Many medical missionaries long for leaders who are well equipped and prepared to take the helm of medical teams. Only when quality leadership is in place are we freed to concentrate on what is close and dear to our hearts and to rest assured that the work will continue after we are gone. Yet the reality is often the opposite. Medical institutions, projects or programs that ran smoothly when medical missionaries were in charge quickly deteriorate, fade in significance, or die completely after the medical missionary leaves. Some find themselves toiling under toxic leadership and in dysfunctional teams, wondering how on earth they are expected to cope. This raises for us the necessity to invest in leader and/or leadership development in our medical missions. Each of us desires to work under competent local leaders who are of like mind and who are both faithful and skillful — men or women who will teach others. We want to leave behind sustainable work; yet our effort sometime fail. Those in whom we invest don’t always turn out the way we hoped. Those who seem to turn out the way we hoped don’t last. And in some instances, there seems to be no one worth our time and effort in leader development. What is an expatriate missionary to do in such situations?