This post has been written in conjunction with Wisdom Maiza and Ruthie Markus

One of the posts that I published whilst I was visiting Malawi recently related to our newly established partnership with the charity AMECA. Since then, we have been making significant progress with plans to develop an exemplar dental clinic in the health centre at Chilomoni, located in Blantyre District. Much of this progress has resulted from the enthusiasm of Ruthie Markus, the CEO of AMECA. Another key player in the plans is Wisdom Maiza, the dental therapist based at Chilomoni Health Centre, who had originally contacted Ruthie about the state of his surgery in November 2023, prompting her to contact the MalDent Project.

Whilst development of the physical infrastructure needed to deliver high quality dental care in Malawi is a priority, equally important are the oral health professionals who deliver that care. This post will introduce readers to Wisdom, who will no doubt be featuring in future posts as the Chilomoni Health Centre project progresses.

Wisdom, now 33 years old, was born in Mzimba District in the Northern Region of Malawi. It is the largest district in Malawi, with its western boundary lying along the Malawi-Zambia border. After leaving school, Wisdom trained for three years as a Dental Therapist at Malawi College of Health Sciences in Lilongwe, graduating in 2013. He undertook his internship in the Dental Department at Kamuzu Central Hospital (KCH) Lilongwe, gaining full registration with the Medical Council of Malawi in 2014. Wisdom then held a series of posts at Mzuzu Central Hospital, KCH, Queen Elizabeth Hospital in Blantyre, and health centres in Mzimba North, Dedza and Ntcheu, before joining Chilomoni Health Centre in 2015.

The population within the catchment area for Chilomoni Health Centre numbers approximately 63,000 and many suffer from dental problems. Wisdom estimates that he treats 350 – 400 patients per month. Because the donated dental chair is not installed, the only treatments Wisdom can currently provide are dental extractions and a few other procedures, including management of dental trauma and tongue tie, with patients seated on the wooden chair in his surgery. All treatments are recorded in a handwritten register and the patient numbers are reported back to the office of the District Health Officer.

A typical day for Wisdom begins when his alarm sounds at 4am. He leaves his home at 5.15am, arriving at Chilomoni Health Centre by 5.30am. 

When Wisdom arrives, patients are already waiting for him. Many of the patients travel long distances on foot to reach the clinic, some starting as early as 2am. One of the reasons for opening the clinic so early is to allow the patients to receive their treatment and still have time for their return journey home by foot before it is too late. Furthermore, many patients are unable to afford three meals a day and prefer to attend in the morning when they typically have a higher blood sugar. 

Wisdom finishes his morning clinic at about 11am and spends much of the remainder of the day performing his administrative role as the Dental Coordinator for Blantyre District. This involves a variety of activities including, for example, organizing supplies of drugs such as local anaesthetic solution, antibiotics, and analgesics, together with consumable items such as local anaesthetic needles. These items are often in short supply, leading to significant challenges for delivery of high-quality dental care.

The two things that Wisdom most likes about his job are working with children and reaching out to the poor. His long-term ambition is to work in a dental clinic where the rich pay for their treatment and the poor receive their dental care free of charge.

Wisdom has a list of changes that he would like to see implemented to enhance his professional role:

• A functional dental chair and surgery that would allow him to sit down to deliver dental treatment, including restorative dentistry, using all the clinical skills within his scope of practice, instead of being restricted to extractions.
• A reliable supply of drugs and consumables.
• An increased number of hand instruments to maximise treatment capacity. 
• A digital system for registration of patients.

Many of these points are covered in Malawi’s National Oral Health Policy, launched in April 2022. Wisdom was one of a group of dental health professionals from across Malawi who participated in a workshop in November 2022 to develop an action plan for implementation of the Oral Health Policy and he was one of the authors of the report that followed the meeting.

Since my visit to Malawi in February, an alternative much larger space has been identified that we can develop as an exemplar dental surgery. 

There is capacity for two dental chairs, a radiography facility and a local decontamination unit. Whilst a refurbishment of this space will not immediately satisfy all of Wisdom’s requirements, it will be a significant start.

Wisdom has a favourite saying:

We make a living by what we get,

But we make a life by what we give.

Sir Winston Churchill

That is a philosophy that AMECA and the MalDent Project can get behind and we look forward with excitement to establishing this exemplar dental clinic in collaboration with Dr Kawalazira the District Health Officer, Wisdom and the wider team.

As explained in an earlier post, whilst my Flying Faculty colleagues headed home to the UK via Addis Ababa, I took an Airlink flight to Johannesburg and then onwards to Cape Town, arriving at the Protea Hotel in Durbanville just before midnight on Saturday 24th February.

The main purpose of my visit was to spend some time with Cleopatra Matanhire, the Zimbabwean dentist whose subject area for the dissertation she wrote for her University of Glasgow Masters in Global Health degree was the MalDent Project work to establish a National Oral Health Policy for Malawi. Cleopatra is now registered for a PhD at the University of Western Cape Faculty of Dentistry, supervised by the Dean, Professor Veerasamy “Jeff’ Yengopal, with myself and Professor Chidzonga at the University of Zimbabwe Faculty of Medicine & Health Sciences as co-supervisors. Our official meeting was scheduled for the Monday morning.

This was my first ever visit to Cape Town and Mwapatsa Mipando, my close Malawian friend and colleague, had told me that I could not just stay in my hotel, but that I had to make sure I saw some of the sights during my short stay. On the Sunday morning I was working on a lecture I had been asked to deliver on the Tuesday when my phone rang. The caller was Khabiso Ramphoma, a Specialist in Community Dentistry at UWC, who had been asked by the Dean to organise my itinerary and check that all was going well with my visit. Khabiso had been alerted by Cleopatra to the fact that this was my first visit to Cape Town and she had very kindly arranged for another colleague, Stephen Sudi, to pick me up in his car and drive me around some of the sights.

Stephen, who was originally from Tanzania, had an encyclopaedic knowledge of Cape Town – and many other subjects as I realised during the course of the day. After he had picked me up we collected Cleopatra. Strangely enough this was the first time that Cleopatra and I had actually met in person, because her year in Glasgow was spent during COVID, when we were limited to on-line meetings!

Stephen took us all over the city and showed us some wonderful views:

Every weekend, Stephen and a group of his friends walk in the mountains surrounding Cape Town and he was able to point out many of the routes that they take, which were not for the faint-hearted!

One of the things that struck me was how the imposing and famous Table Mountain kept appearing from different angles as we drove around the city.

There were so many contrasts in the cityscape. One particularly attractive area was called Bo-Kaap, which is famous for its cobblestoned streets and very brightly coloured houses.

Towards the end of our tour Stephen took us to Haut Bay, which had a beautiful beach, mountains in the background and a bustling wharf.

This is a busy, working port and there were many fishing vessels tied up around the bay.

The seals realised they were onto a good thing, with plenty of fish on hand and visitors to feed them.

It was a beautiful spot which definitely called for a group photo!

Stephen explained that fish and chips at a restaurant on the wharf is very popular with the locals and that the traditional fish to choose is ‘snoek’ (pronounced ‘snook’).

We opted to buy two portions of snoek and chips and one of hake and chips, then shared them. The snoek has a large number of bones, but the flesh is very tasty and we thoroughly enjoyed it.

Stephen had generously given up his Sunday afternoon to show us around and tell us about Cape Town with all the skill of a professional tour guide. This was a wonderful introduction for me to this new city and both Cleopatra and I were very grateful for the trip.

In the evening I continued to prepare my lecture and retired early. After breakfast on the Monday morning I made my way to the Dental School. It was a great pleasure for me to meet Professor Yengopal for the first time. Together with Cleopatra we headed to the Board Room for a discussion about Cleopatra’s PhD studies. We were joined on-line by Professor Chidzonga from Zimbabwe.

Cleopatra had previously submitted a very comprehensive outline of her PhD study plan, with a working title of ‘Situational and gap analysis of human resource need and supply for oral health in Zimbabwe’. The issue of oral healthcare workforce development is a massive challenge in Sub-Saharan Africa and I am very excited that a scholarly piece of work is underway to examine the issue in detail. We had an excellent meeting which culminated in identification of four clear workstreams for Cleopatra to develop as the substance of her thesis.

Following the discussions, we enjoyed lunch together and then Professor Yengopal gave us a tour of the building, introducing us to various members of staff as we went. He had a very warm, relaxed style and we had opportunity to share some ideas on leadership during our time together. Our personal perspectives proved very similar and I thoroughly enjoyed our discussions.

In the afternoon, Cleopatra and I spent more time together on thesis discussions in a beautiful, newly refurbished space that has been developed for visiting faculty. It turned out that we were the first ever to use it – a real honour. During the course of the afternoon Khabiso kept in touch with us and we had the opportunity to take some photos in this fantastic new facility:

Professor Yengopal had kindly invited Cleopatra and I to dinner in the evening. It was agreed that we would eat at the Cape Town Fish Market on the Victoria & Alfred Waterfront. Immediately after work, Khabiso took Cleopatra and I down to the Waterfront in her car. After parking, we had time for a stroll through the shops and around the harbour. It is a beautiful, vibrant area, with once again the famous Table Mountain in the background:

I was intrigued by a street performer and his juggling act:

This stroll in the evening sun was really enjoyable and a great way to work up an appetite for dinner.

On arrival at the restaurant we opted to eat outside as it was such a beautiful evening. Professor Yengopal, Cleopatra, Khabiso and I were joined by Stephen, our guide from Sunday, Prof Amir Afrogheh (Head of Oral / Head and Neck Pathology) and Mr Umesh Bawa, who is a Senior Lecturer in Psychology at UWC but also Director of International Relations. We enjoyed a fantastic evening of great food and wide-ranging conversation. After the meal, Amir kindly gave me a lift back to my hotel and we continued our discussions in the car.

On the Tuesday morning Cleopatra and I returned to the Visiting Faculty Room to continue working. During the course of the morning I had an interesting conversation with Professor Razia Adam, who is the Deputy Dean: Research. The challenges for dental clinical academics of finding time to undertake high quality research in the face of patient and student teaching pressures are the same the world over!

At lunchtime on the Tuesday I was invited to deliver a lecture focusing on the MalDent Project.

I was very grateful for this opportunity. One of our ambitions is to develop Flying Faculty visits to the BDS course at Kamuzu University of Health Sciences by academic colleagues based in Africa. I was very heartened that a number of the UWC team have shown interest in engaging with such activities into the future.

Following my talk, all present were invited to join Professor Yengopal in the Board Room for lunch, where we continued our discussions.

Immediately after lunch, Amir kindly took Khabiso and I across to the main pathology and microbiology laboratories in Tygerberg Hospital, where he is based, for a tour. It is on the same campus as the UWC Dental Faculty and only a short walk away. It was a fascinating visit. Tygerberg Hospital is massive and when first built was the largest hospital in the Southern Hemisphere. I was particularly interested in the large biobank, which includes specimens relevant to one of Amir’s research interests: human papillomavirus (HPV)-related head and neck cancers. Professor David Conway and colleagues at Glasgow Dental School have an interest in the epidemiology of HPV-related head and neck cancers, and I have put them in touch with each another.

At the end of the day, Khabiso dropped me at my hotel. After dinner I dealt with my packing, as the Wednesday would be my last day in Cape Town and my last in Africa, before I headed back to the UK on an evening flight.

Despite the fact that the academic work was done, our thoughtful and generous hosts had set up a wonderful last day. In just the same way that Glasgow Dental School is geographically separate from the main campus at Gilmorehill, the UWC Dental Faculty is in a different location from the UWC campus, so I had not yet seen the latter. That morning, Khabiso picked me up from my hotel and we headed to the UWC campus, where we met Cleopatra. Once more it was a hot, sunny day with blue skies and the campus looked amazing.

Our first stop was at the Confucius Institute, where we enjoyed a tea tasting session with some other guests, one of whom was Dr Pedro Abrantes, a Lecturer in Medical Microbiology at UWC who delivers the microbiology teaching for the dental students. After the tea tasting we had opportunity for a discussion about Pedro’s research interests and ambitions.

From the tea tasting we moved to the UWC Robben Island Museum and the Mayibuye Archives.

We were greeted by Umesh, who had also joined us for dinner on the Monday evening in his capacity as Director of International Relations.

Despite a very busy schedule, Umesh made time to show us around the exhibition entitled ‘Apartheid and Resistance’.

The exhibition was extremely interesting but also sobering. I rapidly realised that my knowledge of apartheid in South Africa and the struggle against it was very superficial. Umesh was an incredible guide who could speak with great authority having been part of the struggle himself.

The rich mixture of artefacts told the story in a very graphic way and I left with a recognition that I needed to learn more.

By the time we had finished our tour of the exhibition it was well into the afternoon.

As we were leaving the campus we passed a sculpture which depicts a mother who is a cleaner with her son who has just graduated, celebrating the value of education. It struck a chord with me and seemed a very apt photo for the MalDent Project blog:

Khabiso drove us to the airport and the three of us shared a meal before I said my farewells and headed off to check in my baggage. I had loved every moment of my time spent in Cape Town. The beauty of the city combined with the immense warmth and friendliness of all of the colleagues I met at UWC had made for a truly memorable visit. I have absolutely no doubt that I will return and hope very much that further collaborations, in addition to our work with Cleopatra, will emerge in due course.

My fourth and final week in Malawi coincided with a visit by five dental colleagues from the UK who would deliver an intensive week of clinical teaching for the BDS 4 and BDS 5 students at Kamuzu University of Health Sciences (KUHeS). Significant preparations for the visit had been underway by the UK team in the run-up to their arrival, led by Andrew Paterson, Senior Lecturer / Honorary Consultant in Restorative Dentistry at the University of Glasgow Dental School. Andrew has significant experience of working in Africa with one of our partner organisations, Bridge2Aid, and had previously engaged in a BDS curriculum conference in Malawi in November 2022, together with one day of student teaching. Andrew was accompanied by Niall Rogerson, Lecturer in Restorative Dentistry at Glasgow Dental School, who was on his third visit to KUHeS, Madeleine Murray, an Honorary Senior Lecturer in Restorative Dentistry at Glasgow Dental School, Abisola Asuni, also an Honorary Senior Lecturer and NHS Consultant at Glasgow Dental School, and Kathy Wilson, an Associate Specialist and Clinical Lecturer in Sedation and Special Care Dentistry at Newcastle School of Dental Sciences. Like Andrew, Kathy has been heavily engaged with Bridge2Aid and has worked on multiple occasions in Tanzania.

Peter, James and I headed to Kamuzu International Airport in good time on Sunday 18th February 2024 to meet the team off their flight. It was great to see them appear with smiles across their faces, despite the long journey from the UK.

After a quick stop for a welcoming photograph …

… we loaded everything up into the two vehicles we had brought to the airport and headed to the President Hotel, our base for the week.

In addition to their personal cases of luggage, the team had brought three bags full of dental instruments and other teaching aids, which would support their activities during the Flying Faculty week. These items would stay in Malawi for continued use by the KUHeS staff and BDS students once the team had left.

After checking into their rooms and freshening up, the team re-emerged to take our Toyota Coaster bus to the Dental Department at Kamuzu Central Hospital with the dental bags, to unload and arrange the materials ready for an early start to the teaching on the Monday morning.

The three cases contained a bewildering array of dental items which James and Peter were delighted to receive.

After the unpacking we returned to the hotel and that evening enjoyed a ‘welcome dinner’ arranged by KUHeS. It was a lovely event and the team members were all in good spirits!

On the Monday morning we arrived early at the Dental Department and greeted Dr Jessie Motha-Namarika, the Dental Surgeon in charge of the facility. Jessie is also a part-time Lecturer on the BDS degree programme and is Course Coordinator for BDS 3.

We then moved to the Board Room, which serves as a classroom for the BDS students. The visitors were welcomed by James before I introduced the team and Andrew addressed the students to explain how the week would run.

The students were divided into suitably sized groups, with the BDS 4 and BDS 5 students taught separately to take account of their different levels of knowledge. In addition to the Board Room , we had access to a large office, an open plan area and the phantom head facility, allowing the smaller group teaching to proceed. Andrew’s teaching would focus on advanced restorative dentistry, law, ethics and professionalism.

Madeleine’s teaching was focused on periodontology:

Kathy’s teaching was focused on Special Care Dentistry, but she would also provide content on ‘how to teach’, bearing in mind the importance to dentists of being able to communicate oral health messages to the community and potentially deliver teaching for other cadres of health care workers.

The teaching delivered by Kathy on Special Care Dentistry was very novel to the students and they were extremely engaged with this new subject area.

Use of spectacles that mimic visual disturbances such as tunnel vision was a valuable educational experience both in the classroom …

… and in the clinic …

The teaching delivered by all the Flying Faculty team members was highly interactive and the students soon became very accustomed to participating:

In addition to the simulation of visual disturbances described above, Kathy also taped up some of the students’ fingers to simulate impairment through arthritis and then set them the task of opening a new toothbrush from its packaging – the case was made quickly!

Later in the week Kathy would deliver sessions on how to teach, which would also be highly interactive:

Abisola, known to her friends and colleagues as ‘Bis’, focused on delivering teaching on endodontics.

Each day there was a lovely spread of finger food for lunch. There was also a constant supply of coffee, tea, water and fruit juices to keep the team going.

My role in delivery of the teaching was limited, but I had some other activities to attend to that week. Professor Heather Cubie, who is currently the Chair of the Scotland Malawi Partnership, was also in Malawi at that time. The Scottish Government funding for the MALSCOT cervical cancer screening and mentoring project, led by Dr Caroline Campbell from the University of Edinburgh with Heather and colleagues, finishes at the end of March 2024 – just like our MalDent Project funding. On the Monday afternoon I met with Heather, together with Peter Chimimba, at the President Hotel. We had a very enjoyable and useful conversation over tea and coffee.

Each evening the team fell into the habit of meeting in the bar at 6pm for a de-brief on the day’s activities. This was an excellent way of focusing attention on particular areas of teaching for the next day. The first day had been partly to gauge the level of knowledge of the students and the experienced team members were able to adapt their teaching very flexibly and at short notice to satisfy perceived need.

The timetabling was done on a day-by-day basis, based to some degree on the de-briefing sessions.

Following dinner, when we all retired to bed, Andrew would type up the timetable so that when we awoke in the morning a very clear schedule would have been sent to us all by WhatsApp. That’s what I call a leader!

On Tuesday 20th February Peter, James and I took time out to attend a meeting at the Ministry of Health with Dr Lilian Chunda, the new Chief of Health Services (Technical). Dr Chunda is an Internal Medicine doctor and is known to James through shared membership of the Board of the Medical Council of Malawi. We had also invited Dr Ayid Patrick Shepard to join us from Mzuzu, following his appointment as the Ministry of Health Oral Health Coordinator, succeeding Martha Chipanda who has left Mzuzu for three years to train as a Paediatric Dentistry specialist in Tanzania. The Chief of Health Services had arranged for Mr George Chitope-Mwale, Director of Clinical Services and Mr Godfrey Kadewere, Director of Health Technical Support Services, to join her for the meeting.

We provided hard copies of the National Oral Health Policy and its summary document, together with the action plan created during the policy implementation meeting held in November 2022.

The agenda included a wide range of subject areas relevant to oral health improvement in Malawi, all of which were linked directly to the content of the policy:

There were some initial technical difficulties related to the projection facilities, but thanks to intervention by the Chief of Health Services an alternative laptop was identified which solved the problem.

I gave a 15 minute presentation about the MalDent Project and the challenges moving forward:

I was keen to stress at the end of the presentation how important the Scottish Government funding and the various cross-sectoral partnerships had been to the success of the MalDent Project to date:

There was an extended discussion following the presentation. We stressed the importance of ensuring that there were suitable facilities available for the new dental graduates who would be finishing their degrees in a year’s time, and for the subsequent cohorts in future years. We also pushed the need for a full-time Chief Dental Officer based at the Ministry of Health in Lilongwe, if meaningful progress were to be made with policy implementation. The Chief of Health Services was very engaged and receptive to our comments. She has asked for monthly written updates and quarterly meetings with the team.

Peter, James and I had a follow-up meeting with Dr Shepard at the President Hotel before we all travelled back to Kamuzu Central Hospital. Over the lunch break, Andrew and Kathy briefed Dr Shepard about the ongoing work of Bridge2Aid, Smileawi and ProDental CPD, in collaboration with the Dental Association of Malawi, to roll out the cascade training of therapists and Community Oral Health Educators, which has been successfully piloted in Northern Region, into Central and Southern Regions.

The teaching aids that have been developed for the Community Oral Health Educator programme have now been translated into both Tumbuka and Chichewa from the English originals.

Within the three bags of dental items that had been brought across by the Flying Faculty team were some brand new scaling instruments that had been purchased from the MalDent Project budget and which will remain in Malawi for BDS student teaching. They were accompanied by some 3D – printed tooth models (thanks to the Glasgow Dental Hospital Dental Technology Lab) around the gum margins of which was red acrylic paint. Hand scaling can be practised by removing the paint. A supply of paint was left with the teachers in Malawi so that the models can be re-used on multiple occasions in the future.

Here, two of the BDS 5 students are practising hand scaling with the instruments and models provided:

One of the aspects of the Flying Faculty week that the students really enjoyed was the ‘hands on’ nature of much of the teaching, including in endodontics. Endodontics was a completely new subject for the BDS 4 students so they were very attentive!

Towards the middle of the week Niall, who had a major role in delivering the simulation training, lost his voice completely and was feeling quite under par. Undeterred, however, he continued to participate, often demonstrating practical clinical procedures whilst Andrew gave a running commentary on the process. It was a great double act!

Following the demonstrations, the students were able to practise and develop their own skills in cutting crown preparations:

On the Thursday evening, Jessie kindly invited the whole team to dinner with her family at their home. I had already arranged, through the Scotland Malawi Partnership, to meet with Drs Ken Jeffrey and Peter Mtika that evening. Ken and Peter were visiting Malawi from the University of Aberdeen to scope out the possibility of establishing a formal partnership with the University of Livingstonia, and were interested in our existing partnership between Kamuzu University of Health Sciences and the University of Glasgow. The three of us enjoyed a wide-ranging discussion over dinner, whilst the rest of the MalDent team had a great evening at Jessie’s house. It was an extremely kind gesture by Jessie and greatly appreciated by the team.

The final day of the Flying Faculty week commenced with a short session on research, delivered to BDS 4 and BDS 5 jointly. I led the session …

… but the main event was a pre-recorded presentation by Professor Shauna Culshaw from the University of Glasgow. This session yielded significant interest from the students, some of whom wish to follow up opportunities with us.

There followed three half-hour sessions on adhesive bridges, classification of periodontal disease and an introduction to implant prosthodontics.

After a break for refreshments, we split the students back into their year groups and spent the next couple of hours talking through a series of cases that Andrew had put together in a fantastic workbook which the students had received at the beginning of the week. The twist here was that we asked the students to present the cases and we sat in the audience. This exercise generated some very valuable discussions.

Finally, when the workbook cases were completed, we all met up again in the Board Room, where our week had begun. There were brief presentations from James, the BDS 4 and BDS 5 Class Representatives, Andrew and myself. All agreed that it had been an immensely valuable and successful week.

As some of us knew, in their youth Peter Chimimba and Wiston Mukiwa had run an outfit called ‘Super Disco 75’ which operated at a range of social functions. Peter had very kindly provided us with a flash drive containing a large number of the Malawian songs that the disco used to play. At the end of the speeches, we played out to one of Peter’s favourite numbers. It was a very joyful Malawian way to close an exceptional week:

Following the frivolities, we headed out to the entrance of the Dental Department for a group photo:

As the group dispersed there were lots of small group huddles and additional photos being taken:

It had been a very intensive and tiring week for both the students and the staff but there was definitely a ‘family feel’ in the air and there is no doubt some long-term professional links have been forged.

Once we returned to the hotel a small number of the team headed back out to the shops, courtesy of our wonderful bus driver, Kennedy Jeputala, whilst the rest of us took it easy and attended to packing.

However, I had one more meeting to go, as I had arranged to meet Natasha Mwenda, WASH and Health Programme Manager for Water Aid in Malawi. I had first met Natasha at a Cross Party Parliamentary Group meeting at Holyrood and she had subsequently attended the workshop held in February 2020 which resulted in establishment of the Task Force that drafted the National Oral Health Policy. Lorna Macpherson and I are keen to examine potential collaborations between the WASH agenda, nutrition and oral health in the context of developing interventions to reduce the incidence of dental caries in children. Natasha was accompanied by her partner Thoko Kapalamula, who is Dean of the Faculty of Veterinary Medicine at Lilongwe University of Agriculture and Natural Resources (LUANAR). The faculty had graduated its first cohort of veterinary surgeons in 2019, so like the BDS programme it is relatively new.

I had a very fruitful discussion with Natasha, before introducing her and Thoko to James and the Flying Faculty team members.

Natasha and Thoko were able to stay on and join us for our final dinner. it was a very nice way to round off the week’s events.

On the Saturday morning we had a relaxed breakfast before some of the team headed back to the shops. James and Peter accompanied us to the airport mid-morning where we took the final group photo and said our farewells.

Once we were through security there was an opportunity for a last team shot. We had enjoyed a tremendous week and I suspect the poster held more than a grain of truth. Some of us at least will definitely be back!

It was at this point my own travels took a different direction from the Flying Faculty team. As they headed for their flight to Addis Ababa and onward to the UK, I picked up a flight to Johannesburg to connect with a second flight to Cape Town. I had business at the University of Western Cape, which will form the substance of a future blog post.

In closing, I would like to thank all who made this week of intensive teaching such a success. First, the clinical teaching staff at KUHeS including James, Peter, Wiston, Jessie, Mirriam, Tasneem and Nathan, who have the ultimate and heavy responsibility of running the BDS degree programme. Particular thanks are due to the administrative team of Annie Mwapasa and Madalitso Kaphamtengo, who did so much to organise every aspect of the Flying Faculty week, from hotel and transport bookings to the food and refreshments that kept everyone going.

Thanks are also due to many colleagues at the University of Glasgow Dental School who, through Andrew, contributed greatly to the preparations for the visit.

The BDS students at KUHeS worked hard and diligently during the week, participating enthusiastically in all the activities and providing valuable feedback that will help to structure future Flying Faculty visits.

Finally, a massive thanks to Andrew, Kathy, Bis, Madeleine and Niall who put their absolute all into delivering an incredible week of very high quality teaching. They will share some of their personal reflections in a future blog post. On behalf of the team a very special thanks to Andrew, who masterminded every aspect of the operation and who demonstrated what leadership is all about. Zikomo!

This is a guest post edited by Andrew Paterson, with contributions from Abisola Asuni, Madeleine Murray-Kerr, Niall Rogerson, Kathy Wilson, and Jeremy Bagg

One of the key challenges in the learning of the first cohorts of dental students in Malawi is to provide specialist teaching for them whilst Malawian assistant lecturers are away training abroad to upskill themselves as specialists, so that this can later be provided by Malawians when they return. “Flying Faculty” support is an extremely valuable way to provide specialist teaching to both students and staff at the Kamuzu University of Health Sciences (KUHeS), plugging a gap short-term until there are sufficient specialists in Malawi so that all aspects of the curriculum can be covered by them.

Following a visit from KUHeS staff to Glasgow in December 2023, subject areas in need of “Flying Faculty” support were identified and a teaching week for BDS 4 & 5 students organised. This was to be at the start of their academic year in February 2024. We were given a wide remit to cover diverse and wide-ranging topics such as dental trauma, endodontics, periodontics, advanced restorative dentistry, management of fluorosis, ethics & professionalism, disability, and teaching the students to teach and cascade key oral health messages to others in their communities.  All these topics would assist KUHeS in having ‘locally relevant and globally competent’ dental graduates. The last topic aimed to empower the BDS students to have the tools to cascade key oral health messages and key health messages on non-communicable diseases widely in whatever communities they would work following graduation, this being a key component of Malawi’s National Oral Health Policy.

Jeremy Bagg was already in Malawi prior to the teaching week so five of us arrived heavily laden in Malawi, carrying much donated equipment to facilitate the teaching week and to provide sustainable resources that could be reused by the KUHeS students in subsequent years. Four of us were from the University of Glasgow, with Kathy Wilson having been smuggled across Hadrian’s Wall from Newcastle!

We hit the ground running, arriving on a warm Sunday afternoon, and after a quick shower went straight to Kamuzu Central Hospital (KCH), Lilongwe to unload and set-up for an 8am start the following day.

We would like to thank the many people who donated equipment for the visit including University of Glasgow Dental School, many dental staff, the dental nursing team and laboratory technicians, and Dentaid. Our visit would have not been possible without the organisational support and assistance of Frank Bonner, Mary-Anne Ferguson, Linda McMichael, Amy Wylie and Yvette Hollywood of the University of Glasgow and our superb hosts James Mchenga, Peter Chimimba, Jessie Mlotha-Namarika, Wiston Mukiwa, assistant lecturers Nathan Lungu, Mirriam Chapinga and Tasneem Chikwatu, and administrators Madalitso Kaphamtengo and Annie Mwapasa.  Finally, we would like to thank Amy McCabe, Graham MacDonald and many others in the NHS Prosthodontic laboratory at Glasgow Dental Hospital who used their time and talents to produce over forty 3D printed models that can be sustainably used for pre-clinical skills periodontal teaching at KUHeS for many years.

Finally, as James Mchenga, Head of the KUHeS Dental School, informed us at the welcome dinner, in Malawian culture an uncle is extremely important as an advisor and facilitator in any Malawian family. We would like to thank “Uncle Jeremy” who has and continues to be the pivotal force in the MalDent family.

Here are the reflections of the “Flying faculty”:

Abisola Asuni (Consultant in Restorative Dentistry, NHS Greater Glasgow & Clyde):

I don’t have experience of practising or teaching dentistry outside the UK, so this was a first for me. Luckily, growing up in Nigeria helped shape my expectation and even though I had never visited countries outside West Africa, it felt very nostalgic with so many similarities in fauna, flora and architecture.

My remit was to cover Endodontics and Trauma. We took a good array of equipment and materials, and immediately set to work preparing everything for the practical sessions. This included preparing the plastic endodontic teeth, which wouldn’t have been ready on time without Nathan’s help! 

I was reassured by Mirriam and Tasneem in my first session, that the prepared topics aligned with and complemented the students’ existing knowledge. The students were enthusiastic and motivated, the ethos of ‘locally relevant and globally competent’ really came into play. The final year students had already received sessions in endodontics and had some experience treating patients. So, the teaching had to be adapted to make it more relevant to their clinical environment. The practical sessions allowed me to gauge their clinical skills and bridge the gap between their theoretical knowledge and practice. Despite long days, engagement did not waiver and the case presentations and discussions at the end of the week demonstrated the students’ commitment to making the most of our visit. 

During the week, we also had mentoring conversations with 5th year students. It was clear that despite the usual anxiety around finals and graduation, they recognised the significance of their cohort and were proud to be the first ‘home grown’ dentists. The two students I mentored were resilient, ambitious and showed entrepreneurism, with one of them being in the process of making a locally produced toothpaste! 

This was an incredibly rewarding experience for me. I’d like to think, in a very small way, that I have been given the opportunity to reinforce teaching and training, and contribute to the future of dentistry in Malawi.  This experience has given me food for thought on intercultural teaching and the importance of adaptability, particularly in situations where resources may be limited. I am thankful to have been given the opportunity and to have worked with an incredible team. Thank you, ‘Uncle Jeremy’, for the invitation, and to Andrew who kept us all in order. Also thank you to James, Peter and Jessie for hosting us, and to Mirriam, Tasneem, Nathan and the rest of the team for looking after us. Jessie and her family also welcomed us into her home, and we experienced traditional Malawian cuisine which was so tasty! It has really been a privilege to have been part of the ‘Flying Faculty’ team.

Madeleine Murray-Kerr (Honorary Clinical Senior Lecturer, University of Glasgow):

I had never been in Africa and what a trip as an introduction. When I was lucky enough to be asked to go with the ‘Flying Faculty’ I knew to expect the unexpected and to be flexible in what happened on the trip. 

I expected it to be hot, it was… I expected it to be wet and buggy, it wasn’t…. I expected hard work, we did indeed work hard…  flexibility with lesson plans extended sometimes to the point that only when the words came out of my mouth in response to a question from the students did I know what was going to happen. 

I didn’t expect such a warm welcome from the local team or such fun and camaraderie amongst the ‘Flying Faculty’ team. We as a Faculty learnt so much from the local team and hope we have introduced treatment concepts that can be used as building blocks for care. It’s hard to know what impact we could possibly make in a week, but I know I was left with an impression of incredible resilience and commitment amongst the Malawian staff and students to learn and improve oral health care provision locally and I feel hopeful, enriched and inspired. 

Thank you MalDent.

Andrew Paterson (Education Lead Restorative Dentistry, University of Glasgow):

My role was coordination of the ‘Flying Faculty’ teaching and to teach a wide variety of subjects including ethics & professionalism, indirect restorations, management of dental fluorosis which is prevalent in Malawi, and to introduce students to dental implants.

There was much problem solving and readjustment after each day’s teaching to try and ensure content was relevant and at an appropriate level as we did not initially have a full understanding of where the knowledge gaps were. We learnt very quickly and so did the students which allowed for a very productive week.

I enjoyed facilitating ethics & professionalism teaching with the students. Sessions were very interactive with much student-led learning and debate. I was very fortunate to be joined at sessions by Peter Chimimba and Wiston Mukiwa, both of whom had formerly had significant roles with the Medical Council of Malawi from its inception in 1988 and helped formulate their ethical codes. Additionally, James Mchenga, the current dental representative on the Medical Council, attended some sessions so the students had excellent role models and gained a fuller understanding of how codes had developed in Malawi. Much debate was had on the difficulties of gaining appropriate consent in rural situations where there still remains a high illiteracy level and many cultural factors at play.

We created a culturally appropriate workbook for the students covering all the topics that they were learning in the ‘Flying Faculty’ week applied to a Malawian context. The engagement of the students was superb and their interest, self-directed and peer learning were phenomenal. I was very impressed with their attitudes and abilities. This culminated with the students presenting on the final day topics that they had learned. We asked them to lead a session, present, debate and discuss with virtually no notice in front of their peers, teachers and ‘Flying Faculty’. They all did this with high-quality presentations fielding many questions and showed growing confidence and leadership skills. 

I asked a lot of the ‘Flying Faculty’ and it was a real joy to work in this setting with Bis, Jeremy, Kathy, Madeleine and Niall – they may feel differently! Days were long and much preparation took place in the evenings following a daily debrief. Their teamwork, humour and skills were amazing, and they all certainly went the extra mile to make a worthwhile positive learning experience for the students together with an exchange of mutual ideas and understanding.  This was borne out by the positive feedback we received from students. It was an absolute pleasure and privilege to teach, mentor and learn from the KUHeS dental students and their hard-working and professional staff who were inspirational, had a great sense of humour and many hidden talents – I will treasure my newly acquired collection of Malawian 70s super disco music from one of the KUHeS faculty, a former DJ! I hope I have the opportunity again to be involved in teaching Malawian dental students. I have every confidence that these first cohorts of Malawian trained dental students will have all the tools required to improve oral health in their nation and in time to inspire others who follow them. 

Niall Rogerson (Clinical Lecturer in Restorative Dentistry, University of Glasgow):

My overarching impression having co-facilitated tutorials and practical sessions covering a range of subject areas is that the expected level of knowledge for years BDS4 and BDS5 is evident and that the students’ enthusiasm to actively participate is apparent.  This strongly indicates that the quality of their learning experience to date is a credit to their teachers at KUHeS.  This achievement is remarkable considering this is a newly developing BDS programme with many constraints and challenges that require to be carefully managed.

One of the main objectives for the visiting faculty is to contribute to the programme in a manner that is likely to have a continuing positive effect.  It is my view that through the many and various learning activities over five days and with opportunities for on-going collaborations with our KUHeS colleagues this will be achieved.  

I reflect that it may not be straightforward to suddenly share your teaching spaces with five faculty from abroad, who arrive with a structured programme and a wide range of educational material.  Therefore, I greatly appreciate the access, facilitation and support KUHeS and KCH staff have provided, enabling the effective delivery of all the sessions.  This welcoming and calm environment with additional input from technical staff enabled the planned sessions to run smoothly, ensuring the students have the potential to gain maximum benefit.  

To conclude, I have an enormous feeling of gratitude to all the Malawian staff for their gracious hospitality and kindness and to the students for their keen and courteous engagement.

Kathy Wilson (Associate Specialist, University of Newcastle-upon-Tyne):

I was delighted to receive an invitation to be part of the ‘Flying Faculty’ and accepted without hesitation. It was such a rich and rewarding experience to contribute to the 4^th and 5^th year BDS students’ wider education.

My role was twofold. Firstly, I introduced the students to the issues of impairment and disability in relation to oral health, a concept not previously addressed in the curriculum. The students fully engaged with the didactic and interactive components of the sessions. Practical activities enabled them to experience visual impairments and physical disability for themselves. The students were able to fully appreciate the barriers facing many individuals, in particular carrying out oral hygiene and accessing services.  The exercises also emphasised the challenges they themselves will face in delivering oral health care to this group of patients.

Once qualified many of the students will be working in rural areas with a responsibility for promoting oral health messages to their communities; as such they need to have the skills to teach. I ran several sessions covering learning styles, teaching methods and how to plan a training programme. The students contributed throughout, firstly by suggesting what makes a good teacher.

I then demonstrated an effective teaching style, using an example of instructing them how to make a paper plane. In pairs the students then taught each other the same skill. They were completely absorbed in the task and clearly reflected on their experiences as both a teacher and a learner.

On the last teaching day, the students presented cases from their workbooks. It was rewarding to hear them discuss and debate treatment options, clearly illustrating the knowledge they had gained. The enthusiasm and participation of the students throughout the week was infectious

After an intense and busy programme, we were all very tired but exhilarated by the unique opportunity to be able to contribute to the development of the first cohort of dentists to qualify in Malawi – a true milestone.

My thanks to all the Dental Faculty at KUHeS for their kindness and hospitality during our stay and to Jeremy and Andrew for allowing me this tremendous experience.

Jeremy Bagg (Scottish MalDent Project Lead, University of Glasgow):

As I said in my preceding post, this had been an exceptional week working with exceptional people. I have been interacting now with this group of students, particularly those in BDS 5, for several years. In 2019, when I first met them, they were an excited group of freshman students embarking on not only a new path of study for themselves, but a completely new degree programme for their country. They have developed, over the intervening years, into mature, dedicated, knowledgeable and highly engaged young healthcare professionals. This is not just my opinion but a view that was shared by all of the Flying Faculty team members. As with any new course established from scratch, it is never plain sailing and massive credit is due to all of the KUHeS staff members and others on the ground who have supported these pioneer dental students to their current state of knowledge and understanding.

The trick now is to ensure sustainability, both of the BDS course and of the ongoing work to prepare the ground for these new young dentists, once they have graduated, completed their internships and entered the workforce as full registrants. There is a long way to go, but we need to take multiple small steps to get there. The Flying Faculty week was one of those steps and every opportunity will be taken into the future to maintain this model, until KUHeS has installed its full staffing complement and has an independent team of specialist teaching staff covering all areas of clinical dental practice.

It was a massive privilege for me and for all of the KUHeS MalDent Project team to welcome Andrew, Bis, Kathy, Madeleine and Niall to Malawi for this Flying Faculty week. I am delighted that it was such a success and I thank each and every one of them for their skill, hard work and wonderful good humour – an ‘A – Team’ if ever there was one!

We were all sad to leave Malawi but have many happy memories of a memorable week

My third week in Malawi coincided with Induction Week at Kamuzu University of Health Sciences (KUHeS) for the students who were joining the Foundation Year prior to entering their chosen professional programmes. It was good to see the campus coming alive with these lively young students about to embark on their careers in healthcare. It was just like Freshers Week at the University of Glasgow! We would meet those who had chosen the BDS degree later in the week.

The previous week I had crossed paths on the campus with another visitor to KUHeS, Dr Neil Merrylees. Neil is a Clinical Senior Lecturer in General Medical Practice at the University of Dundee, with extensive experience in Global Health, including time spent as project director of a leprosy control programme in Bangladesh. He has longstanding academic collaborations with KUHeS. Neil was staying at Fisherman’s Rest, a well-established community project which incorporates a hospitality function. Together with other University of Dundee colleagues, Neil has undertaken a number of projects with Fisherman’s Rest and we agreed that I would visit him there on the Saturday afternoon. My good friend Nelson Nyoloka agreed to accompany me and provide transport in his car, which worked out well.

There are spectacular views from Fisherman’s Rest over the Shire Valley …

… and we enjoyed great hospitality. The facility is owned and run by Wiktor and Sue Chichlowski, and Wiktor joined us for a very interesting conversation. The upshot of that conversation was that I would visit the following week to see in more detail some of the community projects underway.

At that follow-up visit to Fisherman’s Rest on the Monday I saw the laboratories, teaching spaces and construction facilities available to the team. This included an area for teaching community volunteers about maintenance and repair of boreholes, to protect water supplies in surrounding villages:

Wiktor also took us to see the local primary and secondary schools, which Fisherman’s Rest had been instrumental in constructing.

A facility for preparing food was an integral part of the infrastructure:

The scope of activities underway at Fisherman’s Rest is extensive and very impressive. There is definitely scope for collaborations with the MalDent Project moving forwards.

On the Tuesday evening I met with Wisdom Maize and Chikondi Chawinga to continue discussions about the plans to refurbish the dental clinic at Chilomoni Health Centre in partnership with AMECA, following our visit the previous week. The more we discussed the opportunities the more exciting the plan became!

The Wednesday was a busy day, which started with a working breakfast at La Caverna with Ruthie Markus and Paul Thomas from AMECA:

Following that meeting I met with Dr Emma Thomson, the KUHeS Director of the Education and Training Office, to discuss various aspects of academic governance. This was followed by a Zoom call with James Mchenga and two of his colleagues about establishing Dental Surgery Assistant training in Malawi – a cadre of dental healthcare workers which is currently non-existent in the country. That was followed by a Zoom call for Blessings, Mwapatsa and I at 4pm with Deirdre Kelliher, our ever-helpful University of Glasgow Grant Manager, as we move towards the end of the Scottish Government funding on 31st March 2024. The day concluded with an evening WhatsApp call to Andrew Paterson, in preparation for the Flying Faculty visit the following week.

On the Thursday morning I was able to meet with three of the seven KUHeS Masters in Public Health students who are working on funded projects linked to the MalDent Project for their dissertations. When combined, we hope that the outputs from their various research activities will amount to a situational analysis to inform the strand of the MalDent Project that is attempting to develop a child oral health improvement programme that is appropriate for the Malawian environment. It was a fascinating morning and I left feeling very encouraged by the progress of the students and their enthusiasm.

On the Thursday evening I had dinner with Nelson and his friend Alick Vweza, the Acting Head of Biomedical Engineering at Malawi University of Business and Applied Science, who I had met previously at the pool table. We chatted through a variety of ideas around advancing the capacity of biomedical engineering in Malawi to overcome some of the current challenges with broken and damaged medical equipment which lies unused because of a lack of technical expertise. I agreed that I would follow up with Alick once I had concluded conversations with colleagues at the RCPSG HOPE Foundation and at Henry Schein Dental, following my return to the UK.

On the Friday morning we met, for the first time, the Foundation students who will be joining the BDS course after successful completion of the next academic year. James addressed them initially and then Peter provided an overview of the MalDent Project:

Once the formalities were concluded, the students split into four groups and spent time talking with James, Peter, Nathan, Annie and I, in rotation.

These individual group discussions worked very well and provided a good opportunity for the students to ask questions and raise any concerns they were harbouring:

Finally we emerged into the beautiful, bright sunlight and a group photograph was taken:

Immediately after the induction session I had a very useful meeting with James, Nelson and Annie about the ‘Dentist to Dentist’ welfare fund for the students, after which Nelson and I headed out of the campus to Mÿn Kitchen for a really enjoyable lunch. This was the last time I would see Nelson on this trip as James, Peter and I would be heading to Lilongwe the next day to prepare for the arrival of the Flying Faculty team from the UK.

Nelson had gone out of his way during my stay to help me with many activities, from sorting out a new SIM card for my Malawi phone to providing transportation on many occasions. One of the joys for me of the MalDent Project has been the large number of fantastic Malawian friends I have made as a result of our partnership working, which Nelson exemplifies. I’m already looking forward to my next visit!

Since the commencement of the MalDent Project, I have been privileged to observe the work of many organisations, both Malawian and international, that are working to enhance healthcare facilities in Malawi. I wrote recently about the charity AMECA, with which the MalDent Project is now partnering, and during my current visit to Malawi I had a wonderful opportunity to see at first hand the ongoing work of another charity, St Andrew’s Clinics for Children (STACC).

STACC was set up by staff at the University of Glasgow in 1992. Its mission is to support clinics in the poorest areas of sub-Saharan Africa to deliver primary health care for children. STACC supports clinics in Ghana, Kenya, Nigeria, Sierra Leone, Tanzania and Uganda but until recently the organisation was not associated with any clinics in Malawi. That situation is now changing.

In April 2022, STACC agreed to provide support for a project that will deliver primary health care for children in Machinga District, a rural community in Southern Malawi.  The charity is providing some initial capital finance for the clinic in a village called Masambuka, and will make quarterly payments to cover treatments for children in the community for an initial period of five years.

Professor Paul Garside, a key player in the Scottish Government funded Blantyre-Blantyre Project, is also a Trustee on the Board of STACC. He had visited Masambuka in May 2022 before commencement of construction and had promised the Village Chief and visitors that he would return. That opportunity arose recently, when I was lucky enough to accompany him on his second visit, along with Professors Iain McInnes and Andy Waters, also from the University of Glasgow. The visit was facilitated by Dr Mwapatsa Mipando, well-known to readers of this blog as one of the prime movers in setting up the MalDent Project and an ongoing strong supporter. Another hat worn by Dr Mipando is Chair of STACC-Malawi, and he is playing a critical role as the Masambuka Clinic project is getting fully underway. He delivered an excellent on-line lecture to STACC supporters recently and you can listen to it here

Since Paul’s visit in May 2022, work has now started on the construction of both an accommodation block for the paramedics and the clinic itself. Mwapatsa picked Paul, Iain, Andy and myself up early in Blantyre on 11th February and we set out on the three hour drive to Machinga.

Before tackling the last few kilometres of the journey, we met the local Health Surveillance Assistant, Mcpherson Mailosi, who showed us around the Ntaja Health Centre, where he is based. The Masambuka Clinic will be his health post and he currently visits three times per week if possible.

We then all returned to the car and drove the 10 km along a single, track un-metalled road to Masambuka. As we arrived at the village we were serenaded with singing from a group of ladies who had been awaiting our arrival. After leaving the car we were directed to seats outdoors where formal introductions and some speeches were delivered, courtesy of translation by Mcpherson. We received a very enthusiastic and warm welcome and the villagers were clearly delighted that Paul had kept his promise to return. The Village Chief has formed a Building Committee which liaises with the contractors and health authority. 

The Government health officers are very supportive of the STACC project as is the local Village Chief and the community. The Village Chief himself has donated land and the village members have already produced 140,000 bricks to support the project.

After the initial speeches we were shown the existing healthcare building and it was clear why a new facility is needed urgently:

Next we were shown some additional features of the village where further discussions took place around issues such as sanitation and hygiene.

Infections remain a huge problem. The village has an extremely high prevalence of malaria and has been hit hard during the recent cholera outbreak. Mother and child pre- and ante-natal care remain a challenge in this remote area and the women told us stories of mothers giving birth on the road as they currently have to walk to the clinic at Ntaja. Mcpherson also noted how difficult it will be to deliver the four doses required of the new malaria vaccines. The STACC clinic will go a long way to alleviating these problems for the approximately 2,000 people around the larger village and the 15,000 in the broader catchment area.

The contractors have delivered building materials and equipment which is stored securely in a shipping container. They have based a three man team close to the village, led by a foreman who speaks the local yao language as well as chichewa.

Our first stop in relation to the building work that has commenced was to view the foundations for the accommodation block that is being built for healthcare workers delivering service in the clinic:

Currently, staff have to cycle 15 miles along poor quality tracks to attend the clinic, and frequently they can only manage to attend for two or three days a week. The accommodation block will enable them to stay overnight and provide daily services in the clinic. 

After seeing the progress being made with the accommodation block we started walking towards the site of the clinic itself. Spontaneously the ladies from the village burst into song:

En route to the clinic we passed the area where concrete blocks are being produced:  

Soon we were viewing the site of the future clinic, the various rooms outlined by the foundations and first courses of bricks. It is an extremely exciting prospect.

As the viewing of the site was nearing an end, it began to rain (a welcome occurrence for the villagers in light of the very dry rainy season to date) and we returned to the shelter of the existing healthcare building for further discussion and speeches.

Among those who spoke was Mwapatsa Mipando:

At the end of the speeches, the ladies in the village again burst into song and began dancing. You will notice in the video that one of the village spokesmen is joining the ladies in the celebratory dancing. This is apparently very unusual and was a huge honour for us. It was an exceptionally emotional occasion.

This had been an unforgettable experience. Seeing the delight of the villagers at the prospect of having a fit-for-purpose local child healthcare facility was a reminder of how much we sometimes take for granted in the UK. The strapline for STACC is ‘Supporting better health for African Children’ – it will certainly be achieving its mission at Masambuka once the clinic is up and running.

Regular readers of the blog will be aware that the design of the new dental clinical teaching facility and student hub planned for the Blantyre Campus of Kamuzu University of Health Sciences (KUHeS) has progressed through Stages 1 and 2 of the RIBA process. These earlier stages were funded by Scottish Government International Development through The MalDent Project, but the final technical elements of the design process are being funded by the World Bank. After reviewing the original procurement paperwork through which a consortium led by John McAslan and Partners (JMP) had been appointed to undertake the first stages of the design work, the World Bank agreed that JMP should continue as the consultant, working in collaboration with local architects, engineers and quantity surveyors.

On Tuesday 6th February, Peter Lee from JMP was due to arrive in Malawi for a series of meetings to take the project forward. Peter is a Senior Associate with JMP and has taken over from Paul East as Head of the Edinburgh Studio. Peter Chimimba and I went to Kamuzu International Airport in Lilongwe to meet Peter off his plane. When we arrived, his flight had already landed and passengers were disembarking into the airport shuttle buses.

Following the usual formalities of visa purchase, immigration desk, baggage collection and security, Peter emerged through the arrivals channel.

Following the drive to the Sunbird Capital Hotel in Lilongwe, Peter took a couple of hours to rest before meeting members of the team, including Mr Benjamin Kamanga, the consultant who had produced the Environmental and Social Management Plan. This document is essential because the World Bank will only support a construction project if the design abides by its requirements.

Once this meeting was concluded, we enjoyed a meal together. Peter Lee embraced African cuisine by choosing crocodile tail, and conversation relating to the design project continued.

On the morning of 7th February we attended an early morning meeting with the Planning & Implementation Unit (PIU) which has been established to manage the large grant from the World Bank to fund the ‘Skills for a Vibrant Economy’ (SAVE) Project. The $5.2m that has been allocated to the construction of the new building on the Blantyre Campus of KUHeS is being provided by the SAVE Project.

The team assembled with the various technical experts from the PIU. The meeting was led by Grenard Nkwende who chairs the PIU.

I gave a brief 15 minute overview of The MalDent Project to provide context for the subsequent detailed presentation on the building design by Peter Lee. This ‘double act’ was to be repeated twice more during the week and seemed to work well.

Following the presentations there was an extended discussion and agreement that we all needed to work as swiftly as possible, because the SAVE Project funding expires in 2026.

Following the conclusion oƒ the meeting, we set off on the journey down to Blantyre. En route we stopped for lunch at Dedza Pottery.

Watching the skilled artisans at work producing and decorating the wide range of items sold by Dedza Pottery brought back childhood memories of watching my father, also a potter, at work in the studio he had created at our family home.

The shop was stocked with many beautiful items, including some stunning arrays of tiles.

After visiting the factory and shop we enjoyed lunch, sitting outside with beautiful views to admire.

We had been advised that in addition to producing pottery, there was also a brick-making factory on the site. As you will realise from the rest of this post, much thought is now going into finalising the materials that will be used for construction of the new building and Peter was keen to learn as much as possible about locally derived materials whilst he was visiting. Following a request from Peter to the Dedza Pottery staff, we were led out through the back of the pottery studio into another building in which the brick making was underway.

The bricks are individually made by hand using a mould as shown in the following video clip:

The bricks are then stacked to air dry …

… before they are fired in a kiln.

One of the key features of the materials chosen for the building is that they must satisfy the sustainability requirements as dictated by the Environmental and Social Management Plan mentioned earlier. In the case of kiln-fired bricks, evidence must be produced that the wood used to fire the kilns originates from a sustainable source.

Following our lunch break and tour of the brick-making factory we continued on the journey to Blantyre. Our next stop was at a roadside yard that sold stone and gravel for the construction industry. Mwapatsa knew the proprietor, who was keen to show us around. There were piles of stones and gravel of every size, shape and colour.

We were taken to the far side of the yard where the first stage in gravel preparation was underway. Large stones were being hammered by hand into smaller stones – very hard and repetitive work:

Nearer to the road, the next stage was underway as the gravel was loaded into a sieve …

… and then shaken by hand to provide a smaller sized aggregate:

One possible surface under consideration for the floors of the new building is terrazzo, for which materials from a yard such as this could be suitable.

After our arrival in Blantyre, we spent a quiet evening at the hotel, in readiness for a busy time the next day.

On the Thursday morning, Peter Chimimba picked us up and drove us to the Blantyre Campus of KUHeS. On arrival in the office, Peter Lee presented Peter Chimimba with a copy of a book entitled ‘Making Architecture’, which details many of the amazing projects completed over the years by JMP. We very much hope that the next volume will include the completed student hub and clinical dental teaching facility at KUHeS!

The morning meeting started in the Board Room, where Peter Lee met the local team, including Patrick Calisse from MOD Architects, the Mechanical and Electrical Engineer, Structural Engineer, Quantity Surveyor and members of Mwapatsa’s team working on the SAVE Project. Those present were brought up to speed with the current position and some preliminary discussion took place.

We then moved out and took a tour of the proposed location of the building. This was Peter Lee’s first opportunity to see the site and surrounding environment.

Following the site visit we returned to the Board Room. Mwapatsa and I took some time out to purchase pizzas for the team so that they could work on without significant interruption.

We had been informed by the PIU that they had organised a meeting for us to attend at 4pm at the Malawi University of Business and Science (formerly the Polytechnic) with Ministry of Education officials – the Principal Secretary for Education, the Director of Higher Education, and the Director of Science, Technology & Innovation. The Vice-Chancellor of KUHeS was also invited. The PIU asked us to deliver the same ‘double act’ presentation that Peter and I had used at the meeting on the Wednesday morning in Lilongwe. We delivered our presentation, answered questions, and acknowledged the need to move the project along quickly

On the Friday morning we attended a meeting of the KUHeS Senior Management Team. The meeting was chaired by the Deputy Vice-Chancellor, Dr Belinda Gombachika. Peter and I delivered our presentations for the third time and once again responded to a range of questions with input from the KUHeS SAVE team.

The outcome of the meeting was that the design was approved and the contract between JMP and KUHeS was signed. This was a significant moment which now allows the monies from the World Bank to begin flowing, the final design details to be resolved, the tender for a constructor to be issued and work on site to begin in July this year.

Following our meeting with the KUHeS Senior Management, Mwapatsa took Peter and I to the Durabric factory in Blantyre, where we met with Patrick. Durabric produces what are known as soil stabilised bricks (SSBs).

These bricks are not kiln-fired and therefore the issue of wood from non-sustainable sources being burned is not an issue.

Patrick, the MOD architect, had informed us that he had concerns about breakdown of the bricks if they were subjected to significant water contact. The factory was itself built with Durabrics and in places there was evidence of significant erosion despite the fact it had only been opened in 2019. In areas that were protected from water contact, the bricks remained in good condition.

Samson, the site supervisor, informed us that the factory was not currently producing SSBs because of the downturn in the construction industry following the recent 44% devaluation of the Malawian currency. However, he showed us the machine which produces the SSBs. A recipe of 9 parts of fine, sieved gravel, 3 parts river sand and 1 part cement is used as the mix with water, and each brick is allowed to dry and cure for seven days.

Following our visit to the Durabric factory we visited the nearby Terrastone factory. This was a much larger business and brick-making was in full swing.

Patrick knew the manager and soon we were heading into the depths of the factory to view the process of creating their kiln-fired bricks.

The process of making the bricks in a mould was semi-automated compared with the method we had seen at Dedza, but it was still a very hard and repetitive task:

We passed into large warehouses where literally thousands of bricks were stacked to dry;

After the specified drying period the bricks are stacked in large kilns before they are fired.

After our visit around the factory we had a lengthy discussion about terrazzo flooring, which is attractive, easy to clean and very durable.

As our visit was nearing an end, Mr Jose Dacosta appeared. Mr Dacosta moved to Malawi from Mozambique in the early 1960’s and is the founder of Terrastone. He is an expert in terrazzo flooring and therefore we may well be seeing more of him in due course!

Just before we left Terrastone we were shown the stack of blue gum timber used to fire the kilns. If the team decides to use kiln-fired bricks from Terrastone we will need to have written evidence that the wood is from a sustainable source.

Following our fascinating visit to Terrastone, we turned our attention to a different construction medium – wood. At Patrick’s direction we headed to SR Nicholas, a well-established construction company with factories in both Blantyre and Lilongwe. Once through the security gates we parked the vehicles and feasted our eyes on a massive wooden structure being constructed on a concrete block jig. The manager explained that this was a roof structure for a new building. The design was extremely complex, so the individual elements were being hand-cut and assembled in the yard, after which it would be dis-assembled, transported to the project site and re-built in situ.

The manager then explained that the structure was made of laminated rubber wood. SR Nicholas owns a large rubber plantation (1.2 million trees) in the North of Malawi. Rubber trees only yield rubber for a finite period of time and every 32 years they are cut down and replaced with saplings that take 7 years to mature. This renders rubber wood a sustainable material for construction.

The felled trees are converted in a saw mill in Northern Malawi and laminated with a strong waterproof adhesive to produce the timber used by industry, for example in furniture making and building construction.

The laminated rubber wood can be produced in many different shapes and sizes.

After our fascinating ‘brick and timber crawl’ Peter and I headed to the offices of MOD Architects for a final series of meetings with Patrick and the technical team.

The interior of the facility was beautifully appointed …

… and we headed to the Board Room for a final round of discussions on technical aspects of the building and finalisation of the work plan over the coming weeks.

After the meeting, Patrick showed Peter and I around the studios in the practice …

… taking in a cork model that Patrick had constructed many years ago when he was a junior in the practice:

Patrick kindly gave Peter and I a lift back to our hotel and shortly after our arrival I picked up a message from Peter Chimimba to let us know that he was treating us to dinner at Grill 21 in Ryall’s Hotel, to celebrate the signing of the contract. This was also Peter Lee’s last evening in Malawi, so it was a fitting way to round off the very successful week and typical of Peter Chimimba’s generosity and courtesy.

The next morning I accompanied Peter from the hotel …

… to Chileka Airport at Blantyre.

It had been a whirlwind few days. Peter’s grasp of the project, excellent presentations and rapidly established rapport with our Malawian colleagues had made a deep impression on the team. There is a lot of work to do over the next few months, but Peter’s visit has galvanised us all into action, with an absolute commitment to ensuring construction starts later this year. Watch this blog for photos of the earthworks getting underway!

On 11th November I attended the Scotland Malawi Partnership Annual Gathering and AGM. At that meeting, Hazel Darwin-Clements spoke about an audio series called People to People Podcasts. In these podcasts, Hazel is joined by Chimzy Dorey and together they chat informally with guests about partnerships that exist between people in Malawi and Scotland. Hazel intimated that she and Chimzy were keen to identify partnerships in which colleagues would be willing to participate in a People to People Podcast.

It struck me that the MalDent Project would perhaps fit the bill and I spoke to Hazel after the meeting about the possibility. Hazel was very positive and in turn I contacted my colleagues Dr Mwapatsa Mipando and Dr Peter Chimimba at Kamuzu University of Health Sciences, both of whom agreed it was a good idea.

On the day of the recorded conversation Peter was unfortunately unable to participate, but Mwapatsa and I had a very enjoyable conversation with Hazel and Chimzy. Thanks to Hazel and her team the podcast has now been edited and published. You can listen to it here:

This is a guest post written by Lisa Taylor, with input from all the colleagues named in the narrative who participated in this national Child Oral Health Survey, undertaken in Malawi in October 2023.

Following the successful launch in April 2022 of the National Oral Health Policy for Malawi, attention has now turned to implementation. Prevention of dental caries in children is one of the key aims, so the next logical step was to carry out an epidemiological dental survey to determine the current oral health status of the child population. Armed with this knowledge, an assessment could be made in the future about the impact of any oral health interventions.

The survey was in the planning phase for a significant period. The delay was in part due to COVID, but it also took a considerable time to gain permissions from the Malawi Ministries of Health and Education, and ethical approval from the National Health Sciences Research Committee. Grateful thanks are due to Peter Chimimba and Lorna Macpherson for their efforts in this regard. Finally the survey was ready to proceed in October 2023. This blog aims to give an insight into the process of delivering the survey in Malawi.

Initially, a team from the UK and from Malawi was brought together under the leadership of Jeremy Bagg. This comprised Martha Chipanda, at that time the Oral Health Coordinator in the Malawi Government Ministry of Health, Peter Chimimba, the Lead for the MalDent Project at Kamuzu University of Health Sciences, Lorna Macpherson and David Conway, both Professors in Dental Public Health from Glasgow Dental School, Alex McMahon who is a statistician / epidemiologist at Glasgow Dental School, the Smileawi team (Nigel and Vicky Milne) who had previously undertaken a pilot child oral health survey in Malawi, and me as a dentist with previous experience as a VSO dentist in Malawi and UK experience of BASCD (British Association for the Study of Community Dentistry) surveys and of the National Child Oral Health Survey.

Meetings were held over zoom and the project grew over several such discussions. The protocol was developed and followed the WHO Pathfinder format for oral health surveys. It was decided to examine 6 year olds and 12 year olds, as these children are still in primary school in Malawi, making them more accessible. Alongside the clinical examination, two written questionnaires were also developed in conjunction with our Malawian colleagues to enable other social contributors to oral health to be explored. One was for the headteacher of each school and one for each child examined.

The Glasgow Dental School Dental Public Health and Epidemiology team working with colleagues from Malawi determined the number and location of schools to ensure a representative sample. Decisions were made with regard to the training and calibration programme and detailed documents written. These were sent to Malawi to assist in the preparation of their dental teams who would be undertaking the survey, together with preliminary training material for them to work through in advance of the face-to-face training. In addition, Martha Chipanda identified the dental therapists and dentists who would be involved in the project and the team administrators contacted the school that would be involved in the training and calibration exercise.

In October 2023, Nigel, Vicky, myself and my husband, Chris, flew to Malawi to carry out the training and calibration exercise. 

The pilot study carried out by Nigel and Vicky had confirmed the importance of having a survey administrator. Chris’s role was to capture the training and calibration data and to transmit this live for statistical analysis by the Glasgow team. They in turn gave live feedback to the trainer, who could use this to best support the training.

Initial meetings with the Malawi team prior to starting the face-to-face training enabled any challenges to be identified and solutions planned.

The Malawian dental team members were given face-to-face training in adapted BASCD criteria for undertaking surveys.

Interactive training and discussions were also undertaken to enable the Malawian team to plan how they would carry out the survey and to consider any potential difficulties they might face during the survey – not that we could prepare them for everything!  

Following the theoretical teaching a training exercise was undertaken, working with 6 year olds and 12 year olds.

The children seemed to enjoy the exercise:

Feedback was given following the training to help prepare the dental team for the all-important calibration exercise the following day.

The calibration exercise was undertaken with both 6 year old and 12 year old children.

Oral examination data were carefully collected from the children participating in the calibration course, who were examined separately by each of the examination teams. The data were sent electronically by Chris to the Glasgow Dental School team who assessed the results for inter-examiner agreement. Fortunately, all examiner teams passed the calibration and so were able to take part in the formal survey.

The team members were now trained, calibrated and ready to go.

On the first day of the survey it became clear that the examining teams needed to be larger due to the time required to work through the questionnaire with each child.  A meeting was held with the whole group to plan how best to proceed.  The Malawian team members were very flexible and the idea was evolved to divide the group into two larger teams, rather than the three smaller teams initially planned.  This proved to be very successful on the second day and was continued throughout the survey.

We were always given a warm welcome at the schools we attended with great excitement from the children:

The UK team continued the training of the Malawi team for the first couple of schools to ensure they were happy with how to apply all the dental survey criteria. 

Chris supported the administrative teams to keep track of all the survey forms and to ensure no child was missed from the examination.

The teams proved to be very competent and confident in carrying out the survey.  Following this additional ‘in school’ training, the UK team then acted as additional manpower to ensure as many children as possible were examined.  

There was a lot to do with completion of questionnaires and delivery of oral health advice, in addition to the examinations themselves.  These activities took place in a variety of locations depending on the layout of the school and proved the flexibility of the survey team.  

Following the initial excitement of our arrival, the children were generally very patient waiting for their dental examination, clutching their completed questionnaires

The UK team really enjoyed supporting our Malawian colleagues, but time constraints meant that we had to leave them to complete the survey without us.

We knew they were ready to go it alone and they sent photos to prove it:

They even managed to overcome some unexpected challenges!

In this way, 2994 children were included in the survey, one of the first of its kind in sub–Saharan Africa. The data have been securely transferred to Glasgow Dental School, where data entry and analysis are currently underway. A report will be written and disseminated in due course.

The experience of carrying out the survey was really satisfying.  The Malawian team members were very enthusiastic in their approach which contributed to the success of the survey.  They seemed to enjoy being part of Malawi’s first oral health survey of these age groups.  I’m sure they will now have the confidence to undertake a future survey when required … and if they have any questions, they can always call on their friends!

Acknowledgements

Grateful thanks are due to the teachers and pupils in the schools visited, whose willing engagement made the survey possible. In addition to the dentists and dental therapists performing the study, the organisational and administrative support provided by colleagues from the Kamuzu University of Health Sciences, working with Chris, is gratefully acknowledged.

Significant financial support was provided by The Borrow Foundation, and by Scottish Government International Development via the MalDent Project. We are very grateful to these two sponsors without whose support the study would not have been possible.

In early December 2023 I received an e-mail from Ruthie Markus, who is the CEO of a charity called The AMECA Trust. Ruthie founded the Trust in memory of her son, Alex, a British Army doctor who died in 2006. Since 2008 The AMECA Trust has been undertaking many projects in Malawi, largely in liaison with the Blantyre District Health Office, to implement sustainable initiatives in healthcare. The Trust also sponsors many medical students at Kamuzu University of Health Sciences to support them through their studies. The website of The AMECA Trust provides a comprehensive overview of its activities and can be accessed here.

Ruthie wrote to me because at a recent visit she had made to Chilomoni Health Centre, just outside Blantyre, she had been approached by the resident dental therapist, Wisdom, who explained that a new dental chair had been provided to the health centre three years previously, but because of a lack of appropriate materials and engineering expertise it had never been installed. He wondered whether The AMECA Trust could help. By chance, Ruthie had just been reading our MalDent Project blog after it was cited in a recent Scotland Malawi Partnership newsletter, and contacted me to see whether we could help. To cut a long story short, after some follow up e-mail correspondence and a WhatsApp call I visited Ruthie in the UK whilst she was home for the festive season. We had lunch and a five hour conversation during which it became clear we had many common interests and could potentially work together on a variety of activities. It was agreed that when I reached Malawi at the end of January we would meet and look seriously at the possibilities.

As I mentioned in the previous post, Thursday 1st February and Friday 2nd February included visits, organised by Ruthie, that marked the start of our collaboration. I had explained to Peter Chimimba the possible benefits of joint working between The AMECA Trust and the MalDent Project, especially in relation to the enhancement of dental facilities outwith the central hospitals. Peter was fully in agreement and on Thursday 1st February we set off to visit the AMECA Clinic at Chilaweni, which was funded, designed and built by The AMECA Trust. By chance, Paul Thomas, a retired UK surgeon who is the Medical Director of AMECA, had also recently arrived in Blantyre and he travelled in Ruthie’s car whilst I went with Peter Chimimba in his vehicle. Unfortunately the most direct route is not currently available because the bridge over a river was destroyed by Cyclone Freddy. We therefore had to take a more circuitous route along a rough, non-metalled road, surrounded for the most part by maize fields. The following video clip will give you a feel for the terrain.

On arrival at the clinic it transpired that Ruthie and Peter had met previously at KUHeS. We were shown around the facilities which were truly remarkable. The building had been designed by a Malawian architect called Jan Jaap Sonke, who we would meet later in the morning. The facility was very well maintained and there were beautiful touches such as the murals painted on many of the walls.

The large number of patients present showed just how valuable this health centre is to the local community.

Great efforts have been made in the maternity wing to ensure that all the staff are well trained. The mothers are cared for in a dignified manner and the building design affords them appropriate privacy.

In addition to the health centre buildings themselves, there are also well-appointed boarding facilities for the healthcare workers employed there.

One structure of note was the very tall water tower, beneath which a deep bore hole provides a water source. The pump which brings the water to the surface is powered by a bank of solar panels arranged adjacent to the tower. This water tower supplies not only the health centre but also the nearby village, providing additional value to the community.

Following our tour of the clinic, Peter and I headed back into Blantyre to attend to other activities. On the journey we passed an Airtel and TNM station nestling among the maize fields…

… and once we were back on the main road passed both chickens and charcoal being transported into the city on motorcycles.

On Friday 2nd February we had an early morning meeting at the Blantyre District Health Office.

Ruthie had arranged for me to meet with her colleague and friend Dr Gift Kawalazira, who is the District Health Officer for Blantyre. We had an excellent meeting. I was able to provide Dr Kawalazira with a summary of the MalDent Project’s activities to date but, more importantly, our ambitions for the future. With the prospect of Malawi graduating its first ever home-trained dentists in one year’s time, it is critical that we start to upgrade some of the dental facilities in the district hospitals and health centres so that the young dentists will have surgeries that are fit for purpose. Initially we would like to start by upgrading a clinic in Blantyre District that could act as an exemplar and set the standard for other health centres across the country. The plans described by Dr Kawalazira for the establishment of Community Hospitals in Blantyre District, operating in concert with health centres, could fit this model perfectly. We agreed to maintain contact and liaise on possibilities moving forward.

Following our meeting at the District Health Office, we headed off for Chilomoni Health Centre. Once again, Peter kindly gave me a lift. Like the road to Chilaweni, the surface was tricky…

… but we finally arrived at our destination:

Once we were out of our cars, the team assembled. In addition to Ruthie, Paul, Peter and I, we were joined by Chikondi Chawinga, a dental equipment technician who had been invited by Peter, and Jan Jaap Sonke, the well-known Malawian architect mentioned earlier who is a friend of Ruthie’s and who had designed the AMECA Clinic. Shortly after our arrival, Wisdom appeared. I recognised him instantly as one of the dental therapists who had attended the symposium held in November 2022 to develop an action plan for the National Oral Health Policy.

Wisdom led us to the building where his clinic was situated. Even before entering the health centre building, the lack of maintenance of the fabric of the structure was evident.

Once inside, we saw the new dental chair that had been supplied three years previously and to date had not been installed. It is a very good quality Belmont chair which could provide the centrepiece of an exemplar dental surgery within a health centre.

Sadly, the delay in installation of the dental chair was not the only problem. The roof above the room leaked and much of the ceiling had fallen down. There would be little point in moving ahead until the roof had been repaired.

Jan Sonke explained with a diagram how the problem with the roof related to the way in which the bolts were placed through overlapping metal sheets without using a fitment between the rafters and the undersurface of the metal. He told us that this was a common problem in Malawi, but that it would be relatively inexpensive to render the roof watertight.

Wisdom then informed us that he had been offered an alternative, larger room to use as a dental surgery, if we could install the chair. This was a much better proposition…

… but this room also suffered from a leaking roof:

We decided to develop a project plan to strip out, refurbish and decorate the larger room, repair the roof and ceiling, and install the dental chair. The MalDent Project and AMECA Trust teams will work with partners to identify the resources needed to provide this exemplar dental surgery at Chilomoni Health Centre. Once completed, the work would provide a blueprint for other health centres.

Following the visit to Chilomoni, Peter had work to attend to but Ruthie kindly invited me, together with Paul and Jan, to her house for coffee on the khonde. In addition to further reflections on the work to be done at Chilomoni, we had a very wide-ranging conversation. Jan, who is Dutch but has lived in Malawi for almost 50 years, trained as both an engineer and architect. He has also been involved in Malawian politics and was at one time the Finance Minister for Malawi. Unsurprisingly he had many fascinating stories to tell. There is a very interesting interview he gave in 2022 which is available on YouTube for interested readers.

Peter Chimimba, James Mchenga and I had a meeting with the Vice-Chancellor at KUHeS on the Friday afternoon, but that evening I joined Ruthie and Paul for dinner at the Bistro in Blantyre. It was an excellent opportunity to reflect on all that we had seen over the past two days and to continue to firm up our plans for the future.

One of the hallmarks of the MalDent Project has been the massive benefit that has accrued from partnership working with organisations across multiple sectors. The link that has now been established with The AMECA Trust holds great promise as we move our attention to identifying clinical dental facilities in which both dental therapists and dentists can deliver high quality treatment. These facilities will act as oral health nodes within the community from which many of the ambitions reflected in the National Oral Health Policy can be realised. This, in turn, will contribute to the mission of The AMECA Trust to improve Malawian health care facilities in a sustainable way.