A medical elective with the MalDent Project: opportunities and reflections

This is a guest post written by Lewis Olsson

Introduction

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

Background

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

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

Week One

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

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

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

With Dr Chimimba

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

Operating with Dr Mchenga

Week Two

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

 MondayTuesdayWednesdayThursdayFriday
MorningExodontia Principles (lecture)  Basics of OMFS (lecture)Oral Mucosal Lesions (lecture)Exodontia ClinicSuturing Workshop  
AfternoonExodontia Instruments and Technique (phantom head lab)Maxillofacial Examination Skills (lecture and practical)Exodontia Clinic
Timetable of teaching

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

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

Suturing workshop with BDS 3

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

Local dentists in Lilongwe following a riveting morning of Oral Medicine

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

BDS 3 at the Lilongwe facility

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

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

Nelson and I enjoying afternoon tea

Week Three

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

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

BBQ chicken, beans, nsima and vegetables

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

Sunset at Cape Maclear (Lake Malawi)

Week Four

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

Conclusion

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

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

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

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

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

At the end of a long day of operating with Dr. Mchenga

A message from our partner Bridge2Aid

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

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

Martha and Shaenna with friends and family

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

Anne Barrow and Shaenna on the Bridge2Aid stand at the Scottish Dental Show

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

Malawi braces itself … experiences of a ‘Flying Orthodontist’

This is a guest post from my friend and colleague Colin Larmour, Consultant Orthodontist and Senior Lecturer, Aberdeen Dental Hospital and Institute. Many thanks to Colin for his great support of the MalDent Project and for compiling this post describing his recent visit to Malawi.

As part of the MalDent Project ‘flying faculty’ program I travelled to Malawi in May to provide introductory clinical orthodontic teaching to the third year BDS students. This group of students are the ‘pioneer’ students at the new Dental School of the Kamuzu University of Health Sciences (KUHeS). My wife Pauline, a Psychiatrist, also made the journey to Malawi  to provide clinical teaching in psychiatry at the medical school in Blantyre and Zomba Hospital through the Scotland Malawi Mental Health Education Project (SMMHEP).

In the months preceding our trip I was given a lot of advice from Jeremy in Glasgow about what to expect with a trip to Malawi from both a practical perspective and also in relation to the Dental School set up and the curriculum for the BDS course. I was also in close contact with James Mchenga, the academic lead for Dentistry at KUHeS, and Peter Chimimba, the lead for the MalDent Project in Malawi. This included discussions about the orthodontic curriculum and the content of the introductory programme in orthodontics and exchanges of reading material and learning outcomes for the students.

Following a request from Malawi for some orthodontic instruments, including examination kits and rulers, Christian Burdess from DB orthodontics in West Yorkshire was kind enough to donate the orthodontic instruments requested, as well as lip retractiors and mirrors for orthodontic photographs. Many thanks again to Christian and his team in West Yorkshire for their support of the MalDent Project.

As far as travel arrangments in the COVID era, I had lots of advice from Jeremy who had made a recent trip with Chris Cox and Stuart Bassham. Mandatory vaccination and a negative PCR before arrival were still required. As far as COVID is concerned, having seemingly escaped the virus for more than two years I started to develop symptoms two weeks before we were due to travel. Luckily my symptoms were mild and I stopped testing positive after 8 days.  I had a PCR test around day 12 which was also negative so travel plans were still on course…

The journey begins … Aberdeen Airport

The journey began on Wednesday 18th May and the first leg of the journey was with British Airways from Aberdeen to London Heathrow, connecting with an overnight flight to Addis Ababa with Ethiopian airlines.

Early morning at Addis Ababa

An early morning connecting flight to Chileka airport in Blantyre saw us arrive in the early afternoon on the Thursday, almost 20 hours after leaving Aberdeen. Successful negotiation through the COVID clearance tent, where vaccination and PCR status are checked, and onto passport and visa checking at the border control and then, thankfully, reunited with all our luggage including the dental equipment.  

Arriving at Chileka Airport, Blantyre

We were staying at the Kabula Lodge, a guest house about five minutes from the city centre, situated in an elevated position with panoramic views of the city and surrounding mountains.

View from Kabula Lodge

After a couple of days settling in over the weekend I was picked up by a University driver, Richard Jumbe, who brought me for an early morning meeting with James Mchenga and Peter Chimimba at the Kamuzu University of Health Sciences, close to the Queen Elizabeth Hospital.

Kamuzu University of Health Sciences

We were also joined by a new part-time faculty member, Yusuf Maundala.  We had a very productive discussion about the orthodontic curriculum and plans for the orthodontic teaching that would be delivered over the next few weeks while I was in Malawi. We also organised the instruments donated by DB orthodontics so that those required over the next few days in Lilongwe with third year BDS students on clinic could travel with James and myself. One of the challenges at present is having the students split over two campuses with the early phase students (foundation year and first and second year BDS) being at present based in Blantyre and the third year BDS students in Lilongwe, while the team await the completion of the building of the new Dental School in Blantyre. 

James, Colin, Peter and Yusuf at Kamuzu University of Health Sciences

Late morning I left Blantyre and travelled to Lilongwe. This was a very interesting road trip travelling north through Malawi with the road running along the border with Mozambique, reaching Lilongwe around 5 hours later at the Sunbird Capital Hotel in the centre of the city. James was travelling separately with his wife and arrived slightly later. We met for a very pleasant Malawi-style buffet dinner in the hotel, with a chance to catch up around plans for the week ahead.

Travel to Lilongwe, with Richard our driver
Views to Mozambique

Early next morning James and myself were picked up by our driver Richard and were taken across the city to the Dental Department at Kamuzu Central Hospital, where we had a short meeting with Jessie Namarika, the Senior Dental Surgeon at the clinic.

Arriving at the Dental Clinic, Kamuzu Central Hospital in Lilongwe
Jessie Namarika at the Kamuzu Central Hospital

Following this we went to the seminar room to meet a group of local general dentists for a CPD session on orthodontics. We had a lively and interactive session which included a presentation on ‘Dental and Occlusal Anomalies’, including intercepting problems in the mixed dentition.

The following day we met the third year BDS students at the Kamuzu Central Hospital for introductory sessions on Orthodontics, including an update on facial growth and occlusal development.

Introduction to Orthodontics: third year BDS students and Dr Samonte

The students were very enthusiastic and keen to make the most of the sessions, with lots of lively discussion and intelligent questions. We were joined for the session by a local dentist, Dr Samonte, who is based at the clinic and is involved with student teaching.

A full day of lectures and a ‘virtual’ new patient assessment session followed, with the students completing two virtual new patient assessments.

Third year BDS students busy doing ‘virtual’ orthodontic assessments

All the students were happy to contribute to the discussions around each virtual patient and proved confident enough to present their thoughts on the diagnosis of each malocclusion type and development of a problem list. Fuelled with a tasty snack of Scottish shortbread they still had energy to have a go at a short quiz at the end of the day and left with a spring in their step, feeling that it had been a worthwhile day.    

On my last day at Kamuzu Central Hospital in Lilongwe we met the students early for a preparatory tutorial before moving to the clinical areas, where the students carried out orthodontic assessments on each other.   

Students on clinic carrying out orthodontic assessments

Dr Samonte, a local dentist who has an interest in orthodontics, was also present and the students worked very enthusiastically through the orthodontic assessments before presenting their ‘patients’. In the early afternoon we had a debrief and final session for the students with James and myself so they could feed back and ask questions about all they had been learning that week on their introduction to orthodontics course.

Saying “goodbye” to Lilongwe

Following final photos and goodbyes we travelled back to Blantyre. The roads were much busier on the return journey and it took us more than an hour to get out of Lilongwe onto the Blantyre road. We arrived back in the early evening after five hours of driving, enjoying a beautiful African sunset on the way.

Cargo bike, Malawi style
Sunset on the hills close to Blantyre

With a weekend free, Pauline and I went on a  camping trip with the local hiking club which allowed us to travel to the Chikala hills to the north east of Blantyre. This involved a couple of hours travel on rough dirt roads through local communities. This overnight trip turned out to be a highlight of our time in Malawi with a hike through the rainforest and an overnight camp on the summit, with views to Mount Mulanje in the south and the Shire valley in the east.

Sunrise in the Chikala Hills

The following week, back in Blantyre on the Monday I had a meeting with James and Yusuf, with further discussions around the orthodontic curriculum for the BDS students going forwards. We were also visited in the afternoon by a retired dentist from the U.S., Dr Clifford Daines, who was in Malawi with his wife as missionaries with the Mormon church.

Dr Daines and his wife

Dr Daines had brought with him a batch of donated dental instruments which were enthusiastically opened by James and Yusuf.

James and Yusuf inspect the donated instruments

The following day James and I had organised a CPD day for local dentists. Accordingly a group of nine dentists, based in both private practice and government health clinics, met in the board room in the medical college.  We had a good interactive discussion around a presentation on dental and occlusal anomalies, including interception and management of problems in the mixed dentition. Several dentists have an interest in orthodontics and were very enthusiastic and happy to contribute to the day. 

Later in the afternoon Wellington Chikuni, one of the local dentists on the Queen Elizabeth Hospital site, gave me a very informative tour of the Dental Clinic.

Wellington at the Queen Elizabeth Hospital Dental Clinic

Several paediatric patients were in the clinical areas having extractions under local anaesthetic and Wellington discussed how this can be difficult, with many very anxious children presenting with toothache and acute dental infection. There is currently very little access to extractions under general anaesthesia and we discussed the potential advantage of introducing inhalation sedation as an option for younger and more anxious patients. Plans were hatched, with both of us agreeing to take a look at options for developing this service in the future.   

My final few days in Blantyre were busy with further meetings with James, Yusuf and Peter. I was also given the opportunity to speak to the preclinical first and second year BDS students and it was great to see their enthusiasm as they set out on their studies in Dentistry.

Meeting up with the first and second year dental students

They proved a lively bunch and asked lots of questions about orthodontics, especially after I let them into the secret that it is the best speciality in dentistry!

On my final afternoon I was given the opportunity to accompany James and Yusuf to the Plastic Surgery department at Queen Elizabeth Hospital and attend an educational meeting on maxillofacial trauma, presented by the plastic surgery registrars with clinicians at other hospital sites in Malawi linking in via ‘Zoom’. It was a well attended meeting. James and Yusuf contributed to the discussions with it being apparent how much general dentists and dental therapists are involved in managing facial trauma in Malawi with most being proficient at placement of inter-maxillary fixation.

Our final weekend was spent exploring the Mulanje mountain area south of Blantyre, before saying our goodbyes and heading back to the UK. The return trip was uneventful with a reverse of the outward journey travelling from Blantyre to Addis Ababa and then onto London and finally Aberdeen.

On reflection it was a very stimulating and rewarding trip both personally and professionally. I felt privileged to join the MalDent team and make a small contribution to the on-going journey to improve dental health for the people of Malawi. The enthusiasm of the local team including James and Peter is immense and they are very upbeat about the positive changes in dental health and clinical capacity that are slowly starting to take root in Malawi. They have understandably great pride in their ‘pioneer’ BDS students and new faculty members who are the bright future of dentistry in Malawi.    

Big thanks to Medical Aid International for getting ‘MalDent Tech Aid’ off the blocks

This is a guest post that has been compiled and edited by Jonathan Miller, Education and Data Analysis Manager at Medical Aid International. It describes the ongoing programme undertaken by Medical Aid International, in partnership with Martha Chipanda, the Oral Health Coordinator at the Malawi Government Ministry of Health. The programme was funded by the Scottish Government through the MalDent Project. It aims to ensure the sustainability of healthcare equipment investment in the region by providing holistic Biomedical Engineering training for students in Malawi.

Contributors: Martha Chipanda, Jonathan Miller, Tim Beacon, and Jeremy Bagg

Our journey starts over 20 years ago when Tim Beacon noticed the desperate need for medical equipment in low- and middle-income countries (LMICs). Tim, being driven and having a can-do attitude, set about utilising his contacts to make a difference. He built Medical Aid International from the ground up to focus on this aim.

Tim has a varied background across a number of different fields including roles as an Operating Department Practitioner, outdoor adventure trainer, running personal development courses, university and military healthcare lecturing, and more. He completed his Post Graduate Diploma in Travel Health at Glasgow School of Medicine and is also the author of The Gap Year Handbook. An Essential Guide to Adventure Travel (available for free download here).

In all of his previous jobs and his life in general, Tim has a history of responding to challenges with vigour and decisive action. When attending meetings addressing the healthcare situation in LMICs as part of his work at Medical Aid International, he noticed the topic of Biomedical Engineering and maintenance arising almost every time. No one seemed to be doing anything about this need, so Tim sought to address it himself.

At first, Medical Aid International partnered with Mercy Ships to deliver an on-the-ground 8-week  course in Biomedical Engineering. Whilst this programme was extremely effective, the cost was prohibitively expensive to be rolled out to a wider audience; there were also the practical, logistical issues of getting to people! To create the solution that would be equally useful, but more cost effective, Medical Aid International invested over £150,000 to produce a comprehensive, online Biomedical Engineering Programme which is available in both English and French.

This multi-faceted programme includes a robust online training course, professional grade toolkit, a set of textbooks and a digital library of service manuals. The students are taught through a series of over 70 videos covering a wide range of topics, all tailored to the LMIC environment. Students must answer over 300 multiple choice questions throughout the course to pass, ensuring rigorous learning.

The Medical Aid International Toolkit, provided to all trainees as part of the training programme

The course is designed for hospital “fixers” and estates managers who already have responsibility for looking after the hospital equipment, and upskills them to be more effective in their roles. By supporting their passion and enthusiasm with practical knowledge and resources, a huge day-to-day impact is achieved.

A hospital engineer utilising his biomedical engineering skills acquired through the Medical Aid International training programme

Research has been conducted into the effectiveness of the programme and found that students rate the course over 9.5/10 for course satisfaction and over 9/10 for course impact. A full data analysis report on the first 50 students that completed the course can be found here.

Formal report of the effectiveness of the Medical Aid International training programme. The two successful graduates on the cover are both biomedical engineers based at the Beit Cure Hospital in Blantyre, Malawi

This brings us to the present day, where we have over 85 students across more than 12 countries with both the English and French versions of the course in use. Our impact in Malawi is particularly significant, a point of pride for us, with 27 students having either completed the programme or currently studying. These students are spread out geographically across the country, from Karonga in the North to Blantyre in the South (not forgetting Lilongwe in the Centre too). We’re proud to have worked with organisations both large and small, from governments to NGOs.

Medical Aid International is pleased to see the excellent investment in dental equipment that is being made in Malawi as part of the MalDent Project. However, safeguarding the investment for the long-term is also an important consideration. This is where our Biomedical Engineering Programme comes into play. By providing the online course to students we are arming them with vital knowledge to repair and maintain the equipment provided.

The textbooks and service manuals also allow for future study to further the students’ capabilities. By providing the professional grade toolkit we ensure the students are well resourced and can put into practice their newly acquired skills. Through the provision of this Biomedical Engineering training, the investments into new equipment are protected for the long-term and provide a lasting impact into the future.

Now to the MalDent project. Six students (five dental therapists and one biomedical engineer) across all regions of Malawi were selected to undertake our programme. The students have now all received their toolkits and have started the course. Here are some fantastic pictures of students receiving their toolkits; many thanks to Martha for arranging delivery and taking such great photos!

All six students have been working diligently and have completed the course in just a matter of weeks. We truly believe this hard work will pay off, benefiting the students, the healthcare facilities, and their patients. We will be sending out certificates to each of the students shortly to both congratulate them and celebrate their fantastic achievement. We look forward to hearing about the projects undertaken by our graduates and would like to thank the MalDent project, once again, for making this all possible.

The bespoke LMIC course (which focuses on equipment actually found in LMICs) teaches the students about:

  • Unit 0: Health and Safety
  • Unit 1: The Frequency Spectrum
  • Unit 2: Electrical Safety
  • Unit 3: Electrocardiogram (ECG)
  • Unit 4: Defibrillation
  • Unit 5: Patient Monitoring
  • Unit 6: Infusion Devices
  • Unit 7: Premature Baby Incubators (PBIs)
  • Unit 8: Ultrasound
  • Unit 9: Surgical Diathermy
  • Unit 10: Hygiene Guidelines
  • Unit 11a: Anaesthetics, Oxygen and Suction Devices
  • Unit 11b: The Operating Department and Sterilisation
  • Unit 12: First Aid
  • Unit 13: Train the Trainer

We are real advocates of the “Train the Trainer” approach. By this we mean that we train the students how to become trainers, so they can teach others and share their knowledge. This allows for best practice and benchmark standards to be developed hospital-wide – improving equipment maintenance and patient care.

We look forward to sharing the success stories once the students have been given the opportunity to put their training into practice!

Tim Beacon, CEO of Medical Aid International says:

“It is so wonderful to be working with MalDent on this project. Their long-term strategic vision, that we share, which encompasses this vital area of equipment support is to be highly commended. Giving these engineers the physical resources  and foundational knowledge, which can now be built on as they develop their specialisation in dental work, is essential. It has also developed the communication infrastructure between them, which as the drive to develop dental services in Malawi continues, will be extremely beneficial.”

Martha Chipanda, the Oral Health Coordinator at the Malawi Government Ministry of Health says:

“I am very excited to see all of my students succeeding, many thanks to the Scottish Government, University of Glasgow and MalDent Project for the effort they have made to sponsor this program. I will fail in my job if I do not thank the Directorate of Health Technical Support Services (HTSS) Mr. Chimphepo, Ministry of Health Headquarters, for understanding the importance and granting us an opportunity to train dental therapists along with biomedical team in biomedical engineering. This is a development that is going to see our equipment being repaired and taken care of at district level where biomedical engineers are not easily available. It has started to implement our newly launched National Oral Health Policy on the area of infrastructure and equipment. It is my hope that another cohort is on the way to be trained. I am very confident that my team will do a great job on the emergency repairs of our dental equipment. A big congratulations to the students. Tim, Jonathan, Prof. Jeremy you are a blessing.”

Medical Aid International would like to thank the MalDent Project, the University of Glasgow and the Scottish Government for their involvement with this fantastic project.

Malawi launches its National Oral Health Policy – a milestone event

On Thursday 14 April 2022 the Malawi Government Ministry of Health launched its first National Oral Health Policy. This represented the culmination of two years of work and twenty two meetings of the Oral Health Policy Taskforce, which had been established at the Oral Health Policy Workshop held in Lilongwe in February 2020. It was a big day for all concerned and a significant event on Malawi’s journey to ‘Oral Health for All’

Delegates seated beneath a large banner announcing the launch of the Oral Health Policy for Malawi

The launch was held at the Sunbird Capital Hotel in Lilongwe – in exactly the same venue as we had convened the initial Oral Health Policy workshop in February 2020.

Delegates waiting for the formal proceedings to commence

Whilst the guests were assembling, they were treated to entertainment from the Health Education Band, whose members sang songs which included messages about the importance of good oral health. The following video, which will give readers a feel for the music, was provided by Dr Mwapatsa Mipando, whose role in establishing and delivering the MalDent Project, including the Oral Health Policy development, has been so crucial from the outset.

Thanks to the modern wonder of Zoom, those of us who could not attend the event in person were able to join by videoconference from our bases around the world. Dr Yuka Makino, WHO Technical Officer for Oral Health in Africa, had contacted Chief Dental Officers from a number of other African countries, who joined the launch via Zoom. Thanks are due to the technical team at Kamuzu University of Health Sciences (KUHeS), who set up the Zoom link and made it possible for a further thirty of us to join those who were present in person.

The ‘virtual view’ on Zoom

The launch was facilitated by Mr Adrian Chikumbe, who is the Ministry of Health Public Relations Officer. The event started and ended with a prayer .

Mr Adrian Chikumbe was an excellent facilitator for the event

The first speaker was Dr Janet Kayita, who is the WHO Country Representative in Malawi. Dr Kayita commented that she was impressed with the standard set by the policy and that Malawi’s Oral Health Policy was running ahead of the imminent WHO Global Oral Health Strategy.

Dr Janet Kayita addressing the delegates

The next speaker was Dr Peter Chimimba, who had been invited to provide feedback from the perspective of the MalDent Project.

Dr Peter Chimimba providing a summary of the progress being made through the MalDent Project, including its involvement in the writing of the Oral Health Policy

As Malawian lead for the MalDent Project, Peter has been closely involved with all aspects of its work, including the establishment of the new BDS degree at KUHeS.

Peter explained the critical importance of partnership working …

… and gave a very clear account of how the various components of the MalDent Project interface with one another. The new Oral Health Policy and its embedded Implementation Plan would now provide a blueprint for the way forward.

At the conclusion of his talk, Peter invited Dr Mwapatsa Mipando, Dr James Mchenga, Miss Annie Mwapasa and the first ever cohort of BDS students, now in Year 3, to stand up so that he could introduce them to those present and thank them for all that they are doing to support oral health improvement in Malawi.

Following Dr Chimimba’s talk, there was a speech by the Chair of the Parliamentary Health Committee, Hon. Dr Matthews Ngwale MP. He advocated strongly for research in Oral Health and also stressed the importance of access to appropriate care in rural areas.

Hon. Dr Matthews Ngwale MP delivering his address

The next speaker at the lectern was Dr Jones Masiye, Deputy Director of Curative & Medical Rehabilitation Services, who presented the key elements of the policy. As Co-chair of the Taskforce, Dr Masiye had a detailed knowledge of the policy drafting and its final content. He laid out very clearly the key challenges that the policy addressed:

Challenges addressed by the National Oral Health Policy

The Concept Paper, Narrative Review and Situation Analysis undertaken by the Oral Health Policy Taskforce in preparation for writing the policy had identified key priority areas, which then formed the seven pillars on which the strategic direction of the policy was based:

The seven pillars on which the Oral Health Policy is based

The detailed presentation of the policy by Dr Masiye set the scene for Dr Queen Dube, the Chief of Health Services, to address those present. Dr Dube had spoken previously at a Global Oral Health meeting held during the COP26 summit in November 2021 and once again showed tremendous support for oral health improvement. It was wonderful for the BDS students present to hear this strong endorsement and Dr Dube’s assurance that the Ministry of Health has created posts for them once they graduate. Dr Dube also remarked how important the strong links between KUHeS and the Ministry of Health had been to success of the Oral Health Policy development and how critical that partnership continues to be across all aspects of healthcare in Malawi.

Very encouraging words from Dr Queen Dube, Chief of Health Services

Following Dr Dube’s talk, there was a musical interlude from the wonderful Health Education Band, who you heard in the earlier video clip.

More wonderful music from the Health Education Band

Following the music, the presentation moved to the climax of the event – the launch of the National Oral Health Policy by Hon. Enock Phale MP, Deputy Minister for Health. Regular readers of the blog will know that the Deputy Minister trained as a Dental Therapist and subsequently became the Oral Health Coordinator in the Ministry of Health, before his election to Parliament. It was, therefore, very fitting that he should launch the Oral Health Policy! His speech included a strong commitment to support implementation of the Oral Health Policy and he thanked the Scottish Government for its support of Malawi’s work to improve the oral health of its citizens.

Hon. Enock Phale MP, Deputy Minister of Health, addressing delegates before launching the policy

Following the Deputy Minister’s address, attention turned to the ribbon-cutting!

A ribbon and balloons in Malawi’s colours adorn the mounted replica of the front cover of the policy document

Miss Annie Mwapasa, our MalDent Project Administrator, who has worked tirelessly on all aspects of the MalDent Project, including this launch event, presented the Deputy Minister with a pair of scissors ….

… and the ribbon was cut …

To the sounds of cheering and applause, the National Oral Health Policy was declared officially launched!

After the formalities of the launch had concluded, the delegates present assembled outside for the customary group photograph.

Delegates who attended the launch of the National Oral Health Policy gathered for a formal photograph

The meeting concluded with opportunities for informal discussion and lunch.

Dr Jones Masiye (Ministry of Health) and Prof Johnston Kumwenda (KUHeS) enjoying a catch-up after the launch, reflecting the links referred to earlier by Dr Dube

There was significant interest in the policy launch from the national media. You can read here a report from the Malawi News Agency and below is a front page headline in The Nation newspaper:

For those who are interested in reading the Oral Health Policy and the Policy Summary Booklet, these are available below:

National-Oral-Health-Policy-Vr-12-Revised-Final-PRINT-VERSION-17-03-22-1

National-Oral-Health-Policy-Summary-Booklet

This was a significant milestone for the MalDent Project but, more importantly, for the ongoing work within Malawi to improve the oral health of the population. The policy drafting included input from many players and benefitted significantly from the cross-sectoral partnerships involved. It is now important to maintain the momentum by pursuing actively the strategies identified in the policy. As Wilbur Ross once commented:

It’s important to have a sound idea, but the really important thing is the implementation

The foundations are in place, the building blocks are available and it’s now time to work hard towards achieving the goal of ‘Oral Health for All‘ in Malawi.

Kiltwalk success raises funds for ‘MalDent Student Aid’

Now that our charity MalDent Student Aid is fully established, we are embarking on a series of fund-raising events. The Kiltwalk, established by Sir Tom Hunter, is an annual series of events run at different times of the year in Glasgow, Dundee, Edinburgh and Aberdeen. Thousands of walkers from a vast range of charities join these walks to raise money for their respective causes. There is a major additional incentive since Sir Tom Hunter adds 50% to the total raised by each walker, an exceptionally generous act which provides support to a multitude of deserving causes.

We assembled a team from the University of Glasgow Dental School to join 10,000 other participants in the Glasgow Kiltwalk on Sunday 24th April 2022. I was joined by David Conway, his wife Lizanne, Kurt Naudi and Ziad Al-Ani. The event commenced at Glasgow Green, where we were blessed with a beautiful sunny morning and an east-west following wind, conditions which remained with us all the way to the end of the walk at Balloch on Loch Lomond.

All smiles at Glasgow Green before heading off on the 22 mile trek to Balloch

The route soon joined the River Clyde, which looked tremendous in the sun, with a backdrop of many of Glasgow’s most famous landmarks, such as the Hydro and the Armadillo.

Iconic buildings and landmarks as we head out along the banks of the River Clyde.

As the route was about to take us away from the river, we decided on a first group photo opposite Glasgow Science Centre. Ziad is very handy with a camera and an expert on IT. We appointed him as our official photographer for the day and I would like to acknowledge that virtually all of the photos in this post were taken by Ziad. He had come armed with a very fancy selfie stick which also converted into a tripod – it served us well as the day progressed!

Time for a group photo opposite Glasgow Science Centre

Along the route there were a number of pit stops, with toilets available and refreshments. Some of these were provided by participating charities and thanks are due to all the teams of volunteers who helped us on our way with these very welcome watering holes.

Sausage rolls and soup at our first pit stop of the day
Time for a group chat before heading back onto the route

We were really enjoying the walk and before we knew where we were we had reached the pit stop at Clydebank Shopping Centre. Here, I had an important phone call to make. My good friend, colleague and Trustee of MalDent Student Aid, Alex Mackay, lives close to the Kiltwalk route between Clydebank and Bowling. Alex had kindly offered to lay on a lunch for us and had suggested I give her a progress report from Clydebank, which was about an hour away from her home. The call was made and final arrangements concluded!

The pit-stop at Clydebank Shopping Centre

The next section of the walk was through beautiful countryside – stunning blossom, swans nesting and all beneath a bright blue sky.

Blossoming trees along the Forth Clyde Canal – beautiful reflections

We reached the landmark white cottage where we were to turn off the official Kiltwalk route, cross the bridge over the canal, and head a short distance to Alex’s house. We received a characteristically warm welcome from Alex and were led out to a sumptuous spread on a table in the back garden. It was an opportunity to rest, re-fuel and enjoy a great conversation, largely focused on our interests and work in Malawi.

Alex treating us to a wonderful spread of food and refreshments in her garden – an oasis halfway to Balloch!

We rounded off our lunch with freshly brewed tea and coffee and a group photo, before pulling ourselves away from this very comfortable spot to start the second stage of the walk. Massive thanks to Alex for looking after us so well.

We finished up our lunch with tea and coffee – and a toast here to our brilliant hostess Alex

The next leg of the walk took us to Bowling. Just before reaching Bowling Harbour we spotted a houseboat that was sporting a banner for our MalDent Project partners Smileawi, who had also entered a team on the Kiltwalk to raise fund for their fantastic charity.

Our MalDent Project partners Smileawi were also doing the Kiltwalk – they had their personal advertisement (and cake!) courtesy of friends on a houseboat at Bowling

From Bowling, the route picked up the Bowline, a disused railway viaduct and track with lots of photo opportunities!

Leaving Bowling – a lovely part of the route along this disused railway line

By the time we reached Dumbarton, we were beginning to sense that the end was in sight. We remained in good spirits and our legs were holding out well.

Catching a breather on the bridge over the River Leven at Dumbarton

This next stretch, along the River Leven, was another very scenic part of the walk, with views to the hills in the distance.

On the banks of the River Leven – a very pretty section of the route

There’s something about a ‘1 Mile To Go’ board that is very cheering! We were among a queue of teams waiting for their picture at this spot – all helping each other by providing a photographer for the other teams in line!

Nearly there!

Reaching the finishing line was a fantastic feeling – cheers from the crowd mingling with strains of the Red Hot Chilli Pipers performing in the marquee just ahead of us.

At the finishing line in Balloch – all still smiling and in remarkably fine fettle

It was time to sit down with a drink on this lovely sunny evening, soak up the atmosphere and proudly display our medals!

There’s nothing like a medal to make it all worthwhile!

For those who are interested in the route and figures, here’s a summary of our team’s Kiltwalk:

Our route and data – inclusive of pit stops and lunch with Alex!

If you’d like to see a dynamic representation of our walk, you can view it here.

Finally, our JustGiving page remains operational until 4th May 2022 and is available here.

Acknowledgements

I’d like to thank all those who have made this fundraiser for MalDent Student Aid possible.

My walking colleagues were fantastic company and really good sports – I hope you’ll join me again next year and that we can put together an even bigger team!

Many thanks to Alex Mackay, not just for a splendid lunch, but also for all the support of our Kiltwalk through your social media channels.

A very big shout out to those who have supported our Just Giving page – at the time of writing we have raised just over £4000.

A special thank you to Martin Aitken & Co, who helped with the set-up of the charity and with its ongoing governance and management. We were proud to include the company logo on our T-shirts.

The Kiltwalk is a massive logistical exercise for the organisers both in the run-up to the event and the day itself. The organisation was first-class and thanks are due to the many official team members and helpers who made it such a memorable occasion.

Finally, huge thanks are due to Sir Tom Hunter, for the original concept of the Kiltwalk and for the amazing 50% top-up that he provides to the donations raised by all the walkers. Our £4000 will become £6000, which will provide significant benefit to those dental students in Malawi who are training to support our long-term MalDent Project ambition of ‘Oral Health for All’.

Oral health cascade training in remote and rural Northern Malawi

This is a guest post that has been compiled and edited by Andrew Paterson. It describes a recently completed pilot programme undertaken jointly by Bridge2Aid and Smileawi in partnership with Martha Chipanda, the Oral Health Coordinator at the Malawi Government Ministry of Health. The project aligns closely with the disease prevention component of Malawi’s new National Oral Health Policy, due to be launched on 14th April 2022. The pilot programme was funded by Scottish Government through the MalDent Project, and supports the workstream on communicating messages which promote good oral health.

Contributors: Martha Chipanda, Andrew Paterson, Shaenna Loughnane, Nigel Milne, Victoria Milne, Jeremy Bagg

One of the key challenges in African healthcare is providing appropriate coverage for those living in remote and rural areas, which includes 60-80% of the population in countries like Malawi. These areas are underserved by both health services and health promotion. With the inclusion of oral health into the Malawi Government’s essential package of healthcare, the recent World Health Assembly statements on the importance of oral health, the MalDent Project and the new Malawi Bachelor of Dental Surgery degree programme there is significant momentum to address rural oral health in Malawi.

80% of the population of Malawi live in rural areas

In 2020-2021, funded by a Scottish Government grant to Smileawi, Northern Malawi dental therapists were upskilled in the relationships between oral health and non-communicable diseases and taught skills to teach rural community volunteers to cascade-train key oral health messages within their remote communities. This course was delivered remotely using tablet computers (mOral Health) and coordinated locally. It was a collaborative effort of the NGOs Bridge2Aid and Smileawi, ProDentalCPD, the Dental Association of Malawi, The Ministry of Health of Malawi, the MalDent Project and the Universities of Glasgow and Dundee.

The next stage was for the therapists themselves to design a programme best suited to training community volunteers who could then cascade the oral health messages widely in their own remote communities. This was resourced by the Scottish Government funded MalDent Project and involved collaboration between Bridge2Aid, Smileawi, the Dental Association of Malawi, The Ministry of Health of Malawi, the Red Cross, the MalDent Project, the University of Glasgow, and the Kamuzu University of Health Sciences. The therapists were coordinated, supported, and managed by Dr Martha Chipanda (National Oral Health Coordinator) and production of teaching materials was facilitated, supported, and edited by Bridge2Aid and Smileawi volunteers.

Dental therapists hard at work designing the teaching course
Teaching materials were produced in the predominant language of Northern Malawi, Tumbuka. This slide shows gum disease and tooth decay
Teaching materials emphasised the effects of poor diet. Here the potential effects of carbonated drinks on health – tooth decay, diabetes and obesity
Teaching materials also delivered positive messages. Here the importance of a healthy diet is stressed

The area selected for the first cascade training was Mzimba North in Northern Region Malawi. This is the largest District in Malawi with a population of over 600,000 people predominantly based rurally with agriculture being the main work in the area. Crucially some of the therapists who had received our training in 2020-2021 work in Mzimba North. There are many barriers in Mzimba North to access rural areas as the road system is primarily unpaved and the main form of transport is bicycle. Public transport is infrequent and often fails to predictably reach destinations. Many areas are inaccessible in the rainy season. Having well trained oral health promoters available locally is the key to disseminating important oral health messages in this area.

The therapists delivered the training they had designed to Red Cross volunteers from many parts of Mzimba North in a central location over two days, which included empowering the volunteers to present the newly learned key oral health messages. The volunteers received teaching aids to use in their communities, being an oral health flip chart in the predominant local language of the area, Tumbuka and a tooth model and brush to demonstrate effective toothbrushing techniques.

One of the therapists demonstrating toothbrushing to the volunteers
An excerpt from the oral health flip chart. Community volunteers had simple tools in a language understood by their communities to aid key oral health message delivery. Here is an explanation of tooth decay

Here are the reflections of some of the key stakeholders in this part of the project:

Martha Chipanda (National Oral Health Coordinator, Malawi):

Training Oral Health Promoters is one of the ways to implement Malawi’s National Oral Health Policy. This pilot programme was focused on the promotion of oral health and prevention of common oral diseases. It tested the concept of cascade training using dental therapists to facilitate the training of non-health volunteers who would have a pivotal role in spreading oral health messages in their communities.

The Smile North therapists were extremely well organised which was important to the smooth running of the programme. Identification of volunteers was important. We targeted volunteers with the help of the Malawi Red Cross Society which enabled coverage of large parts of Mzimba North.

The volunteers were very excited and eager to learn. They actively participated in the programme and showed by their presentations that they were competent to deliver important oral health messages. At the end of the two days ten were successfully trained and hopefully they will play an important role in local oral health promotion. A certificate of attendance was given to the participants.

Martha looks on as one of the community volunteers receives their oral health promoters course completion certificate

Feedback from the training therapists has been very positive:

“The programme is good for oral health promotion. The advantage is that it targets everybody, the rural, urban, and semi-urban population. But it is most advantageous to the rural population where oral health information is difficult to access”

“The programme is a mindset changer and a primary preventive measure that is bound to reduce the number of dental and oral conditions in most rural parts of the District. The programme is already gaining publicity within Mzimba North rural areas”

Following the programme, the therapists have also suggested modifications that may improve the programme such as providing some phone support for the community volunteers so that questions can be answered, additional support provided for challenges that may arise and to update the trained volunteers on changing oral health priorities.

This long-awaited programme has given hope and light to Oral Health Promotion and Prevention in the Northern Region. It is the hope that this can be similarly rolled out to other regions in Malawi.

Thumbs up to Bridge2Aid, Smileawi, the MalDent Project, the Malawi Government, the Scottish Government, the Dental Association of Malawi, the University of Glasgow, and the Kamuzu University of Health Sciences who all collaborated to bring about a successful course. There were many others who contributed to the delivery of this course who are too numerous to mention but their input is much appreciated.

Andrew Paterson (University of Glasgow & Bridge2Aid Trustee):

Being involved in the initial training programme to upskill the dental therapists and to teach them teaching skills and then to be further involved in a Malawian led and developed oral health cascade training programme has been, and continues to, be an uplifting experience.

A legion of problems was overcome by close collaboration and teamwork. One of the unexpected benefits of the programme has been that when the stakeholders involved in oral health in Malawi work cohesively and closely together the benefits of those relationships is good for the improvement of oral health.

The decision to provide teaching aids for the community workers in the local language of the area, Tumbuka, makes this form of cascade training particularly relevant and culturally appropriate to the needs of rural communities and will hopefully translate into improved oral health literacy in the area.  This fits with the WHO principle of not leaving anyone behind by giving all the opportunity to receive appropriate health messages in a format they understand. That said there were a few uneasy moments after this decision with the realisation that our combined knowledge of Tumbuka amounted to five words.  Nevertheless, good communication and a ‘never say never’ problem-solving attitude from all collaborators involved meant the end goal was achieved.

This model of cascade training has benefits not just for oral health but for general health too. The messages speak to the prevention of NCD’s as part of the Sustainable Development Goals agenda. Take for example the messaging around quitting smoking. This messaging may impact on the many adverse effects of smoking more generally such as cancer and heart disease. In rural areas where general health promotion is sparse, oral health promotion offers significant benefits to general health.

Flip chart messages: Empowering community volunteers to cascade key oral health messages also impacts general health. Volunteers have the tools to encourage smoking cessation

This programme is a first step to cascade training for oral health in remote and rural Malawi. Much reflection is required on the lessons learned, problems solved, barriers and benefits of the programme and then it can hopefully be expanded into other Malawian regions with teaching materials in languages like Chichewa to remain relevant to specific localities. This training model may have potential for use in the wider Sub-saharan Africa region but there are many distinct cultural groups and what works for one area may not work for another, so if it were to be used widely then local oversight and collaboration will be imperative to remain culturally appropriate.

Shaenna Loughnane (CEO of Bridge2Aid):

It was fantastic to see the online training course created and delivered last year to the Dental Therapists based in Northern Malawi.  However, this course was never designed to stand alone, and was co-created by a partnership of organisations and people passionate about making a real impact on the oral health of remote and rural communities in Malawi.

It has been great for Bridge2Aid to continue to work with similar partners to plan, create and deliver the second part of the programme – training Oral Health Promoters to work in their own communities to prevent oral disease and to share knowledge and behaviours that will have a huge impact on community health.

“Localise”, “capacity building” and “community-led development” are buzzwords in international development and have been around for a few years now. The concepts and values behind these buzz words, and other words such as “partnership”, “prevention” and “power-shift” are at the heart of the recent changes in strategy and programme focus at Bridge2Aid.

Capacity building: A single trained community volunteer can deliver essential oral health messages to many in their community

However, it is important that we don’t just pay lip-service to these concepts but embed them in all that we do. I truly believe that this programme embodies all these core values and is a real demonstration of what can be achieved if you work together, and ensure your project is led, managed, and delivered locally. It embodies the principles of building capacity for oral health education and aims to continue to spread important oral health messages to the remote and rural communities that so desperately need them.

We now need to ensure that we fully evaluate the programme, and the effect it has on oral health literacy and behaviours in the communities in which these volunteers work to ensure we are having the impact that was intended. This will allow for learning to take place to further develop the programme.

Nigel & Vicky Milne (Founders of Smileawi):

Smileawi has been enormously proud to be involved in this great project. When we first visited Malawi 10 years ago, we had no doubt that any significant improvements in oral health services would need to come from a governmental level and that seemed an impossible dream all those years ago. However, with the MalDent Project and all its different strands we are starting to see positive changes and not least with our friends and colleagues in Smile North. In 2020-2021 with a Scottish Government small grant Smileawi was able to produce and deliver the Oral Health Course to twenty-four dental therapists along with partners Bridge2Aid, the Dental Association of Malawi and Prodental CPD. The collaboration between these different organisations was highly successful and the course was very well received with positive feedback from all the participants.

“I have enjoyed very much the presentations and the knowledge I gained will help to improve oral health service delivery in the community”

“It was well organised and has really improved my teaching skills in imparting oral health messages to different groups of people”

Community volunteers learning from a dental therapist trainer

The MalDent Project then stepped in to fund the next part of the process and we watched from afar as the team in Malawi led by Dr Martha Chipanda brought together six dental therapists and ten volunteers. The dental therapists then spent a couple of days teaching the volunteers basic but vital oral health messages and how to best pass these messages on to their communities. The challenges thrown up were mostly to do with financial and physical logistics and it was frustrating not to be there to help. We feel that the autonomy this has brought to this group of dental professionals can be seen as a triumph and our feeling is that they will grow in strength and conviction and with their voices being heard and the momentum they have achieved everything will continue to move in the right direction for oral health services in Malawi.

Jeremy Bagg (MalDent Project & University of Glasgow):

One of the great strengths of the Scottish Government-funded MalDent Project has been the extensive network of partnerships and collaborations it has generated. In retrospect, when the grant application was written, we did not have a full understanding of the scope and scale of what we were proposing. If it hadn’t been for our wonderful team of partners, we’d be way behind by now!

This proof-of-concept programme, examining the effectiveness of training dental therapists to deliver education on oral health to community workers, who can then cascade these messages to the population at large, is a perfect example of our joint working. Smileawi gained a small initial grant which supported work with Bridge2Aid, ProDental CPD and the Dental Association of Malawi to develop e-learning materials for a group of dental therapists in Northern Malawi. These therapists completed the online programme via devices and data purchased with the grant and have now delivered training to community workers (with assistance of the Malawian Red Cross), who in turn have gained experience of training others.

Successfully completed cascade training: Martha, the dental therapist trainers and the first cohort of trained community volunteers

This oral health promotion programme directly supports the key plank of the new National Oral Health Policy (also developed as part of the MalDent Project), which is the importance of a preventive, as opposed to curative, approach to oral and dental disease in Malawi. As we move into the policy implementation phase, the timing is perfect.

On behalf of all at the Kamuzu University of Health Sciences and the University of Glasgow with responsibility for delivering the objectives of the MalDent Project, can I offer a massive vote of thanks to all partners involved. Yewo! Zikomo!

Back to the ‘Warm Heart’ after COVID – meetings, maintenance and new friends in Malawi

One of the work streams in the MalDent Project that has been most impacted by the COVID pandemic is the completion of the re-equipping of the Dental Department at Kamuzu Central Hospital, which we commenced with our partners Dentaid and Henry Schein in 2018. Since then, many items of donated equipment had been delivered to Dentaid in Southampton for refurbishment and servicing by Stuart Bassham and his team. The shipping container that we purchased with financial support from the RCPSG HOPE Foundation had been loaded and transported across to Malawi last year, ready for Phase 2 of the refurbishment. The one missing part of the jigsaw was a visit by our team to install the equipment.

As travel restrictions began to ease, we were able to plan this last step. On Sunday 13th March I made my way to London Heathrow Airport to meet Stuart and our latest recruit to the MalDent Project, Chris Cox from Henry Schein Dental. This was to be the start of a very busy, successful and memorable working visit to Blantyre and Lilongwe.

Stuart and Chris with coffee and cake at Heathrow Airport

Jacqueline James at Dentaid had looked at several options for our travel and, after consultation with Stuart, we decided to take a new route via Addis Ababa with Ethiopian Airlines.

About to board

After a very comfortable seven hour overnight flight on an airbus A350 we arrived safely in Addis Ababa.

Stuart and Chris leaving the plane for the airport bus to the terminal at Addis Ababa

As you will see from the photo above, Stuart is wearing a boot on his left foot and walking with crutches. He had broken his foot earlier in the year but did not allow this to deter him from travelling to Malawi. It also did not hold him back once the hard work started!

We had a two hour stopover in Addis Ababa and found a lovely coffee shop. I had already realised that Chris was a very keen coffee drinker and a cup of the strong black liquid soon had him smiling after the overnight flight.

Authentic Ethiopian coffee – the perfect pick-me-up after an overnight flight

Ethiopia is widely believed to be the birthplace of coffee. Apparently Ethiopia is the only place that coffee grew natively. According to a story written down in 1671, coffee was first discovered by a ninth century Ethiopian goat-herder called Kaldi. Allegedly he noticed the energy his goats received from eating the cherries! Whatever the veracity of the legend, we were very grateful for the energising we received that morning!

Our second flight, aboard a Boeing 737 to Chileka Airport in Blantyre, took only four hours.

Parked up at Chileka Airport, Blantyre

On arrival at the airport, our first visit was to a large tent, in which our COVID tests and vaccination certificates were checked.

COVID test checks before entering the terminal

We then headed into the terminal building to purchase our visas and clear immigration. This took a while, and when we were finally through to the baggage reclaim area, I was delighted to see that Peter Chimimba had come to meet us. Our airline baggage tags were checked by security before going through the X-ray scanner:

It was fortunate that Peter was present, because one of the security staff operating the scanner wanted to understand why Chris was bringing in the large tool bag. There was a discussion in Chichewa, which did the trick, but I think we might have struggled to explain had we been on our own!

Once into the airport car park, our bags were loaded into a Toyota Hilux pickup that would be our steed for the duration of our visit.

Mountains and storm clouds form the backdrop to our arrival

We also met our driver from the Kamuzu University of Health Sciences, Sibande Balaka, who would become a very trusted and loyal friend during our stay and who is pictured here a few days later at Kamuzu Central Hospital:

Sibande and the Hilux – we all got to know each other very well over many miles!

After a 20 minute drive we reached the Sunbird Mount Soche Hotel at about 1.45 pm. I was so pleased to see the familiar surroundings and many familiar hotel staff after the COVID-enforced two year absence from Malawi.

Blantyre, viewed from our hotel

We quickly checked in and whilst Chris and Stuart headed to their rooms, I travelled to the KUHeS campus with Sibande for a meeting with Professor Ken Maleta. We discussed some aspects of our work in the area of prevention of dental caries in children, which aims ultimately to establish a Malawian model that is akin to Scotland’s Childsmile programme. I was grateful to Professor Maleta for his valuable advice and guidance, providing suggestions to pursue once back in Scotland.

With Professor Ken Maleta at KUHeS

After the meeting I headed back to the hotel and to the red sofa in the bar where Peter and I have had so many meetings and discussions in the past. We had arranged for Stuart and Chris to meet with Professor Wilson Mandala, Executive Dean of the Academy of Medical Sciences at Malawi University of Science and Technology. In addition to making introductions, we were also keen to update Prof Mandala on the plans for the training of Malawian dental therapists and biomedical engineers in dental equipment maintenance that have recently evolved. Ever since our visit to MUST in 2019, we have been keen to work with staff in its Biomedical Engineering programme on delivery of teaching around dental equipment maintenance. We had a very positive meeting and look forward to further joint working.

With Peter Chimimba, James Mchenga and Wilson Mandala on the red sofa, talking biomedical engineering

Following the meeting with Prof Mandala we enjoyed dinner in the hotel and after a good night’s sleep were up promptly on the Tuesday for meetings at the Blantyre Campus of KUHeS. Our first set of discussions was held with Professor Johnstone Kumwenda, the Dean of Medicine, who has been very supportive of the new BDS programme. After introductions, we briefed Prof Kumwenda about the purpose of our visit and then enjoyed a general discussion about the new course and how things were progressing.

With Professor Johnstone Kumwenda in Peter’s office

After our meeting with the Dean, we walked across the campus to meet the Acting Vice-Chancellor, Professor Macpherson Mallewa and the Registrar, Mr Stuart Chirambo. We had a very positive set of discussions, after which Stuart, Chris and I were presented with gifts to mark our visit.

After our meeting with the Registrar (far left) and Acting Vice Chancellor (centre)

For me it was a great pleasure to meet Lucia Msiska, formerly the PA to Dr Mwapatsa Mipando when he was Principal of the University of Malawi College of Medicine, and now supporting the AVC. Lucia played a very important role in the early days of the MalDent Project, before Annie Mwapasa was appointed as our Administrator. Lucia reminded us that exactly four years ago she had been in Glasgow with the CoM delegation that visited, and was part of the team that wrote the successful MalDent Project grant application to the Scottish Government. After the formal meeting we had a chance for a quick catch up, which I really enjoyed.

A good chat with Lucia, one of our early team members

Our next engagement was with the BDS students in Foundation Year and in BDS 1 and 2. We met them in the same auditorium as the BDS Programme launch had been held in 2019 and it was quite emotional to see the large cohort of budding young dentists as the course gathers momentum.

Foundation, BDS 1 and BDS 2 dental students at KUHeS

After introductions by James and Peter, Chris, Stuart and I each took our turn to address the students. It was a great opportunity to update them on the broader aspects of the MalDent Project, including the forthcoming launch of the National Oral Health Policy and the progress being made with the design of the new teaching facility on the Blantyre campus.

In the afternoon we headed across to the Dental Department of the Queen Elizabeth Hospital.

The Dental Department at Queen Elizabeth Hospital, Blantyre

When I had first visited this facility in 2017 it was in a dreadful state. Since then, with funding from the Ministry of Health and KUHeS, a significant amount of refurbishment and re-equipping has been undertaken, bringing about great improvements. However, there were still a number of equipment issues that remained to be addressed and Stuart and Chris soon had the tool kit out and set to work:

Whilst Chris and Stuart were busy, I left them to head back to the KUHeS campus for a meeting with Joyce Gondwe, the Dean of Students and Collins Chiliwawa, the Scholarships Officer. We had a very fruitful discussion about MalDent Student Aid and the Dentist to Dentist scholarships that are being established at KUHeS.

James, Collins, Joyce and I – once again in Peter’s office!

I returned to the Dental Department at the Queen Elizabeth Hospital later in the afternoon, expecting Chris and Stuart still to be working. However, they were at the entrance chatting with staff, having completed all the repairs required:

The next few photographs illustrate some of the improvements that have been made recently to the clinical facilities. First, a panoral radiography set up has been installed:

New dental chairs have been fitted in re-decorated areas of the building and the dividers between each unit have been replaced with new fittings that feature oral health messages:

Here, some of the dental therapists who work in the Department are posing in a surgery that has colourful painted murals:

It was fantastic to see these significant improvements, all of which had taken place outwith the funding from the MalDent Project itself, and which bring tremendous added value to the work being undertaken to improve oral health in Malawi.

We returned to the hotel for dinner and I was delighted that my good friend Nelson Nyoloka, Lecturer in Pharmacy at KUHeS, was able to join us. Nelson had spent the previous year in Glasgow completing his MSc in Clinical Pharmacology, and it was great to see him again and introduce him to Chris and Stuart.

Nelson enjoyed dinner with us on our last evening in Blantyre

The following morning we were up early for the long drive to Lilongwe. I have now completed this journey on a number of occasions and always enjoy it. For Chris and Stuart, it was their first time on this road, and they both found the variety of views and beautiful countryside fascinating. En route I spotted a private dental clinic in one of the towns and managed to take a photograph as we passed.

A private dental clinic in one of the towns between Blantyre and Lilongwe

We checked into our hotel in Lilongwe and had a light lunch before heading across for a reconnaissance of the work to be undertaken at the Dental Department in Kamuzu Central Hospital. Whilst we were enjoying our lunch there was a very heavy rainstorm, which lasted for a matter of minutes before abating:

Serious rain!

On arrival at KCH, and after greeting the team there, we headed straight to the pre-clinical skills facility, since a priority for the visit was to install the second group of six A-dec 4810 phantom heads to complement the six identical simulators we had installed in 2018.

Whilst the existing cabinetry looked in a reasonable state from the outside…

… a quick look inside revealed exactly the same problem we had encountered in 2018 – massive destruction of the composite board by termites, which had reduced much of the internal structure to a brown dust:

It was clear that the structure needed to be removed, so Chris, Stuart and I set about removing the fittings, breaking up the wooden structure and removing it completely

The ‘moth-eaten’ appearance of the wood is clearly evident in this photo…

… as are the piles of termite dust in these photos:

By close of play, covered in dust and wearing sweat-drenched clothes, we were very pleased to have completed this part of the work on our first day in Lilongwe, to allow the hospital carpenters to start building the new cabinetry the following day.

A pile of termite dust to show for our labours!

After showers, a decent meal and a good sleep at the hotel, we were up early to head back to KCH. On arrival I enjoyed a chat with Jessie Mlotha-Namarika, the senior dentist at the facility, who I have known since my first visit to Malawi in 2017. Jessie was delighted with some tooth models and teaching materials that Stuart had donated to her on behalf of Dentaid.

Jessie at her desk with the training models donated by Dentaid

Shortly after our arrival, we were joined by the hospital carpenters. Stuart and Chris explained what was required, referring to the structure built in 2018 for the first six simulation units, which provided a template for what we needed. Wood was ordered and once it arrived the carpenters set to work.

A little later, the equipment from the shipping container arrived on a truck…

… and unloading commenced

The chairs were placed in the circulation space in the centre of the building …

… and the six phantom head units lined up outside the pre-clinical skills facility:

The shipping container from which the equipment had been delivered to the Dental Department that morning is now permanently stowed at the Lilongwe campus of KUHeS. It is available to ourselves and all our partners, including Smileawi and Bridge2Aid, as a storage facility and staging post for all our various activities associated with oral health improvement in Malawi.

Just as the truck with the equipment was arriving, I had to leave for a meeting at the Ministry of Health with Dr Jones Masiye, Deputy Director Clinical Services – NCDIs and Mental Health. On arrival I apologised for my ‘working clothes’, before we started our discussions, including the detailed planning for the launch of the National Oral Health Policy, which had just been re-scheduled for 14th April. It was a very valuable meeting.

James, Peter, myself and Dr Jones Masiye at the Ministry of Health

I returned to Kamuzu Central Hospital, where the carpenters were busy constructing the cabinetry for the phantom head units. In light of the termite issue, the structure was liberally coated with an anti-termite preparation, which should help to preserve it.

These views show the metal manifold from which the compressed air is directed to each of the simulation units

The carpenters were happy to pose with Chris, once their work was done:

We returned to the hotel in the evening and enjoyed a dinner in Vincent’s Restaurant with colleagues from the Ministry of Health. We were honoured that Enock Phale MP, Deputy Minister of Health, was able to join us, along with Martha Chipanda, the Oral Health Coordinator at the Ministry and Jones Masiye, who we had met earlier in the day. Jessie, Peter and James also joined for a truly memorable evening.

(L to R) Enock Phale MP, Martha, Chris, Peter, Jessie, Jones, Stuart, myself and James enjoying a convivial meal

Enock Phale and Martha Chipanda had been classmates at the College of Health Sciences when they initially trained as dental therapists. We were able to capture this lovely photo of Enock and Martha (seated) and Jones and Jessie (standing) – all key players in the journey to improve oral health for the citizens of Malawi

Key senior stakeholders for oral health improvements in Malawi!

On a previous visit to Malawi I had sampled crocodile tail, which I had really enjoyed. On my recommendation, Chris (and I!) chose the crocodile for our main courses and both thoroughly enjoyed it.

Chris and his crocodile tail – with chips!

The next day turned out to be highly significant. As explained in the previous blog post, Martha Chipanda has identified five dental therapists and one biomedical engineer who will complete the online training programme on equipment maintenance delivered by Medical Aid International. We had arranged for these six candidates to attend at KCH Dental Department on Friday 18th March to shadow Chris and Stuart as they were installing the replacement dental chairs. Martha and I spent an initial twenty minutes with the group, explaining how their involvement fitted into the broader MalDent Project. They then joined Chris and Stuart for the rest of the day. Their enthusiasm and willingness to become closely involved in the work was inspirational. Chris and Stuart were fantastic teachers, such that after a fairly short time the team of trainees was doing much of the work under supervision:

This photo was probably our favourite of the trip – the most positive image you could wish for:

A dental therapist turned biomedical engineer – happy with his new found skills!

When Stuart had been packing the shipping container at Dentaid headquarters, he had included an Oxford hoist, which had previously been used to care for an elderly relative. His intention had been to donate it to the main hospital, but we then realised that it could be used to lift and transport the dental chairs and other weighty items. Anyone who has tried to move dental treatment units will know how heavy and awkward they are. Moreover, the base is designed to be non-slip for stability, making sliding the chair very difficult. We were very grateful for Stuart’s brainwave in packing the hoist, which made our lives much easier.

The hoist made child’s play of moving the dental chairs

Mid-morning on the Friday I walked across to the Lilongwe KUHeS campus to meet with the pioneer cohort of dental students, who have now commenced BDS 3. Our extensive discussions were accompanied by refreshments. It was an opportunity for James, Peter and I to update the class about a number of developments underway on the MalDent Project and for the students to air some of their feedback and concerns.

Morning coffee with BDS 3!

At the conclusion of our meeting, we enjoyed lunch together …

Lunch is served

… and then moved to the steps at the front of the building for a photograph.

Smiles all round from Malawi’s pioneer dental students!

Grateful thanks are due to Madalitso Kaphamtengo, Administrator at KUHeS, for organising the venue and refreshments.

Following the meeting with the BDS 3 students, I returned to KCH. The trainees were still busy working with Chris and Stuart. At one point they were divided into two teams and each given a chair replacement to complete under the watchful eyes of Chris and Stuart. They were extremely fast learners and this experience bodes well for the Medical Aid International training they are about to commence.

Close of play – tired but infinitely more knowledgeable than on arrival!

On the Saturday, we returned to KCH to continue working on the equipment. Chipi, one of the therapists from the group of six who had visited the previous day, joined again voluntarily on the Saturday and the following Monday, as he lived locally

Chipi and Chris fixing a faulty spittoon

On the Saturday evening, as we were enjoying a drink in the bar, Peter recognised an acquaintance of his, Professor Francis Moto, who is Chairman of the KUHeS Council. Formerly Professor Moto was the Malawian High Commissioner to the UK (2005-10) and subsequently Malawi’s first Ambassador in Brazil (2011-15). Peter greeted him and he kindly came across to join us for a fascinating discussion on a wide range of subjects. It was a memorable evening. I was especially interested in the tartan scarf that Professor Moto was holding. It turned out to be the official Malawi tartan – designed at his instigation whilst High Commissioner in the UK!

An evening in the bar with Professor Francis Moto

On Sunday, Chris and Peter were away for the day visiting a charity (the Chinthowa Development Trust) outside Lilongwe – Chris’ family has close involvement with this organisation.

I stayed in the hotel and completed some academic work that required attention. In addition, it was World Oral Health Day 2022, and we were able to publish a series of tweets about the work we were doing in Malawi, including the following three:

On the Sunday evening we were all joined by Dr Mwapatsa Mipando, who had travelled to Lilongwe that day from Blantyre, having only just arrived back from a visit to Zambia. We enjoyed a working dinner together, ahead of a visit on the Monday by Mwapatsa to see the results of the work at the KCH Dental Department.

Dr Mwapatsa Mipando visiting the phantom head facility, as Chris, Chipi and Stuart make the final checks and adjustments

Whist at the Dental Department, he was able to meet with the BDS 3 group who were waiting to have a lecture in the Conference Room there. It was good to see the tablet computers that we had helped to fund being put to good use by the students.

Dr Mwapatsa Mipando with the BDS 3 students at KCH

By this stage, the installation work was largely complete, with small details being attended to before we left. The phantom head unit was transformed into a first class training facility:

Twelve fully functional A-dec simulators, ready for use

In total, six refurbished dental chairs were installed and five existing chairs serviced and repaired…

One of the replacement dental treatment units that was installed

… and seven chairs were prepared to be transported and installed in district clinics. The therapists who are undergoing the biomedical engineering training will be able to support these installations.