MalDent at the NHS Scotland Global Citizenship Conference 2019

Thursday 31st October and Friday 1st November were busy days on account of the invitation to Dr Mwapatsa Mipando (Principal of the University of Malawi College of Medicine) from Scottish Government International Development to attend and address the NHS Scotland Global Citizenship Conference 2019. This was a fantastic opportunity for the University of Glasgow Maldent Project and Blantyre-Blantyre Project to have time for face to face discussions with Mwapatsa and for both projects to feature in the Global Citizenship Conference.

On the Thursday morning, Profs Paul Garside and Andy Waters from the Wellcome Centre for Integrative Parasitology, Mwapatsa and I took an early train to Edinburgh. We walked from Waverley Station to The Scottish Parliament, where Mwapatsa was to meet at 10am with the Minister for International Development, Mr Ben Macpherson MSP.

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Prof Andy Waters, Dr Mipando and I arriving at the Scottish Parliament Building. Photo courtesy of Prof Paul Garside, our fourth team member!

In addition to Mwapatsa, the Scottish Government had also invited Dr Lalick Banda, Medical Director of St Francis Hospital, Zambia to discuss the long-term partnership between his hospital and NHS Borders, and Dr Joseph Mulenga, to discuss the newly emerging partnership between the Scottish National Blood Transfusion Service and the Zambian National Blood Transfusion Service in Lusaka.

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Dr Joseph Mulenga, Mr Ben Macpherson MSP, Dr Mwapatsa Mipando, Dr Lalick Banda and Mr Fred Ntongwe with the Minister in his office

Mwapatsa was able to update the Minister on progress with both the Blantyre-Blantyre and MalDent Projects, ahead of the Conference the following day.

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Mr Ben Macpherson MSP and Dr Mwapatsa Mipando

After the meeting with the Minister had concluded, we set off on the 15 minute walk up to Saint Andrew’s House.

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Fred Ntongwe, myself, Paul Garside, Mwpatsa Mipando, Andy Waters, Nicola Cogan and Ian Nicol – about to head up the hill to St Andrew’s House

Joanna Keating, Head of the International Development Team at Scottish Government, led a very interesting discussion among all the parties present from Malawi, Zambia, NHS Borders and the University of Glasgow, with her own team in attendance. It was a pleasure to meet Tasha Boardman who has been appointed as the new Malawi Manager on the Scottish Government International Development Team.

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A panorama of the group meeting in Saint Andrew’s House

After the discussion there was time for a group photograph outside St Andrew’s House, before we headed back to Waverley Station to catch the Glasgow train.

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Meetings over – ready to head back to Glasgow

Once back in Glasgow, Mwapatsa, Paul and Andy headed up to the main University of Glasgow campus, for an afternoon of meetings devoted to the Blantyre-Blantyre Project. I walked back to my office at the Dental School to finalise and submit our Mid-Year Report on the MalDent Project to Nicola Cogan at Scottish Government, which was due by close of play that day.

At 5.45pm Mwapatsa arrived at the Dental School for an evening meeting with Chris Platt, Professor of Architecture at Glasgow School of Art, and his two students, Breffni O’Brien and Ciara Durkin, for a follow-up with them on the design workshop that they had led in Blantyre in September. Niall Rogerson and Petrina Sweeney were both able to join us for the discussions. We made excellent progress and are now close to finalising the schedule of accommodation for the new building on the College of Medicine Blantyre campus which, in turn, will inform an estimate of the capital costs.

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A good evening’s work completed – ready to head to dinner!

The following day, Niall Rogerson joined Mwapatsa, Andy Waters, Paul Garside and I on the 8am train from Glasgow to Edinburgh. We alighted at Edinburgh Haymarket and shared a taxi to Murrayfield Stadium, the home of Scottish rugby. The NHS Scotland Global Citizenship Conference 2019 was held in the President’s Suite. In total, 280 delegates had registered for the meeting and it was very busy.

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The event was opened by Professor Jackie Taylor, President of the Royal College of Physicians & Surgeons of Glasgow. This was very fitting in view of the pioneering work led on behalf of the RCPSG by Stuart Ferguson and Mike McKirdy, who had produced the original report on Global Citizenship in the Scottish Health Service that was accepted by Scottish Government and and has helped to stimulate activity in this area (https://rcpsg.ac.uk/documents/publications/global-citizenship-report/204-global-citizenship-in-the-scottish-health-service/file).

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Prof Jackie Taylor, President of the Royal College of Physicians & Surgeons of Glasgow, opening the Global Citizenship Conference

Two keynote speakers followed Professor Taylor. The first of these was Mr Ben Macpherson MSP, Minister for Europe, Migration and International Development. His passion, enthusiasm and support for the global citizenship programme provides great encouragement for all who are involved. He commented that: “As we continue to develop the NHS Scotland Global Citizenship Programme and as we build and maintain health partnerships, we need to continue to ensure they are designed to be sustainable, effective, impactful”. These themes were picked up by many other speakers during the day.

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Mr Ben Macpherson MSP delivering his keynote lecture

The second keynote speaker was Dr Catherine Calderwood, Scotland’s Chief Medical Officer. In a very touching and personal presentation, Dr Calderwood related an experience of hers as a medical student during an elective project in sub-saharan Africa, which has greatly influenced her choice of medical specialty and her acute awareness of the problem of health inequalities, both at home and globally. Her charge to the delegates was:  “Let’s make Scotland the leading country for Global Citizenship in the world”.

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Dr Catherine Calderwood, Chief Medical Officer for Scotland, at the lectern

The morning session continued with a wide variety of presentations describing progress in NHS Scotland’s Global Citizenship programme. Of particular interest for the MalDent Project was a presentation by Jean Ngoie entitled ‘Ethical and Sustainable Kit and Equipment Donation’. Equipment supply, maintenance and repair are inevitable components of a dental programme and it was encouraging that many of the recommendations made by Jean are being followed in our work with Dentaid to re-equip the Dental Department at Kamuzu Central Hospital.

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Jean Ngoie discussing the ‘do’s and don’ts’ of equipment donation

After a series of interesting presentations on Global Citizenship developments in NHS Boards, we entered a section entitled ‘Sharing Challenges and Learning from Global Health Partnerships’. There were three presentations delivered jointly by Scottish and international partners:

  • NHS Borders Logie Legacy – Brian Magowan and Dr Lalick Banda, Medical Superintendent at St Francis Hospital, Zambia
  • Scottish National Blood Transfusion Service and Zambian National Blood Transfusion Service – Susan Cottrell and Dr Joseph Mulenga
  • Malawi Dental School – Jeremy Bagg and Dr Mwapatsa Mipando

This was an excellent opportunity to share experiences and to learn lessons from one another.

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Dr Mwapatsa Mipando speaking about the MalDent Project partnership

After lunch, which presented excellent opportunities for networking, there was a series of workshops. We attended and participated in the Malawi and Zambia Focus Workshop, led by Nicola Cogan and Ian Nicol.

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Nicola Cogan introducing the Malawi component of the ‘Malawi / Zambia’ workshop

Paul Garside and I had been asked to deliver brief presentations on learning points from the Blantyre-Blantyre and MalDent Projects in Malawi and Susan Cottrell to speak about the recently developing joint work between the Scottish National Blood Transfusion Service and the Zambian National Blood Transfusion Service. There was a lively discussion, with great input from our international partners.

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Prof Paul Garside describes the Blantyre-Blantyre Project and lessons learned 

After a final coffee break, we enjoyed a very insightful presentation by Ben Simms, from the Tropical Health & Education Trust (THET). He focused on the need for activities in developing countries to be innovative, strategic, ethical and responsible. He was very complimentary about Scotland’s rapid progress in developing its global citizenship agenda. His presentation closed with observations on the current climate emergency and the need to ensure that all flights that were taken were essential and maximum use was made of the time spent in the partner country.

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Ben Simms from THET presenting on ‘Innovation in Partnerships’

The conference finished with a presentation by Emily Broadis, the Chair of the Lead Champions Network, entitled ‘Our carbon footprint’, picking up the climate change story where Ben Simms had left off. Mike McKirdy then summarised the day’s activities before John Brown, Chair of the NHS Scotland Global Citizenship Programme Board, announced the poster winner and gave a vote of thanks to those involved in the organisation of the day.

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Mr Mike McKirdy summarising the content and learning after an excellent conference

This had been a tremendous event. It was inspiring and thought provoking to hear the perspectives of so many colleagues engaged in global citizenship activities. The high level political support and leadership shown in Scotland for this work is second to none and it is a real privilege to be able to participate .

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‘Herding kittens’ pays dividends

This is a guest post written by Nigel and Vicky Milne, founders of the charity Smileawi. Smileawi is one of the major charity partners in the MalDent Project and this post describes the success of one of our recent joint initiatives.

2019 has been an incredible year for Smileawi (www.smileawi.com). During this year we have created some excellent new links both in Malawi and here in the UK. As alumni of the University of Glasgow Nigel and Vicky Milne were delighted when discussions with Professor Jeremy Bagg, the Head of Glasgow Dental School, led to our involvement in June in an Oral Health Survey of 5-12 year old children in Malawi.

The survey was designed by Professors Lorna Macpherson and David Conway. To help us collect and collate the data for the full three weeks we had three University of Glasgow dental students Paula Houston, Kirsty Smith and Katie Read-Challen and Abigail Gliksten a dental student at the University of Dundee. For our final week we would be joined by University of Glasgow dental students Rosie Grimes and Martin Laird.

Making up the rest of the team were Nigel and Vicky, Heather Lancaster a retired Medical Practice Manager, Conor O’Brien an Oral Surgeon from Glasgow Dental Hospital and his son Daniel. We were also joined by Alan Stewart and Andy Lancaster who were with us as ‘Smileawi Spanners’, an offshoot of Smileawi which puts hospital transport vehicles and ambulances back on the road. As we were to cover quite a distance in our rented 4x4s it was reassuring to know that we had our own mechanics with us.

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Paula, Kirsty, Katie and Abigail meeting some of the children who took part in our survey

Our first communication attempts with the students proved difficult and answers to straightforward questions were not always forthcoming. As a result Nigel, muttering under his breath, described working with them as being like herding kittens. However, as soon as the students had completed and passed their final examinations, we were met by a completely different attitude. Suddenly we realised that we had working alongside us a focused, intelligent group of young professionals who intended to take full ownership of this project.

The project involved a number of different aspects. First, we would examine the mouths of all consenting children in 6 different primary schools. In order to do this we were all first calibrated using a test which the Scottish NDIP (National Dental Inspection Programme) teams use – http://www.wordpress.com/post/themaldentproject.com/621. This proved more challenging for the older dentists in the team!

The training and calibration allowed us to examine the mouths of the children, measuring the number of decayed missing and filled teeth in their mouths, looking for active signs of infection and checking to see if there was any fluorosis present.

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Collecting data in the church at Ekwaiweni

Secondly our wonderful team of local Malawian translators would collect useful social data from the children on a form designed by Lorna and David.

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Collecting the social data and carefully writing the child’s name on her toothbrush which was then kept in her own class toothbrush hanger

Thirdly we gathered data on the fluoride content of the water in the well closest to the school. This was done because Malawi sits in the Rift Valley an area where high levels of fluoride in water can be detected at times. The testing equipment and training for this came courtesy of the University of Strathclyde.

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Testing the water from the local well for the presence of fluoride.

Finally we gave every child who participated a toothbrush and a lesson on toothbrushing. The toothbrushes were donated by the Humble Co. https://thehumble.co/ a wonderful organisation with a great ethos who make oral hygiene products which are as eco-friendly as possible. We were very grateful for the donated toothbrushes.

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One of the children practising brushing with his new Humble toothbrush
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A toothbrushing and diet lesson being given at the Embangweni School for the Deaf, a challenge that our students rose to.

The students decided that it was not enough to simply teach the children, they also wrote a song called ‘Suko Mino’ in Tambuka, then translated it into Chichewa when we were in a different region. Finally they learned to sign it for the School for the Deaf. A particular highlight happened in Mua – after teaching one class of children the oral health message they returned to their classroom, where thirty minutes later we overheard them singing Suko Mino.

The Oral Health Survey was a huge success, with the team examining more than 2600 mouths and uploading all the data into a spreadsheet. In our final week Rosie and Martin joined us and proved to be every bit as hard working as their colleagues.

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The full team and translators but minus our mechanics at Mua

Mua proved to be very interesting as it was the only area where we found marked fluorosis. This was backed by the team finding fluoride present in the local well.

Meanwhile the Smileawi Spanners were working hard at Mua. The following photo shows them fixing one of the six vehicles that they put back on the road during this trip. Alan is displaying one of the many toolkits donated by Arnold Clark to be given out to the Malawian mechanics, who were very grateful as they often have to work with a limited number of tools:

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So a project that at first felt like herding kittens was transformed into one which felt like a huge success. We would like to thank the following people. A huge thanks to Heather Lancaster for her organisational skills and for keeping the data safe at all times! Many thanks to Jeremy Bagg for his tireless work in bringing the team together and for his patience in getting ethical approval for the project. Conor and Daniel for their hard work and sense of fun. Lorna Macpherson and David Conway for the wonderful work they did putting together the survey, ensuring that we were all calibrated and that we all understood the forms, the data that we were collecting and the spreadsheet for collating the data.

Finally we would like to thank the six students who worked tirelessly to ensure the success of the project. They give us enormous hope for the future of dentistry and now, when Nigel talks about them, there is no muttering, only pride in his voice.

If you would like to support the work of Smileawi, please visit their web-site at http://www.smileawi.com

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Two days in Edinburgh with Scottish Government International Development and the Scotland Malawi Partnership

Two consecutive days were spent recently in Edinburgh on activities associated with the MalDent Project. The first, on Friday 4th October, was to attend a Scottish Government International Development practical grant management workshop at the Scottish Government offices at Victoria Quay in Leith.

On arrival I met Alex Mackay and Simon Guild, both from the University of Glasgow and who, like me, were attending to represent their respective grants.

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With Alex and Simon before the workshop

It was an extremely useful morning which taught me a lot about budget management and reporting. There are a number of things I will be doing differently from now on.

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Ian Nicol explains the ups and downs of currency exchange rates and the potential risks for grant-holders

The following day I travelled back to Edinburgh on the train with Alex Mackay and Paul Garside to attend the 2019 Scotland Malawi Partnership AGM. This year it was held at the Royal College of Physicians of Edinburgh.

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Paul and Alex on arrival at the RCPE

The lecture theatre was all set up with a brightly coloured and cheerful stage set. Whilst people were filtering in to join the meeting a quiz was held, allowing guests to become familiarised with the software programme Mentimeter, which would be used later in the afternoon.

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The colourful stage set 

The afternoon was formally opened by Professor Heather Cubie, the recently appointed Chair of the Scotland Malawi Partnership, who welcomed everyone present.

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Heather Cubie, SMP Chair, opened the meeting 

After hearing from the SMP team about some of their personal highlights during the past year, we enjoyed a presentation from Dr Ann Phoya, the Chair of the SMP’s sister organisation the Malawi Scotland Partnership (MaSP).

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Dr Ann Phoya at the lectern

The core business of the AGM, including adoption of the 2018/2019 accounts, took place next. This was followed by an interactive discussion about the 2020-2023 Strategic Plan for the SMP.

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David Hope-Jones led the session on the 2020 – 2023 Strategic Plan

The first half of the event was rounded off by the Youth Committee, which talked us through the networking opportunities and stalls available during the coffee break in the adjacent marketplace.

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The SMP Youth Group in action

The coffee break was a great chance to meet colleagues and friends we knew well …

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Nicola Cogan and Joanna Keating at the Scottish Government International Development stall

… and to meet new friends:

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A good chat at the Mary’s Meals stall

After coffee we were treated to the Scottish Premiere of the short film ‘LAZARUS’. This film is about the Malawian musician Lazarus Chigwandali, who has albinism. The film, produced by Madonna, was featured at the Tribeca Film Festival in April 2019 and is receiving wide acclaim. A good summary can be found at: https://www.bbc.co.uk/news/entertainment-arts-48021425

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Watching the screening of the film LAZARUS

We then met Lazarus himself and enjoyed an initial Q&A session with him, compèred by Chimzy Dorey.

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Lazarus taking questions from the audience

Subsequently the music started and it wasn’t long before members of the audience were on their feet, clapping and dancing. Here is a short sample of Lazarus playing solo:

Lazarus was then joined by Brave Mnyayi and Davie Luhanga for more rousing renditions:

After the fantastic music, the Youth Committee returned to the stage to distribute prizes  following the variety of competitions that had been running during the event. The afternoon was then brought to a close with an inspirational address from Ben Macpherson MSP, the Scottish Government Minister for International Development.

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The closing speech from Minister Ben Macpherson MSP

We headed back to the market place where Lazarus was selling T-shirts, so a signed one was de rigeur after enjoying his stirring performance with such an important message in support of those with albinism.

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An eye-catching T-shirt design

It was a real privilege to meet such an inspirational artist.

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With Lazarus after he had signed my T-shirt

It had been another lively SMP AGM and a thoroughly enjoyable afternoon. Our smiles at the end of the day, following a chat with the Minister Ben Macpherson MSP, sum it up nicely!

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If you would like to see the official video and related materials published by the Scotland Malawi Partnership following the AGM you can find them at http://www.scotland-malawipartnership.org/news-events/past-events/agm-2019/

Bridging nations, bridging partners and bridging rural health inequality

This is a guest blog post written by my friend and colleague Andrew Paterson. Andrew is a Senior Lecturer / Honorary Consultant at the University of Dundee Dental School, one of our partner organisations in the MalDent Project. The focus of this post, however, is Andrew’s work with the charity Bridge2Aid, another of the major partner organisations working on the MalDent Project. The post describes the excellent progress that is being made by Bridge2Aid, in partnership with the Dental Association of Malawi, to improve access to emergency dental care in rural areas of Malawi.

I am very fortunate to be a volunteer, trustee and site clinical lead for the UK charity Bridge2Aid which for the last 15 years has trained clinical officers in rural settings in Tanzania to provide safe, sustainable and simple emergency dentistry to their communities whilst delivering relevant oral health messages and appropriate referrals of more complicated cases to dental therapists and dentists in district health facilities.

During that time 570 health workers have been trained and around 20 District Dental Officers trained to be potential local trainers. The ongoing programme in Tanzania has treated 56,500 patients and provided 5.7 million rural Tanzanians access to simple emergency dentistry. Put in the words of Dr Mohammed Khalfan, Clinical Director of Bridge2Aid’s Tanzanian partner Education & Health for All (EH4all), “that’s access to the equivalent of more than double the population of Botswana due to the efforts, drive and collaboration of many”.

Bridge2Aid has more recently felt that the Tanzanian training model was applicable to other nations and Malawi was one of the countries in which it may provide benefit to the health system. Ongoing discussions in 2018 culminated in Professor Jeremy Bagg visiting Tanzania to see the model first hand during a programme I was privileged to lead (https://www.wordpress.com/post/themaldentproject.com/171). Many discussions were had and Jeremy’s sterling efforts brought partners together to investigate collaboration possibilities including the Dental Association of Malawi, Smileawi, Bridge2Aid and the Universities of Glasgow and Dundee towards a common goal of improving oral health in the rural periphery in Malawi. The concept has been  approached with a positive mindset by everyone

Bridge2Aid and the Dental Association of Malawi were successful in gaining a new projects start up grant from the Tropical Health Education Trust and in June 2019 Paul Tasman, Bridge2Aid’s Operations Manager, visited Malawi to assess the feasibility of the project with, amongst others, the Dental Association of Malawi, The Medical Council of Malawi, The Ministry of Health and the Chief Dental Officer (https://www.wordpress.com/post/themaldentproject.com/834). Responses of the Malawian Government and dental community to Bridge2Aid’s proposals were very encouraging as they appeared to dovetail well with the Government’s existing policies and their ongoing attempts to facilitate access to care in rural and hard to reach areas.

Underpinned by this goodwill, Bridge2Aid CEO Shaenna Loughnane and I travelled to Malawi on 10th September 2019 to have further discussions with Malawian stakeholders and to try to put arrangements in place for a first Bridge2Aid programme to be delivered in 2020. September had been chosen as Smileawi were running a programme that provided emergency dental care near Mzuzu at that time, which gave us the opportunity to see first-hand the challenges of providing dentistry in rural Malawi. Smileawi had been instrumental in bringing together the Smile North Dental Therapists Group and they organised a conference in Mzuzu which gave a forum for discussion and CPD for therapists from all parts of the Northern Region. Smileawi and Smile North had kindly invited Bridge2Aid to present and discuss the training model to them at the conference. We would be joined on the visit by Dr Mohammed Khalfan who in addition to his role with EH4all is a Dental Therapist. Mo had had to travel independently from Mwanza via Dar-es-Salaam. The dental therapists would be at the heart of Bridge2Aid’s proposed training model in Malawi where the Medical Assistant cadre, rather than Clinical Officers, would be trained and later they would be mentored and supervised by dental therapists.

Shaenna and I arrived in Lilongwe on the 11th September 2019 to be greeted by Dr Wiston Mukiwa, a proud alumnus of the University of Dundee (where I have my “day job”) and Secretary of the Dental Association of Malawi. Whilst I had lived in Malawi, many years before, more recently I had travelled frequently to Tanzania so it at first felt strange to not be landing in Dar or Mwanza.

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Meeting Wiston

Wiston’s welcome was warm and we were driven through the busy Lilongwe traffic to our hotel, the Korea Garden Lodge. After a quick freshen up, Shaenna and I joined Wiston for dinner during which many issues were discussed and solutions brainstormed.

Wiston would pick us up the following morning and fortunately the airport was on the road North so we picked up Mo and headed on the six hour drive to Mzuzu. Discussions continued in the car regarding the programme and many other subjects. I was beginning to understand that Wiston was both knowledgeable and engaging on many important issues ranging from hybrid mangoes to the problems of deforestation in Africa. It made the time pass quickly through the beautiful scenery, past familiar rural scenes but in a ‘more Scotland-like’ mountainous terrain (without the inevitable rain) than Tanzania

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A tough road for a bike ride

We arrived in Mzuzu at the glorious Umunthu camp and were joined by the founders of Smileawi, Nigel and Vicky Milne, during the evening. Our plan was to visit Smileawi’s training sites the following day as any first Bridge2Aid programme would require collaboration and cooperation with both local partners and Smileawi. Accordingly it was important to see the Smileawi model first hand, the potential logistic issues that may occur and to understand who to engage with within the local community. Nigel and Vicky were amazingly open and helpful offering great advice and local knowledge.

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Andrew, Nigel, Vicky, Mo, Wiston and Shaenna at Umunthu Camp, Mzuzu

We followed Vicky and part of the Smileawi team early next morning to the Kambombo Health post, following her car flying the St Andrew’s cross up the rutted dirt road, a remarkably similar journey when accessing a Tanzanian dispensary.

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Vicky and the Smileawi team ‘flying the flag’

The health post was in a beautiful setting with banana plantations and mountains in the distance. This multi-purpose building was used by villagers throughout the year mostly for childcare and had been funded by our late Scottish dental colleague and Smileawi volunteer Alan Walker and is a lasting legacy for the local rural community.

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View from the Kambombo health post

On entering the health post it became a bit of a reunion for me. Former colleagues from the Maxillofacial Unit at Crosshouse Hospital in Kilmarnock, Helen Patterson and Liz Leggate, were volunteering with Smileawi – a fairly surreal experience to bump into them here.

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Dr Patterson and Dr Leggate I presume! In Kambombo Clinic

Shaenna, Mo, Wiston and I each had different roles in trying to make the most of our visit. Mine was largely to look at the logistics of Smileawi’s operation, so I spent time looking at their sterilisation facilities and how the clinic operates and flows. There were far more similarities than differences and indeed the sterilisation facilities were identical to those Bridge2Aid uses in Tanzania. Whilst Bridge2Aid concentrates on training and Smileawi concentrates on treatment much of the ethos of the organisations is remarkably well aligned. Smileawi have really engaged with a local youth organisation “Taarifa” led by the engaging and impressive Shupo Kumwenda who we met at our next Smileawi site. Taarifa provide local volunteers who facilitate waiting patients and act as interpreters and it was great to see the symbiotic relationship between Smileawi and the local community.

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Liz operating in Kambombo, assisted by a youth volunteer, whose distinctive attire is likely to make a Scottish volunteer feel that they’re actually in Glasgow!

After meeting the local chief and holding further discussions with community headmen we travelled to another Smileawi site at Ekwendeni hospital near Mzuzu. Here Nigel was leading a team with large patient numbers waiting for treatment. Smileawi were running a slick operation and were working hand in hand with the local dental therapist. This was excellent collaboration but Mo, Wiston and I had to resist our urge to put on some gloves and assist in clearing the backlog of patients. We observed the desperate state of oral health in these rural areas with widespread dental decay in many, meaning there was a massive need for both safe emergency dentistry and oral health education exactly like Tanzania.

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Always sad to see poor dental health in rural Africa. Here an 18 year old Malawian has multiple decayed and abscessed teeth. This all too typical rural Malawian scene is sadly replicated throughout rural Tanzania

We left the Smileawi sites convinced that the Bridge2Aid model was both feasible and much needed in Malawi and that it would be possible to cascade-train health workers here which Wiston felt was such an important priority for Malawi.

It is imperative that NGO’s planning on putting programmes into new areas discuss and negotiate plans with senior local stakeholders so that the programmes appropriately meet the needs of the community. Wiston therefore arranged for us to meet Dr Don Chiwaya, one of the two dentists at Mzuzu Central Hospital. Wiston and Shaenna discussed Bridge2Aid’s plans and were met with a very positive response. I was able to send greetings to Don from his former colleague, Remus Chunda, a dental therapist and now a PhD student at the University of Dundee.

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Don, Shaenna, Mo, Andrew & Wiston at the Dental Department, Mzuzu Central Hospital

On leaving the hospital we bumped into Alan Stewart and his team from Smileawi Spanners, mechanics who repair local ambulances and train local people in vehicle maintenance. They had already managed to put two ambulances back into service – great work.

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Smileawi Spanners showing innovative use of a bed pan to collect oil from an ailing ambulance

The following day Smileawi and the Smile North Dental therapists group had their conference at the St John of God Conference Centre, Mzuzu. Smileawi had been instrumental in bringing together the Northern dental therapists from a wide and remote geographical area to interact together and enhance their lifelong learning and continuing professional development. This was a very impressive group who would be pivotal as trainers during a Bridge2Aid programme and mentors and role models for trained Medical Assistants after any programme. Helen Patterson gave an inspiring talk on managing disability in rural Malawi and then Shaenna introduced the Bridge2Aid model to the therapists. I discussed the nuts and bolts of the Bridge2Aid model and the proposals of how it may work or be modified for Malawi and Mo discussed the benefits of the training model for a local dental therapist. We were, though, all merely warm up acts for Wiston who gave the audience one of the most inspiring talks I have ever heard in over 30 years as a dentist. His complete understanding of public health issues in rural Africa was inspirational.

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Collaboration at the Smileawi Conference

Wiston concluded that he felt that the Bridge2Aid project would make a difference as it brings together many partners to buy into a sustainable programme that will systematically and consistently train Medical Assistants in rural areas in the provision of emergency dental care services and referral of difficult cases that are beyond their competency. He felt that this would in turn free some of the Dental Therapists time for them to deal with more complicated cases and importantly empower them with the opportunity to be the natural trainers, supervisors and mentors of the trainees.

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Mo and Shaenna in full flow at the Smileawi Conference

I managed to surprise Wiston at the Conference by presenting him, on behalf of the University of Dundee, with some alumni memorabilia and as a member of staff there I was able to tell Wiston how proud the University is of his contribution to public health and dental public health in Malawi given his many roles and many years of excellent service.

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Surprising Wiston with his Dundee alumni memorabilia

After lunch Wiston, Shaenna, Mo and I facilitated a wide ranging discussion with groups of dental therapists regarding the Bridge2Aid proposals, exchanging ideas and jointly problem solving our way through potential barriers with the therapists to move the proposals forward.

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Andrew in group discussions with Smile North Dental therapists

That evening we joined the full Smileawi team for dinner prior to returning to Lilongwe the following day. As they say, a good time was had by all! Our route to Lilongwe involved stops in Mzimba and Jenda to scope out potential sites and accommodation for possible future programmes.

Mo had to return to Tanzania and for the next two days Wiston, Shaenna and I discussed and refined our thoughts on a potential programme based on what we had observed to ensure its relevance to Malawi. In addition we met a local NGO to discuss logistic support needs for Bridge2Aid programmes which is essential for their smooth running.

As Bridge2Aid has a sustainable model, a key aspect of its sustainability is its ability to work alongside local partners and within existing healthcare structures and priorities. To ensure that this is done effectively during our remaining time in Malawi we met key partners and stakeholders including Dr Nedson Fosiko, Deputy Director of Clinical Services at the Ministry of Health and Dr Jessie Mlotha-Namarika, Chief Dental Officer of Malawi. Both were entirely positive and we were reassured that the Bridge2Aid model was relevant to Malawian health needs and supported wholeheartedly by both Government and the dental community.

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Shaenna, Andrew, Wiston and Dr Jessie Mlotha-Namarika, Chief Dental Officer of Malawi, at Kamuzu Central Hospital, Lilongwe

 

Dr Fosiko
Wiston, Andrew, Shaenna and Dr Fosiko at the Ministry of Health

Finally it was sadly time to leave this beautiful country with its friendly hospitable people, but hopefully Bridge2Aid will return to Malawi very soon.

So what now?

Whilst there remains some administrative groundwork still to be done to ensure that both Bridge2Aid and Malawian stakeholders are in agreement over their respective roles, the first Bridge2Aid programme in Malawi has been planned for mid-2020 with tentative plans to further roll out the Malawian training model during 2021 following reflection on the first programme.

In the spirit of collaboration and continued partnership the trainers on the first programme will include Wiston, Nigel and Vicky from Smileawi and myself and EH4all will attend that programme to help train Malawian logistic partners based on their experiences in Tanzania.

I am honoured to be leading a Bridge2Aid programme in Mara Region, Tanzania in November 2019 and it will be a privilege then to have Wiston and a representative from the Malawian Ministry of Health visiting that programme to observe the Bridge2Aid training model in action so final lessons can be learned prior to the first programme in Malawi.

Just like the MalDent project, the Bridge2Aid Malawian project has so far involved the drive, positivity, collaboration and goodwill of many to attempt to build bridges between nations, partners and above all in a small way to try to bridge some of the rural health inequality gaps. I am confident it will be a success that will offer real sustainable benefits to oral health in Malawi.

 

Return to Malawi by Martin Laird

Martin Laird is a dental student at the University of Glasgow. He undertook his elective project in Malawi between the fourth and fifth years of the BDS course. This is his reflection on part of that elective experience.

In the past, I had been to Malawi with my high school in 2014 and 2015. My time there was spent with local primary schools, orphans and prisons across southern Malawi. However, there were three people who I met on those occasions that have had such a profound impact on me that I made it my solemn duty to meet them again. As fortune would have it, I had the chance to return to Malawi for my elective after four years of waiting!

The first of these remarkable people I’d like to talk about is a lady called Deborah Nglande. She is a principal teacher at Mendulo School in Mulanje district.

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Rosie and myself with Deborah 

Not only is Deborah extremely dedicated to the children she teaches, but she also runs an orphanage and a hundreds strong programme for disabled children out of her own home to provide a safe place for these estranged children and their parents. These families are often ostracised from their villages purely because of their child’s disability. It is through this project that I met the next person in my story. So without Deborah really none of the rest of this is possible – a special thanks to her.

The second person I would like to talk about is Regina Baulen.

I was paired with Regina five years ago as a sponsor. Take from this what you will, but the stars seemed to align somewhat with myself and Regina meeting each other, from our random allocation amongst the hundreds of children as part of the disabled project. Little did we know that we were both exactly the same age (despite our very obvious physical differences) and we both have scoliosis – a relatively common spinal deformity. Mine is very mild and I have more or less overcome it, but Regina’s is far more severe and she has suffered various repercussions from not receiving treatment. I was fortunate enough to be able to fund a degree of treatment and buy a pushbike for her that allows her to travel to school independently. Despite her mental acuity being normal, her disability has meant she has only reached Form 5 of primary school.

Thanks to Deborah, I was able to meet Regina again at Chindola Primary School where we were initially greeted by the head teacher and brought into his office. What was remarkable about this place was that there was a large tarpaulin sign of partnership between Chindola and Our Lady and St. Joseph’s Primary School in Glenboig which is not even 5-10 minutes drive from my home back in Scotland. To see this in one of the most remote places I had ever been in my life was not only immensely comforting but incredible too – saying that we live in a small world doesn’t do it justice.

It was at this moment that I turned to face the open doorway to see Regina herself. I could tell that despite my much more hirsute visage she recognised me straight away and we embraced each other warmly. That moment for me made all the travelling, stress and doubt disappear, and in that instant I knew my decision to come back to Malawi was the right one.

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Myself, Regina, her class teacher on the right and Principal on the left – with the wonderful symbol of Scottish and Malawian cooperation in the backdrop

We then took Regina in the car to her village. I recognised her house straight away and we were greeted by her father and shortly after by her mother. Through Deborah, I spoke to her family about how grateful I was to see them again and then asked them what sort of things they needed. Unfortunately, their house had been damaged by flooding; their roof was very unstable with the metal sheeting that made it up being tethered down with bricks. I told them that I would help fix this as well as providing anything else they needed.

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Holding talks with Regina and her family while some of the villagers look on. Note the bricks holding the roof down, and the damp, weak points in the wall

I then proceeded to give over some clothes and a new schoolbag I had bought for Regina. She also required new shoes but her current ones had no size on them – I had to take pictures of them next to my own size 11 shoes so I had a size comparison. Looking back on that photo it really hit me how vulnerable she is, and how impossible it seems that we are the same age and yet how different our lives are.

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A very poignant reminder to never take your circumstances for granted

My sincere thanks to Professor Bagg for recording some of this interaction with Regina – I had no idea that he was filming so it was wonderful to see this meeting in such a pure and genuine way (View). Afterwards, we took Regina back to her school. I will be the first to admit I did get upset in the back of the car as we drove away after dropping her off, but I hope it won’t be long till we meet again.

The final person I was reunited with is nothing short of a modern day saint – Sister Anna Tomasi. Anna is a retired Catholic nun who has lived in Malawi for (I believe) around 20 years.

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A true person to aspire to be like – Sister Anna

She started the C.C.C trust in Blantyre, an organisation which provides teaching and employment to former inmates of the numerous prisons in southern Malawi. Many of these inmates have been unjustly imprisoned and, from seeing the prisons for myself, they live in the most squalid and inhumane conditions. However, thanks to the work of this astounding woman, the prisons have slowly improved, and multitudes of inmates have been granted their freedom, an education and ultimately a job as a result of her tireless efforts. I was so happy to see her again after such a long time, and for the second time that day I received a hug I’ll never forget – one with the strength that belied her scarcely 5ft tall Italian frame! I could tell she was genuinely happy to see me which made me so relieved that she still remembered me after all these years. She sat and told us about the work she’d been doing, and from listening to her, she seems to be doing more than ever. If anything, she looked younger now despite being around eighty years old and working twelve hour days. I was delighted to hear that her work had finally begun to gain recognition in Europe, with the Catholic Church and Italian government awarding her €250,000 towards her efforts, which she has implemented to great effect – allowing the CCC trust to grow arms and legs and take some of the pressure off her, not that she’ll ever utilise any free time to rest!

To think that this was just one day in my elective is absolutely mind-blowing. To a degree, I’m still processing that one day and will do so for some time. The remainder of the elective project, spent at the College of Medicine in Blantyre with Rosie (my classmate), working at Kamuzu Central Hospital, Lilongwe and conducting data collection with Smileawi amongst so many other things, was tremendous. But for me, being able to say I got to see these three special women again allows me to be content that my elective experience will live with me forever. I was honoured to experience it with Jeremy and Rosie, and I hope they have an equally powerful memory of that special day too.

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Until we meet again

Malawi Elective 2019 – a reflection by Katie Read-Challen

Katie Read-Challen is a dental student at the University of Glasgow. She undertook her elective project in Malawi after completing the fourth year of the BDS course. This is her reflection on that elective experience.

Spending 3 weeks in Malawi this June for my dental elective was such a fantastic experience, mostly thanks to the group of people we travelled with and those who we met along the way. Vicky and Nigel Milne knew so much about Malawi and had made many close connections from the time they had previously spent in the country. I was very inspired by all their efforts at making their charity more sustainable including the funding of local dental therapists through University, bamboo toothbrushes (donated by Humble) to reduce plastic waste and the Smileawi Spanners branch of the charity who helped local engineers fix hospital vehicles. It was great meeting Alan Stewart and Andy Lancaster, the two mechanics, as well as Heather Lancaster who did a great job at organising us dentists during the data collection. We had a good laugh the whole time and I would definitely recommend joining a Smileawi trip to anybody who is interested!

The Smileawi Team. Heather_ Nigel_ Katie_ Abi_ Paula_ Kirsty_ Vicky
The Smileawi team: Heather, Nigel, Katie, Abigail, Paula, Kirsty, Vicky

Starting this September, I will be studying an intercalated degree in Global Health which I am looking forward to even more since the Malawi trip. The oral health survey is an exciting project to be involved in and it was interesting and satisfying seeing it right through up to the input of the data on the laptops, despite the data input itself being tedious at times! Collecting the data at the selected primary schools was immensely fun as the children were so sweet, the teachers so welcoming  and the translators who helped us were brilliant at keeping the good mood going all day.

Abi putting data into the laptop - not a bad place for it!
Abi putting data into the laptop – not a bad place for it!

We set up in church halls or classrooms and used head torches, mirrors and cotton wool to carry out the dental examinations. The translators helped us to fill out the questionnaires and the children would then wait very patiently for their turn to see us and collect their toothbrush afterwards. We suspected that some older children told us that they were in the survey’s age range of 5-12 years in order to get a toothbrush, as there was a surprising amount of wisdom teeth seen for children that young! The fact that many children did not own a toothbrush was one of many poignant reminders of the poverty in Malawi and reinforced the need for a dental prevention programme there.

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We worked in pairs with one person examining the child and calling out the charting whilst another person scribed

The School for the Blind in Ekwendeni and School for the Deaf in Embangweni were really inspiring and turned out to be very fulfilling experiences, after my initial nervousness about how we would communicate effectively with the children there. We were able to teach our visual prevention lesson to the children at the blind school by describing the pictures and we were able to sing our toothbrushing song in the school for the deaf using dance moves – which the children loved! The following two photos show some of the the children at Embangweni School for the Deaf after receiving their bamboo toothbrushes donated by Humble:

At Ekwendeni School for the Blind we handed out Days for Girls reusable period kits and taught a small class of girls in one of the dorm rooms, some of whom had albinism, how to use them.

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The girls at Ekwendeni School for the Blind receiving their Days for Girls reusable period packs

Overall the experiences at these two schools were my favourite due to the challenges we were able to overcome in order to carry out our survey and brushing instruction as well as the admiration I had for the teachers and the pupils overcoming their own daily challenges, always with a smile.

There is so much more I could have written about Malawi – each day was packed full of experiences that would have easily filled an elective poster. Going forwards we hope to raise money to fund two feeding programmes at Dunduzu and Malivenji primary schools in the North in order to aid nutrition of the pupils as well as help the schools to increase the number of pupils that go. It would also be great to send mosquito nets to the residential schools (Ekwendeni School for the Blind and Embangweni School for the Deaf) as well as plastic teeth for the phantom heads at the School of Health Sciences which trains dental therapists. I have left extremely inspired by the work of Smileawi and the MalDent project and I look forward to seeing the results of the survey and the positive effects it could have on the oral health of Malawi.

The Smileawi team with staff at the School of Health Sciences and the phantom heads donated by the MalDent project
The Smileawi team with staff at the College of Health Sciences and the phantom heads donated by the Maldent Project

A Summer in Malawi by Paula Houston

Paula Houston is a dental student at the University of Glasgow. She undertook her elective project in Malawi between the fourth and fifth years of the BDS course. This is her reflection on that elective experience.

In June 2019 I was fortunate enough to travel to Malawi with fellow BDS students, dentists and volunteers with the charity ‘Smileawi’. We were conducting a survey of the prevalence of dental caries in children aged 5-12 years in rural primary schools across the country. We visited six schools in total and surveyed more than 2600 children’s teeth. I believe it will be the largest study of its type among children conducted in Sub-Saharan Africa and it was an invaluable experience.

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As a group we discussed and strategized over the daunting task of charting 3000 children’s dentition within the narrow timeframe that we had. (It would require seeing a patient every 2 minutes on average).

We used basic fold down dental chairs (manufactured by the charity Dentaid), a plastic mirror, some cotton wool and a head torch. We took it in turns to assess the patient and to scribe the results and swapped roughly every 20-minutes when inevitable fatigue set in – in order to minimise human error.

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Myself and Nigel Milne conducting an exam 

In addition to gaining significant data, we were able to give the children of Malawi a positive impression of dental treatment. Unlike children in the UK, most (if not all) of the children that we looked at had no previous experience of dentistry and this survey stood as an opportunity to acclimatise them to dental treatment. It was so encouraging to see how cooperative the children were and how excited they were about our visit!

We had some local Malawian volunteers who helped the children complete the questionnaires and also taught us some useful local phrases.

‘Yasa Mula’ – Open your mouth

‘Yasa Mula Chomeni’ – Open your mouth very much

‘Tawonga chomeni’ – Thank you very much.

These basic words got us by, although admittedly on occasions we mixed up ‘thank you’ with ‘open your mouth’ and had children climbing off of the table post-exam, then jumping back on with wide open mouths in perfect obedience!

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An oral health lesson in Ekwaiweni Primary School

For each school that we visited we also spent some time teaching the children some basic oral hygiene and delivering tooth brushing instruction. With the help of our translators, we conjured up a song which reminded the children to brush their teeth twice a day. It wasn’t a chart topper, but it was certainly trending in Malawi! One of the moments that really stands out to me on this trip was hearing an assembly of children singing our song back to us in both Tumbuka and English.

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It was an educational trip and checked a box in completion of our required university project, but in the end, it was so much more than that to all of us. Not only have I fallen in love with the beautifully kind people of Malawi, but I am left in awe of the incredible work that Smileawi conduct annually. This small charity, founded by Nigel and Vicky Milne, has made such a noticeable difference to the rural villages of Northern Malawi. They provide emergency dental treatment, in addition to funding dental therapy students to complete their education and provide materials to DCP’s working throughout the country. Furthermore, Smileawi has funded the construction of a kitchen at one of the schools we visited, in order for the children to be fed at school and encourage attendance.

I left Malawi with some great memories, great friends and a great desire to return and help as a dentist in the future.

To Blantyre and Mzuzu for a College of Medicine / elective student / Smileawi collaborative.

This post relates to the second phase of a visit I made to Malawi last June. It has been delayed in publication and forms the first of a series of four posts which cover an exciting collaborative project that took place between the charity Smileawi and dental students from Glasgow and Dundee Dental Schools. Three of the students have written reflections of their experiences, which complete the ‘mini-series.’

My involvement started with a very early morning flight on Tuesday 11th June from Lilongwe to Blantyre, following meetings on the previous day with Paul Tasman from Bridge2Aid, Ministry of Health officials, Wiston Mukiwa from the Dental Association of Malawi, and the Christian Health Association of Malawi (https://www.themaldentproject.com/2019/06/23/with-the-scotsman-bridge2aid-and-malawian-partners-in-lilongwe-two-busy-days/). Chris, a local taxi driver, picked me up from my hotel at 04.30 and I caught the 06.15 flight south. We landed at 06.50 and I was picked up by a College of Medicine driver who delivered me to my hotel.  After some breakfast I headed straight to the College of Medicine and met with the Principal, Dr Mwapatsa Mipando, and his PA, Lucy Msiska. Following a variety of discussions during the day at the College of Medicine I returned to the Sunbird Mount Soche Hotel for some dinner and an early night.

On the Wednesday Peter Chimimba arrived after breakfast to pick me up and deliver me to the College of Medicine. He was accompanied by Martin Laird and Rosie Grimes, two Glasgow BDS 4 students who had arrived in Blantyre the previous Thursday and who, at the generous insistence of Peter and his wife, Frider, were staying at their house. With the impending enrolment of the first group of BDS students at the College of Medicine, I had been keen to engage students at Glasgow Dental School with the MalDent Project. Ultimately, we would aim to establish a  student exchange programme between the two schools. I was, therefore, delighted that Martin and Rosie had chosen to visit the College of Medicine for their elective project this year.

On arrival at the College of Medicine, we went straight to the office of Professor Nyengo Mkandawire, Dean of the Faculty of Medicine, where I was presented with a bound copy of the BDS curriculum and the signed certificate from the University of Malawi Senate confirming its approval. This was symbolic of the completion of the first milestone in the MalDent Project – partnership working to achieve an approved BDS curriculum.

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Martin, Rosie and I in the Dean’s office with Peter, Mwapatsa and Nyengo, displaying the curriculum and certificate – an important first step!

Next, we headed to the other side of the Library Building to see Peter Chimimba’s new office. In addition to his office, Peter now also had an assistant, Annie Mwapasa, who had recently been appointed with support of the Scottish Government funding of the MalDent Project. This was great progress as Annie’s role would be essential when the first BDS students were enrolled, as well as the management of the other strands of the project linked with policy development at the Ministry of Health and the design of the new dental facility, together with its construction, on the Blantyre site.

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Peter and Annie – a great team at the centre of the MalDent Project

That morning, Peter went with Martin and Rosie to visit a primary school in Blantyre, which they reported later to have been a great success. I had a significant amount of written work to complete linked to the elective students’ project with Smileawi, so I spent much of the day working in Peter’s new office.

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Peter’s new office – a very pleasant environment for my day of desk work!

At 12.30pm I decided to have a break and head to the Beit CURE Café for some lunch. By chance I met Martin, Rosie and Annie heading to the same venue and then, whilst there, we met the team from the University of Glasgow Institute of Infection, Immunity & Inflammation who were busy installing laboratory equipment as part of the Scottish Government-funded Blantyre Blantyre Project. Inevitably, we decided to have a group photo – far too good an opportunity to miss!

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Annie, Rosie, Martin, Hannah Scales, Tom Evans, Carole Rose, Alex Mackay, 
Caron Paterson and myself – all smiles after a good lunch!

During the evening, Martin and Rosie treated Peter, Frider and I to dinner at 21 Grill, a very nice restaurant at Ryalls Hotel. It was a lovely evening and one way in which Martin and Rosie were able to show their appreciation for the exceptionally kind and generous hospitality afforded them by Peter and Frider during their stay in Blantyre.

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Relaxing at 21 Grill after a very enjoyable evening meal courtesy of Martin and Rosie

On the Thursday, Martin, Rosie and I headed to Mulanje to visit some friends of Martin’s that he had got to know many years previously as part of a twinning project between his school in Lanarkshire and a primary school in Mulanje. You will be able to read Martin’s story in his own blog post which will be published shortly. For my own part, I would just wish to say that we met some utterly inspirational people on that day, including the most engaged and cheerful children I think I have ever met. My reflection, having met the teachers and children we came across, was that a caries prevention programme based upon the supervised toothbrushing model of Scotland’s  Childsmile programme would likely be adopted with enthusiasm.

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Enjoying time with the children of Chindola Primary School

On the Friday, Martin, Rosie and I, complete with our luggage, left the College of Medicine to head to Mzuzu. The College kindly provided us with a minibus and driver for the nine hour road trip north.

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Rosie and Martin at the College of Medicine Blantyre Campus, just before leaving for Mzuzu

It was a long journey but by and large the roads were of good quality. We stopped and enjoyed lunch with our driver at Salima before the final push, arriving at Mzuzu just after dark.

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A wooden bridge on our journey north

Our home for the next two nights was ‘Joy’s Place’, a backpackers’ lodge which boasted a Korean Kitchen. There was a power cut as we arrived, so we checked in by candlelight, but shortly afterwards power was restored.

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Some views of Joy’s Place

Just after we reached the lodge, Nigel and Vicky Milne, together with the rest of the Smileawi team, Conor O’Brien and our remaining elective students from Glasgow and Dundee arrived to greet us (see: https://wordpress.com/post/themaldentproject.com/621). They were staying nearby at Umunthu Lodge, and we agreed that we would all eat together there later that evening. An hour later the full team was assembled and we enjoyed a lovely meal together – an excellent introduction to Mzuzu for Rosie, Martin and I.

We were up early on the Saturday morning for breakfast, when we met Nathan Bradley, a Peace Corps volunteer who was a soil scientist from Virginia, USA. He was reaching the end of a two year visit to Malawi, and was working with a local group of beekeepers to put their honey through the various analyses and certifications necessary to allow them to export their product. He told us he frequently visited Joy’s Place, together with other Peace Corps volunteers, for relaxation at weekends.

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Nathan and a sample of honey from the local bee keepers with whom he was working

After eating, we headed to the Saint John of God Conference Centre, where Smileawi had organised a conference for dental therapists. As part of the programme, Conor O’Brien, an oral surgeon from Glasgow Dental Hospital, had agreed to deliver a minor oral surgery update lecture and I was to provide a presentation on the problem of antibiotic resistance and the importance of antimicrobial stewardship. After lunch I had agreed I would provide an update on progress with the MalDent Project. The students from Glasgow and Dundee were also keen to speak about their background and  experiences to date.

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The Saint John of God Conference Centre, Mzuzu

One of the highlights of the day for me was meeting Edward Hara, who had worked in the area as a therapist for many years. I had heard a lot about Edward previously from my good friend Lisa Taylor who had worked as a VSO dentist in Mzuzu many years ago, shortly after she completed her masters degree at Cardiff Dental School. It was a great pleasure to meet him in person at the conference.

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With Lisa’s friend Edward Hara at the morning coffee break

The Guest of Honour at the meeting was Dr Owen Msopole, from the Ministry of Health Directorate of Quality. We spoke at length during the morning coffee break and it transpired that he was a good friend of Dr Nedson Fosiko, with whom we had met in Lilongwe earlier in the week to discuss the Bridge2Aid initiative (see: https://wordpress.com/post/themaldentproject.com/834).

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Dr Owen Msopole, Guest of Honour at the conference, addressing the delegates

As with any self-respecting conference, a group photo was in order. It is hard to believe that by Malawian standards this was a winter scene!

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A group photo at the conference – many Smileawi T-shirts in evidence!

Conor delivered an excellent presentation on minor oral surgical techniques, incorporating a significant amount of content on quality and governance issues.

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Conor in full flood – an excellent presentation on minor oral surgery

More sun was lapped up during lunch, which was served outdoors.

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Al fresco dining at lunchtime

Towards the close of the event, the four dental students who had been working with the Smileawi team delivered a first class presentation. They talked about their BDS course back in the UK and also described with great enthusiasm and clarity the work in which they had been engaged since arriving in Malawi. You can read more in their reflections that will be published immediately after this post.

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Paula, Kirsty, Abi and Katie gave an excellent presentation to the delegates, with Nigel and Vicky Milne looking on

The event finished with an excellent networking opportunity enjoyed over tea, coffee and snacks. It was fascinating and very valuable to hear from the therapists themselves about their day-to-day work. They were clearly very stretched because of the workforce challenges (nationally there are only 137 therapists in Malawi against a Ministry of Health establishment of 300). There was also great interest in the BDS programme which was due to commence at the College of Medicine in August 2019 and two of those present had submitted applications for entry.

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Great conversation over post-conference refreshments

After the conference, we all returned to Umunthu Lodge and turned to data entry from the hard copies of the clerking forms used for the dental inspections. This was a massive job, which the team had been tackling every evening until the sun set.  The industry and enthusiasm of the team was extremely impressive and by the time they left Malawi all of the data had been uploaded.

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Al fresco data entry underway

Once it became too dark to continue working, dinner was ordered and there was great conversation over a beer (or cider) or two! Adjacent to the eating area was a log-burning fire pit which was where the evenings ended, with a sense of time well spent and a tremendous team spirit.

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Chatting around the fire after dinner – a perfect way to end the day

Massive thanks are due to Nigel and Vicky Milne, the founders of Smileawi, for having invited our students to Malawi for this unforgettable experience. The joint working between Smileawi, the University of Glasgow and the University of Dundee has been an outstanding success and will hopefully continue long into the future.

On the Sunday morning, Martin, Rosie and I headed back south to Lilongwe – a drive of about five hours. There was some beautiful scenery and the following video clip gives an idea of the ‘road home’, which was not unlike some of our Scottish scenery:

That evening, I had invited Martin and Rosie to have dinner with me, as I was flying back to Glasgow the following day. As it turned out, Dr Mipando, the College of Medicine Principal, had arranged for Peter Chimimba and I to accompany him early on the Monday morning to deliver a presentation about the MalDent Project to the Senior Management Meeting at the Ministry of Health. As a result, Peter also had to come up to Lilongwe on the Sunday evening, so we all had dinner together.

It was a complete surprise when Steve Mannion, a well-known orthopaedic surgeon  (http://www.stevemannion.com), appeared in the restaurant. He had arrived that day with his team from the UK to undertake a series of operating sessions in Malawi. I know Steve as a result of sitting on the Royal College of Physicians & Surgeons of Glasgow Global Health Group (GHG). Indeed, it had been Steve who had stressed during my first attendance at the GHG in 2017 the importance of trying to develop dental services in Malawi, long before the MalDent Project had emerged. We had some excellent chat!

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Rosie, Martin, myself and Peter with Steve Mannion at the Sunbird Capital Hotel, Lilongwe

The following morning, the Principal, Peter and I had very positive feedback from those attending the Senior Management Meeting at the Ministry of Health. It was a most uplifting way to finish this visit to Malawi and as I headed to the airport I felt very buoyed by the enthusiasm and support that had been displayed.

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Peter, Mwapatsa and I outside the Ministry of Health after the briefing with the Senior Management Meeting

I had a trouble-free journey back to the UK, arriving in Glasgow on the Tuesday morning. That afternoon we had our Dental School Prize Giving and the following day was BDS Graduation. Both were proud occasions for our students, relatives and staff. With Malawi still ringing in my ears, I reflected on what a great day it will be when the College of Medicine graduates its first cohort of dentists in Blantyre.

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The University of Glasgow BDS Class of 2019

Workshopping in Malawi: two GSA architecture students reflect on their experience

This is a guest post by Breffni O’Brien and Ciara Durkin from the Mackintosh School of Architecture, Glasgow School of Art

Earlier this month, two Mackintosh School of Architecture (MSA) stage 5 students, Breffni O’Brien and Ciara Durkin, took part in a stakeholders’ workshop at the University of Malawi College of Medicine, involving 25 senior academics, architecture students and architects.

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University of Malawi College of Medicine, Blantyre Campus

This was a result of an invitation from Professor Jeremy Bagg, the Head of Glasgow University’s Dental School, to Professor Christopher Platt, MSA’s Chair of Architecture, to lead a workshop to inform the design process for a new building for the recently inaugurated Dentistry Degree Programme at the University of Malawi College of Medicine Blantyre campus.

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Breffni, Ciara, architect Peter Creaser, Jeremy Bagg and College of Medicine colleagues tour the campus site

Breffni and Ciara took a leading role in two of the workshop groups.

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Chris and Ciara record findings from workshop group discussions

Ciara Durkin writes,

“The energy during the workshop was powerful and invigorating, with an holistic and beneficial exchange of ideas.  I enjoyed watching the Scottish and Malawian participants use this workshop to cement a common vision within a unique team of international and local collaborators.”

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Breffni presents the findings from her workshop group

Breffni O’Brien writes,

“To be involved in such a collaborative and thought provoking design process was an incredibly unique experience. Being given the opportunity to contribute to such an exciting project and work alongside Malawian architecture students and the staff of the College of Medicine was an honour.”

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The workshop in full swing!

Christopher Platt writes,

Breffni and Ciara were hugely effective in how they worked closely with a range of academic and student stakeholders to explore the key issues which should inform the new building’s brief. They led some of the discussions, presented their group’s findings to the wider workshop body and used their architectural graphic skills to quickly sketch key ideas which could be easily understood to a lay audience. They were outstanding ambassadors for MSA and GSA and we all enjoyed the experience with Professor Bagg and his colleagues in Malawi enormously, which has established firm foundations for future collaborations.”

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Tired but very happy! Jeremy, Ciara, Breffni and Chris about to board the first of three aeroplanes taking them from Malawi back to Glasgow

 

 

Mackintosh School of Architecture leads a design workshop in Blantyre – exciting new development for the MalDent Project

Partnership working is key to international development activities and we have been extremely fortunate with the MalDent Project to have established a network of enthusiastic, multi-skilled collaborators. That network developed another arm recently when Mwapatsa Mipando and I met Chris Platt, Professor of Architecture at the Mackintosh School of Architecture, Glasgow School of Art (https://wordpress.com/post/themaldentproject.com/966).

On Tuesday 3rd September I headed to Glasgow Airport to meet with Chris and two of his senior students, Ciara Durkin and Breffni O’Brien. We were heading to Blantyre for a site survey of the College of Medicine campus and a stakeholder workshop – all set up to inform a design brief and costing exercise for the new teaching facility that will house the clinical components of the Bachelor of Dental Surgery course.

We travelled via Dubai and Johannesburg.

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The smiling faces of Ciara, Breffni and Chris at Dubai Airport – the journey was going well at this point…!

Complications to our journey began after we landed in Johannesburg. First, the A380 from Dubai taxied too far towards the terminal building at the gate and we needed to wait for 20 minutes until a tug arrived to push us back to the correct position for the doors to be opened. We were seated at the back of the plane, so it took a long time to disembark and our connection was quite tight. After passport control we ran to the Malawian Airways desk, to be told that the flight on which we were booked was not available! After some extended phone calls by the ground staff, we were finally given boarding passes for a plane to Lilongwe and then an onward connecting flight to Blantyre.

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The Malawian Airlines Being 737-700 that took us to Lilongwe

As a result, we arrived at Blantyre Chileka Airport several hours later than planned, but remarkably so did our bags!

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Chris and I with our bags safely in tow at Chileka Airport

We were driven to the Sunbird Mount Soche Hotel by a College of Medicine driver, arriving at about 6.30pm. After a quick shower, I headed downstairs for a meeting with Dr Nedson Fosiko, Deputy Director of Clinical Services at the Malawi Government Ministry of Health, and Dr Peter Chimimba. We had a very positive discussion about the oral health policy development activities that are planned through the MalDent Project, and now have a clear way forward to commence the work.

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With Drs Nedson Fosiko and Peter Chimimba after our meeting at the Mount Soche Hotel

Chris, Ciara, Breffni and I then had dinner together in the hotel and turned in early for some much-needed rest.

The next morning, after breakfast, we were collected by a College of Medicine driver and then headed to the College Library for a meeting with the Principal and Peter Chimimba.

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The Principal provides some background about the College of Medicine campus layout, informed by views from the windows of the top floor of the library

The Principal laid out the history of the project and the need, now, to create a design and establish a costing for a new facility in which to deliver clinical dental teaching. Later in the morning we were joined by Peter Creaser, an architect from a local, well-established practice called MOD Architects. This company has worked on many projects at the College of Medicine through the years and Peter and his colleagues have extensive knowledge of the campus.

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Peter and Robert from MOD Architects, Annie, Peter, Chris, Ciara and Breffni  in discussions led by the Principal.
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Peter Creaser describing some of the key features across the site of the College of Medicine campus

After these initial discussions in the Board Room, we enjoyed some refreshments and general discussion…

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The Principal enjoying a chat over coffee and biscuits with Ciara and Breffni

… a group photo

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A photo with the new BDS pull-up banner – the course now a reality.

… then all headed outside to walk around the campus, armed with a site plan and Peter’s local knowledge. Chris, Ciara and Breffni took notes and many photographs for future reference.

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Chris in discussion with Peter and Robert from MOD Architects

Breffni and Ciara provided excellent support for Chris during the site survey.

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Breffni’s architect’s scale ruler came in handy!
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Annotating the site plan

Once the walk-round was complete, Chris, Ciara, Breffni and I went back to the hotel for a quick lunch. We were then collected and taken to the Polytechnic, which is part of the University of Malawi, to visit staff and students at the School of Architecture:

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We were welcomed by the Head of the School, Ike Phiri, and introduced to a number of his staff colleagues and students. There was great enthusiasm for our visit and for their invitation to the stakeholder meeting the following day.

Chris presented Ike with a copy of the MacMag, which is an annual publication from The Mackintosh School of Architecture.

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Ike receiving his copy of the MacMag from Chris

I was also delighted to meet Grace Phiri Zimba, the Estate and Development Officer for the Kamuzu College of Nursing, which is about to merge with the College of Medicine to establish the Kamuzu University of Health Sciences. Among her qualifications, Grace has a BSc in Architectural Studies from the Polytechnic. Grace is inevitably involved with the  establishment of the new dental teaching facility on the Blantyre College of Medicine campus.

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With Grace Phiri Zimba at her alma mater

Just before leaving we took a group photo and during the discussions that went on as people organised themselves for the shot, Ike mentioned that he had done his Masters degree in Dublin, Ciara and Breffni’s alma mater!

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An unexpected connection – Ike, Ciara and Breffni all studied in Dublin

Just after the photograph was taken, Dave Rodocanachi from The Dental Warehouse in Johannesburg (a Henry Schein company) arrived. He would be providing expertise from a dental equipment perspective at the workshop the following day. Whilst Chris, Ciara and Breffni headed back to the College of Medicine to check out the venue for the workshop the following day, Dave and I headed back to the hotel and had a discussion in the bar based around a PowerPoint presentation on the equipping of a dental outreach teaching facility in South Africa which is currently in the final planning stages. There were a number of relevant learning points for the workshop the following day.

In the evening we were joined by the Principal for dinner at 21 Grill on Hannover. It was a good chance for many of us who would be participating in the workshop to get to know one another better. Peter Creaser from MOD Architects sat next to me and it was fascinating to hear about his career as an architect, starting in Lincoln but culminating in many years spent in Africa, particularly Malawi.

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A lovely evening in 21 Grill – crocodile starters for several of us!

The following morning we set off from the hotel at 8.30am to set up for the workshop, which was held at the Research Centre at the College of Medicine campus.

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Dave, Ciara, Breffni and Chris arriving at Chimutu House to prepare the meeting room

Once the tables were laid out it was a matter of waiting for the many stakeholders to arrive and for the work to start. 

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Pens, paper and water – ready for action

Whilst waiting for the event to commence …

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Dave taking Chris, Ciara and Breffni through the plans for a new dental outreach centre in South Africa – generic points of interest for the forthcoming workshop

… and Chris spent time speaking with Peter Creaser and his business partner Patrick from MOD Architects:

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It was a very successful event. Chris first described how he had become involved in the MalDent Project and about his own background …

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… before explaining the purpose of the workshop and how the day would be based around four tasks undertaken in small groups, with feedback delivered after each task.

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Peter Creaser looks on as Chris explains to delegates how the workshop is structured and what it aims to achieve

The initial task aimed to identify the main themes that delegates believed to be important for consideration during the design of the building. These themes would then form the basis of the following three tasks, examining specific issues in increasing detail. The work undertaken is best described in pictures:

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Group A discussing its views on the main themes that should be covered during the day in Tasks 2-4

After each piece of group work, a spokesperson fed back for 5 minutes:

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Ciara feeding back on the views of Group A following Task 1

Chris made notes as each group fed back to the delegates:

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Group B feedback following Task 1
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The Principal uses the campus site map to illustrate part of the feedback from Group C

After Task 1 was completed we broke for coffee and a group photograph:

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Enjoying the sun during a coffee break between Tasks 1 and 2

During the coffee break, Chris identified and wrote up the main themes that had emerged from Task 1 on a flip chart. This was slightly refined following discussion with the delegates. The themes were then allocated to individual groups who would work on them during Tasks 2 and 3.

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The themes identified after Task 1

After Task 2 and feedback we enjoyed lunch, when the discussions continued on many fronts:

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One of the advantages of the College of Medicine campus is the vista of the mountains and distant scenery, that can be viewed from so many angles. This was mentioned during the workshop as a feature that should not be forgotten when the new building was being designed.

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View from the balcony of the Research Centre

For the final task we were asked to consider which of the three possible sites we would choose to erect the new building and to submit some relevant drawings. I found the latter particularly difficult, but Ciara was well versed in the concept and produced six drawings for Group A with no difficulty whatsoever.

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Patrick busy drawing for Group C
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Breffni feeding back on the drawings she had completed for Group B
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Ike and Chris in discussion over the drawings from Group D

By the end of the day, we had accumulated a very large number of feedback sheets:

When the meeting closed, Breffni and Ciara photographed all of the sheets. The hard copies were left with Ike who will use them for a design exercise with his architecture students at the Polytechnic. Chris, will work from the photographs of the sheets.

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Ciara and Breffni busy photographing the feedback sheets

At the end of the event the Principal, Patrick from MOD Architects, Chris and I sat down to discuss the next steps. The outputs from the workshop would be used to inform a design brief, which in turn would allow a schedule of accommodation to be created and a cost estimate to be made.

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Discussing the next steps ...

We returned to the hotel, totally exhausted but very happy with the outcome of the day. After a couple of celebratory drinks in the bar, shared with Peter Chimimba, we had dinner and retired early in preparation for the start to our journey home at 5.15am the next morning.

Our driver arrived on the dot at 5.15am and everything went smoothly at Chileka Airport. It had been a whirlwind visit, packed with activity. As we headed out to the plane on the tarmac in the early morning light it was hard to believe how much had been achieved in just two days – an immensely successful outcome. 

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Heading home – now well informed and ready to develop the design brief