In 1979, he went to Canada for medical reasons, and while there, he was invited to confess, counsel, and teach the Orthodox Christians in their churches and homes. Through these meetings he acquired many spiritual children, who urged him to return annually to confess them and guide them in their spiritual lives. He understood that it was God’s will for him to return to Canada and also to visit parishes in the United States. By the appeal of the Orthodox faithful and with the blessing of the bishops of the Greek Orthodox Archdiocese of America, Geronda Ephraim began the work of establishing monastic communities in North America, which he continued to do after his final move to Arizona in 1995. Orthodox faithful throughout the United States and Canada have embraced, supported, and collaborated in this endeavor. These communities provide spiritual guidance, and they help to preserve the holy traditions of the Church through an exemplary Christian life and devotion to God. Also, by handpicking worthy successors (abbots and abbesses), Geronda Ephraim has ensured the continuity of his apostolic work in serving the Church and her needs.