Following receipt of the funding, the College of Medicine rapidly purchased a large consignment of tablet computers, which were distributed to students who required them by drivers from the College vehicle pool. Support was also provided with provision of inexpensive data bundles.
These devices were in heavy use by BDS students during the week beginning 1st February, when two of my good colleagues and I joined forces with local College of Medicine faculty to deliver a programme entitled ‘Introduction to Dentistry’. Richard Welbury, Al Ross and I had been due to fly out to Malawi in March 2020, to deliver the programme in person, but the trip was cancelled two weeks before we were due to leave, on account of COVID-19. The availability of the digital devices for the students had now facilitated delivery of much of our planned material through Zoom.
Professor Richard Welbury was previously our Professor of Pediatric Dentistry at Glasgow Dental School, a former Dean of the Dental Faculty of the Royal College of Physicians & Surgeons of Glasgow and a past President of the International Association of Paediatric Dentistry. Dr Al Ross is Senior Lecturer in Human Factors in Healthcare at Glasgow Dental School and a leading international figure in the field of human factors. Between the three of us we put together a series of presentations relating to paediatric dentistry, communication skills, patient safety, infection control, oral infections, antimicrobial drug use / abuse and antimicrobial stewardship.
On Day 1 we held an introductory session with both the local and Scottish teaching faculty to familiarise the students with the plans for the week’s events.
The local faculty, Drs James Mchenga, Peter Chimimba, Wiston Mukiwa and Jessie Mlotha-Namarika, provided additional sessions on periodontology, oral medicine and on issues relating to professional regulation.
For my own part, I thoroughly enjoyed interacting with the students. We covered multiple aspects of oral infection ….
… principles of infection control…
… practical aspects of infection control in dentistry …
… and appropriate use of antimicrobial agents
The recordings of the lectures and the Powerpoint presentations have all been made available to the students in support of their ongoing learning and revision.
A formal post-course questionnaire has been issued to the students so that we can learn from their feedback how to enhance our delivery of on-line teaching for the future.
The COVID-19 pandemic has caused havoc in many ways with education in schools and universities. However, as teachers we have been forced to learn rapidly the principles and practice of teaching and assessment on-line. For international educational initiatives, such as the MalDent Project, it has emboldened us to embrace digital technologies and harness them to our advantage. In this era of serious climate change concerns and the need to make careful choices about volume of air travel, our learning from courses such as the one described above will actually help us to engage in a more regular and sustainable way with students overseas. To quote a famous French artist:
There are always flowers for those who want to see them
Thanks are due to the Scottish Government for financial support towards purchase of the digital devices to allow equitable access of all College of Medicine students to on-line teaching. We would also like to thank Ev Wallace at Glasgow Dental School and Annie Mwapasa, the College of Medicine MalDent Project Administrator, for their support in the organisation of the ‘Introduction to Dentistry’ programme.
The FDI World Dental Federation is an international, membership-based organization that was founded in 1900. It acts as a representative body for over one million dentists worldwide, and is involved with around 200 national dental associations and specialist groups in close to 130 countries. The organisation is based in Geneva, Switzerland, from where it pursues its mission to lead the world to optimal oral health.
The membership of the Vision 2030 Working Group was as follows: Michael Glick (Co-Chair), David M. Williams (Co-Chair), Ihsane Ben Yahya, William W. M. Cheung, Enzo Bondioni, Pam Clark, Stefan Listl, Manu Raj Mathur, Peter Mossey, Hiroshi Ogawa, Gerhard K. Seeberger, Michael Sereny.
Professor David Williams, one of the co-chairs said: “Vision 2030 outlines the ways in which we can integrate our profession within global development agendas, including the UN Sustainable Development goals and the implementation of universal health coverage, that determine important health priorities.”
Fellow co-chair Professor Michael Glick said: “How can we, as members of the oral health community, anticipate transformational changes and trends in the global healthcare environment? How do we seize opportunities to become productive members of healthcare teams delivering person-centered care? These are some of the broad questions we strive to answer through Vision 2030.”
One of the key issues relates to better integration of oral health within overall health, an ambition that is central to the work currently underway by the MalDent Project team in conjunction with the Ministry of Health & Population and other stakeholders on the Oral Health Policy Taskforce in Malawi. Many of the other principles cited in the FDI Vision 2030 document also resonate with the Maldent Project activities.
We were delighted when we were approached by the Working Group to provide a short Case Study of the MalDent Project for inclusion and here it is:
Both the FDI Vision 2030 report and the oral health resolution adopted by the WHO are very important developments for the enhancement of oral health globally and of very special relevance to the work of the MalDent Project. The web-links in the narrative above to the Vision 2030 report and the WHO resolution provide easy access and are strongly recommended to all who have an interest in this area.
I would like to thank the Vision 2030 Working Group for all their work in producing such an excellent document and for having invited us to provide an illustrative example of some of the principles espoused.
One of the distinguishing features of the Maldent Project is its close interaction with a number of charity partners. These include Dentaid, Smileawi, the Borrow Foundation and the organisation which is centre-stage in this post – Bridge2Aid.
I was introduced to Shaenna Loughnane, the Chief Executive Officer of Bridge2Aid (B2A), by Andy Evans, Chief Executive Officer of Dentaid, at the Scottish Dental Show in 2018. By then, the MalDent Project was already working closely with Dentaid on collection and refurbishment of dental equipment bound for the Dental Department at Kamuzu Central Hospital (KCH) in Lilongwe.
Shaenna explained the task-shifting model that B2A had developed which delivers training in emergency dentistry for Clinical Officers based in rural Tanzania. It immediately became clear that a model of this type could prove valuable in Malawi, which faces similar dental workforce challenges. Subsequently, Shaenna invited me to visit a B2A training programme in Tanzania, which was a real eye-opener as to the amazing results that could be achieved with their methods of training. Since then, Shaenna and her team have been working with the Malawi Government Ministry of Health & Population and the Dental Association of Malawi around introducing B2A’s task-shifting model to rural Malawi. A pilot programme, planned for June 2020, had to be postponed because of COVID-19 but is being re-scheduled for 2021.
In addition to our partnerships with charities, the MalDent Project has also received great encouragement and support from the company Henry Schein Dental, thanks to the interest shown by Patrick Allen, their Managing Director for the UK and Ireland. For example, the re-equipping activities at KCH were aided significantly by involvement of Jonathan Langley, a UK Henry Schein engineer, whose expert services were provided completely free of charge.
The following video is a very interesting discussion between Patrick and Shaenna, which gives a flavour of the enthusiasm and energy of these two colleagues for the partnership work we are all doing to improve oral health in low- and middle-income countries.
For an organization led by someone with Shaenna’s energy and enthusiasm, it has not been surprising that despite the impact of COVID-19 on the training programmes run by B2A, other avenues for meaningful activity have been identified. One of these was the concept of an international e-conference which would bring together participants from across the globe to discuss a variety of issues relating to remote and rural healthcare. Those of us who have been involved in conference organization know what a huge amount of work is entailed, and for this type of on-line meeting there are additional complications such as consideration of delegates’ time zones. However, the conference was duly announced – a partnership between B2A and a well-known and respected on-line educational platform called ProDentalCPD:
This was an intense conference, delivered as six sessions over two days, as outlined below:
Mwapatsa and I were delighted to have been invited to participate in the session ‘Partnerships in Health Education’, chaired by Bridge2Aid volunteer Kiaran Weil. We presented along with Dr Meredith Giuliani, a radiation oncologist and Education Director at the Princess Margaret Cancer Centre in Toronto who described a health education partnership with the King Hussain Cancer Centre in Jordan. The content of that session is available to view in the following video:
It was uncanny that so many of the principles of partnership working that we described from our experiences of the MalDent Project were mirrored in Meredith’s excellent presentation. There is definitely scope here for some joint working in 2021.
This conference was a tremendous success. Many congratulations must go to Shaenna and her team at B2A and also to Rob Dyas at ProDental CPD, whose technical wizardry kept things running smoothly. In due course, much of the conference content will be uploaded to YouTube and relevant links will be added to this post when they become available.
Let’s hope this COVID-19-induced innovation from B2A and ProDental CPD is not a one-off event – the MalDent team is already looking forward to the next one!
Those who are regular followers of our blog will know of the partnership working between the MalDent Project and the charity Smileawi. Our first joint endeavour was a very successful pilot child oral health survey carried out in Malawi in July 2019, which was a collaboration between Glasgow Dental School’s Community Oral Health Research Group, six senior students from Glasgow and Dundee Dental Schools and Smileawi.
Since then, a strong working relationship has also developed between Smileawi, Bridge2Aid, the Dental Association of Malawi and the MalDent Project, leading work to establish a task-shifting emergency dentistry training programme in Malawi.
Like all charities, Smileawi is highly reliant on donations from members of the public. As a result of the COVID-19 pandemic, 2020 has been a very difficult year for fund-raising. Nigel and Vicky Milne, the founders and directors of Smileawi, are both University of Glasgow Dental School alumni and by a happy coincidence a festive on-line fund-raising opportunity arose at their alma mater.
Glasgow Dental School is immensely fortunate to have its own musical troupe – the Big Smile Big Band. Its founder and director is Callum Wemyss, a Class of 2016 Glasgow dental alumnus, who established the band whilst still a student and has maintained his role as band leader since qualifying. He is now a Specialty Trainee in Oral Surgery at Glasgow Dental Hospital & School, so he has returned home to his band’s base! Such is Callum’s drive and enthusiasm that many fellow alumni, as well as current staff and students, continue to support and perform with the band.
Clearly the COVID-19 pandemic has brought an end to live events, but earlier in the year the band put together two on-line songs by individually recording their parts and then submitting them to be digitally edited together into final performances. These so-called ‘Dental Lockdown Sessions’ were part of a very successful fund-raising initiative for Glasgow’s Prince & Princess of Wales Hospice, led by another Glasgow dental alumnus, Clive Schmulian.
A few weeks ago I met Callum by chance in the Dental Hospital. He was toying with the idea of pulling the Big Smile Big Band together digitally again, to record two Christmas songs. Callum was keen to incorporate a fund-raising element into the project and we decided to have a discussion with Nigel and Vicky, about a plan to make Smileawi the recipient charity. Since then, the project has come together and the two songs were launched at 8pm on Tuesday 22nd December to an on-line audience.
It was a fantastic event and for those who were unfortunate enough to miss it, you can see it on ‘Big Smile Big Band Catch up TV’ here:
Massive thanks are due to Callum and all the members of the Big Smile Big Band. Special thanks also to Roger Marsh who completed the audio mixing (as well as playing trombone!) . Finally, big thanks to Clive Schmulian for kindly providing access to the digital platform and to Clyde Munro for sponsoring the event.
My colleague and friend Niall Rogerson, who works with me on the MalDent Project, was closely involved for several years with the establishment of the new Bachelor of Dental Surgery programme at the University of Rwanda. The initial connection had been made via a former University of Glasgow clinical academic, Professor Phil Cotton, the founder Dean of the University of Rwanda Medical School and subsequently the Principal and Vice-Chancellor of the University of Rwanda.
The experience gained by Niall at the University of Rwanda has been very helpful as we develop the new BDS programme at the University of Malawi College of Medicine.
Dental students at the University of Glasgow Dental School undertake an elective project over a period of four weeks between BDS 4 and BDS 5. For many years Niall was the Academic Lead for our electives programme and in 2017 one of our students, Katy Wood, spent four weeks at the University of Rwanda Dental School. In 2018, two more Glasgow students, Graeme Brown and Rebecca Baird, chose to visit the University of Rwanda Dental School for their elective study where they collaborated with Rwandan dental students in oral health improvement projects.
There is a long-standing criticism of international health electives that the educational benefits tend to flow to the developed countries, with little possibility for students from low- and middle-income countries to be advantaged by studying overseas. We were determined that this should not be the case as the Glasgow – Rwanda Dental School partnership developed and in 2018 we were able to identify funding to support an elective placement in Glasgow for a dental student from the University of Rwanda.
The Dean of the School of Dentistry, Doctor Chrispinus Mumena, identified a level four student who he believed would be particularly well placed to gain maximum benefit from undertaking an international health elective. The student he selected was Bizumuremyi Karebu. During his time in Glasgow, Karebu followed a busy academic schedule …
and sampled many scenic and cultural delights of Scotland:
By chance, Karebu’s visit to Glasgow coincided with a visit by Dr Mwapatsa Mipando from the University of Malawi College of Medicine, one of the main driving forces behind the Maldent Project. It was a very happy coincidence that we were able to make this introduction.
One of the highlights of Karebu’s elective placement in Glasgow was a meeting with one of our Professors of Dental Public Health, David Conway. Their discussions stimulated great interest in the Scottish Government Childsmile Programme and how such an oral health initiative could be transferable to Rwanda. On his return to Rwanda, Karebu grasped the nettle and has written the following blog post which describes the initial steps he is taking with colleagues to develop a Childsmile model suitable for use in his home country:
Bizumuremyi Karebu’s story– the Bwiza Childsmile Initiative
The Bwiza Childsmile Initiative has been established in Rwanda with reference to the Childsmile Programme in Scotland. It aims to promote and improve the health and wellbeing of children in Rwanda and to reduce inequalities in both dental health and in access to dental services.
The idea of Bwiza Childsmile arose in 2018 when Bizumuremyi Karebu (now a BDS Final Year student at the University of Rwanda) visited the University of Glasgow as part of an exchange programme between the two Dental Schools.
On his return to Rwanda, Bizumuremyi Karebu linked up with intern Dr Ndisanze Amini and a BDS Final Year student, Habumugisha Jean Marie Vianney. They sat together and took the initiative to establish Bwiza Childsmile. Bwiza Childsmile was launched officially on 8th May 2020. It launched with its first online campaign called the “TESTIMONIES CAMPAIGN” in which families took pictures and videos practising oral hygiene and shared them on social media platforms like Twitter or Instagram and tagged their friends. At this time the country was in total lockdown and children were not at school due to the COVID-19 pandemic, so this was an activity they could undertake from home.
At the end of this campaign the country was lifted from lockdown to curfews, so we were able to conduct an outreach campaign in a rural area of Kigali City, in Jabana sector, Bweramvura Cell. We have raised the awareness of oral hygiene practices and COVID-19 preventive measures within this community and we have distributed more than 1000 toothpastes and biodegradable toothbrushes to the families and children.
Happy families and children after receiving their oral health education, toothbrushes and toothpaste
The aim of the Bwiza Childsmile Initiative is to reduce inequalities in both dental health and access to dental services. We are working on a new project called the “CROCO SMILE PROJECT” which will be based on providing oral health education basic materials such as posters, videos, games and also handwashing education to nursery and primary school children. We will also introduce daily supervised toothbrushing for nursery and primary school children, and provide basic oral health training to the community health workers.
This post illustrates the value that can be gained by providing carefully designed elective experiences for senior undergraduates and the positive influence it can have on these individuals and their peers after they return to their home institutions. It was a pleasure and a privilege to host Karebu’s elective studies at the University of Glasgow and especially exciting to see the activities now ongoing in Rwanda that were stimulated by his visit to Scotland.
We are now in the process of linking Karebu and his colleagues with Ronald Manjomo, who is undertaking a PhD at the University of Malawi College of Medicine with a focus on developing a Childsmile type of intervention that would be applicable in Malawi. The potential opportunities for joint working and learning are extensive and we look forward to developments in 2021 and beyond.
Once the pandemic permits, we look forward to welcoming further students from Rwanda and other sub-Saharan African countries to Glasgow. The Maldent Project is all about partnerships and the involvement of young oral health professionals like Karebu, who are enthusiastic and motivated, is what will maintain its momentum and impact into the future.
I am delighted that our MalDent Project blog is today publishing a guest post from my friend and colleague, Dr Julian Fisher.
Julian is a dental surgeon who qualified from the University of Birmingham in 1985. Subsequently he completed an MSc in HIV/AIDS from Stellenbosch University in 2002 and gained his MIH (International Health) from Charité University, Berlin in 2005. Julian, who is based in Germany, is now working as a policy advisor and analyst specializing in health workforce education, social and environmental determinants of health, and global oral health. These are aspects of health that are central to the MalDent Project and, not surprisingly, we have identified multiple synergies. Julian’s ongoing consultancy work with WHO, UNESCO / UNEP, provides further valuable input to our joint interests.
In this post, Julian describes a very exciting initiative in which the MalDent Project, University of Malawi College of Medicine and the University of Glasgow are among many participants across the globe.
In the early 2000s I worked in Brooklyn Chest Hospital in Cape Town, South Africa caring for the oral health of patients co-infected with HIV AIDS and TB. Every summer Cape Town would have water restrictions, but in 2018 the Western Cape Government warned that water reservoirs were so low that there was a real risk that 12th April would be ‘Zero Water Day’.
So what would happen when the water taps ran dry in Cape Town? At the end of the National Geographic short film ‘what happens when Cape Town runs of water’, the narrator of the film Ray De Vries sums up by saying that everyone can learn from Cape Town’s experiences, in his words “what we did wrong and what we are doing wrong, what we did right and what we are doing right”.
But the children and Youth in my classes were often at Fridays for Future demonstrations and were becoming increasingly frustrated about not being able to ‘do something’. And they were right! I set out to develop a learning plan that I could use in both higher education / university courses as well as in secondary schools so that students could learn how to transform (Transforming our world: the 2030 Agenda for Sustainable Development). Learning to transform that would engage their families and friends, the whole school and local communities and work together to take action.
The result was the Zero Water Day Partnership, which drew on my work for UNESCO around Lifelong Learning and Health, and my engagement with UN Mountain Partnership through the Training for Health Equity Network.
Zero Water Day Partnership (ZWDP) was launched via a webinar on Tuesday 24th November with over 25 participants from schools in 14 countries around the world. Prof Jeremy Bagg from Glasgow Dental School spoke about plans for the COP 26 Climate Change summit and the MalDent Project.
A key part of ZWDP is supporting learning in the classroom and applying it though whole school, whole community action. Action in school will support WHO UNESCO initiative of making every school a health promoting school. One of the core objectives of the ZWDP is connecting health promotion activities (SDG 3 Health) such as toothbrushing with the health of our planet through conversations around water use and management (SDG 6 Water), and reducing inequality (SDG 10). The MalDent Project has established Malawi’s first dental school and is supporting development of a national Oral Health Policy, including a dental caries prevention and health promotion programme for children.
EM Alcides Francisco Brantes, a ZWDP participating school in Salinas region of Nova Friburgo Brazil, has programmes supporting sustainable practices such as family agriculture and water preservation practices for the communities within the 3 peaks state park.
Project Learning to Smile in Nova Friburgo, uses health/environmental social practices such as milk teeth exchange and clean water preservation to formulate online literacy content and support teachers’ lesson plans.
Our ambition, established in 2019, was to deliver a one-day high-level meeting with Scottish Government, WHO, UNESCO and other key stakeholders, followed by a two and a half day workshop. These were to take place just before the COP 26 Climate Change summit in Glasgow that had been scheduled for November 2020. The University of Glasgow had agreed to host the meeting and plans were developing well until the COVID-19 pandemic resulted in postponement of all these events to November 2021. Undeterred, we have re-booked our slot with the University and intend to run the same format of activities in November next year.
A highlight of the event, regardless of exact timing and mode of delivery, will be an opportunity for schoolchildren and their teachers to present materials they have generated through participation in the Zero Water Day Partnership activities during 2020 / 2021 (see below). This will provide a very powerful demonstration of the critical importance of linking education, health and care for the environment to empower young people through their learning in schools.
What is the Zero Water Day Partnership?
ZWDP is a voluntary partnership of schools with teachers and children learning with and from each other to take action on water and sustainable development in their homes, schools and communities. A key focus is on mountains as water towers of the world and promoting the #mountainsmatter campaign in schools to empower Youth to play an active role in protecting ecosystems around the world’s summits for future generations, including issues such as sustainable mountain tourism.
ZWDP looks to learn in and from the COVID pandemic and provides maximum flexibility for all schools to participate, so that children have the opportunity to share with others around the world despite all the immense challenges they are facing. Participating schools will have an opportunity to present during the 3.5 day workshop to be held in Glasgow the week before the COP 26 Climate Change Summit in Scotland, November 2021, and contribute to a short film and eBook.
Students at Freie Waldorf School have started building the weather station, as well as a ZWDP signpost to all the other schools. Community action will use United Nations International Days including International Mountain Day to emphasize the interconnectedness and interdependence of issues, and promote multi-, inter- and intra-generational conversations.
ZWDP will help share and exchange experiences across schools, for example Wanakha Central School and Shaba Higher Secondary School in Bhutan (SHSS).
SHSS and its Spring Water Conservation project was initiated by the Bhutan Centre for Media and Democracy. Members of the school, which includes teachers and students, helps citizens to understand their roles in democratic processes as well as to improve overall media literacy. One of their programmes includes teaching the youth to harness the power of the media to help their communities and volunteerism.
Spring water conservation, Shaba Higher Secondary School, Bhutan. Photos by Chimi Wangmo
I have been organising a series of Oral Health Navigators Training Programmes to dental students in Europe and around the world. A key element is exploring how a shift to a model of oral health and dentistry based on social determinants of health approaches can help to mainstream oral health across and between the 17 Sustainable Development Goals, and within SDG 3 (Health). Oral health is closely related to almost all SDG 3 targets.
Such an approach will open new ways of thinking, and new ways of working, which will help to create resilient and sustainable dental practice for the future.
We have recently had the pleasure of welcoming Nelson Nyoloka to Glasgow. Nelson is a Lecturer in Pharmacology at the University of Malawi College of Medicine and has enrolled on the MSc in Clinical Pharmacology at the University of Glasgow. He works closely with Peter Chimimba’s wife Frider, who is also an academic member of the pharmacology staff team at the College of Medicine. Lorna Macpherson and I had been able to meet Nelson in Blantyre in February 2020, when we visited Malawi for the national Oral Health Policy Workshop.
As a result of the COVID-19 pandemic, the start of Nelson’s MSc programme had been deferred to November. I was delighted to hear that he had arrived in Glasgow, but for the first two weeks he had to quarantine according to the COVID-19 regulations. Shortly after his quarantine period ended, we agreed to meet on a Saturday morning for a socially distanced outdoor coffee, a chat and a walk around the University.
After a very enjoyable catch up over our coffee, we set out for the main University of Glasgow campus.
We were lucky to catch a dry spell before rain arrived later in the day and Nelson was excited to see the beautiful buildings around the campus – lots of photographs were taken!
Our walk back to Nelson’s hall of residence took us through Glasgow’s Botanic Gardens. The many squirrels were a novelty for Nelson, and I recounted how the equivalent novelty for me in Malawi had been to see monkeys running around a conference centre near Mangochi which we were visiting for one of the early BDS curriculum development meetings.
It is unfortunate that Nelson has arrived in Glasgow during this period of COVID-19 restrictions. However, he is very positive and determined to make the most of his time in Scotland. We look forward to sharing that experience with him.
Our other recent meeting was with Cleopatra Matanhire, who has joined the University of Glasgow from Zimbabwe to complete an MSc in Global Health. Cleopatra is one of three postgraduate students (one each from Malawi, Zambia and Zimbabwe) in Glasgow funded by the Beit Trust on their Joint University Partnership scheme. Cleopatra trained as a dentist in Zimbabwe and in view of this, our good friend Alex Mackay from the Wellcome Centre for Integrative Parasitology, who is closely involved with the Beit Trust-funded students, passed on Cleopatra’s details. However, even before I had made the connection, Charlotte had been in touch with us at Glasgow Dental School, demonstrating her commitment to developing partnerships and pushing forward with her professional ambitions.
Cleopatra gained a Bachelor of Dental Surgery degree with Honours in 2015 from the University of Zimbabwe College of Health Sciences. Whilst undertaking her internship at Harare Government Dental Centre, she completed a Masters of Business Administration degree at the National University of Science and Technology in Zimbabwe. Since 2018, Cleopatra has been undertaking multiple roles as a Government Dental Officer with the Ministry of Health & Child Care, responsible for coordination of Dental Surgery Assistant training, a Volunteer Lecturer at the Ministry School of Dental Therapy and Technology and, since 2019, a Part-Time Lecturer at the University of Zimbabwe College of Health Sciences, Department of Dentistry.
It was a great pleasure for Lorna and I to catch up with Cleopatra over Zoom recently. It is clear that Cleopatra is highly motivated to make a significant difference to the oral health of those living in Zimbabwe, particularly children, patients in hospital care and those with psychiatric illness. Her list of achievements to date is very impressive and shows a passionate determination to improve public sector dentistry in Zimbabwe.
The MSc in Global Health at the University of Glasgow requires each student to complete a research project and dissertation. Cleopatra is interested in studying the role of dental associations and academia in establishing oral health policies. We have pointed out that a current work stream for the MalDent Project is the development of a national oral health policy for Malawi, with major input from the Dental Association of Malawi, the University of Malawi College of Medicine and the University of Glasgow. On that basis, we would be a real-time subject for study!
It has been a real privilege to meet Cleopatra and we will be continuing our conversations and, hopefully, joint activities into the future. The challenges for oral healthcare in Zimbabwe, as related to us by Cleopatra, are common to many African countries. If we collaborate and share our ideas, working with impressive young professionals like Cleopatra, we will be able to make a real difference to the lives of many of those who currently have little or no access to either preventive measures or oral healthcare.
‘Networking’, ‘partnerships’ and ‘collaboration’ are words that are used frequently in the context of international development. Those of us in Scotland who are engaged in projects with Malawian partners are extremely fortunate that there are many initiatives to support joint working. In addition to the direct and generous leadership of Scottish Government in this arena, the Scotland Malawi Partnership and its sister organization the Malawi Scotland Partnership play a pivotal role. Their input is evidenced by this story of a collaboration which is starting to bear fruit and shows great potential in two important areas of the Sustainable Development Goals – safe water supplies (SDG 6) and good oral health (SDG 3).
In October 2018 I attended the Annual General Meeting of the Scotland Malawi Partnership, held in the Student Union of the University of Glasgow.
Whilst there, I met Ieuan Isaac from the Rotary Club of Ayr, who discussed with me the work of the club on a water borehole project at a Malawian village, delivering sustainable water to over 700 residents. Their project had received valuable assistance from Professor Bob Kalin, based at the University of Strathclyde. Ieuan asked if I would be prepared to address the Ayr Rotary Club members about the MalDent Project, which I was delighted to do.
Purely by chance, on the date that was set for my brief address (26th February 2019), Dr Mwapatsa Mipando, Principal of the University of Malawi College of Medicine, was in Scotland and he accompanied Niall Rogerson and I to Ayr, where we gave a joint presentation and answered questions.
Bob Kalin was in the audience. Bob is the Director of the Climate Justice Fund: Water Futures Programme (WFP), which is funded by the Scottish Government. Following the formal part of the evening, Bob, Mwapatsa, Niall and I had a very interesting discussion about potential synergies between the MalDent Project and the Water Futures Programme in the context of the fluoride content of water.
For readers who don’t have a dentistry background, fluoride is of great importance to dental health. At appropriate concentrations (0.7 – 1.2 parts per million), fluoride in drinking water strengthens tooth enamel and reduces the risk of dental decay. Some places have sufficient fluoride in natural water sources whilst in some geographic locations fluoride is added to the water supply. If the drinking water is low in fluoride, then regular brushing with fluoride-containing toothpaste has been shown to provide added protection. However, excessive fluoride in drinking water interferes with the formation of enamel when children’s teeth are developing, resulting in an appearance of the teeth which can be unsightly.
In an unrelated series of discussions, Nigel and Vicky Milne, the founders of Smileawi, had approached Glasgow Dental School for support with a child oral health survey which they were keen to undertake in some of the schools based in Malawian villages that they visited regularly to support dental healthcare. Furthermore, they wondered whether any of our senior students may be interested in participating. As regular readers of the blog will know from previous posts, this all went ahead, and as part of the preparations we linked the Smileawi team with Bob Kalin and one of his PhD students, Marc Addison, who is studying fluoride in groundwaters in Malawi.
Marc provided the Smileawi team with fluoride-measuring kits to assess the water in the boreholes at each of the six schools they visited, though it is important to recognise that it is the fluoride content in village water supplies where the children live during the period of tooth formation that is of critical importance. At one of these schools, in Dedza District in Central Malawi, they identified a higher level of fluoride than in the others. In this same school they also identified a significant number of children with dental fluorosis, quite unlike the clinical picture in the other five schools.
Once all the epidemiological data collected by the Smileawi team had been checked for accuracy, they were passed in anonymised format to Marc, to consider in the context of his work to predict groundwater vulnerability to geogenic fluoride risk. Recently, Marc contacted us to review the outcome of his cross-referencing, which has proved very exciting.
In summary, the school in Dedza is located in an area where Marc’s work has predicted that an underground hot spring is buried beneath sediment. The relevance of this is shown in the whisker plot below, because the water that emanates from hot springs contains very high levels of fluoride.
At present, the Malawi drinking water standard is 6 mg/l, a concentration which can cause both dental and skeletal fluorosis. In due course, through a staged process, the ambition is to reduce that standard to the WHO drinking water standard of 1.5mg/l.
In light of the hard work put in by the Smileawi team to gather the epidemiological data, Bob and Marc kindly agreed to repeat their presentation for Nigel and Vicky Milne on the evening of 28th October 2020.
It was as exciting for the Smileawi team as it had been for us to see how these separate pieces of work in two distinct disciplines had come together in a complementary way.
Gaining an understanding of how the underlying geology could impact on fluoride levels in drinking water, which in turn has a very significant effect on dental health (for good or bad, depending on concentration), was extremely enlightening.
Despite the fact that Bob and Marc had already provided a presentation summarising these results on two occasions for us, there was to be a third time! A major strand of ongoing work for the MalDent Project is its involvement in the development of a national Oral Health Policy with the Government of Malawi Ministry of Health & Population. The fourth meeting of the policy task force was scheduled for Thursday 5th November, and with the agreement of the chair, Dr Nedson Fosiko, we invited Bob and Marc to deliver a presentation to the task force members. At Bob’s suggestion, we also invited Modesta Kanjaye, who is the Director of Water Resources at the Ministry of Forestry and Natural Resources.
Bob gave an initial, brief overview of the Climate Justice Fund: Water Futures Programme, to provide context for the task force members
He showed a series of slides, including an illustrated description of the extensive mapping of water points that has been completed.
Following Bob’s introduction, Marc described his PhD studies on fluoride levels in the Malawian water supply.
What is striking, as we had heard in Marc’s previous presentations, is the very wide variation in levels of fluoride across the country, which are totally dependent on the underlying geology.
Marc has very recently published a paper on his work, entitled Predicting groundwater vulnerability to geogenic fluoride risk: a screening method for Malawi and an opportunity for national policy redefinition, which interested readers can download here. Further papers are in preparation.
The relevance of these wide fluoride level fluctuations to dental health is substantial. There will be areas of the country where the natural fluoride level is optimal for dental caries prevention, others where additional fluoride (eg from regular supervised toothbrushing with a fluoride-containing toothpaste) would be recommended and some areas in which excessive levels are causing dental fluorosis. We have now added geographic distribution of drinking water fluoride levels to the situational analysis the Oral Health Policy Task Force is currently undertaking, to inform the policy content.
To illustrate the complexity of the problem, Bob showed a graph of the various water points in the villages surrounding the school in which children with fluorosis were identified by the Smileawi team. All of these points are now being tested for their fluoride content, in an attempt to identify the specific water sources that are responsible for the fluorosis in the children.
In summary, this joint work is mutually supportive. From the perspective of the MalDent Project, our increased understanding of the geographic distribution of the varying fluoride levels in drinking water will inform both the design of the forthcoming national child oral health survey and the content of the oral health policy. From the perspective of the Water Futures Programme, epidemiological data that we gather from the national child oral health survey and related dental research programmes can act as a proxy to help the team focus its efforts on fluoride reduction in water supplies to those water points most likely to require attention. Furthermore, the engagement of both the Ministry of Health & Population and the Ministry of Forestry & Natural Resources in ongoing discussions provides key central links within the Government of Malawi.
Since this story started with the Ayr Rotary Club and the kind invitation from Ieuan Isaacs to one of their meetings, we should perhaps close on the same theme. I took a photo of this plaque in the Savoy Park Hotel on the evening that Mwapatsa and I spoke to the members there.
Those initial discussions with Bob Kalin have turned into a substantial and valuable collaboration. In line with Rabbie Burn’s exhortation – we caught the moments and we’re putting them to good use.
Despite the challenges of the COVID-19 pandemic, many of the core activities of the MalDent Project continue to make good progress. This post provides an update on some of the recent developments.
Refurbishment of the Dental Department at Kamuzu Central Hospital
One of the projects that has been delayed by the pandemic is Phase 2 of the refurbishment of the Dental Department at Kamuzu Central Hospital in Lilongwe. Following the success of Phase 1, financial support from Scottish Government and the Royal College of Physicians & Surgeons of Glasgow HOPE Foundation has funded the collection and refurbishment of more dental chairs and dental simulator equipment which Dentaid has serviced ahead of transportation and installation in Lilongwe. We have purchased a shipping container and it was loaded just before lockdown. On 23rd September I had a call with my friend and colleague Stuart Bassham, Dentaid’s Warehouse and Engineering Manager.
We have decided to arrange for shipping of the container from Dentaid’s depot in Southampton in the next few weeks. This should ensure it arrives in Lilongwe in early 2021, when it will be placed permanently on a site in the grounds of the College of Medicine campus, adjacent to Kamuzu Central Hospital. We will unload the equipment when we visit Lilongwe to undertake the installation, which is tentatively scheduled for June 2021.
Scotland Malawi Partnership Meeting Annual General Meeting, 3rd October 2020
Throughout the COVID-19 pandemic, the Scotland Malawi Partnership (SMP) has done a fantastic job of keeping partners in both countries connected and updated on the progress of the infection in our respective homelands. The regular Zoom meetings, which commenced on 31st April 2020, have been informative and, despite the challenges of the pandemic, inspirational in many ways. The COVID-19 hub on the SMP web-site is an excellent source of up to date information.
The SMP Annual General Meeting, held virtually on 3rd October 2020, was a highlight of this year’s activities. One of the centrepieces was the keynote speech from the President of Malawi, Dr Lazarus Chakwera:
In his uplifting speech, Dr Chakwera outlined the priorities he saw for the relationship between Scotland and Malawi in the coming years.
One presentation that was of particular interest for me was the update on the COVID-19 case numbers in Malawi, delivered by Dr Mwapatsa Mipando, Principal of the University of Malawi College of Medicine and a driving force behind the MalDent Project. The data he presented were very encouraging:
However, fingers remain crossed that the pattern of disease seen in many other parts of the world, and currently presenting a major challenge in Scotland, is not repeated in Malawi. As I write this post on 23rd October, things remain hopeful, as demonstrated in the figure below, tweeted by the Government of Malawi Ministry of Health yesterday:
Other details of the SMP AGM are all available to interested readers on the Scotland Malawi Partnership web-site.
Participation in WHO Africa webinar on COVID-19 impact on oral health care service
Regular followers of this blog will have read previously of the MalDent Project links with Dr Yuka Makino, who is the WHO Africa Technical Officer for Oral Health, based in Brazzaville. Yuka played a central role in the National Oral Health Policy Workshop in Lilongwe held on 13th and 14th February 2020.
We were approached by Yuka to ask whether we would contribute to a webinar that she was organising entitled ‘Continuity of essential oral health service in the context of COVID – WHO African Region’. The event was run on 28th and 29th September.
Yuka introduced the objectives of the webinar:
Yuka had invited speakers from around the globe, including Dr Benoit Varenne who is the Dental Officer at the World Health Organization, based in Geneva:
The presentation on the situation in Scotland and the broader UK was scheduled for Day 2:
It was a privilege for the University of Glasgow to participate in the event.
In addition to speaking about the UK context, Yuka had asked me to provide an update on the MalDent Project, and the challenges that had arisen from COVID-19. I focused on the challenges of delivering on-line learning to students in Malawi because of issues around accessibility of digital devices, WiFi and affordable data bundles. It was good to be able to report on how joint working between Scotland and Malawi had been able to overcome some of these difficulties at the University of Malawi College of Medicine.
This was an excellent webinar, very well organized and run by Yuka. It finished with two concluding slides:
As I read the second of these slides, which focused on the now well-known phrase ‘Build Back Better’, it struck me how many of these recommendations are feeding directly into the ongoing work of the Government of Malawi Oral Health Policy Task Force. In a future blog post we will update on the work of that group, which aims to publish a finished policy document by the middle of 2021.
Recordings of both days of the webinar are available on YouTube and are recommended to all interested readers.
Progress with design of the integrated dental teaching facility and student hub
Further to the earlier post, the Stage 1 Report has now been finalised and presented to the MalDent Project team by Paul East and his colleagues at the Edinburgh offices of John McAslan + Partners. The final page of the report includes a rendering of the concept for the building at this stage of the design process.
Following the initial presentation of the Stage 1 Report, Mwapatsa Mipando shared the draft document and the recording of the design team discussions with key stakeholders at the College of Medicine. He hosted a formal feedback session, to ensure inclusivity of all players who would benefit from this exciting enhancement to the campus infrastructure:
Subsequently, that feedback was shared with Paul East and the design team, followed by a Zoom meeting in which Mwapatsa Mipando and Peter Chimimba clarified queries raised by the local responses.
Paul and the design team have now commenced on Stage 2 of the design process, which is scheduled for completion by the end of November 2020.
Developing a childhood caries prevention programme for Malawi
Ronald Manjomo, the recently appointed PhD student based at the College of Medicine, has made an excellent start on his study programme. He provided an update at a meeting held on 20 October with his two main supervisors, Professors Ken Maleta (College of Medicine) and Lorna Macpherson (University of Glasgow).
Since Ronald’s work feeds directly into the activities of the Oral Health Policy Taskforce, he is now joining the meetings of that group as an Observer in the first instance.
In addition to funding from the Scottish Government MalDent Project, Ronald is partly funded by the Borrow Foundation. The Borrow Foundation has recently updated its web-site, which now includes a link to the MalDent Project and specifically mentions the work that Ronald is undertaking as part of our overall programme.
In conclusion, we are maintaining momentum for the MalDent Project despite the COVID-19 challenges. Once again, it is the very strong partnership working at all levels, and the enduring support of our funders, that is enabling us to make progress.
In the very first post I wrote for this blog on 1st September 2018, I quoted Helen Keller, who said: “Alone we can do so little; together we can do so much”. That has proved so true for the MalDent Project to date and has laid the foundations that will see us through the COVID-19 challenges towards achieving our aim of ‘Oral health for all‘
At the third meeting between the design team members and the MalDent team, held recently on Zoom, Paul East of John McAslan + Partners, together with his colleagues, presented the work they have been undertaking to complete Stage 1 of the design process for the new Dental School / Student Hub Building on the Blantyre campus of the University of Malawi. It was an exceptionally exciting and eye-opening two hours. Little did we know what was to follow after the opening slide of the presentation.
Paul initially reminded us of the phasing of the project and associated timeline. The team is working to a very tight schedule but at present it is all on track, which is a fantastic achievement:
For the the first part of the presentation, Sophie Burgess provided a description of the site analysis that had been undertaken. Of the three possible locations that had been previously identified, Site B was chosen as the one that best satisfied the design brief.
This choice was superimposed on a photograph of the campus, which illustrates its position on the perimeter of the existing buildings but bordering open space for potential future developments.
The site was also considered from the perspective of photographs taken from different locations. These pictures also serve to illustrate the stunning backdrop for the new building.
We were next given information on the topographic analysis that has been completed. There is a significant slope to the site, which it later transpired would be very relevant to the design process.
Paul and Sophie next handed over to Sam Haston from Buro Happold, to discuss the climatic analysis that has been completed. It was fascinating to hear how impactful the climate data are in relation to the design process.
Every aspect of the climate, including temperature, relative humidity, wind speed and cloud cover were considered at each time of the year.
Sam explained how combined use of shading and air-flow could have massive impacts on levels of comfort for those using buildings and how relevant consideration of these factors were critical to the design process.
To explain this in more detail, Sam gave a description of what are known as passive design principles
He showed a diagram illustrating how overhangs can be used to provide shade to the North and South elevations, but that vertical structures are more efficient on the East and West:
There are also rules governing building designs that will increase the efficiency of cross ventilation:
The priority for this building is to use passive design principles as much as possible to reduce the amount of mechanical ventilation required. This improves natural efficiency, reduces power usage and enhances the green credentials of the building.
In addition to natural ventilation, there are many other design features that can improve the overall efficiency of buildings and which are environmentally friendly. These are all being considered during the design process:
The final slide in this section summed up the opportunities provided by Site B and why it had been chosen over Sites A and C.
Paul then moved on to the brief, to explain the progress of the team through Stage 1.
One of the first considerations had been to consider how the functional elements should be organized within the structure, to ensure appropriate adjacencies.
Having considered the adjacencies, the next step was to consider how the various elements should be organised. On their next slide, we were treated to the first set of architect’s hand drawings which then morphed into three possible organisational options – ‘organic’, ‘slices’ and ‘spine’.
Paul then proceeded to take us through a series of slides which illustrated how each of these three organizational options could begin to translate into a concept for the building. The design team had come to the conclusion that Option 3 – Spine, worked best.
The building would extend over three floors and this is where the topography of the site became relevant to the design.
We were then treated to a series of pen and wash sketches, through which the design was developed and emerged. I have always loved this type of illustration, and to see the design concept appearing out of the page was incredibly exciting.
In this sketch, the use of the lie of the land is becoming clear.
Another sketch provided an illustration of how the entrances to the building and surrounding landscaping could be envisaged.
Suggested floor plans were illustrated for each level of the building
The design then emerged through a series of sketches …
… followed by computer simulations based upon those sketches:
Paul explained that some of the components of the design had stemmed from considering features of other buildings that had similar requirements in the brief, so-called precedents:
At the end of the two hour presentation, there was general discussion about progress and the vision for the building design that had been shared with the MalDent team. In summary, we were both astonished at the amount that had been achieved and delighted with what was being proposed.
It was agreed that Dr Mipando would share the recording of the presentation with other key stakeholders in Malawi, to garner their views and feedback. Paul agreed to send the printed Stage 1 report to all present.
Reflecting on the workshop held in Blantyre in September 2019, led by Professor Chris Platt, it is now extremely exciting to see the design appearing, based upon principles that flowed from those stakeholder discussions held a year ago. The benefits to the entire campus will be legion, quite apart from providing a teaching focus for the new BDS programme. Thanks to John McAslan + Partners, together with the design team they have established, we are off to a flying start!