New Malawi training centre ‘transformational’

The newly opened Clinical Research Excellence And Training Open Resource (CREATOR) is a specialist postgraduate medical and research training centre in Malawi. It will provide the most sophisticated clinical research training environment in the region, and will be truly transformational and life-changing for the African nation. CREATOR, which has been built in the city of Blantyre, the country’s second largest city, was officially opened by the President of Malawi, Dr Lazarus McCarthy Chakwera, in a ceremony in August this year.

The vision of CREATOR is to transform postgraduate medical education and research in sub-Saharan Africa. Its mission is to ensure that medical and scientific expertise will remain in Malawi, helping to inspire the next generation of African scientists. CREATOR will be critical in both training and retaining the brightest clinical and research talent in-country, and in promoting a sustainable clinical research eco-system in Malawi. It has been developed to focus on catalysing new ideas, better health outcomes, and improved clinical care for the people of Malawi and the wider sub-Saharan African region.

A ‘modern and welcoming’ aesthetic

The architectural design of the CREATOR building combines a modern scientific and welcoming aesthetic, with high technical performance specifications and longevity. The facility’s inspirational design includes a roof celebration space, ‘team project’ desks for interdisciplinary working, and an Innovation Hub for translational support and enterprise development. The five-storey building has a ‘Round Room’ for collaborative decision-making, and a webinar theatre for international learning and teaching engagement.

Its wide range of facilities include a new laboratory, allowing for single-cell transcriptomics, modern imaging and rapid pathogen sequencing, modern teaching spaces, a postgraduate resource centre for 200 clinical trainees, and library space and offices to support advanced epidemiology and clinical trials.

CREATOR has been designed to deliver opportunities for clinicians and researchers to make themselves experts. Recording and live-stream capabilities enable interaction with global health leaders anywhere else in the world.

A partnership approach

CREATOR is a partnership between KUHes (previously the College of Medicine), Queen Elizabeth Central Hospital in Blantyre, Malawi, the Liverpool School of Tropical Medicine (LSTM), the University of Liverpool, and the medical research charity, Wellcome.

It will significantly enhance the work of The Malawi Liverpool Wellcome Research Programme (MLW). The multi-million-pound investment will support MLW with additional research facilities and space for postgraduate medical training, helping to retain talent and expertise in the region, and scaling up research capacity by 30% over the next decade.

It has almost doubled MLW’s physical capacity, and will make MLW better equipped to meet emerging health challenges — from the impacts of climate change to non-communicable diseases.

Since 1995, MLW has contributed to the improvement of healthcare by translating its research into policy and practice in Malawi and beyond. MLW began its research with a single focus on Cerebral Malaria, but over time its research portfolio has expanded. MLW has hosted high impact research trials on tuberculosis, HIV, pneumonia treatments, maternal and child health, and vaccine policy. The first research projects will begin in the CREATOR building later this year.

Understanding the complexities

The CREATOR project was launched in 2019. Architecture practice, Cassidy + Ashton, based in Preston in the North West of England, worked on the initial design stages for the centre, along with Manchester-headquartered structural engineering specialist, TRP Consulting.

Chris Taylor, director at Cassidy + Ashton, a multidisciplinary practice of chartered architects, building surveyors, and town planners, was the lead conceptual architect. In those early stages he undertook a fact-finding mission to the proposed site of CREATOR as part of his work on the project. He says: “From initially visiting the site in Malawi and understanding the complexities of the location and the end-user’s objectives, our strategy was to develop the design in the UK, and then hand over the project to a local multidisciplinary practice.

“The initial design involved careful consideration of available materials in the area, and local building methods and regulations.” Chris Taylor explains that the aim throughout the design process was to create a meeting place of like-minded professionals in clinical research and training.

A ‘circular element’ was a key factor in that initial design work. That reflected the vision of Professor Stephen Gordon, Professor of Respiratory Medicine at LSTM, to create a building reflecting inclusion and no hierarchy.

Circular design was adopted as an inclusive concept throughout the building, which even included round tables for the boardrooms. TRP Consulting worked alongside on the structural development of the project. Its structural engineers have a strong track record in delivering large and complex building works, and have widespread expertise in sectors ranging from health to sports stadia development. Following that initial design work, FBW Group, which has offices in Uganda, Kenya, and Rwanda, was appointed to lead the African design and technical team to take the project forward on the ground.

It has been delivering medical projects across East Africa since it was founded more than 25 years ago, including clinics and hospitals serving remote rural areas — developments that have made a real difference to people’s health and lives. The multidisciplinary architecture and engineering consultancy’s initial work on CREATOR involved undertaking surveys on the proposed site of the facility to assist in the preliminary design process.

FBW went on to create and deliver the technical designs for the development, and provided technical oversight throughout the successful delivery of the project. Its services on the project included architecture, structural and civil engineering, and MEP engineering, including the preparation of construction packages, tendering, and technical oversight during construction.

A learning environment

The Training Open Resource on the ground floor of the CREATOR building has been designed as as a space for teaching and working, with open access to training resources suitable for future leaders. The second floor of CREATOR houses its Postgraduate Resource Centre, with 24/7 access that will allow for self-learning to a high degree made possible by a modern digital library. The second and third floors have been created as research offices designed to promote clinical research excellence. Advanced epidemiology and large clinical trial support will be accommodated in open plan offices.

Single-cell transcriptomics, modern imaging, and rapid pathogen sequencing, will be accommodated in the fourth-floor laboratory. The orientation of the building, facing south, has been optimised for minimal midday heating, and the air-conditioning system designed for the building is both intelligent and environmentally sensitive.

CREATOR’s ‘Training Open Resource’ is a fully accessible, versatile space for small, interactive specialist training courses. Here there are training rooms, a webinar theatre for hybrid teaching, electronic poster display areas, and many small breakout spaces. The building houses the first postgraduate medical library in Malawi, which offers peaceful secure study space with reliable internet at all hours and days of the week. Meeting rooms are located nearby, with quiet reading spaces and internet-enabled terminals, with networked printers and templates for papers, theses, posters, and talks.

In easy reach of the wards, and with an inspiring view of the hills, and with internet calling pods for quiet online conversation, the aim has been to create a first-class learning environment for postgraduate trainees and their mentors.

A place for research

The second and third floors of the building are research spaces designed to promote ‘clinical research excellence’. The building’s design has created multidisciplinary team spaces around large open tables. Group meeting breakout rooms and small kitchens make these spaces interactive, promoting collaboration.

Three research themes will occupy each of the research floors — population health, vaccines, and clinical and experimental medicine on the second floor, with social sciences, infection biology, and maternal, neonatal, and child health, on the third. Research support unit and operational department teams will work across the research spaces. Single-cell transcriptomics, modern imaging, and rapid pathogen sequencing for outbreak responsiveness, are accommodated in the fourth-floor laboratory. CREATOR’s labs are innovative and technology driven.

The Innovation Hub has been designed as a space where ideas will be born, tested, and grown through collaboration. The programme’s aim is for its science to be world-class, relevant, and innovative.

CREATOR’s ‘Far View’ roof terrace has an unequalled view of Mount Soche and all the Blantyre hills, and has been designed as a space for celebration and reflection. It is one of a number of key spaces designed as part of the development that includes full accessibility to the site’s gardens and parklands. These spaces include the ‘South Lawn’, which has been designed with educational, public engagement, and VIP reception facilities. A dining terrace has also been created to provide a cultural meeting place. ‘The Learning Forest’ is another open space in the grounds of the building, and is a place where people can walk and meet, learn and discuss. CREATOR’s environmentally friendly transport support includes a bus terminal and cycle racking.

A focus on climate change

The CREATOR building faces south, with a direct view of the mudslides on Soche Mountain that occurred during Cyclone Freddy in February 2023, killing more than 500 people in the Chilobwe disaster. Climate change, weather instability, and community vulnerability, are urgent issues in the local community. Informative displays on the South Lawn will describe the current state of climate change, the environmental threats and mitigation strategies that can be deployed in Malawi, and the means for community engagement with these issues ‘to make a difference’.

The displays are designed to be a focus for visiting schools’ groups and community engagement functions on the South Lawn. To the south and east of CREATOR, 700 indigenous trees are being planted to conserve the urban ecology. Tables and benches will allow for relaxed meetings and well-being time for researchers and health workers.

CREATOR has been built on the site of Queen Elizabeth Central Hospital, the largest teaching hospital in Malawi. It is also near to KUHeS, the foundation medical and allied health professionals’ school in Malawi, and sits beside MLW, the largest research institute in the region. The critical location of CREATOR, in the hospital grounds and between existing laboratories and the wards, ensures that the centre is a meeting place, not only between clinicians and scientists, but also as a hub for interaction with other research affiliates, including Blantyre Malaria Project and the Johns Hopkins HIV Project.

The strategically placed building will also act as a base for MLW’s expanding community outreach teams, who have mapped over a million people in intervention studies across the country.

Making a difference

The importance of CREATOR cannot be underestimated. Speaking at the building’s official opening, Prof. Henry Mwandumba, director of MLW, said: “CREATOR is extremely important because it creates the infrastructure and support that will enable clinicians to conduct high quality research that can promote the health and wellbeing of people in Malawi and beyond. It is a significant milestone in health research in Malawi.”

Professor David Lalloo, Vice-Chancellor of LSTM, said: “CREATOR is more than a building. It is a significant step in the transfer of power in clinical research capacity and knowledge towards the Global South, which is a key part of LSTM’s mission.”

Prof. Louise Kenny, Executive Pro-Vice-Chancellor of Health and Life Sciences at the University of Liverpool, said: “This milestone moment in our shared journey will build on our collaborative work to tackle the most urgent health challenges in sub-Saharan Africa, realising ambitions to create an optimal research environment for tomorrow’s health research leaders in Africa.” Meanwhile, John-Arne Røttingen, CEO of Wellcome, said: “CREATOR provides world-class infrastructure, but more than that, it provides an exciting opportunity.

“Through collaborative science, CREATOR will nurture new generations of research and clinical leaders to learn, discover, experiment, and ultimately solve, urgent health challenges.”