Building Again — This Time for the World
by Echo Nomsa VanderWal
Adjusting to the New Normal
Someone asked me the other day how I was doing.
I smiled—which is something I have not always been able to do during the deep period of grief over the last couple of years—and said, "Adjusting to the new normal."
Over the past two decades, TLC built a model scaled to care for 30,000 patients every month with high-quality healthcare at the lowest fully loaded cost in the region—healing, loving, saving lives—powered by compassion, innovation, and efficient, effective systems at the core.
For us, it’s never been about numbers. From day one, we wanted to be build a movement of hope, with the hearts of everyone on the team giving love and receiving love at the same time.
Today, we’re taking care of about 2,000 people a month.
We’re not shrinking.
We’re sharpening.
We have chosen to lean forward.
From the time the first seed went into the ground, we had a vision to replicate the model elsewhere. We have seen this vision unfolding over the last five years as our team has developed solutions that not only meet the needs of the moment but also have the potential to reshape the future globally.
While the path hasn’t been without resistance, the challenges have only made the foundation stronger.
The Pivot We Didn’t Choose—But Now Embrace
This pivot isn’t something we chose lightly.
Initially, it felt forced. But now, we see it for what it is: a hard mercy—the painful gift that opened the door to the future we are called to build.
We’re walking through it—deliberately, courageously, and anchored to our calling.
We’re still in the middle of the pivot. It’s not all behind us.
But we are holding on—standing with courage, choosing every next step with care.
This is about deciding, with intention, where this heart work goes next.
Eswatini: Our First Love, Our Forever Home
Eswatini will always be our first love.
It’s where this work was born.
It’s where it was tested.
It’s where we built something tangible and life-changing—with integrity, with impact, and with people we deeply trust.
We have been fulfilled here beyond measure.
No amount of distance, challenge, or change will ever lessen the love woven into our story in Eswatini. In the midst of this love story, we became Emaswati citizens—and nothing will ever change that.
This place has transformed all of us—those we’ve served, and those of us who have had the privilege to serve from the deepest core of our hearts.
The team here built something extraordinary.
They built something beautiful—layer by layer, patient by patients, moment by moment.
No matter what happens, that will never change.
Facing Reality—and Responding with Courage
But we’ve also had to face the reality:
Over the last several years, it became clear that the partnership we had hoped for simply wasn’t materializing, no matter how hard we tried or how much logic we put on the table.
Despite the valiant efforts of so many in Cabinet and Parliament, there are forces—some internal and some external—working to block the government from being a long-term growth partner, at least for now.
And when you add in global aid cuts that continue to shrink opportunities across Africa, the path becomes even more complex.
That realization has been deeply painful—and visible both publicly and privately in ways we never imagined.
It wasn’t our first choice. But now that we’re here, we are a team responding with clarity and conviction.
We choose purpose over paralysis.
Resolve over reaction.
Solutions over survival.
We’ve chosen to protect what works—not to preserve ourselves, but to preserve the future impact that must not be capped by politics or blocked by short-lived forces.
The mission is bigger than a political moment.
It always has been.
Choosing a New Path: Stewarding What Works
To ensure future sustainability in Eswatini moving forward, The Luke Commission (TLC) Eswatini will only provide services that are fully funded.
The previous model—serving everyone for everything—while it was a very low-cost, high-quality solution in the current political environment—proved neither sustainable nor durable, as evidenced by a fourfold growth in service volume from 2018 to 2023—the nation itself speaking loud and clear with their feet, showing what they needed, wanted, and believed in.
For years, we believed that if we worked harder or dug deeper, those with power would recognize what was possible, together.
But while many worked hard for collaboration, the response did not came—not in resources, not in recognition, not in the willingness to collaborate—at the scale required to continue serving the numbers of patients TLC was engineered to serve.
Their initial silence—and now their vicious and desperate attacks (more on that later)—are not just obvious to those of us in Eswatini, but are obvious to the world.
Not only did they block progress, but they have tried to claim and destroy the Miracle Campus—the very place sacrificially built brick by brick, gift by gift, by grandmas, grandpas, small business owners, and families across North America who gave with deep trust, open hands, and courageous hearts to join hands to build a vision with a team they believed in.
At some point, we had to face the truth: There was a deliberate and intentional effort to block what was best for the patient and for the nation.
It was heartbreaking.
For years, we’ve done everything we can to advocate for change in Eswatini.
But the temporary powers were not simply disinterested—they were determined. Determined to protect something broken, even at the cost of lives.
It wasn’t just unfortunate. It was unconscionable.
Recognizing that the resistance was not accidental, but entrenched, we chose to pivot—decisively and with eyes wide open.
To safeguard both the investment and the heart behind the mission, TLC’s work in Eswatini will move forward strictly in step with secured resources.
The organization is diversifying its funding model through new self-generating revenue streams (doing what we can with what we have), performance-based partnerships (partnering with willing partners in a definable and measurable way), and scalable systems (as always, using humans with deeply compassionate hearts, powered by technology and innovation). We’re creating a durable, efficient, high-quality, long-term healthcare model that works and brings change and impact, whether it is for 30,000 or for 2,000—or for the world.
This isn’t about retreating. It’s about stewarding the model wisely—for today, for tomorrow, for Eswatini, and for the globe.
God’s Faithfulness Through Every Season
Through it all, we have seen the faithfulness of God every moment—on every blind step of faith, providing when circumstances seemed impossible, and carrying us when our grief was unmeasurable.
If this season has taught us anything, it’s that the vision was never ours to sustain. It has always been His. And His plans are still unfolding.
Because of His faithfulness, what He built didn’t just survive—it’s calling us to keep building, keep believing, and keep moving forward under His covering.
The Take10 Challenge: Building Together
We’ve launched the Take10 Challenge—an open invitation for every friend, family member, and believer in this mission to stay part of the story.
It’s simple:
Give $10 a month.
Invite 10 friends who may not know about TLC to take 10 minutes to learn—and then give $10 a month and invite 10 more to do the same.
Together, we can build a global future where healthcare is delivered with innovation, excellence, and hope.
A cascading movement.
This isn’t just about protecting what’s proven. It’s about powering what’s next.
Learn more about the Take 10 Global Challenge >>
If you’ve ever believed in this work, this is the moment to be part of its multiplication—not just as a supporter, but as a co-builder of something the world has been waiting for.
Multiplying Hope Across the World
And now, step by step, we are preparing to replicate globally.
It’s a model that can serve millions—one life, one story, one family at a time—if we protect it, if we scale it, and if we carry the same heart into every place it goes.
And each step we take moves the future farther out of reach for those who only ever had power in their small and shrinking spheres.
The team here in Eswatini will be at the heart of that expansion. They’ll be the ones bringing it to life in other countries—training, mentoring, building.
The people who carried this from the beginning will be the ones shaping the next chapter.
Their hands and hearts will carry the mission forward across borders, to the hearts of millions.
What was born in Eswatini will now multiply across the world.
Their legacy isn’t ending. It’s expanding.
This isn’t the end of the story. It is the beginning of a bigger one.
And instead of a standoff, we choose to see this as a starting line.
It’s not the ending we imagined. But maybe—just maybe—it’s the beginning the world has been waiting for…