After obtaining permission of the Dutch Medical Specialist Registration Committee (RGS) and the Dutch Surgical Council (CCN) in 2010, Manuel Koppe spent three months of his 5th surgical training year working in the Queen Elisabeth Central Hospital (QECH), a large university training hospital in Blantyre, Malawi. Permission was granted upon a written plan describing the work that was to be done and who was the responsible supervising surgeon in charge. At the QECH, Manuel saw a great number of patients at the outpatient clinic, was responsible of ward rounds, participated in night shifts and performed or assisted in a total of 131 surgical procedures. A substantial number of operations were acute surgeries, including small bowel obstructions, strangulated inguinal hernias or sigmoid volvulus. In Malawi Manuel was taught some new techniques of repairing inguinal hernias, learned to do emergency laparotomies by him self, improvise in case of unexpected encounters thus gaining self confidence and gained an enormous respect for his Malawian colleagues and the Malawian patients. Apart from professional growth, Manuel’s family including his wife and three children were deeply involved in the Malawian culture. In his talk, Manuel will discuss his personal experiences and summarize the necessary preparations that Dutch specialist residents should make before leaving for a residency in low Resource setting countries, focusing on administrative regulation issues and safety topics.