I recently went through the various papers that I had stuffed in the cover of my Bible, because it was getting too full. It contained some cute doodling my kids had done on the back of church bulletins, some old sermons that I had preached and other memorabilia. I also found a dedication that I had written to God about 10 years ago, before the Partners in Hope Medical Center existed. It began, "Trusting in Your ability to communicate and accomplish Your will in my life, I commit..." It was a year that I was seeking assurance that my plans for ministry aligned with God's plans. It's easy for me to trust in God's ability to do whatever He wants. What is often difficult is to trust ME and MY understanding of what God wants. This too is a lack of faith. Just as God can speak through a donkey (Numbers 22:21-41), surely He can communicate to me what I need to know to stay in His will. I just need to listen.

2013 was indeed a year of listening. God has been speaking through failures as well as successes,…losses as well as gains…the removal of essential staff, and the addition of others who I now wonder how we ever did without. He spoke through an external organizational assessment, and He spoke through our own staff as we organized retreats to dream together. While I certainly don't know all of what is ahead, I do have a strong sense that we are on the right path...together seeking to hear God's voice.

Some of what we have heard:
1) PIH is to grow beyond a focus on HIV/AIDS, developing into a full-service, non-profit teaching and research hospital with an aim to strengthen the health care system in Malawi.
2) We should continue to grow in our involvement in Medical Education of Malawian health care providers. This will include expansion and deepening of our partnerships with UCLA and Malawi's College of Medicine.
3) We should continue investing in building the capacity of other hospitals and health centers through training, mentoring and infrastructure.

He is Able
Even as I write this, it seems an enormous task. Yet, as I look back on this last decade, it is clear that God is able to do exceedingly and abundantly above all that we can ask or think (Ephesians 3:20). We're far from being a perfect organization, but the foundation that has been laid in our facility, our systems and our staff is now suited to take on this level of growth. Some of the key events in the last 12 months:
• External organizational assessment
• Updating our Constitution, Mission Statement and Core Values
• Strategic Planning Retreats (every staff member, senior management and board)
• The addition of Dr. Dan Namarika, who has recently been promoted as our new Medical Director
• The addition of Dr. Victor Mallewa to manage a contract providing medical care for all of the United Nations staff in Malawi.
• Expansion of our relationship with Malawi's College of Medicine
• Expansion of our HIV and Tb training project (EQUIP-Malawi) to over 70 health facilities in Central and Northern Malawi...all the way to the boarder of Tanzania.
• Acquiring aviral load laboratory that supports the Ministry of Health’s program to monitor HIV therapy for three districts;this represents over 2,000 patients each month.
• The addition of a missionary chaplain, Dr. John Danford, and his wife, Kamille.
• The addition of a missionary Director of Operations, Andy Boettcher, raising the bar for financial and human resource systems at PIH. 
The addition of Kurtis Budden, an SIM missionary laboratory technician from Australia.

What's Next?
Of course, expansion to a teaching and research hospital does not happen overnight. It happens step-by-step. In consideration of the most urgent gaps in health care in this region, PIH plans to move toward adding:.
• A pediatric in-patient ward-We will develop a 40-60 bed children's ward which will work closely with the local government hospital to care for seriously ill children. The ward will have two large free wards, functioning as a public children's hospital, as well as a few private beds for patients who are able to pay for extra privacy and comfort (part of our sustainability strategy).
• Surgical services-Despite the fact that Lilongwe is the capital city in a district of over 1.5 million people, there are few good options for surgeries. A new building with two operating rooms, an endoscopy suite and 17 ward beds will be a tremendous boost to surgical services in Lilongwe. It has the potential to become a regional referral center, saving countless lives. It will also be used to train Malawian surgeons in more advanced surgical techniques.

What will we need to make this a reality?
• People-especially surgeons, anesthesiologists/nurse anesthetists, pediatricians and family doctors, construction workers and accountants.
• Equipment-Donated new and used equipment, includingurgical instruments, patient monitors, and beds (pediatric and adult).
• Resources-We'll be starting a fundraising campaign with our key partners, UCLA, SIM and Partners in Malawi, in the coming months.