The day begins early with research nurse Martha meeting all of the new patients admitted the night before.

The children’s guardians are exhausted, having slept while sitting up on little metal benches at their children’s bedside. Sometimes they don’t leave their child for weeks on end. Thankfully, many give us their consent to collect blood for creatinine testing at an external lab, so not to burden the already-strained hospital resources.

I arrive to collect information in a chart, which I quickly learned is a pile of scrap paper (nothing goes to waste!) held together in one corner with a bandaid (or anything sticky enough to hold paper together). I begin writing between the lines of recycled computer text.

It doesn’t take long before an intern approaches me showing concern about a patient with a kidney injury. “What’s his creatinine?” I ask. Soon, I learn that getting a creatinine test is a luxury.

“Ok, what is his potassium?” I felt I needed to know the urgency of the intervention. Another new fact I quickly picked up: we cannot order potassium or bicarbonate at the hospital.

If I was going to work in nephrology in Malawi, my first three questions as a typical Canadian renal consultant were going to need modifying. I recalled the words of John Feehally a few months back: “You go to learn, not to teach.” And so I learned.

A month passed and I discovered the incredible teamwork that goes on at the hospital. Consulting physicians always asking each other what they think because so much relies on physical examination, clinical acumen, and a history gathered from a culture that is not based on the detail-oriented diet that I had come to expect in my training prior to this trip.

Despite the differences, decisions are made. The acute peritoneal dialysis service that we set up was brilliantly simple in some ways, and ‘sleep-robbingly’ complex in others. Simple because there were only a few things that could be done. Complex because there were only a few things that could be done.

Without daily labs, how do we decide the frequency of exchanges? Without a scale, how do we decide the fluid type? Who will do the exchanges, since there is no a peritoneal dialysis team?

We consulted with each other, pediatricians, intensivists and colleagues working overseas to ensure that these decisions were shared. The global community and the local community are all there, if you call on them. And everyone in our global community is willing to help morally, and intellectually.

And life, death, saves, misses, frustrations, victories… These all happen with a different flavor but the same frequency and emotions are present as in any other hospital, city or country across the globe.