We were subsequently contacted by Dr Emma Thomson, the Director of the College of Medicine Education and Training Office, to ask whether we had any experience of delivering clinical examinations using on-line platforms. At Glasgow Dental School we have been very fortunate that a small team of academic staff has perfected a method for running Virtual Objective Structured Clinical Examinations (VOSCEs) via the on-line platform Zoom.
Recently my three colleagues James Donn, Alun Scott and Craig Mather delivered an excellent presentation for Emma, which demonstrated the methods they have developed. In addition to the VOSCE format, they also gave a demonstration of how the same on-line platform has been used recently to run the Case Presentation examination for our Fourth Year BDS students.
The presentation was recorded and the video file made available to Emma so that she can share it with Prof Nyengo Mkandawire, the Dean of Medicine, and with other interested colleagues in Malawi.
Sharing ideas and novel methods for teaching and assessment during the COVID-19 era are an essential part of life for all higher education institutions. The potential for delivery of on-line examinations also provides added value to the investment made by Scottish Government in the purchase of the digital devices. A great example of collaboration and innovation!
The National Oral Health Policy Workshop held in Lilongwe last February resulted in the establishment of a task force to take the policy development work forward under the aegis of the Ministry of Health and Population (MoHP).
After the workshop, the Ministry drafted Terms of Reference for the task force, but by March we were being challenged both in Malawi and the UK by COVID-19. Inevitably this placed significant pressures on all parties to manage the pandemic, resulting in some delay, but on Thursday 27th August the first meeting of the task force was held via Zoom, chaired by Dr Nedson Fosiko, Deputy Director of Clinical Services in the MoHP.
The main purposes of the meeting were to confirm acceptance of the Terms of Reference and then to map the way forward for developing the policy.
Brian Chaima, from the Policy Development Unit, Department of Planning & Policy Development at the MoHP, took us through a brief presentation on the standard process used for policy development by the Malawi Government.
The initial step is to develop a concept paper:
Much of the content required to create a concept paper was covered at the Policy Workshop in February and this stage will be relatively straightforward.
Once the concept note has been approved by the Principal Secretary, the next stage is to develop a Policy Analysis Document (PAD):
This phase of the process requires a situation analysis. One element will be a rapid review of relevant literature, which Lorna Macpherson and I have agreed to lead on, with involvement of Ronald Manjomo. We will also create a list of key questions relating to the local environment e.g. up to date statistics for the oral health workforce in Malawi. This will involve consultation with a wide range of stakeholders and we will work closely with Peter Chimimba and Wiston Mukiwa on this part of the programme.
On the basis of the situation analysis, policy options will be generated, followed by a process of policy impact assessment:
Ultimately a recommended option will be generated together with an accompanying implementation plan:
Finally, the Policy Framework Document will be developed, for review and approval by senior Ministry and Government officials up to the level of the Cabinet:
This is a complex and ordered process, but being led by Nedson Fosiko and Brian Chaima from the Ministry of Health & Population will ensure we keep on track. A series of regular meetings is now being scheduled to ensure we also keep to time!
The COVID-19 lockdown has affected all areas of our lives. The impact on higher and further education has been no exception. In the UK and many other high income countries the availability of internet based platforms such as Zoom has played a major role in helping to mitigate the cessation of face to face teaching on campuses. In the Dental School at Glasgow we were able to rapidly transition to on-line teaching and assessment methods which allowed us to complete the 2019/2020 academic session for all of our students in May / June 2020. The steep learning curve for both staff and students was challenging, and it is remarkable what has been achieved.
Whilst it may have been challenging we were fortunate to have access to the necessary digital technologies. Sadly, the same cannot be said for many low- and middle-income countries. At the University of Malawi College of Medicine the campuses were closed to students from the middle of March 2020, with no delivery of undergraduate teaching since then and no assessments undertaken.
There have been two major challenges. One of these is the wide geographic variation in WiFi availability within Malawi. Many of the students have gone home to their villages in rural areas and are without readily accessible WiFi. Purchase of data bundles is relatively expensive and beyond the means of many students. The second major challenge is that many students do not have access to suitable digital devices on which to download teaching materials and undertake their studies. It would be very unfair for any university or college to deliver on-line teaching if some of the students were unable to access it, merely adding to inequalities within the student body.
The College of Medicine identified that 267 of its 1076 students did not have access to suitable digital devices for on-line teaching. In mid-June it therefore launched an appeal called #267forCOM to “bridge the digital divide”.
This digital access issue and appeal were of immediate relevance to the MalDent Project. The students on the BDS 1 course, which had commenced in August 2019, were severely affected along with all the other undergraduate programmes, including the foundation course which also included students keen to join the next cohort of dental students. However, regardless of their course of study, this challenge of digital access was impacting all students across the College of Medicine, and required an urgent partnership response.
We set up a Zoom meeting with Dr Mwapatsa Mipando, Principal of the College of Medicine and Dr Emma Thomson who leads the College of Medicine Education & Training Office, to consider possibilities. A number of options were discussed including fund-raising in the UK, an approach to the Turing Trust by Shaenna and an approach by myself to the Scottish Government to enquire whether some re-purposing of a small amount of the MalDent Project budget may be possible.
It soon became clear that fund-raising would be too slow to provide the urgent support needed to bring teaching back on track. Shaenna had a very productive discussion with the Turing Trust which raised the possibility of purchasing, at low cost, up to 50 laptop computers from a consignment which, at the time, was in a container en route to Malawi and bound for distribution to schools via their partnership organisation the Centre for Youth and Development.
For my part, I worked with Deirdre Kelliher, our MalDent Grant Manager, and identified that in the 2020/2021 budget estimate we had costed in £20K for ‘Flying Faculty’ teaching which would not be used because of the travel restrictions, which are anticipated to be in force until at least 31 March 2021. However, much of that education and instruction could be delivered in a modified way by the ‘Flying Faculty’ volunteers if all the students had access to on-line teaching. Accordingly, we prepared a short briefing paper which was followed up by a very positive Skype call with the Scottish Government International Development Team. Our request was to re-purpose the £20k towards purchase of 100 suitable digital devices, as a contribution to the #267forCOM appeal. It was agreed that this request would be taken to the Minister for International Development, Ms Jenny Gilruth MSP.
I was delighted when we were informed recently that our request to re-profile the £20K towards the purchase of digital devices had been approved. What I had not been prepared for, nor was expecting, was the offer of additional funding from the Scottish Government of up to £33K to support purchase of 230 of the digital devices required. I was completely overwhelmed by this generous response, the impact of which will be immense.
Through their own local fund-raising, the College of Medicine had sufficient monies to cover the cost of an additional 37 devices. The following photograph shows the Principal receiving MWK 6,000,000 (approximately £6000) from one of its supporters, NICO Holdings plc, which is helping with purchase of devices.
Reaching this milestone, which now enables purchase of the 267 devices required to satisfy the #267for COM appeal, in effect unlocks the delivery of on-line learning and, potentially, assessment for 1076 healthcare students in Malawi. It represents a massive step forward and will have a lasting impact even beyond the COVID-19 pandemic.
Following the award of this additional funding, Malawi’s Public Procurement and Disposal Authority (PPDA) allowed the University of Malawi College of Medicine to use an emergency but transparent procurement process. The advert was floated on the PPDA website and two companies tendered their bids. Subsequently the College’s Internal Procurement and Disposal Committee met to identify the preferred bidder and it is anticipated that the devices will be delivered within a matter of days.
The other piece of the jigsaw is the access to affordable data bundles and there has been success on this front too. The Principal, DrMipando, has been interacting with the Malawi Government and with telecommunications companies to identify a way forward.
Through negotiations involving the Malawi Government and Telekoms Network Malawi (TNM), Dr Mipando has secured a reduced rate on data bundles, which the College of Medicine will purchase on behalf of the students.
For the MalDent Project, there is relief and excitement that we can now move forward with delivery of on-line learning and once more engage fully with the students on the BDS and foundation programmes. However, on a much broader scale this outcome provides the opportunity for all the students at the College of Medicine to revert to their studies and, we hope, obviate the need for them all to face lengthy extensions to their degree programmes. The generosity of the Scottish Government and Malawian sponsors in facilitating this major step forward will have a lasting impact on the lives of many young healthcare workers and, ultimately, the patients they look after, for many years to come.
The last word should come from Dr Mwapatsa Mipando, Principal of the University of Malawi College of Medicine, who established the #267for COM appeal and has worked tirelessly to see it succeed:
“ As a Principal of COM and as a Malawian, I am thankful for the support that we have received from Scottish People, our local companies and our alumni. This support will allow us to purchase Tablets for all our needy students. This is really the spirit of UBUTHU!! This UBUTHU has surmounted the digital divide that was amongst our students. The cherry on top, is the partnership that the COM has entered with Telekom Networks Malawi PLC (TNM) resulting in the College providing 10Gbs of internet data every month to every student. COM is a trailblazer in Malawi through the above support and we hope to release more health care workers into our already overstretched health system!”
At the recent Zoom meeting of the design team for the new dental teaching facility / student hub building on the Blantyre campus of the University of Malawi College of Medicine, it was agreed that a visit to Glasgow Dental Hospital & School could provide useful contextualisation for the architects and engineers involved.
On Thursday 30th July, Niall Rogerson and I were delighted to host a visit by Paul East and Sophie Burgess, from John McAslan + Partners, together with Sam Haston from Buro Happold. We are very grateful to Andy Hamilton, the NHS Greater Glasgow & Clyde Dental Hospital Estates Manager, who kindly accompanied us for the whole duration of the visit.
We spent the first 45 minutes in a socially distanced face-to-face meeting, which set the scene for the subsequent walk round.
One of the main issues which was discussed related to ventilation and air changes in the clinical teaching areas. Dentistry as a profession is currently suffering badly because many of the procedures undertaken involve use of instruments, such as high speed handpieces, which generate aerosols. In the COVID-19 era this poses wicked problems in relation to safety of patients, staff and students. Additional infection control procedures are required, for example fallow times in surgeries between patients who have been treated with aerosol generating procedures (AGPs) to allow sufficient air changes to dilute aerosol particles, and the use of additional personal protective equipment (PPE). The problem is even greater in many dental schools because the students undertake patient treatment in open-plan multi-chair clinics, to allow close supervision by clinical tutors. Control and management of aerosols in such spaces is very difficult.
The timing of the MalDent Project building design project will allow us to develop and build in features which will help to overcome these challenges around air-flow and ventilation.
The design team members were able to visit all the key elements of a dental school building and learnt a significant amount from Andy about some of the specialised technical aspects linked to dental equipment and associated infrastructure. Andy has kindly provided his contact details to the design team members so that they can liaise with him directly as necessary – another willing partner is welcomed into the MalDent Project team!
As reported in an earlier post, the contract to design the new student hub and clinical dental teaching facility at the University of Malawi College of Medicine Blantyre campus was awarded to a consortium led by John McAslan + Partners.
The first meeting of the project team was held on Friday 17th July by Zoom.
This initial meeting, chaired by Paul East, established administrative, working and communication methods.
A variety of surveys are required in the early stages of the programme. Quotations for a topographical survey and geotechnical site investigations are currently awaited and a number of other items of information are being sought, as outlined in the following screenshot.
It was exciting to see a plan of the College of Medicine site with a cross hatched area which identifies where the new building is to be sited – suddenly this part of the project is coming alive!
Lines of external communication have been set up through John McAslan + Partners, the University of Malawi College of Medicine Communications Team and the University of Glasgow Communications Office. An initial press release has been drafted for distribution to media outlets in Malawi and Scotland.
Weekly meetings will be scheduled for the foreseeable future as the work to develop the design brief and the subsequent stages of the project progress. We will keep readers updated!
One element of our successful MalDent grant application to the Scottish Government was to appoint a PhD student to collaborate with us on the work stream to develop a model programme for prevention of dental disease in children that would be applicable in Malawi. Subsequently, this element of the project has received a major boost with additional funding of $75,000 from the Borrow Foundation.
The PhD studentship was advertised in 2019 and interviews for the short-listed candidates took place by Zoom on 19th December 2019. Professor Lorna Macpherson and I took part from Glasgow and the process was chaired by the Dean for Postgraduate Studies at the College of Medicine, Dr Fanuel Lampiao.
Following the interviews, we identified Ronald Manjomo as the preferred candidate, and he was duly recommended to the Vice-Chancellor for approval .
We are very excited about Ronald’s appointment, as his skills and experience fit very well with the work that is required for this oral health improvement project. Ronald graduated with a Bachelor of Social Science degree from the University of Malawi, Chancellor College in 2010. He majored in sociology, economics and psychology, and completed a dissertation entitled ‘Assessing the socio-economic impacts of a resettlement scheme on a local community in Machinga District’ as part of his course-work. From 2012 he worked for the Baobab Health Trust and in 2018 completed his Master of Public Health degree at the University of Malawi College of Medicine. His MPH project was entitled ‘Assessing the integrated management of non communicable diseases at Area 25 Urban Health Centre in Lilongwe, Malawi: experience from a human resources limited setting’.
Lorna Macpherson and I were able to meet Ronald in person when we visited Lilongwe in February this year for the National Oral Health Policy Workshop. We were joined by James Mchenga, the Academic Head of Dentistry at the College of Medicine, and enjoyed a very productive discussion.
The various administrative procedures that have been necessary for Ronald to take up his studentship have now been completed and on Monday 13th July we held the first Zoom meeting with Ronald and his supervisory team. Professor Ken Maleta, who is Professor of Public Health at the College of Medicine School of Public Health & Family Medicine, is the Lead Supervisor in Malawi and Professor Lorna Macpherson will co-supervise from the Community Oral Health Research Group at Glasgow Dental School. Dr James Mchenga will provide the academic link to Dentistry within the Faculty of Medicine. Other academic colleagues will link into the project as it develops.
Many thanks are due to the Scottish Government and to the Borrow Foundation for the funding that supports the studentship to which Ronald has been appointed. The work to develop a dental caries prevention programme for children in Malawi is a crucial strand of the MalDent Project. We look forward to working closely with Ronald and with the other stakeholders, including the Ministry of Health & Population and WHO Africa, in this project to develop a sustainable prevention model based upon the principles of Scotland’s successful Childsmile programme.
It is nearly three months since I published a post on our MalDent blog. The COVID-19 situation has inevitably impacted on progress with some aspects of the project, including the shipping of equipment from Dentaid HQ to Lilongwe for Phase 2 of the KCH Dental Department refurbishment.
All students at the College of Medicine, including the BDS students, have been off campus since late March and plans are in place to commence delivery of some teaching on-line. However, this is challenging because many students do not have access to WiFi in their homes or, in many cases, availability of suitable computers, tablets or phones. There has been regular contact between the CoM and University of Glasgow in order to find ways in which we can provide support and this partnership work is continuing.
Nevertheless, there has been significant activity in other areas. During April, we completed all of the documentation for the End of Year 2 reporting to Scottish Government. This was a large piece of work, which included the generation of a COVID-19 risk assessment. The latter was a valuable exercise and we are very fortunate that there are two major strands of work which can continue over the next few months, despite the lockdown and travel restrictions:
1. Drafting of the National Oral Health Policy
Following the very successful workshop in Lilongwe on 13th and 14th February 2020, the Terms of Reference and task force have both been agreed and we can work on development of the policy document through digital communication and video conferencing.
2. RIBA phases 1 and 2 of the design of the dental teaching facility and student hub on the Blantyre campus of CoM
Following the very successful design workshop held in Blantyre in September 2019, a schedule of accommodation was created, together with a cost estimate. This in turn informed documentation that was created with support from the University of Glasgow Procurement Office to allow us to tender for a design team via the Public Contracts Scotland portal. Bids were received and assessed formally according to standard procedures, including interviews that were held on-line. Grateful thanks are due to Gillian Ray from the University of Glasgow Procurement Office for her expert and cheerful support throughout the process.
I am delighted to announce that the contract has been awarded to John McAslan & Partners, working in a consortium with Studio KAP, Buro Happold, David Narro Associates and Quant Consult Associates.
This is a massive step forward for the MalDent Project and very exciting. John McAslan + Partners is an award-winning international architectural practice, with headquarters in London but further studios in Edinburgh and Sydney. It has an extensive portfolio of projects in the UK and overseas including education, cultural, hospitality, commercial infrastructure, residential, urban design, heritage and landscape sectors.
John McAslan + Partners has a long-term commitment to volunteering in Africa and in Malawi in particular. This has included work with the Clinton Global Initiative, Malawi Ministry of Education and The Hunter Foundation on the Malawi Schools Programme. The requirements for those school buildings were very similar to those for the new building on the Blantyre campus:
An inclusive design, which would welcome parent engagement
Extended schools that would enable the community to use the buildings beyond school hours for other activities eg adult learning
Embedding of the school buildings within the community
Teaching spaces that would allow students to learn in different forms – group work, individual work, activity-based work – otherwise known as transformational learning environments.
The design incorporated features that improved the quality of light in the buildings and their environmental performance, at a very competitive cost.
An outstanding example of the work of John McAslan + Partners which will be known to many who travel from London to the North-East of England and Scotland by train is the beautiful transformation of Kings Cross station that was unveiled in 2012.
The design work for the MalDent Project will be delivered by the Edinburgh Studio, which consists of four RIAS Chartered Architects and three technologists, headed up by the studio lead, Paul East.
This Glasgow based architectural practice is known for innovative, award-winning human scale designs which are built with a high degree of craftsmanship. Their work has been published internationally and is characterised by a strong empathy for physical and cultural settings and a design process which involves clients in a collaborative role in shaping each project. They have long-standing research and practice relationships in low income countries in the Global South, particularly in their ongoing collaboration with Abba architects in Ethiopia.
Quant Consult Associates
This Project Management and Chartered Quantity Surveying Firm, was registered in 2000 by Joseph Malingamoyo and the late Morrison Alfred Sulumba. Since 2011, Yvonne Sulumba-Phiri is Partner Designate. The strength of the firm lies in the collective experience of the partners and members of staff who have held various positions, responsibilities and portfolios in Central Government, Local Government and Private Sector both in Malawi and abroad. Since its inception in 2000, the firm has undertaken a number of challenging commissions, including a notable positive contribution in the tertiary education sector and in particular for the University of Malawi College of Medicine campus.
This practice of Consulting Structural Civil Engineers, with offices in Edinburgh, Glasgow, Forres and Stirling, was established in 1986. The practice has considerable experience in the design of education and research buildings for private, public and university sectors and has a long association with a number of clients in this field. This project will be delivered from their Glasgow Office, where they have 12 Chartered Engineers.
This international, integrated consultancy of engineers, consultants and advisers operates in 24 locations worldwide, with over 1,900 employees. Sustainability is intrinsic to the economic and social impact of their work. They always strive to deliver solutions with a sense of economy for our planet and its resources. This project will be delivered from their Edinburgh office, where they have 23 MEP Engineers.
This carefully chosen consortium, with tremendous experience of working in the Global South, can now start on the next exciting stage of the journey to deliver not only the infrastructure required for the clinical teaching of dental students on the Blantyre campus, but also a student hub that will offer great benefits for all staff and students on the campus as well as the local community. As part of their bid for the project, the consortium provided an early impression of how the facility may look:
Suddenly this important strand of the MalDent Project is coming alive – exciting times ahead!
Acknowledgement: Thanks to Paul East, Associate at John McAslan + Partners, for the final image in this post.
Previous posts have described the first phase of the refurbishment of the Dental Department at Kamuzu Central Hospital, which was completed in May 2019. We recognised then that there was further work still required and we have since been planning Phase 2. This has entailed collection of more donated equipment, both by the Dentaid team and the Glasgow Dental School team, work which has also been reported previously.
By the Autumn of 2019, much of the equipment required had been identified and we began to plan the logistics of transportation of the kit to Malawi, followed by its installation. Rather than renting a shipping container, we decided to purchase one. The container will subsequently be installed in the grounds of the College of Medicine campus in Lilongwe, where it can act as a storage facility for dental equipment / materials for the MalDent Project and to support the work of our partner charities Smileawi, Bridge2Aid and Dentaid.
The costs associated with the container purchase, shipping, equipment servicing and installation were significant, and not part of our main MalDent Project grant. We therefore made applications to both the Scottish Government and the Royal College of Physicians & Surgeons of Glasgow HOPE Foundation for financial assistance.
We are delighted and very grateful to both organisations for the financial support they have made available. This funding has supported all components of Phase 2 of the KCH Dental Department refurbishment.
On 3rd February 2020, our container arrived at the Dentaid Headquarters in Southampton. This was not just any container – it was now ‘our container’, which will continue to serve a valuable role long after the consignment reaches Malawi, once it is installed as a storage facility in Lilongwe.
Once the truck was in position, it was time for the container to be unloaded into its new temporary space in the Dentaid Headquarters yard.
The operation proceeded without a hitch and the container was soon in situ, ready for its next consignment of materials and equipment for Lilongwe.
Dentaid’s fantastic team of volunteers has been busy identifying and preparing the items to be packed into the container. These range from small pieces of equipment …
… to the large items which still require servicing and checks before dispatch.
Dr James Mchenga, Academic Head of the BDS programme at the College of Medicine, had sent some lists of equipment that he needed to procure as he establishes an oral surgery service at the Dental Department of the Queen Elizabeth Hospital in Blantyre
Dentaid has extensive stocks of donated instruments, a small selection of which can be seen on these demonstration mounts:
As a result, many of the items requested by James will find their way into the container as part of the consignment of dental items and equipment.
The packing of the container began immediately after it arrived:
Our plan had been to arrange for uplift of the filled container in late March / early April, followed by a one-week visit for the installation in June 2020. However, these scheduled activities have had to be put on hold because of the COVID-19 lockdown in the UK. As I write this piece, Malawi is reporting four confirmed cases of SARS-CoV- 2 infection.
Clearly it is impossible to predict when we will be able to resume the work towards Phase 2 of the KCH Dental Department refurbishment, but all the ground-work is complete for when more normal operations can begin. In the meantime, the most important thing is for all of us to follow the rules of our respective governments and to ensure the safety of ourselves and those around us.
I would like to finish by reiterating the thanks of all those involved with the MalDent Project to the Scottish Government International Development team and to the Board of the Royal College of Physicians & Surgeons of Glasgow HOPE Foundation for their financial support of this equipment replacement project.
I would also like to thank the many volunteers who work with such commitment to deliver the equipment and dental instrumentation elements of Dentaid’s work – none of our re-equipping activity would be possible without them.
Thanks to Jill Harding, Communications Manager, Dentaid and to Stuart Bassham, Warehouse and Engineering Manager, Dentaid, for the photographs in this post.
On Tuesday 25th February, Dr Mwapatsa Mipando arrived back in Glasgow to attend the Capacity Strengthening in AfricaSymposium that was being hosted by the University of Glasgow on Friday 28th February. His early arrival allowed time for him to work with Prof Simon Guild on their Scottish Government funded project on academic governance which will support the establishment of the new Kamuzu University of Health Sciences.
On the first day of his visit, Dr Mipando was able to take a trip through to Edinburgh to meet with the newly appointed Minister for Europe and International Development, Ms Jenny Gilruth MSP.
On the Thursday, we were able to fit in a brief meeting between Dr Mipando and Ms Inas Ghonsol. Inas, who is from Libya, has recently completed her MSc in Oral Sciences at Glasgow Dental School and is now registered for a PhD. Her project will be directly linked to the MalDent Project and will examine aspects of professional governance, scope of practice and continuing professional education, as Malawi begins the task of building its own dental teams with dentists trained in country for the first time.
The symposium was opened on Friday 28th February by the Principal of the University of Glasgow, Professor Sir Anton Muscatelli:
Shortly before the symposium, the Principal of the University of Glasgow and Professor Ernest Aryeetey, the Secretary General of the African Research Universities Alliance (ARUA), had signed an MOU between the two organisations.
The first presentation was from Professor Adam Habib, who is the Vice-Chair of ARUA. This was a very thought-provoking lecture, addressing not only the importance of capacity strengthening in Africa but also the challenges and the need to re-think some of the ways in which we are working
The morning progressed with a series of excellent presentations, including input from Dr Mipando on developments at the University of Malawi College of Medicine.
In particular, he focused on the Blantyre-Blantyre Project and the progress that is being made in establishing a clinical laboratory facility on the College of Medicine campus in Blantyre, Malawi, for which the Scottish Government is a major donor:
In the afternoon there was a session of small group round-table discussions.
I joined the table that was chaired by Prof Ernest Aryeetey and Mr Ian Nicol, to consider the question: ‘How can governments and funders play a role in capacity strengthening and what are their responsibilities?’. We enjoyed a lively discussion and it was heartening that there was significant interest in the impact of the Scottish Government funding for the MalDent Project to improve oral health in Malawi.
Pamela Armstrong, University of Glasgow International Recruitment Manager for Africa, acted as rapporteur for our group:
After the meeting closed, there was a reception in the Hunterian Museum. It had been an excellent day and congratulations should go to Prof Paul Garside and Ms Rachel Sandison for organising the event.
Later that evening, I was able to introduce Dr Mipando to Ms Fatima Dantata. Fatima is from Nigeria and currently completing her MSc in Endodontics at Glasgow Dental School. She is keen to enrol for a PhD that will examine aspects of oral health policy in Malawi, including workforce modelling, clinical facilities and infrastructure.
This had been another very valuable visit to Glasgow for Dr Mipando. Progress was made on all three of the Scottish Government-funded projects at the University of Malawi College of Medicine and the conference had been a great success. As always, we look forward to his next visit.
On 11th February, my colleague and good friend Prof Lorna Macpherson and I set off for Malawi to participate in the National Oral Health Policy Workshop that was scheduled for Thursday 13th and Friday 14th February in Lilongwe. The component of the MalDent Project that is focusing on policy development and the establishment of a caries prevention programme for children is critical to success. We had been working for a number of months to plan the workshop, in partnership with the Malawi Government Ministry of Health, University of Malawi College of Medicine and the World Health Organisation.
We had a trouble-free journey and landed in Lilongwe in the early afternoon of Wednesday 12th February. Dr Peter Chimimba met us at the airport and we were soon checked in at the Sunbird Capital Hotel, our home for the next three days and also the venue for the workshop.
After a short rest and freshen-up, we caught up with Peter again and were subsequently joined by Dr Yuka Makino, the WHO Africa Technical Officer for Oral Health and Dr James Mchenga, the Academic Lead for the BDS programme at the College of Medicine. Dr Makino had travelled from her office in Brazzaville, Republic of the Congo. We sat outside in the beautiful grounds of the hotel and worked through all the detail of the forthcoming workshop.
The following morning we were up early for breakfast and headed for the Viphya Suite where the workshop was being held. Many thanks are due to Annie Mwapasa and her colleagues for making all the arrangements and manning the reception desk.
The delegates soon began to arrive and we spent time making appropriate introductions between key players, as well as having opportunity to chat with colleagues.
It was a great honour that the Secretary for Health and Population, Dr Dan Namarika, attended the first part of the workshop.
Before the workshop commenced, Dr Namarika spent some time speaking with Yuka, Lorna, Peter and I, accompanied by Dr Nedson Fosiko, Deputy Director of Curative Services at the Ministry of Health.
Once the delegates were assembled, and following a prayer, the meeting began. The chairperson was Dr Kaponda Masiye, who is the Director of Planning and Policy Development at the Ministry of Health & Population. Dr Masiye trained initially as a dental therapist before studying medicine, so he has both a good understanding of, and interest in, oral health.
The first speaker was Dr Mwapatsa Mipando, Principal of the College of Medicine. He gave a brief overview of the recent developments and successes at the College before focusing on the MalDent Project and the subject matter of the workshop.
The World Health Organisation is a very important partner in the oral health policy development and we were delighted that Dr Kelias Msyamboza from the WHO Malawi Office attended the workshop. In his opening remarks he stressed the importance of implementation as well as development of policies.
We were next addressed by Dr Chithope-Mwale, the Director of Curative Services at the Ministry of Health & Population. He quoted the famous Bible passage from Ecclesiastes 3 – ‘A time for everything’ – and said that he felt that now was the time for progress to be made in the context of oral health in Malawi. He expressed his thanks to the College of Medicine for all that it does to support the Ministry of Health & Population.
Before we stopped for coffee it was the turn of the Secretary for Health & Population, Dr Dan Namarika, to address us. He stressed that a policy is ‘a document about people’ and how important it is to ensure that a policy, once created, actually impacts positively on the people for whom it is intended. The importance of embracing community health was highlighted and he announced that the President had determined that 9th October would become National Community Health Day. A key component of the National Health Policy is ‘prevention, prevention, prevention‘, and the Oral Health Policy must align with this principle. He spoke also of how data drives economies and how important it is to develop research within the area of oral health. The importance of cross-sectoral engagement involving, for example, education was a theme which also emerged in other presentations over the next two days.
There were many aspects of this presentation which fitted perfectly with the anticipated direction of travel for the forthcoming policy work.
There followed a coffee break during which a group photo was taken.
There were extensive discussions during the break, which provided an excellent opportunity for networking.
Dr Nedson Fosiko, Deputy Director of Curative Services, spoke next. He stressed that many of the Government Ministries are relevant to the health agenda. He also emphasised the point made previously, by Dr Namarika, that health information, ie data, is critical if healthcare services are to be planned effectively. Discussions later in the workshop demonstrated the need to enhance efficiency and accuracy of data collection procedures. Dr Fosiko also emphasised the importance of prevention of disease and of the ‘One Health’ concept.
Dr Yuka Makino, the WHO Africa Oral Health Technical Officer, delivered an excellent presentation on the WHO African Region Oral Health Strategy 2016-2025. She spoke of the severe dental workforce shortages in Africa and also the lack of data on oral health. Yuka pointed out that in the EU, 70% of dental care is funded by patients themselves – how could this work in lower income countries in Africa? A key theme was around Universal Health Coverage and the importance of community prevention initiatives, not just health service infrastructure. It is important to integrate oral health into general health coverage, including for example nutrition and smoking cessation. Similarly, oral health surveillance could be integrated into existing health information systems and ongoing NCD surveillance programmes. Importantly, people and communities, not just diseases, should be put at the centre of health systems.
Just before lunch, an additional presentation was added that had not been on the programme. The speaker was the Honourable Enock Phale, who is now a member of the Malawian Parliament but is a qualified dental therapist and former Oral Health Lead in the Ministry. I had met him in his former role during my first visit to Malawi in 2017 and it was lovely to meet up with him again. It transpires that he sits on the Parliamentary Health Committee, which is highly relevant to his dental background.
The Honorable Phale had already begun work on an Oral Health Policy document before he left the Ministry, and he took us quickly through the early draft. This document will be very helpful to us as we progress the strategy writing.
Before heading off to lunch I enjoyed a quick catch-up with the Honourable Phale. It was an immense honour and privilege to have a Member of Parliament at the workshop and we were very lucky to have been provided with a draft policy to kick-start our work.
Discussions continued over lunch before we headed back into the main conference room for the afternoon’s work.
Immediately after lunch we were given a very useful overview of the policy development process and public policy framework used by the ministries and Government in Malawi. This will provide a blueprint for the structure of the Oral Health Policy.
Dr Wiston Mukiwa then delivered a fascinating history of the evolution of dental health services in Malawi, as seen through the lens of his own experiences. This context for our work to develop an Oral Health Policy was extremely helpful.
The WHO NCD MAP Toolkit will be used in our work to develop the Oral Health Policy and move through to implementation. The toolkit was presented by Dr Kelias Msyamboza. He discussed the main steps of assessment, engagement, formulation, implementation and monitoring / evaluation.
Day 1 closed with small group discussions around two questions:
What are the opportunities for embedding oral health within the broader NCD and UHC agendas?
Who would be key partners in a multi-sectoral approach for developing an oral health policy in Malawi?
Each group fed back and the outcomes are being collated by Annie Mwapasa to inform the policy work moving forward:
Day 2 of the workshop was very colourful. Whilst I had turned up in my regulation business suit and tie, many of my Malawian friends were dressed in bright, colourful shirts – Friday is a ‘dress-down’ day! The Principal, Dr Mipando, has now offered to take me to meet his tailor so that I can enhance my wardrobe for future working Fridays!
The session began with a reflection on the proceedings of Day 1, delivered by Dr Janet Guta, Deputy Director for Clinical Services at the Ministry of Health & Population.
It was then the turn of Dr Masiye, who had been the workshop chair on Day 1, to talk about the NCD agenda in Malawi and how oral health could fit into the ongoing activities. In an excellent presentation he stressed the importance of community partnership and community empowerment, which are essential in any new policy. Dr Masiye also commented on the relatively small amount of funding available for the NCD agenda, despite the fact that these diseases now account for 30% of the disease burden in Malawi.
After Dr Masiye’s talk and a discussion led by Dr Fosiko, we broke again for coffee. We were delighted that on Day 2 of the workshop, Natasha Mwenda was able to join us from WaterAid Malawi. I had met Natasha in Edinburgh last year when she presented at a Malawi Cross Party Parliamentary Group meeting at Holyrood. Having embraced the importance of a cross-sectoral approach to improving oral health, it is critical that we consider water and sanitation. We look forward to collaborating with WaterAid as we develop the policy.
The morning session finished with an excellent presentation from Prof Lorna Macpherson, demonstrating how all the principles we had been talking about, including the WHO NCD MAP toolkit, had been applied in Scotland to establish the highly successful Childsmile model for prevention of dental caries in children. The high quality monitoring and evaluation that has been part of the overall process in Scotland has proven beyond doubt the effectiveness of the approach, which is now being introduced in multiple countries following completion of situational analyses to create models that are effective in each specific environment. The potential applicability in Malawi was plain to see.
The morning’s presentations stimulated additional discussion before we broke for lunch.
One of the novelties of this visit for me was the timing – I had never previously experienced Malawi in the rainy season. Whilst there were many bright periods, and it was constantly warm, the downpours of rain were impressive, even by Scottish standards! Here’s a short video-clip from lunch-time on Day 2:
After lunch, Lorna and I did a double act to update the delegates on overall progress with the MalDent Project and to show how the activities of this workshop were informing the policy and prevention aspects of the programme.
We then came to the climax of the workshop, which was to agree on the next steps. First, having agreed on the need for a task-force, we discussed the composition of that group. This was a lengthy debate, but finally agreement was reached, as follows (numbers in parentheses represent number of members):
Ministry of Health & Population (Clinical, Nutrition, Planning Nursing (1)
UoM College of Medicine (2)
Kamuzu College of Nursing (1)
University of Glasgow (2)
Regulatory bodies ((MCM, NCM, MPB) (1)
World Health Organisation (1)
Dental Association of Malawi (1)
It was further agreed that the Ministry would provide the Terms of Reference for the task-force, after which its work could begin.
These key decisions comprise just the outcome that was required to allow the policy development component of the MalDent Project to proceed.
Fittingly, it was Dr Fosiko, who has shown such great enthusiasm for the MalDent Project over recent months, who closed the workshop. This is what he said:
There was significant interest in the workshop from many of the national newspapers and broadcasters. You can read an article in the Nyasa Timeshere
This next photo, captured during one of the coffee breaks, is of two gentlemen who have worked tirelessly for over thirty years to enhance oral healthcare and, indeed, broader areas of healthcare in Malawi. Drs Wiston Mukiwa and Peter Chimimba have both held many senior roles in the Malawian health service, Ministry of Health, regulatory bodies and higher education institutions. One might think that by now they would be tired and their enthusiasm dulled, but not at all. They have amazing energy, commitment and a positivity which is remarkable and seemingly in endless supply – they are both an inspiration. The policy workshop that had just passed and been such a success was under-pinned in so many ways by these two outstanding professionals. We are so lucky to have them closely involved in the MalDent Project.
In the evening, following the end of the workshop, Lorna, Peter, James, Wiston and I enjoyed a celebratory meal with the Honourable Phale and two of the Dental School Assistant Lecturers, Drs Tasneem Chikwatu and Mirriam Chipinga. It was an excellent opportunity for me to speak at length with Tasneem and Mirriam, both of whom are very excited about their new roles.
We set out from the hotel in Lilongwe at 07.45 on the Saturday morning to drive to Blantyre. We stopped off en route at the famous Chikondi Stopover for a short rest and to buy some refreshments.
We reached Lilongwe by midday and after a quick bowl of soup we headed across to the College of Medicine campus, where we met a large number of the BDS 1 students and some of those on the Foundation Course. We enjoyed an interactive two hour session on dental public health, incorporating a lot of the material that had been covered during the workshop over the preceding two days. It is important that these pioneer dental students also feel part of the ongoing policy development, much of which will shape the oral healthcare environment into which they will emerge at the end of the BDS course.
We had a good rest on the Saturday evening. After breakfast on Sunday Lorna and I went for a walk around the city centre close to the hotel.
At 11am, Dr Chris Moxon came across to the hotel for a chat. Chris is a Clinical Senior Lecturer at the Wellcome Centre for Integrative Parasitology, University of Glasgow and an Honorary Consultant in Paediatric Infectious Diseases at the Royal Hospital for Children. His research focus is on cerebral malaria and he spends several months a year working in Malawi. We had a very enjoyable and wide-ranging discussion covering topics relevant to both our areas of interest.
Peter Chimimba’s wife, Frider, is a Lecturer in Pharmacology at the UoM College of Medicine. One of her young colleagues, Nelson Nyoloka, had applied to join the MSc in Clinical Pharmacology at the University of Glasgow and has been accepted. He will start the course in September 2020 and I had suggested that he should join Lorna and I for lunch at 12.30pm. We met in the hotel foyer and enjoyed a great time together for about an hour and a half. We provided lots of information about Glasgow and told us a lot about regulation of medicines and products such as toothpastes in Malawi – mutually useful! We look forward very much to welcoming Nelson to Glasgow in the Autumn.
Our visit was nearing an end but we had one more activity to look forward to – afternoon tea with the Principal at his home. Dr Mipando picked us up from the hotel at about 3.30pm and before driving to his house took us on a beautiful drive to the tea and coffee plantations just outside Blantyre. The undulating hills were covered in a sea of green tea plants, interspersed with trees – it was stunningly beautiful.
On reaching his house, Mwapatsa took us on a tour of the extensive garden that he and his wife, Linda, have established and continue to develop. They grow a myriad of fruits, vegetables and herbs, as well as flowers. We then retired to the patio for tea and to enjoy some avocado (known locally as ‘pear’) that had just been picked from the garden – it tasted fantastic. We are grateful to Mwapatsa and Linda for their kind hospitality – it was a lovely way to end our short visit to Malawi.
Mwapatsa drove us back to our hotel and we then had dinner with Peter Chimimba, before turning in early, ready for our journey home the next day.
The journey home was long (27 hours) and entailed four flights, but all were on time and there were no problems with connections or baggage.
Although this had been a short visit to Malawi, it had been immensely successful. The blue touch paper has now been lit to forge ahead with the policy work stream. Dr Fosiko finished his presentation on Day 1 with a slide that read “Let the game start”! I can’t think of a better way to close this post!
Acknowledgement: Many thanks to Gift Kayuni, UoM College of Medicine, for providing many of the photos in this post