Exciting and successful National Oral Health Policy Workshop in Lilongwe

On 11th February, my colleague and good friend Prof Lorna Macpherson and I set off for Malawi to participate in the National Oral Health Policy Workshop that was scheduled for Thursday 13th and Friday 14th February in Lilongwe. The component of the MalDent Project that is focusing on policy development and the establishment of a caries prevention programme for children is critical to success. We had been working for a number of months to plan the workshop, in partnership with the Malawi Government Ministry of Health, University of Malawi College of Medicine and the World Health Organisation.

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Lorna and I waiting at Heathrow Airport for our flight to Johannesburg

We had a trouble-free journey and landed in Lilongwe in the early afternoon of Wednesday 12th February. Dr Peter Chimimba met us at the airport and we were soon checked in at the Sunbird Capital Hotel, our home for the next three days and also the venue for the workshop.

After a short rest and freshen-up, we caught up with Peter again and were subsequently joined by Dr Yuka Makino, the WHO Africa Technical Officer for Oral Health and Dr James Mchenga, the Academic Lead for the BDS programme at the College of Medicine. Dr Makino had travelled from her office in Brazzaville, Republic of the Congo. We sat outside in the beautiful grounds of the hotel and worked through all the detail of the forthcoming workshop.

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Lorna, Yuka, Peter, James and I completing our final planning for the workshop

The following morning we were up early for breakfast and headed for the Viphya Suite where the workshop was being held. Many thanks are due to Annie Mwapasa and her colleagues for making all the arrangements and manning the reception desk.

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Conference packs distributed ready for the delegates and the hard work to come

The delegates soon began to arrive and we spent time making appropriate introductions between key players, as well as having opportunity to chat with colleagues.

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A quick catch-up with Dr Mipando and Dr Chimimba. We were delighted to see the policy work finally about to start.

It was a great honour that the Secretary for Health and Population, Dr Dan Namarika, attended the first part of the workshop.

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Dr Mipando introducing Dr Dan Namarika

Before the workshop commenced, Dr Namarika spent some time speaking with Yuka, Lorna, Peter and I, accompanied by Dr Nedson Fosiko, Deputy Director of Curative Services at the Ministry of Health.

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Smiles all round as Dr Namarika shares an anecdote with us

Once the delegates were assembled, and following a prayer, the meeting began. The chairperson was Dr Kaponda Masiye, who is the Director of Planning and Policy Development at the Ministry of Health & Population. Dr Masiye trained initially as a dental therapist before studying medicine, so he has both a good understanding of, and interest in, oral health.

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Dr Masiye opening the workshop

The first speaker was Dr Mwapatsa Mipando, Principal of the College of Medicine. He gave a brief overview of the recent developments and successes at the College before focusing on the MalDent Project and the subject matter of the workshop.

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Dr Mipando opens proceedings 

The World Health Organisation is a very important partner in the oral health policy development and we were delighted that Dr Kelias Msyamboza from the WHO Malawi Office attended the workshop. In his opening remarks he stressed the importance of implementation as well as development of policies.

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Dr Kelias Msyamboza from the WHO Malawi Office

We were next addressed by Dr Chithope-Mwale, the Director of Curative Services at the Ministry of Health & Population. He quoted the famous Bible passage from Ecclesiastes 3 – ‘A time for everything’ – and said that he felt that now was the time for progress to be made in the context of oral health in Malawi. He expressed his thanks to the College of Medicine for all that it does to support the Ministry of Health & Population.

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Dr Chithope-Mwale, Director of Curative Services

Before we stopped for coffee it was the turn of the Secretary for Health & Population, Dr Dan Namarika, to address us. He stressed that a policy is ‘a document about people’ and how important it is to ensure that a policy, once created, actually impacts positively on the people for whom it is intended. The importance of embracing community health was highlighted and he announced that the President had determined that 9th October would become National Community Health Day. A key component of the National Health Policy is ‘prevention, prevention, prevention‘, and the Oral Health Policy must align with this principle. He spoke also of how data drives economies and how important it is to develop research within the area of oral health. The importance of cross-sectoral engagement involving, for example, education was a theme which also emerged in other presentations over the next two days.

There were many aspects of this presentation which fitted perfectly with the anticipated direction of travel for the forthcoming policy work.

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Dr Dan Namarika, Secretary for Health & Population, delivering his opening remarks 

There followed a coffee break during which a group photo was taken.

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Delegates at the National Oral Health Policy Workshop, Lilongwe

There were extensive discussions during the break, which provided an excellent opportunity for networking.

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Drs Mukiwa, Chimimba and Masiye discussing the programme before heading back into the workshop

Dr Nedson Fosiko, Deputy Director of Curative Services, spoke next. He stressed that many of the Government Ministries are relevant to the health agenda. He also emphasised the point made previously, by Dr Namarika, that health information, ie data, is critical if healthcare services are to be planned effectively. Discussions later in the workshop demonstrated the need to enhance efficiency and accuracy of data collection procedures. Dr Fosiko also emphasised the importance of prevention of disease and of the ‘One Health’ concept.

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Dr Fosiko providing a Ministry of Health perspective on existing oral health services in Malawi and ambitions for the future

Dr Yuka Makino, the WHO Africa Oral Health Technical Officer, delivered an excellent presentation on the WHO African Region Oral Health Strategy 2016-2025. She spoke of the severe dental workforce shortages in Africa and also the lack of data on oral health. Yuka pointed out that in the EU, 70% of dental care is funded by patients themselves – how could this work in lower income countries in Africa? A key theme was around Universal Health Coverage and the importance of community prevention initiatives, not just health service infrastructure. It is important to integrate oral health into general health coverage, including for example nutrition and smoking cessation. Similarly, oral health surveillance could be integrated into existing health information systems and ongoing NCD surveillance programmes. Importantly, people and communities, not just diseases, should be put at the centre of health systems.

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Dr Yuka Makino presenting her talk on the WHO African Regional Oral Health Strategy, 2016 – 2025

Just before lunch, an additional presentation was added that had not been on the programme. The speaker was the Honourable Enock Phale, who is now a member of the Malawian Parliament but is a qualified dental therapist and former Oral Health Lead in the Ministry. I had met him in his former role during my first visit to Malawi in 2017 and it was lovely to meet up with him again. It transpires that he sits on the Parliamentary Health Committee, which is highly relevant to his dental background.

The Honorable Phale had already begun work on an Oral Health Policy document before he left the Ministry, and he took us quickly through the early draft. This document will be very helpful to us as we progress the strategy writing.

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The Honourable Enock Phale, Member of the Malawian Parliament

Before heading off to lunch I enjoyed a quick catch-up with the Honourable Phale. It was an immense honour and privilege to have a Member of Parliament at the workshop and we were very lucky to have been provided with a draft policy to kick-start our work.

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Enjoying a reunion with the Honourable Enock Phale, Member of Parliament for the Salima North West Constituency

Discussions continued over lunch before we headed back into the main conference room for the afternoon’s work.

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Immediately after lunch we were given a very useful overview of the policy development process and public policy framework used by the ministries and Government in Malawi. This will provide a blueprint for the structure of the Oral Health Policy.

Dr Wiston Mukiwa then delivered a fascinating history of the evolution of dental health services in Malawi, as seen through the lens of his own experiences. This context for our work to develop an Oral Health Policy was extremely helpful.

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Dr Wiston Mukiwa speaking of his experiences over many years of engagement with dental health care in Malawi

The WHO NCD MAP Toolkit will be used in our work to develop the Oral Health Policy and move through to implementation. The toolkit was presented by Dr Kelias Msyamboza. He discussed the main steps of assessment, engagement, formulation, implementation and monitoring / evaluation.

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Dr Kelias Msyamboza, from the WHO Malawi Office, introducing the WHO NCD MAP Toolkit

Day 1 closed with small group discussions around two questions:

  1. What are the opportunities for embedding oral health within the broader NCD and UHC agendas?
  2. Who would be key partners in a multi-sectoral approach for developing an oral health policy in Malawi?

 

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Dr Fosiko at the flip-chart to record discussion outcomes for Group 1
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Dr Chithope-Mwale chaired the discussions in Group 2

Each group fed back and the outcomes are being collated by Annie Mwapasa to inform the policy work moving forward:

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Day 2 of the workshop was very colourful. Whilst I had turned up in my regulation business suit and tie, many of my Malawian friends were dressed in bright, colourful shirts – Friday is a ‘dress-down’ day! The Principal, Dr Mipando, has now offered to take me to meet his tailor so that I can enhance my wardrobe for future working Fridays!

The session began with a reflection on the proceedings of Day 1, delivered by Dr Janet Guta, Deputy Director for Clinical Services at the Ministry of Health & Population.

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Excellent summary of Day 1 prepared by Dr Janet Guta

It was then the turn of Dr Masiye, who had been the workshop chair on Day 1, to talk about the NCD agenda in Malawi and how oral health could fit into the ongoing activities. In an excellent presentation he stressed the importance of community partnership and community empowerment, which are essential in any new policy. Dr Masiye also commented on the relatively small amount of funding available for the NCD agenda, despite the fact that these diseases now account for 30% of the disease burden in Malawi.

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A fact-filled presentation from Dr Masiye – very useful context

After Dr Masiye’s talk and a discussion led by Dr Fosiko, we broke again for coffee. We were delighted that on Day 2 of the workshop, Natasha Mwenda was able to join us from WaterAid Malawi. I had met Natasha in Edinburgh last year when she presented at a Malawi Cross Party Parliamentary Group meeting at Holyrood. Having embraced the importance of a cross-sectoral approach to improving oral health, it is critical that we consider water and sanitation. We look forward to collaborating with WaterAid as we develop the policy.

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Natasha Mwenda (fourth from left) with delegates from the Ministry of Health & Population, College of Medicine, WHO Africa and the University of Glasgow

The morning session finished with an excellent presentation from Prof Lorna Macpherson, demonstrating how all the principles we had been talking about, including the WHO NCD MAP toolkit, had been applied in Scotland to establish the highly successful Childsmile model for prevention of dental caries in children. The high quality monitoring and evaluation that has been part of the overall process in Scotland has proven beyond doubt the effectiveness of the approach, which is now being introduced in multiple countries following completion of situational analyses to create models that are effective in each specific environment. The potential applicability in Malawi was plain to see.

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Prof Lorna Macpherson in full-flow on the Childsmile prevention model

The morning’s presentations stimulated additional discussion before we broke for lunch.

One of the novelties of this visit for me was the timing – I had never previously experienced Malawi in the rainy season. Whilst there were many bright periods, and it was constantly warm, the downpours of rain were impressive, even by Scottish standards! Here’s a short video-clip from lunch-time on Day 2:

After lunch, Lorna and I did a double act to update the delegates on overall progress with the MalDent Project and to show how the activities of this workshop were informing the policy and prevention aspects of the programme.

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Delivering the MalDent Project update

We then came to the climax of the workshop, which was to agree on the next steps. First, having agreed on the need for a task-force, we discussed the composition of that group. This was a lengthy debate, but finally agreement was reached, as follows (numbers in parentheses represent number of members):

  1. Ministry of Health & Population (Clinical, Nutrition, Planning Nursing (1)
  2. UoM College of Medicine (2)
  3. Kamuzu College of Nursing (1)
  4. University of Glasgow (2)
  5. Regulatory bodies ((MCM, NCM, MPB) (1)
  6. World Health Organisation (1)
  7. Dental Association of Malawi (1)

It was further agreed that the Ministry would provide the Terms of Reference for the task-force, after which its work could begin.

These key decisions comprise just the outcome that was required to allow the policy development component of the MalDent Project to proceed.

Fittingly, it was Dr Fosiko, who has shown such great enthusiasm for the MalDent Project over recent months, who closed the workshop. This is what he said:

There was significant interest in the workshop from many of the national newspapers and broadcasters. You can read an article in the Nyasa Times here

This next photo, captured during one of the coffee breaks, is of two gentlemen who have worked tirelessly for over thirty years to enhance oral healthcare and, indeed, broader areas of healthcare in Malawi. Drs Wiston Mukiwa and Peter Chimimba have both held many senior roles in the Malawian health service, Ministry of Health, regulatory bodies and higher education institutions. One might think that by now they would be tired and their enthusiasm dulled, but not at all. They have amazing energy, commitment and a positivity which is remarkable and seemingly in endless supply – they are both an inspiration. The policy workshop that had just passed and been such a success was under-pinned in so many ways by these two outstanding professionals. We are so lucky to have them closely involved in the MalDent Project.

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Drs Mukiwa and Chimimba, deep in conversation

In the evening, following the end of the workshop, Lorna, Peter, James, Wiston and I  enjoyed a celebratory meal with the Honourable Phale and two of the Dental School Assistant Lecturers, Drs Tasneem Chikwatu and Mirriam Chipinga. It was an excellent opportunity for me to speak at length with Tasneem and Mirriam, both of whom are very excited about their new roles.

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(L to R) Mirriam, Peter, Lorna, James, JB, Honourable Phale, Wiston and Tasneem, enjoying some relaxation after the busy, but successful, workshop

We set out from the hotel in Lilongwe at 07.45 on the Saturday morning to drive to Blantyre. We stopped off en route at the famous Chikondi Stopover for a short rest and to buy some refreshments.

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Lorna and Peter at Chikondi Stopover

We reached Lilongwe by midday and after a quick bowl of soup we headed across to the College of Medicine campus, where we met a large number of the BDS 1 students and some of those on the Foundation Course. We enjoyed an interactive two hour session on dental public health, incorporating a lot of the material that had been covered during the workshop over the preceding two days. It is important that these pioneer dental students also feel part of the ongoing policy development, much of which will shape the oral healthcare environment into which they will emerge at the end of the BDS course.

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Lorna and Peter with the dental student group – lots of happy faces!

We had a good rest on the Saturday evening. After breakfast on Sunday Lorna and I went for a walk around the city centre close to the hotel.

At 11am, Dr Chris Moxon came across to the hotel for a chat. Chris is a Clinical Senior Lecturer at the Wellcome Centre for Integrative Parasitology, University of Glasgow and an Honorary Consultant in Paediatric Infectious Diseases at the Royal Hospital for Children. His research focus is on cerebral malaria and he spends several months a year working in Malawi. We had a very enjoyable and wide-ranging discussion covering topics relevant to both our areas of interest.

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Enjoying a good chat with Dr Chris Moxon in the hotel grounds – beautiful views out to the mountains

Peter Chimimba’s wife, Frider, is a Lecturer in Pharmacology at the UoM College of Medicine. One of her young colleagues, Nelson Nyoloka, had applied to join the MSc in Clinical Pharmacology at the University of Glasgow and has been accepted. He will start the course in September 2020 and I had suggested that he should join Lorna and I for lunch at 12.30pm. We met in the hotel foyer and enjoyed a great time together for about an hour and a half. We provided lots of information about Glasgow and told us a lot about regulation of medicines and products such as toothpastes in Malawi – mutually useful! We look forward very much to welcoming Nelson to Glasgow in the Autumn.

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With Nelson, in the hotel grounds, after a very enjoyable lunch

Our visit was nearing an end but we had one more activity to look forward to  – afternoon tea with the Principal at his home. Dr Mipando picked us up from the hotel at about 3.30pm and before driving to his house took us on a beautiful drive to the tea and coffee plantations just outside Blantyre. The undulating hills were covered in a sea of green tea plants, interspersed with trees – it was stunningly beautiful.

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Enjoying the serenity of the tea plantations

On reaching his house, Mwapatsa took us on a tour of the extensive garden that he and his wife, Linda, have established and continue to develop. They grow a myriad of fruits, vegetables and herbs, as well as flowers. We then retired to the patio for tea and to enjoy some avocado (known locally as ‘pear’) that had just been picked from the garden – it tasted fantastic. We are grateful to Mwapatsa and Linda for their kind hospitality – it was a lovely way to end our short visit to Malawi.

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Enjoying afternoon tea on the patio at the Principal’s house

Mwapatsa drove us back to our hotel and we then had dinner with Peter Chimimba, before turning in early, ready for our journey home the next day.

The journey home was long (27 hours) and entailed four flights, but all were on time and there were no problems with connections or baggage.

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View from the middle seat on the overnight A380 flight from Johannesburg to Heathrow

Although this had been a short visit to Malawi, it had been immensely successful. The blue touch paper has now been lit to forge ahead with the policy work stream. Dr Fosiko finished his presentation on Day 1 with a slide that read “Let the game start”! I can’t think of a better way to close this post!

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Acknowledgement: Many thanks to Gift Kayuni, UoM College of Medicine, for providing many of the photos in this post

 

Another delivery to Dentaid – and a new connection with Uganda

Previous blog posts have documented recent visits to Aberdeen, Inverness and Dunblane to collect dental chairs that had been kindly donated to the MalDent Project. We have become well acquainted with the excellent staff at Leslie Commercials from whom we rent our vehicles and on Friday 24th January we were back again for a Luton van to take the dental chairs down to Dentaid in Southampton. We were given the red carpet treatment and loaned the same new Mercedes that Mike Broad and I had driven up to Inverness a few weeks previously.

I was accompanied on this trip by my good friend Stan Harvey, a retired HGV driver – great to have a professional trucker on the team! On arrival at Glasgow Dental Hospital, we were met by our first class team of porters, Paul, Robert and Bob, who helped us load the van.

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The loading commences

In addition to the three dental chairs, we also had five cages containing boxes of toothpaste and toothbrushes, which will be ideal for the work we have planned to develop and test supervised toothbrushing programmes in Malawian schools.

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Fluoride toothpaste and toothbrushes bound for schools in Malawi

The van was swiftly loaded, leaving space for a fourth dental chair which we were to collect in Birmingham, en route to Southampton.

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All smiles after the hard work is completed – ‘ready for the off’

We set off just after 2pm and enjoyed an easy drive to the Travelodge at Hilton Park Services, just off the M6 and 15 miles North of Birmingham, where we were staying overnight.

We set our alarms for an early start and left the Travelodge at 5.45am on the Saturday morning. Half an hour later we arrived at the Washwood Heath Health & Wellbeing Centre in Birmingham to collect the fourth dental chair.

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Early morning pick up – easy access to a deserted car park!

The security guard, Elmi, was extremely helpful and we soon had the donated chair loaded onto our skateboard trolley, ready to be loaded into the van.

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Elmi and Stan head for the van

Our grateful thanks are due to Sumit Chauhan and Jackie Sampson​ of NHS Birmingham East and North Community Health Partnerships for organising this donation.

We were back on the road by 6.45am and headed directly to Southampton. We stopped for breakfast en route and reached Dentaid’s new premises at about 10.45am. We were met by another good friend Stuart Bassham, Dentaid Warehouse and Engineering Manager, and soon we had the van unloaded.

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Stuart and Stan with two of the donated chairs outside Dentaid’s new HQ

Stuart then gave us a tour of the workshops in which all the donated dental equipment is serviced and refurbished.

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A very neatly organised set of tools – demonstrates the wide range of technical work undertaken by the Dentaid team
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The ‘heavy engineering’ room

The highly portable Dentaid dental chairs that have been designed for use by volunteer organisations, working in rural areas without electricity or other services, are fabricated from scratch in the workshop.

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‘Scratch building’ Dentaid portable dental chairs – fantastic craftsmanship

The international scope of Dentaid’s work is reflected in the ongoing projects listed on the workshop white board:

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All the smaller items of donated dental equipment and instrumentation are checked, repaired when necessary and stored in this dedicated area, which houses items worth a total of many thousands of pounds:

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Dentaid’s dental instrument store – thousands of items for distribution

After our guided tour, Stan and I enjoyed a baked potato and chilli courtesy of Jacqueline James, the Overseas Projects and Volunteer Manager. Jacqueline was running a governance meeting with some of Dentaid’s dental volunteers and we joined in with their lunch break. It was also a good opportunity for some discussion with Andy Evans, Dentaid’s CEO, about our ongoing joint work in Malawi.

We had previously agreed with Jacqueline that we would transport a Dentaid chair and some other dental equipment that had been ordered from Dentaid by a customer, Karen Adams, who lives in Lenzie, just outside Glasgow. As a result, we made good use of the van in both directions.

Our journey back to Glasgow was uneventful and we arrived home just before 10pm on the Saturday evening.

On Sunday, I delivered the Dentaid items to Karen in Lenzie. Karen has kindly written the final section of narrative in this blog post to give some background to how the Dentaid chair and equipment we have delivered will be used.

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Karen with the Dentaid chair and related clinical kit

Karen writes:

My daughter now lives and works in Uganda. In the last 7 years, since she has become involved with the wonderful people there, we have set up a small charity called ‘Rock Projects Uganda’ registered in Scotland SCO47717. We have a website under the name of Rockprojectsuganda.org and a Facebook page called Rock Projects Uganda.

Since starting the charity we have built  a school from nursery through to secondary. There are also dormitories for children who are orphans or live too far to travel to school each day.

The village where my daughter Caitlin works is situated 20 miles away from Kampala. Most of the people in the small village of Busiika have never been to Kampala . They are extremely poor and mostly work on the land to earn enough money to feed their families. Some of the children have been given the opportunity to be educated through our sponsorship programme. For as little as £20 per month a child will receive education, love and care and most of all hope for their future.

Malaria and typhoid are part of life there and many die because they cannot afford treatment for these diseases, along with HIV AIDS.

My daughter Caitlin has such a caring heart for the people there as did her dad who sadly passed away 15 months ago from cancer at the age of 54. He had  been very involved in the charity until he became ill. My family have built a small 10 bed hospital
in Busiika as a legacy to my husband Paul . This is something that he often talked about doing when he was well. Sadly he will not see it but we know how much happiness it would bring him. We also have the facility within it for a dentist.

The Dentaid dental chair is going to be well used.  Many suffer pain from toothache as there is no dentist for miles around. We are very excited for the future of the hospital as we look forward to its official opening in April this year. We would love to extend an invitation to anyone who would like to visit Uganda and use the dental facility to treat the people of this small village.

I would like to thank Professor Jeremy Bagg for delivering the Dentaid kit to me in Glasgow.  It will be leaving in a container bound for Mombasa next week. It will then be transported to Busiika to hopefully arrive in March.

Photoshoot time for Malawi’s first dental students

Following the launch of the new Bachelor of Dental Surgery programme at the University of Malawi College of Medicine in August last year, the students who enrolled in BDS 1 are progressing well. Recently, they joined forces with their fellow students who are in the Foundation Year, and who will form the second intake to BDS 1 in August 2020, to create a ‘corporate’ T-shirt. Having taken delivery of their new T-shirts, they arranged a photo-shoot to launch their visual identity:

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Malawi’s pioneer dental students

After considering a number of designs they had settled on the following:

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‘Promoting Oral Health’ is the absolute core of the MalDent Project – a perfect slogan for the BDS students’ T shirts

After their indoor photograph, they decided to have some further shots taken out and about on the sunny College of Medicine campus:

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Having announced recently on this blog the exciting appointment of Dr James Mchenga as the first Academic Head of the Bachelor of Dental Surgery programme, it is wonderful to see how the first intake of students is flourishing.

Having received these photos, I asked Luke Phiri, one of the students, if he could ask some of his fellow BDS students for some quotes on their experience of the course so far. All were very positive and showed a real commitment to the programme. Here is a small selection:

“Becoming a dentist is not a simple job to accomplish. However, if you think you can do it, nothing can draw you back. You can do it.”

“Do your best, your very best, and every day.”

“We, dental students meet hindrances and think we will not make it. It always seems impossible until it is done.”

“Becoming a dentist is my dream ever. Yes, there are many giant bullies I may be afraid of handouts, studies, or whatever. I may have fear but ‘Courage is not the absence of fear but the triumph over it’.”

“No masterpiece was ever created by a lazy artist, never. Always stay committed and dedicated  to fulfil your dream to be a dentist.”

“Our focus is to be the best pioneers of this program and we will always ‘focus on the focus’.”

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Future leaders of oral healthcare in Malawi – exciting times!

I head out to Malawi in a couple of week’s time and really look forward to meeting these budding young dental professionals for a face-to-face catch-up. You’ll be able to read all about it in a future blog post.

 

Dr James Mchenga appointed as the Academic Head of Malawi’s first Bachelor of Dental Surgery programme

Another significant milestone has been reached in the establishment of Malawi’s first Dental School with the appointment, by the College of Medicine, of Dr James Maurice Mchenga as its first Academic Head.

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Dr James Mchenga BEd, Dip.Odont (University of Pretoria), BDS, MDent (MFOS) (MEDUNSA)

Dr Mchenga was born in Nchenga Village, T/A Kuntaja, next to Chileka International Airport, Blantyre, Malawi. He attended Lirangwe Primary School and then completed his secondary education at Blantyre Secondary School, leaving for University in 1976.

Initially, James studied for and obtained a Bachelor of Education degree (majoring in mathematics and physical sciences) at the University of Malawi Chancellor College, graduating in 1981. He taught at Salima Secondary School from 1981 – 1984 then moved to teach at Malamulo Adventist Secondary School in Thyolo. Whilst there, in 1986, he suffered serious toothache on a Friday evening and needed to travel 80 kilometers to receive treatment at the Queen Elizabeth Central Hospital Dental Department in Blantyre. The relief of pain he experienced following extraction of the offending tooth stimulated him to do some research about dentistry and he then realised what a drastic shortage of dentists existed in Malawi.

James subsequently secured a place at the Medical University of Southern Africa (MEDUNSA) and obtained his Bachelor of Dental Surgery degree in 1995. He completed specialist training in Oral & Maxillofacial Surgery, gaining the MDent (MFOS) degree in 2005.

Dr Mchenga has been involved in the teaching of both undergraduate and postgraduate dental students at Medunsa Campus of the University of Limpopo as well as the Sefako Makgatho Health Sciences University for the last 15 years. He has also served as an External Examiner at the University of the Witwatersrand, University of Pretoria and the University of KwaZulu-Natal in Durban.

In addition to the appointment of Dr Mchenga, a number of other staff members have been appointed recently. Two very experienced Malawian dental surgeons, Dr Jessie Mlotha-Namarika and Dr Wiston Mukiwa, have taken up their roles as part-time Clinical Lecturers. Both Jessie and Wiston have been closely involved with the MalDent Project since its inception. In addition, four young dentists have been appointed as Assistant Lecturers – Dr Don Chiwaya, Dr Shiloh Bonya, Dr Tasneen Chikwatu and Dr Mirriam Chipinga. These Assistant Lecturers will be spending some time at Wits University Dental School, preparing them for their future roles as clinical academics.

Recently, the team had its first staff meeting, chaired by Dr Felix Manboya, the Acting Deputy Dean of the Faculty of Medicine. Dr Peter Chimimba (Dental School Project Coordinator) and Ms Annie Mwapasa (Dental School Project Administrator) also participated. It was an extremely positive and productive meeting, towards the end of which the group was joined by the Principal of the College of Medicine, Dr Mwapatsa Mipando.

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A seminal moment – the first ever staff meeting for the new Bachelor of Dental Surgery programme at the University of Malawi College of Medicine

After their meeting, the staff team posed for a photograph. This photo will be one for the history books when the story of establishing Malawi’s first Dental School is recounted in future years.

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Back row left to right: Dr James Mchenga (Academic lead in Dentistry), Dr Wiston Mukiwa (Clinical Lecturer in Dentistry), Dr Peter Chimimba (Dental School Project Coordinator), Dr Don Chiwaya (Assistant Lecturer in Dentistry), Dr Felix Namboya (Senior Lecturer in Anesthesiology and Acting Deputy Dean of Medicine)

Front row right to left: Dr Jessie Mlotha-Namarika (Clinical Lecturer in Dentistry), Dr Shiloh Bonya (Assistant Lecturer in Dentistry), Dr Tasneem Chikwatu (Assistant Lecturer in Dentistry), Annie Mwapasa (Dental School Project Administrator), Dr Mirriam Chipinga (Assistant Lecturer in Dentistry)

‘Doon the watter’ – MalDent visits Smileawi and its new mobile surgery

The phrase going ‘doon the watter‘ refers to holidays that would be taken by Glaswegians in towns on Scotland’s west coast that were reached by sailing down the River Clyde. The launch of the Clyde’s first steamboat, Henry Bell’s Comet in 1812, made such holidays accessible for many. Dunoon, my destination on Sunday 22nd December, was one of the most popular of these holiday resorts, but the purpose of my visit was not for a Christmas break but to visit my good friends Nigel and Vicky Milne and to view their latest acquisition for the work of their dental charity Smileawi.

I took a train from Glasgow Central to Gourock Station where a CalMac ferry was waiting and shortly due to leave.

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In line to board the Argyll Flyer at Gourock

The weather was grey with occasional light drizzle but I stayed up on deck for the 35 minute crossing.

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Dunoon just appearing on the horizon

Dunoon’s history as a resort for those holidaying from Glasgow was very evident as the old pier hove into view:

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Sail almost over

Once the ferry had docked it was a short walk up the ramp to a welcome from Caledonian MacBrayne …

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… and a further very short walk into Dunoon itself, an excellent base for visiting this part of Argyll & Bute, as testified by the sign in the photo below

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Nigel picked me up from the ferry terminal and we headed to The Hollies Dental Surgery. Vicky greeted us on arrival and we enjoyed some lovely home-made soup and toast before heading outside for the official viewing.

The mobile dental surgery that has been donated by NHS Highland is a sizeable vehicle, based on a Mercedes Benz truck chassis and engine. It has been sitting in the open-air for a considerable time and requires some mechanical servicing, which will be undertaken by Smileawi Spanners.

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Inside the vehicle is an airy, fully-equipped surgery with an adjacent waiting room. The Belmont PRO II dental chair is exactly the same type as we have been installing in the Dental Department at Kamuzu Central Hospital – rugged and uncomplicated engineering, which is ideal for the environment in Malawi.

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Nigel and Vicky proudly demonstrate Smileawi’s latest acquisition 

At the back of the truck is a hinged compartment which houses a large water tank and the compressor:

There are possibilities of two further mobile dental surgeries from other sources, all of which could be serviced on a regular basis by Smileawi Spanners during their visits to Malawi.

There are a number of logistical, legal and governance issues which need to be worked through, but it is easy to see multiple uses for these vehicles in support of the work of Smileawi, Bridge2Aid and the MalDent Project, in collaboration with the local healthcare teams. In addition to delivery of clinical service, they could support epidemiological surveys and play a part in outreach teaching of dental students in later years of the new BDS programme.

After a shared pot of Mzuzu coffee and mince pies, Nigel drove me back to Dunoon Ferry Terminal for my journey home.

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Although only a brief visit, it was great to see Smileawi’s new acquisition and to chat through a number of our plans for moving forward in 2020.

Smileawi is raising money for its Mobile Dental Clinic Fundraiser Appeal at Wonderful.org. If you would like to support their work, you can do so by making a donation here

Coffee and mince pies fuel new links for the MalDent Project

On Tuesday 17th December I took a train from Glasgow to Edinburgh to attend the Scottish Government International Development festive networking coffee morning at St. Andrew’s House. After  a brief introduction from Joanna Keating, who was accompanied by her whole team, those of us from our various projects were able to roam at will and meet our fellow grant-holders. Joanna’s team was able to make any links requested, to facilitate new collaborations. It was a great event and the room was soon converted into a hubbub of coffee and mince-pie fuelled discussions.

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Following my attendance at the most recent Malawi Cross Party Parliamentary Group (CPPG) meeting at Holyrood on 20th November, I was very keen to have a discussion with colleagues from Mary’s Meals and Water Aid. I was in luck! Elizabeth McKernan from Water Aid and Gillian McMahon from Mary’s Meals were both attending the event.

Water Aid seeks to provide ‘clean water, decent toilets and good hygiene‘, three things which should be normal for everyone across the globe. In just about every human activity, water is essential and this certainly applies to the objectives of the MalDent Project. Delivering the most basic dental treatment requires a clean, safe water supply and there are especially interesting issues around the level of natural fluoride in Malawi’s groundwaters. Fluoride at a level of 1 part per million can reduce the incidence and severity of dental caries, bringing considerable oral health benefits. The underlying geology of the rift valley has resulted in some areas of Malawi having virtually no fluoride in the water, whilst other areas have potentially toxic levels which result in dental fluorosis and other systemic pathologies. This is, therefore, an area of research interest in the context of dental public health.

Following the CPPG meeting at Holyrood, I had travelled back to Glasgow on the train with Elizabeth and two of her colleagues from Water Aid Malawi, Natasha Mwenda and Yankho Mataya. Natasha had delivered a great presentation at the meeting and both Elizabeth and Yankho had participated in the subsequent discussions with delegates.

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Natasha Mwenda delivers her presentation at the Cross Party Parliamentary Group meeting

On the train, we discussed the possible interfaces between the work of Water Aid and the MalDent Project, of which there were several. I mentioned that in February 2020 we were organising a workshop in Lilongwe to launch our work with the Ministry of Health on development of a national oral health policy for Malawi. Yankho was very keen that Water Aid be involved and I have now e-mailed both Yankho and Natasha to invite them to attend on 13th and 14th February.

The oral health policy will contain a significant emphasis on prevention of oral disease, particularly in children. We know from research evidence gathered in Scotland that supervised toothbrushing with fluoride-containing toothpaste in schools is a very effective intervention. Work over the next couple of years, involving a PhD student based in Blantyre (see a future post), will focus on developing a version of this approach which would be applicable in Malawi. Mary’s Meals has been working for many years in Malawi’s schools and earlier in the year I had met with Daniel Adams, the Executive Director of Mary’s Meals, for an informal discussion about this aspect of the Maldent Project. We enjoyed a very valuable hour sharing ideas and agreed to keep in touch as the MalDent Project progresses.

It was good to hear and see more of the work of Mary’s Meals when Gillian McMahon delivered her excellent presentation at the Cross Party Parliamentary Group meeting at Holyrood.

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Gillian McMahon presenting at the Cross Party Parliamentary Group meeting

It was also very exciting to hear that Water Aid and Mary’s Meals have started some collaborative work. I was, therefore, delighted that both Elizabeth and Gillian were attending the recent coffee morning. We were able to commandeer some chairs in a corner of the room for a valuable chat, which identified some very tangible possibilities for joint working into the future. It was a particular pleasure when the Minister, Mr Ben Macpherson MSP, joined our discussion for a while and we were able to summarise some of our initial ideas.

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Mr Ben Macpherson MSP joining the discussion with Elizabeth and Gillian over possible collaborations between Water Aid, Mary’s Meals and the MalDent Project

There were also representatives from Police Scotland and I enjoyed a long and interesting conversation with John Wyllie, Head of its International Development and Innovation Unit. We have a number of joint interests, including use of mobile phone technology for public messaging, and have agreed to meet early in the New Year to continue our discussions.

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Busy networking underway!

This was a very useful event for the MalDent Project and from the lively conversations that were taking place around the room, I’m sure the same will have been true for many others. Many thanks to Scottish Government International Development for setting up the morning and to the Scotland Malawi Partnership for organising the Cross Party Parliamentary Group meetings. These information-sharing and networking events are invaluable for establishing partnerships that combine skill sets and result in effective, sustainable partnerships.

To Inverness and Dunblane – more dental chairs for Lilongwe

Phase 1 of the refurbishment of the Dental Department at Kamuzu Central Hospital in Lilongwe took place last May. Joint work is now underway with Dentaid and Henry Schein Dental for Phase 2, which will allow replacement of the remaining original dental chairs and installation of a further six phantom head units. We have, therefore, been on the lookout for additional Belmont dental chairs that can be serviced by Dentaid and then shipped to Malawi.

Recently, NHS Highland kindly agreed to donate a Belmont PRO II chair, which would need to be collected from Inverness. Through contacts of Smileawi, we were also made aware of a chair that was available from a practice in Dunblane. I spoke to my good friend Mike Broad, who had accompanied me previously when we drove 16 dental chairs down to Dentaid in Salisbury, and he kindly agreed to accompany me on a trip in a white van to collect these two items.

We set out at 7am in our hire van and made good time on the trip North. With its sections of single and dual carriageway covered by average speed cameras from Dunblane to Inverness, the A9 can be a frustrating road to drive, but the scenery is tremendous.

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Lovely scenery – and a mist hanging over the fields

We had agreed on a break at the House of Bruar for a bacon roll and coffee, but our plan was dashed when we arrived 35 minutes before the café opened at 9.30am!

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At House of Bruar, with our lovely new van – but no bacon rolls!

We carried on up to Aviemore and headed for an alternative pit stop known to Mike – The Coffee Corner.

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We enjoyed a fantastic breakfast roll and coffee, before continuing our journey to the Centre for Health Sciences on the Raigmore Hospital Campus.

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Phase 1 of the trip completed – arrival at the Centre for Health Sciences in Inverness

We arrived about an hour earlier than we had anticipated, but everything was ready for us as promised by Anne Frame, the Operational Manager of the Dental Department, so many thanks Anne!  Thanks also to Amanda Clark, the Clinic Head Dental Nurse -Unscheduled Dental Care, who greeted us at the Inverness Dental Centre and showed us the chair, which was perfect for our needs. We had brought with us a skateboard trolley, kindly lent to us by our Glasgow Dental Hospital porters, which made moving the chair straightforward. We took it out through a fire escape door which had a ramp and from there it was straight onto the tailgate lift and into the van.

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Mike and chair, ready to ascend!

Following an introduction from Elizabeth Emery Barker, a 2009 Glasgow Dental School graduate who had travelled to Malawi in 2006 with Students for Kids International Projects, we had also arranged to meet with one of her colleagues, Dr Fary Johnson Vithayathil. Both work at Wick Dental Practice and Fary had kindly offered to donate some dental instruments  that would be suitable for the pre-clinical skills facility in Lilongwe. He met us at the Health Sciences Centre for the handover.

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A box of instruments from Fary, destined for the pre-clinical skills facility in Lilongwe

Whilst we waited for Fary we enjoyed some lunch in the van, courtesy of the picnic that had been prepared by Mike’s wife, Rosie.

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A trucker’s picnic underway – thanks to Rosie!

The second chair was to be picked up from Stuart Howie’s former practice in Dunblane High Street. We set off back down the A9 and encountered some very heavy rain and strong winds. We knew that the surgery was on the first storey of a tenement and that the chair would be tricky to extract. My good friend Will McLean lives in Crieff and kindly offered to drive across with his son, Fin, to help Mike and I to transfer the chair to the van.

On our arrival in Dunblane, Stuart’s wife Elizabeth was waiting for us outside the practice. The surgery was reached via a corridor from the street:

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The corridor

followed by two flights of concrete stairs:

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A tricky curve at the bottom of the stairs – negotiated safely in the end!

Stuart had suggested that ropes and a carpet may be the answer to a safe removal of the chair. Heeding this advice, Mike had brought a long roll of carpet and Stuart had provided rope, so we had the gear!

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Mike with the rope, ahead of the action
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The red carpet is out for our important but fragile passenger!

With the help of Will and Fin we managed to negotiate the two flights of stairs without damage to the chair, the building or ourselves and the chair was soon lashed securely inside the van.

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Mike, Will and Fin as we prepared to tackle the second flight of stairs

After bidding farewell to Elizabeth, we headed to a local hostelry where we enjoyed a very tasty meal.

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Great food and atmosphere in The Riverside

It had been a very successful day and it was really enjoyable to sit and chat for an hour over some very good fish and chips.

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Happy and replete, thanks to the hospitality at The Riverside

The final leg of the journey took place early on the Monday morning, when the chairs were off-loaded at Glasgow Dental School for temporary storage until we drive them down to Dentaid’s HQ in Southampton.

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Ready for unloading at Glasgow Dental Hospital, early in the morning. 

Paul our Head Porter and Alan from our Estates Department both helped us to unload the van and then headed into the lift with the chairs to take them down to their temporary storage space in the hospital basement.

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Off to the basement with a smile!

Hopefully we will soon be extracting the chairs once again, in addition to many other items we have collected, and filling up another van for the trip to Dentaid in Southampton as the kit prepares for its ocean voyage to Mozambique and then on by road to Lilongwe.

Many thanks to John Lyon of NHS Highland and to Stuart Howie for donating the chairs, Fary Johnson Vithayathil for the instruments and to Mike, Will, Fin, Paul and Alan for all their help with the logistics – much appreciated. Thanks also to Elizabeth Emery Barker for making the original connections for us with NHS Highland and Fary.

 

The MalDent Project and Smileawi feature in a graduation, an electives evening and a postgraduate study day

The MalDent Project is impacting on many aspects of the academic work of Glasgow Dental School and this was especially evident during the week beginning Monday 2nd December 2019.

On Tuesday 3rd December we enjoyed Graduation Day for our postgraduate students who had completed the MSc in Oral Sciences. One of these students was Inas Ghonsol, whose project dissertation was entitled ‘Oral health inequalities in sub-Saharan Africa with special reference to Malawi’.

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Inas (second in line) heads up towards the dais to receive her degree from the Principal and Vice-Chancellor, Professor Sir Anton Muscatelli

Some of the data for the project were collected during the Smileawi CPD Conference that was held in Mzuzu in September 2019, and reported in an earlier post. Following successful completion of her Masters project, Inas is now keen to pursue a PhD, in which she plans to study professional roles and the developing dental team model in Malawi, following the launch of the BDS programme at the University of Malawi College of Medicine.

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Inas (centre) with some of her class-mates and staff in an array of colourful gowns 

Following the Graduation on the afternoon of 3rd December, I headed straight to Trades House in the Merchant City area of Glasgow for the Incorporation of Barbers Medical & Dental Elective Awards 2019. Each year, the Incorporation of Barbers generously hosts a competition in which medical and dental students, selected by the University of Glasgow for the high quality of their elective studies, present their projects to a panel of judges. This year, two of the selected dental students, Katie Reed-Challen and Kirsty Smith, had completed their elective studies in Malawi, with the charity Smileawi. Their joint presentation was first class and a great reflection of the pilot child oral health survey in which they participated.

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Drs Aileen Bell, Viv Binnie and Al Ross with the dental students presenters, including Kirsty (4th from left) and Katie (2nd from right)

Finally, on Friday 6th December 2019, the West of Scotland Division of the Faculty of General Dental Practice held its annual Study Day at the Glasgow Science Centre. This is a large event, attracting dentists from all over Scotland. In addition to the lectures, the event hosts a trade show and the Dental School is very grateful that each year it is invited to participate. Furthermore, the organisers allow all of our BDS 5 students to attend and to receive a series of presentations aimed specifically at their needs.

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Our presence, with a stand, provides a wonderful opportunity to network with students, alumni and with colleagues from the dental industry. This year, we had a major focus on our work in Malawi and shared our stand with Smileawi. Once again we were able to share the work undertaken in Malawi by our undergraduate students during their elective projects last Summer. There was much interest from the delegates who visited us and it was another chance to spread the word about the MalDent Project and the work of Smileawi.

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A Malawian theme to our FGDP Study Day trade stand this year

The current Dean of the Faculty of General Dental Practice, Dr Ian Mills, attended the Study Day and came across for a chat. Ian is a Glasgow graduate and was a contemporary of  Nigel and Vicky Milne, the founders of Smileawi. Ian is a strong supporter of Smileawi and the MalDent Project. Earlier this year, Nigel and Vicky were the recipients of the FGDP Dean’s Award in recognition of their tremendous work with Smileawi. This was a great reunion photo opportunity!

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Nigel and Vicky Milne with Ian Mills – three exceptional Glasgow dental alumni at the stand of their alma mater!

The increasing involvement of so many participants in our work in Malawi, including undergraduate and postgraduate students, academic staff, charities and related professional organisations, in both Scotland and Malawi, is creating a very vibrant community. The three events in this post, together with establishment of our link with WHO described in the previous post, all in one week, reflect the multiple facets of the Maldent Project and the tremendous support we have to maintain our current momentum.

 

 

 

WHO African Region joins the MalDent Project team

The strand of the MalDent Project which relates to development of an oral health policy for Malawi is now underway. It had always been our intention to work closely with the WHO. Benoit Varenne, who is the Dental Officer in the Prevention of Noncommunicable Diseases (NCDs) Department at the WHO in Geneva, is aware of the MalDent Project, and has also taken a keen interest in Scotland’s Childsmile programme.

On Wednesday 3rd December our formal links with WHO African Region were established, when we held a Skype meeting between Yuka Makino in Brazzaville, Peter Chimimba at the College of Medicine in Blantyre, and Lorna Macpherson, David Conway and myself in Glasgow. Yuka is the Technical Officer for Oral Health in the WHO Regional Office for Africa.

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Lorna Macpherson and David Conway in conversation with Peter Chimimba and Yuka Makino

The Skype meeting was extremely positive. We were able to explain to Yuka the background to the MalDent Project, the progress we have made to date and our future plans. Yuka agreed to communicate with the WHO Country Office in Malawi and we had initial discussions around the establishment of an MOU. We also gave consideration to the potential for our involvement with work on the broader WHO Regional Oral Health Strategy.

WHO African Region

In February 2020, Lorna Macpherson and I will be visiting Malawi for several days of discussions with key stakeholders involved in the work to develop the oral health policy. Yuka has agreed that she will join us for that visit, thereby ensuring that the WHO is involved from a very early stage. This partnership working is critical to success and we look forward to a long and fruitful collaboration.

 

Glasgow Dental Class of 2020 Panto raises money for Smileawi

Every year, it is a tradition at Glasgow Dental School that the Final Year students write and perform a Christmas pantomime. The show, which is staged at the Glasgow University Union, is always based around a fairytale or Disney movie but re-written with a dental theme. The script is full of references to life at the Dental School, so staff members who attend need a thick skin! Most importantly, the event is always a sell-out and raises a lot of money for charity.

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The programme for the Glasgow Dental Class of 2020 Panto production

Two very deserving charities were chosen by the Glasgow Dental Student Society this year as beneficiaries – Brain Tumour Research and Smileawi. Last Summer, a group of dental students from Glasgow and Dundee joined Smileawi to undertake a child oral health survey in rural Malawi, and several personal posts written by team members have appeared on this blog. The data are currently being analysed for publication and are informing the design of a national child oral health survey in Malawi over the next three years.

The students who had worked with Smileawi last Summer were all very involved with the panto production and one of them, Kirsty Smith, played the lead role of Baby Belle. They had no doubt been influential in the choice of charities to support!

During the interval, Joe Woollcott (Fundraising and Development Manager for Brain Tumour Research (Scotland & Northern Ireland)) and Nigel Milne (Trustee of Smileawi) spoke briefly to the audience about the work of their organisations.

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Nigel Milne, from Smileawi, looks on while Joe Woolcott talks about the work of the charity Brain Tumour Research

The interval also provided an opportunity for the Smileawi / student team, that had worked so successfully together last Summer, to meet again in a very different venue – far from the evenings spent around the fire-pit at Umunthu Lodge in Mzuzu, relaxing after a hard day of clinical work.

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Re-united – the Smileawi / student team, with Kirsty Smith (far right, front row) enjoying a short break from her Baby Belle duties

During the second act there was a further reference to Glasgow Dental School’s collaborations with the University of Malawi College of Medicine, Dental Association of Malawi, Smileawi, Bridge2Aid and Dentaid, via a (doctored!) photograph of me delivering a presentation about the MalDent Project at a Scotland Malawi Partnership meeting in Edinburgh. Mysteriously, our BDS 5 student digital team had replaced my original slide with an image of our wonderful colleague and teacher from the University of Glasgow Anatomy Department, Professor Stuart MacDonald, who has been revered by many BDS classes over the years.

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A little bit of Edinburgh City Chambers in the Glasgow University Union 

As ever, the BDS 5 scriptwriters brought the performance to a happy outcome for Glasgow Dental School.

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Kirsty Smith, as baby Belle, takes centre stage in one of the closing scenes

Finally the show was over and the performers took their bows:

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Afterwards I met with my ‘stunt double’, Amy Carroll, who in addition to playing the ‘Bagg role’ had also been the Script Supervisor for the show.

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Congratulations to Amy Carroll after the show

Amy and her whole team had done a fantastic job. In addition to the on-stage activities, the 24-piece orchestra was also superb, expertly led by its Musical Director, Ryan McSorley. The musicians were drawn from all five years of the BDS course, which bodes well for forthcoming pantos.

The Dental School Christmas Panto is a wonderful tradition. The skills of the students and their team-working never cease to impress, all in aid of good causes. Long may it continue.