchtime so we headed to Caffe Grazia for a snack. Jess then dropped me back at KUHeS before she and Leon visited one last supplier.

As described above, during our first meeting with Leon on the Monday, he had requested that a 1m x 1m demonstration wall be constructed near the planned site for the new building. Following the visits we had made to brick and SSB production facilities in February with Peter Lee, the design team had agreed that they would specify bricks made by the Malawian company Terrastone. Leon contacted Patrick Calisse at MOD Architects who spoke with Terrastone. We were delighted to hear later on the Monday that Terrastone had agreed to donate bricks and construct the wall according to the technical specification provided by Leon.

On the Tuesday, the bricks were delivered together with a wooden former that was placed into the recess dug for the foundation. Cement would be poured to allow the brick building to commence on the Wednesday.

On the Wednesday morning the bricklaying got underway on the cement foundation which had set overnight:

By lunchtime the wall was built and ready for pointing …

… thanks to these three bricklayers and their foreman from Terrastone:

At 12 noon that Wednesday I was picked up at the KUHeS campus by my friend Mwapatsa Mipando and we drove to Malawi University of Science & Technology (MUST). Mwapatsa has recently retired from KUHeS and is now a member of academic staff at MUST. I had visited this university in 2019 and on arrival I was as impressed with the campus and its buildings as I had been previously.

The main reason for our visit was to discuss the feasibility of setting up a small plant to produce affordable fluoridated toothpaste. The high cost of fluoridated toothpaste in Malawi was identified during the recent workshop in Mponela as a major barrier to our ambition to improve child dental health via supervised toothbrushing programmes in Early Childhood Development Centres and primary schools. MUST’s vision and mission have a major focus on entrepreneurship, including provision of links between academia and industry. We have already been in discussion with colleagues in the Institute of Pharmacy & Biomedical Sciences at Strathclyde University, who are also keen to collaborate.

We met in the University Technology and Innovation Garage…

… where we enjoyed a very positive discussion with Professor Dalison Mkwambisi, who is Professor of Environment & Development, and Director of MUST Institute of Industrial Research & Innovation, along with some of his team. Prof Mkwambisi showed great interest in our proposal and agreed that it could fit well with MUST objectives. We will now proceed with producing a concept paper to take the idea forward.

We drove back from MUST to Blantyre and enjoyed lunch at La Caverna. At Mwapatsa’s suggestion, we then returned to the KUHeS campus where he introduced me to a friend and colleague of his, Dr Luckson Dullie. Dr Dullie trained in medicine at the University of Malawi College of Medicine (now KUHeS) and is currently the Chief Leadership Development & Engagement Officer for the organisation Partners in Health. He has been a pioneer in the development of Family Medicine in Malawi, and those interested in reading more of his ground-breaking work, including his role in developing HIV and NCD (non communicable disease) management protocols in Neno, can do so here.

Whilst we had been drafting Malawi’s National Oral Health Policy we had heard about the NCD demonstration project at Neno, a district in the Southern Region of Malawi. One of those involved, an American physician called Dr Todd Ruderman, had joined the seventeenth on-line meeting we held during the policy writing process and described his work on NCDs and PEN Plus in Malawi. We remain keen to identify whether the ongoing work in Neno would provide an existing platform in which could we pilot integration of oral disease prevention, building on the principle of common risk factors. Dr Dullie has agreed to link me with the key players so that we can instigate some initial discussion.

After our meeting with Dr Dullie, and as we were driving out of the campus, we passed the trial brick wall, which was now being pointed by two of Terrastone’s staff members. As instructed by Leon, the horizontal jointing was recessed and the vertical jointing flush, using a mortar that was stained to provide a red colour that matched the bricks. Mwapatsa and I stopped to view progress and to speak to the two bricklayers. It may seem a fairly trivial development to many readers, but for those of us who have been involved in the design work since 2019 that small demonstration wall represents a very significant milestone.

Since my recent return to Scotland, Leon has kindly sent me this image of the finished product – in Leon’s words, “a totem to the future”!

Mwapatsa gave me a lift home from KUHeS. On arrival, we visited Ruthie in her house and had a drink together on the khonde. Ruthie had been putting the finishing touches to the next newsletter for her charity AMECA and she shared many of the photographs from the ongoing work at Chilomoni Health Centre, including the new dental clinic, with Mwapatsa.

This was my final evening in Blantyre before leaving for Scotland the next day. It had been a varied and exciting three weeks of activity during which I had also made a number of new friends. The MalDent Project has a long way to go but with small steps, like the demonstration wall, we’re making progress.

For the middle part of my visit to Malawi the weather was uncharacteristically cool, wet and windy – not at all the hot, dry season that would be anticipated for this time of year. Comments were made that I had brought Scottish weather to the Warm Heart of Africa! This change in the weather was compounded by multiple power cuts, one of which lasted for more than 24 hours. The solar powered lanterns that Ruthie normally used on the khonde in the evenings came in very handy for interior lighting.

On Tuesday 1st October Ruthie drove me to The Beehive Social Enterprise at Chilomoni. Many of my colleagues in the Scotland Malawi Partnership had praised this organisation on multiple occasions in discussion and I was grateful to Ruthie for making the introduction. There are many strands to the work of Beehive, but I was particularly keen to hear about their work in Early Child Development Centres (ECDCs) and schools.

Our visit was hosted by Limbani Njewa, the Community Services Manager, who introduced us to Hannah Kagona, the Outreach Manager. Limbani explained that the focus of their work is to support vulnerable people in the community, with an emphasis on family support. They have an extended schools team and provide education and support from ECDC (nursery) level through to tertiary education. Limbani’s teams collect data on the ECDCs and associated food programme. The food is provided by Seibo and prepared by local villagers through parent forums.

Following Limbani’s description of their activities, I spoke about our ambitions for child oral health improvement in Malawi, including our search for potential sites in ECDCs and schools to undertake feasibility studies. Limbani was very enthusiastic and encouraging in relation to a possible role for Beehive as we develop our plans, so there is tremendous scope here for collaboration.

On Wednesday 2nd October I spent the morning with the Blantyre District Health Management Team. Although he was away on other business, this meeting had been set up by Dr Gift Kawalazira, the District Health Officer.

The morning started with three summary presentations by postgraduate students. The first related to distribution of essential medicines in Limbe, an area in the Blantyre district …

… the second on ergonomic hazards in healthcare in Malawi …

… and the third on a PhD project on retinopathy in children with cerebral malaria …

There followed reports from the coordinators of six of the healthcare programmes operating in Blantyre District. The School Health & Nutrition Programme is led by Ennis Kaunda, who gave a very interesting presentation that is of direct relevance to the work we are planning around child oral health improvement interventions in schools:

We also heard from Chrissy Banda who heads up the Health Promotion Programme:

One of Chrissy’s slides was especially relevant to our ambitions to improve child oral health, citing that health education messaging, whilst important, is insufficient on its own to change behaviour:

My good friend Wisdom gave a brief presentation on oral health care for children:

Following the presentations from the leaders of the individual programmes already underway, I gave a short talk about the MalDent Project and our plans for the future. Once again, there were clear opportunities for collaboration moving forwards and I left the meeting feeling very encouraged.

One of the challenges facing any form of dentistry in public institutions in Malawi relates to ensuring a reliable pipeline of the required consumables such as local anaesthetic solution and filling materials. On Thursday 3rd October my friend and colleague Nelson Nyoloka, a Lecturer in Pharmacy at KUHeS, kindly arranged a meeting for Peter Chimimba and I at the Central Medical Stores Trust (CMST) offices and warehouse in Blantyre so that these supply issues could be discussed.

Mr Geoffrey Ngwira, the CMST Director of Pharmaceutical Operations and Mr Vincent Chilinda, the CMST Finance Manager, had both travelled from Lilongwe to join the meeting, for which we were extremely grateful. Later, we were also joined by Mr Godfrey Kadewere, Director of Health Technical Support Services at the Ministry of Health.

It was a very valuable morning. First, Mr Stewart Lichapa, the local CMST Manager, delivered a Powerpoint presentation that provided an overview of the CMST and its operations. The former Central Medical Stores, operating under the Ministry of Health, converted to its current structure through a Trust Deed in 2010 and the CMST became operational in 2012. Its function is to procure, warehouse and sell pharmaceuticals and equipment to public facilities and CHAM hospitals.

CMST has to estimate the volume of materials it procures based on projected Ministry of Health requirements, but is then reliant on public health facilities having sufficient funds to purchase those drugs and equipment. Unfortunately, public health facilities have limited funding, leading to significant financial challenges for CMST, including cash flow problems resulting from delayed payments by customers, potentially compounded by currency devaluations.

It was explained that availability of specific drugs responds to the Essential Health Package, which has resulted in creation of a Must Have List (MHL) of 405 items, from a catalogue of 5842 items. There are currently 10 dental items on the MHL, which we have been invited to review and amend as required. We have agreed to create a document that will define in more detail the list of commodities and volumes required to support both dental education and delivery of dental clinical services.

One of the final activities to satisfy requirements of the Scottish Government MalDent Project grant is to undertake an end of project evaluation. The advert to recruit a suitable consultant has now been lodged in the local press with expressions of interest due by 17th October. We look forward to this external evaluation of work to date, which may also provide some guidance for our future plans.

Blantyre Farmers’ Market is a local tradition that takes place on the first Saturday of every month, so one was scheduled for Saturday 5th October. Ruthie normally attends and she kindly invited me along too. At the end of a busy week it was good to take some time out and enjoy this new experience.

The event is a hub for promoting locally made products, including food, crafts and textiles. It aims to support the growth of local businesses and artisans.

Once parked, we entered the market. It was a vibrant event full of colour and the aroma of good food cooking.

I wandered around the market and purchased some locally made items from two of the stalls:

After perusing the stalls, I settled down to chat with some of the new friends I have made during my recent stay, thanks to introductions from Ruthie.

This short video gives a feel for the atmosphere at the event, enlivened by the music being played by the live band:

On the Sunday, I enjoyed lunch with my friend Nelson, who was about to leave for Lilongwe, where he would be teaching pharmacology to nursing students for the next week. We visited Sky Lounge Restaurant, an eatery that was new to me and which served up a very tasty lunch.

This had been an excellent week for making new contacts with whom we can collaborate as the MalDent Project moves into its next phase. Over the following week we would be joined by Leon Grobbelaar from John McAslan + Partners, a longstanding collaborator, when our attention would turn back to finalising the designs and gaining permissions for the new dental teaching facility / student hub on the Blantyre campus of KUHeS.

In a previous blog post, I described the Oral Health Forum that was organised by the Scotland Malawi Partnership whilst Esther Khomba and Chifundo Banda, two dental students from Kamuzu University of Health Sciences, were visiting Scotland. If you would like to watch the forum, a time-stamped video is available here.

Tracy Morse, Professor of Environmental Health and Head of the Centre for Sustainable Development at Strathclyde University, Maria Soko, a Behaviour Change Specialist from Water Aid Malawi, and I delivered a short presentation during the forum which examined the possibilities for collaboration between colleagues working on projects addressing the WASH agenda in schools, particularly hand hygiene, and our plans for developing oral health interventions aimed at improving oral health in children.

One of the very positive outcomes of the meeting was that Tracy subsequently arranged a Zoom call that allowed Lorna and I to meet her friend and colleague Dr Kondwani Chidziwisano who is an academic at Malawi University of Business and Applied Sciences. Kondwani did both his Masters degree and PhD at Strathclyde University and has been working with Tracy for many years.

During that on-line conversation we learned about a project of Kondwani’s that was about to begin, which would examine aspects of sanitation and hygiene in Early Childhood Development Centres (ECDCs) – facilities that provide care for children under the age of six years who are not yet attending a formal school or equivalent. Lorna is keen that we include such centres, as well as primary schools, in our plans to develop oral health improvement interventions. Kondwani explained that his team was developing a data collection tool to gather relevant information from ECDCs and invited us to submit a small number of oral health questions that could be included. Lorna sent the appropriate material and it was agreed that I would meet in person with Kondwani during my current visit to Malawi.

On arrival in Malawi I contacted Kondwani who explained that he and his teams would be going out into the field on Friday 27th September to pre-test the data collection tool, which included the small number of oral health related questions submitted by Lorna. He invited me to join them, which provided an excellent opportunity for me to visit an ECDC and to meet the members of the team.

Kondwani collected me from The Leslie at 9am and we set off for the selected ECDC. We were soon driving along very rutted, unmetalled roads through busy villages:

Eventually we arrived at a junction and Kondwani called a colleague for directions – we were to take the left fork.

Finally we arrived at a very steep incline which put the 4×4 Ford Explorer pickup through its paces …

… before arriving at our destination, Kachumbe Community Based Childcare Centre (CBCC):

CBCCs are buildings that are used as pre-school facilities and as feeding stations for children between 3 and 5 years old. This particular building that we were visiting is also used in the afternoons to deliver classes to older children.

As soon as we arrived, and out of courtesy, Kondwani introduced me to the headteacher. Whilst I was there, he enquired about delivery of oral health education messages to the children, but we were told that none are provided.

Whilst the team worked hard with pre-testing of the data collection tool, I was allowed to wander and observe activities. This was a wonderful opportunity for me to gain a feel for what may be possible in terms of oral health interventions in such environments. Around the site, Kondwani’s team members were busy collecting information from those who work at the CBCC …

… and making observations on the facilities available relevant to sanitation and hygiene:

Each element of data collection was repeated independently by two team members to check for inter-observer consistency of responses and observations, which would be assessed in the afternoon when the team reviewed the data.

I was standing in the shade of the verandah when suddenly there was an outpouring of childrens’ voices – meal time was close and the children were running out through the back door to a handwashing station.

I ran around to the rear of the classroom and saw the children clustered together under supervision of two of the staff members – this was the handwashing station:

As the children finished their handwashing, they skipped and ran back into the classroom to wait for their porridge;

Once the last two children had completed the handwashing …

… the children all sat on the floor of the classroom and tucked into the food they were served:

The feeding component of the work of CBCCs is a critically important part of their activities. There is significant hunger in many parts of Malawi and receiving at least one good meal per day makes a tremendous difference to both the children and their parents.

The food is prepared in a small kitchen behind the classroom:

There was a team of ladies who prepared and served the food and who cleaned all the utensils and dishes after the food had been served.

There was no soap available for either the handwashing or the cleaning of the cooking utensils, dishes and spoons. Kondwani explained that the village community was dependent on NGO supplies and that when soap was available it was often prioritised for washing clothes.

As our visit came towards a close, I went inside the classroom …

… specifically to check whether there would be a secure space in which we could store toothbrushes and toothpaste if we were to consider the feasibility of a supervised toothbrushing programme in facilities like this CBCC. I was very pleased to be shown two lockable cupboards:

This visit left a very deep impression on me. The outward happiness of the children at play and receiving food in very basic surroundings was heartwarming. The dedication of the teachers and staff involved was also inspiring.

I left with the feeling that there was definitely a potential opportunity to include an oral hygiene element into the daily routine, which would complement the handwashing and nutrition programmes already in place. With the support of colleagues like Kondwani, Tracy and Maria we look forward to the next steps in our mission to integrate oral health interventions with the WASH and nutrition sectors as part of the proposed National Child Oral Health Improvement Programme for Malawi.

Chig Amin, who runs a dental practice in Surrey, has provided dental care for Ruthie Markus, CEO of AMECA, for many years. As explained at the end of the previous post, he had travelled with me from the UK to Malawi to gain an insight into the work of AMECA and to see some of the activities underway on the MalDent Project.

We were staying at The Leslie, a beautiful lodge close to Kamuzu University of Health Sciences (KUHeS). On arrival, we relaxed on the khonde and in the evening had dinner with Ruthie, Dr. Peter Chimimba (MalDent Project Malawian Lead) and Mr. Nelson Nyoloka (Lecturer in Pharmacy) before turning in early after the 24 hour journey from the UK.

The next day, after breakfast, Chig and I headed to the main campus of KUHeS.

We met with Dr Peter Chimimba and Dr James Mchenga (Acting Head of the Bachelor of Dental Surgery [BDS] degree course) before driving to the Dental Department at the Queen Elizabeth Hospital, where the BDS 5 students were working.

James and Peter showed Chig around the dental facility, including the recently re-painted surgery for children:

Chig also had an opportunity to speak with some of the BDS 5 students during his visit:

We left the Dental Department…

… and took Chig to show him the site where the new dental clinical teaching facility and student hub will be built …

Our next stop was in the Pharmacy Department where we met with my good friend Nelson Nyoloka and two of his BSc students, Roadwell Kapela and Churchill Henry Mwamwatembe. These two students are undertaking a research project that will measure the concentration of fluoride in toothpastes that are sold in Malawian markets, such as the following:

In addition to hearing about the methods that are under consideration for their laboratory work, Chig, Peter and I were able to provide some dental context to the project that Roadwell and Churchill are doing under Nelson’s supervision.

I was keen that Chig be shown some of the private dental clinics in Blantyre. Accordingly, following our meeting with Nelson and his team, James drove Chig and I to the Seventh Day Adventist Hospital Dental Clinic.

We were shown around this state of the art facility by the senior dentist, Dr Jesse Agra, who runs the clinic with his wife, Sheila.

James also took us on a tour of the Seventh Day Adventist Hospital situated directly behind the Dental Clinic.

Our next stop was at the dental clinic owned and run by Dr Shabana Yusuf:

Shabana is a graduate of Kings College, London and provides general dentistry but has a special interest in orthodontics. She has enhanced her skills in orthodontics through undertaking further training, both on-line and in-person in the UK. It became clear through discussion that Chig and Shabana had previously worked in clinics in the UK that were situated very close together and had possibly even referred patients to one another – what a small dental world we operate in!

Shabana is involved in teaching the BDS students at KUHeS, focusing on orthodontics. Regular readers of the blog will recall that she played a major role in the recent welcoming event for the new BDS students entering the Foundation Year.

‘Dental Chic’ is a beautiful practice. Patients and other visitors are first greeted by Chikondi, the receptionist:

The surgery was very well equipped …

… and the practice tastefully decorated:

We look forward to continuing collaboration with Shabana as the BDS course develops.

We drove from Shabana’s practice back to the KUHeS campus and met with one of the librarians who showed us some of the dental text books that had been purchased with the Scottish Government MalDent Project grant. Some of the books had been sent to the KUHeS Library at the Lilongwe Campus, to provide access for the BDS 3 and 4 students who are currently based there.

Chig and I then headed to Mijn Kitchen, a restaurant near to the KUHeS campus, where we enjoyed lunch in the beautiful gardens attached to the property. The sign on the restaurant counter seemed very apt for a couple of dentists:

On the Friday morning we set out with Ruthie for Majete Wildlife Reserve. It was very hot and sunny with beautiful views out over the escarpment. The road took us down to the River Shire where we stopped to stretch our legs. A local trader tried hard to sell Ruthie a live chicken …

… before Chig took a selfie of us, with the river in the background:

After about 90 minutes of driving from Blantyre we reached the large sign heralding the entrance to Majete Wildlife Reserve:

From the sign we drove along an unmetalled road to Thawale Lodge, which would be our base for the next 24 hours.

We were given a short history of African Parks, the organisation which manages Majete, along with many other reserves throughout Africa. We were then shown to our individual tents …

… where we left our bags before returning to the main lodge building for lunch. Whilst we were relaxing there one of the guides, Samuel, appeared. Samuel is a friend of Ruthie’s and they enjoyed a chat whilst Chig and I sipped our coffee.

Before lunch was served we enjoyed an amazing spectacle. Initially, one of the other guests spotted a small number of buffalo in the distance. They were walking towards the watering hole that is situated immediately in front of the balcony at Thawale Lodge. Slowly the initial group turned into a massive line of buffalo all walking in file towards us. Ultimately a herd of at least 200 buffalo arrived to drink, directly in front of us. It was quite a sight!

We enjoyed a delicious lunch and then relaxed until the game drive that was scheduled for 4pm.

We were well rested when Samuel called us at 4pm and we headed out to our safari vehicle, a converted Toyota Land Cruiser.

Samuel was soon driving us along dusty roads in the bush:

As we travelled, Samuel pointed out various flora and fauna. At one point we went up into a hide and saw lions in the distance, together with a variety of animals at a watering hole close by:

Sunset arrives quite early in Malawi and as it came closer Samuel parked the Land Cruiser beside the river …

… and prepared a picnic table for sundowners:

The sunset itself was glorious, throwing the trees and vehicle into silhouette against a fiery backdrop:

On arrival back at Thawale Lodge we had dinner and then retired to our tents. A strong wind had developed during the evening which had my mosquito net billowing! We were up early in time for a morning game drive which commenced at 6am. Once again, Samuel was our guide and he was soon pointing out footprints of specific animals:

As the drive progressed, Samuel was convinced there were elephants in the vicinity. He followed a variety of signs, including chewed branches and footprints, until his persistence paid off and there were elephants right in front of us.

As our drive was nearing a close, Samuel spied a couple of giraffes near a water hole, which rounded off our trip nicely.

It had been a real pleasure and privilege to see these magnificent animals at close range in their natural habitat. I also really enjoyed seeing the variety of shrubs and trees, especially the baobabs.

On return to Thawale Lodge we enjoyed a large cooked breakfast before heading off to a second nearby establishment called Ngona Lodge, on the bank of the River Shire. Much of the signage featured crocodiles, reflecting the large number of these reptiles in the river.

We enjoyed a drink together on arrival …

… before taking our bags to our rooms. We were all too full of Thawale Lodge breakfast to eat lunch, and spent the afternoon relaxing, some in the sun and pool, myself in the shade of the lodge itself. It is a beautiful place to chill in peace.

The following day the weather changed dramatically, becoming much colder, on account of a chiperoni. The weather in South Africa at the time was very cold, with snow in Johannesburg, and this was apparently a contributory factor. When the wind blows from south south east, clouds are forced to rise over Chiperoni mountain in Mozambique, bringing cold, rainy conditions to the Shire Highlands. This was especially evident as we drove back to Blantyre after breakfast. A very dense fog hung over the escarpment making the driving conditions extremely difficult for Ruthie. However, once we reached the outskirts of Blantyre the fog lifted, though the weather remained cool.

Chig and I spent the afternoon at The Leslie, and in the evening we were picked up by Ruthie to go to the Bombay Palace for dinner. We had a lovely meal, including the famous speciality, a rumali basket, as a starter.

On the Monday morning we were up early to attend a meeting with Dr Gift Kawalazira, the District Health Officer (DHO) for Blantyre. I had met Dr Kawalazira previously, but we had a great deal to update him about, including progress with the development of a dental clinic at Chilomoni – largely a result of efforts by Ruthie and AMECA – and our plans to establish a Child Oral Health Improvement Plan for Malawi. Dr Kawalazira had much useful advice for us and kindly agreed to arrange for me to meet some of his team later in my visit to Malawi.

We left the DHO’s office and headed to Chilomoni Health Centre, where a large amount of demolition and construction work was underway. AMECA is undertaking improvement works for both physiotherapy and maternity services at Chilomoni Health Centre, as well as funding the building works required to set up the new dental clinic.

First, we visited the recently completed physiotherapy unit, where patients are already receiving treatment.

The decor is really beautiful and a variety of items of equipment have been made locally to support the work of the physiotherapists employed there:

Peter Chimimba had now joined us for the visit and we were amazed at the transformation of the space into a bright, airy and functional physiotherapy unit:

We next moved on to the maternity unit, which is undergoing a massive redesign and renovation. Jan Sonke, the architect, had now arrived and the head of the construction company, Mr Mbewe, was also present.

The inside of the building was largely reduced to a shell prior to the new interior being built:

Whilst discussions continued inside the maternity unit with one of the senior nurses, Chig, Wisdom and I enjoyed a dental conversation outside:

We next moved to the space that has been identified to establish a new dental clinic. Jan Sonke explained the plan and there followed a series of discussions over some of the finer detail. It was especially valuable that Chig was present, since his technical knowledge, based on years of developing and running a dental practice in the UK, allowed us to make some well informed, final decisions on the project plans.

This is the space as it looks currently:

Watch out for later blogs that will show the transformation that is to come.

Chig was keen to see the original small room that is still being used by Wisdom as his surgery, including the Belmont dental chair that has never been properly installed:

After leaving Chilomoni Health Centre, we headed to Caffe Grazia, both for some lunch but also for Chig to see the shop which has many beautiful Malawian memorabilia for sale. Whilst there, friends of Ruthie’s from Amsterdam appeared, and shared lunch with us:

We spent the afternoon at Ruthie’s house and then at 6pm were joined by Ruthie’s friend Saira, who had prepared an oxtail stew which was really tasty, served with a variety of vegetables.

Chig was due to leave for the UK in the early afternoon of the Tuesday. After breakfast, once he had checked out of The Leslie, Ruthie drove us to the AMECA Clinic at Chilaweni. I have written about this amazing place before. Chig was given a full tour of the facility and was very impressed with all he saw.

Ruthie had kindly arranged for the Group Village Headman, Chief Makwelani, to meet us. Once we had finished the tour of the clinic, we went on a walk through Chilaweni village with the Chief. He showed us the remains of a bridge which had been largely washed away during Cyclone Freddy, causing significant logistical challenges for those villagers on the other side of the river, who are cut off during the rainy season. It is also a major problem for ambulance access to the AMECA Clinic during the rainy season, when the alternative access road is impassable on account of its steep gradients and unmetalled surface.

We spoke to Chief Makwelani about the work we have planned to examine ways of improving child oral health through working with schools and he was keen that we consider Chilaweni when we are ready to start the pilot studies.

Sadly it was finally time to drop Chig at Chileka Airport to catch his flight to Johannesburg. It had been a wonderful few days for Ruthie and I, sharing our various Malawian activities with Chig. Thanks to Chig’s interest and enthusiasm we have some ideas to take forward, but they are for a future post!

Acknowledgement

Some of the photographs in this post were taken by Ruthie and Chig, to whom due acknowledgement is given.