The Haitian Donkey Faces A Fork In The Road Again

Hi All:

Since I last updated the situations, the protruding tumors out of my ostomy site have continued to grow, making it a struggle to contain them and the intestinal output the colostomy and ileostomy contribute to the bag.  We have looked into various options, they make larger bags, but they don’t have fasteners on them as the ones I presently use have loops that I can attach a belt to and thus encourage sticking to my skin.  The larger bags are made for patients who are pretty much bedridden for the time, so we are still looking into options.  

One thought I had was to consider radiation therapy, somewhat risky for intestinal tumors as the intestines, bladder and lungs are especially sensitive to the radiation, while the tumors may not be.  I thought I would contact Dr. Bartlett at University of Pittsburgh Medical Center, as he has done over 1000 of these surgeries and likely had some experience to comment on.  I called his nurse, the recording mentioned to push various buttons for a number of different surgeons, but no Bartlett.  Searching on the internet showed that, after 19 years at University of Pittsburgh, Dr. Bartlett had been enticed by the other powerhouse in the Pittsburgh medical realm, Allegheny General Hospital System, a promotion to head up all their cancer research and work 3 months ago.  The internet stated that he would be busy with administrative duties for several months and then restart clinical practice and research.  The donkey decided that my chances for getting through to him in a new, unfamiliar system would be unlikely. Dr. De Cook thought that radiation might help shrink the growths sticking out of my abdomen and give us some relief in the way of controlling the output.  I made an appt with a radiation oncologist and saw him last Thursday.  He was very nice (I knew him a bit from surgical residency, he is 75 but loves his work and thus still doing it), examined me well, but finally felt that he figured he would do more harm than good.  

With this news, Rachel decided the donkey gave up too easily and contacted Allegheny General and was able to connect with Dr. Bartlett’s new nurse navigator.  The nurse promised that she would have Dr. Bartlett call me this week when he returned from vacation.  I was skeptical, but was amazed when he called me at 9 am this morning and we discussed options for a bit.  He wants a repeat CT scan sent to him, he will get my records from UPMC and consider the case.  One option he presented was to repeat the surgery he has done 3 times on me already, an extensive, 15 hr marathon with a lot of risk, needless to say.  It carries a greater than 5% mortality, as hours under anesthesia, lots of scar tissue, etc, make this a land mine infested territory to travel through.  However, I am not sure what reasonable options remain, other than just watching the tumors grow, leaking bags to try to control the outgoing intestinal contents and always smelling a bit off due to the situation.  

Dr. William called last weekend, he hopes to be done by August 31, though still has to write and defend his thesis by the end of the year.  Dr. Luke Channer has been helping him with getting access to information via the internet, as I am out of my element in that area.  Thus, I am excited about arriving at the end of this long struggle to be able to provide 24/7 surgical coverage for the hospital, our dream for the last 17 years.  He already has done an evangelistic campaign during the summer with a pastor and they have a group of about 60 new believers who are meeting under a borrowed tent until they can arrange for a bit more permanent accommodation.  I am excited that he and Dr. Moise do this in the summers and a new church is being formed in the area.  It will also be good to have him back home with his 5 active sons, undoubtedly a relief for his poor wife after all these years.  Pray for a good adjustment as he reintegrates back to the hospital.  Overall, the hospital seems to be functioning well, Covid doesn’t seem to have hit Haiti anywhere nearly as hard as it has been reported to strike the US and other countries, how to interpret that is unclear.  I have not been able to contact Dr. Moise since we talked on Saturday, so not sure how they survived the hurricane on Sunday yet.  

So, would appreciate prayer for wisdom for the Donkey as he considers the alternatives before us.  The huge repeat surgery would be risky and difficult, but I must admit I don’t enjoy much having the tumors on my belly either.  So, will get the repeat CT scan and see what Dr. Bartlett suggests and go from there.  As always, thanks so much for praying for us, supporting us in that way and so many other encouragements.  Will update you as we get more information.

In HIs Service,

Bill, Dan, Duane, James, Jenn and Rachel

The Haitian Donkey Makes Slow, Stumbling Headway

Hi All:

It appears that I have not written in quite a while.  As you all know, I am quite technologically challenged, so progress in that department moves at a snail’s pace.  I apologize for not keeping things more up to date, especially the progress in Haiti.  I finished another course of 4 weeks of Avycaz, the $1000/day IV antibiotic, now 9 days ago.  I felt pretty good throughout and have been hoping that this one will give me a longer infection free interval.  Three days after I was done, the low grade fevers, especially in the evenings, nausea, vomiting and feeling dragged out a bit continually restarted.  Thus, 4 days ago, I repeated my blood cultures and labs, the WBC is back up at 13,000 with a left shift, all signs pointing to a persistent/recurrent infection, but so far, the cultures are no growth.  However, at times it takes a week or so for them to grow out the bug.  My ostomy (the 3.5 x 2.5 inch hole in my lower abdomen) has been giving us grief as the bags are not large enough so lots of leaks.  Plus, my belly is quite scarred from all the surgeries and they make for little gaps to let the intestinal contents seep out and eat away at the skin.  Medicare has sent out an ostomy nurse for 22 visits, but so far, she has struggled even more with leaks as has never seen such a large hole and is running out of ideas.  Jenn and Rachel have a good handle on it, but have to return to their jobs soon and will be less available.  Several of my former Georgetown Med Center coworkers have volunteered to help out, I am humbled and appreciative and we will embark on that soon to try to improve the situation.

I have been working on getting supplies for Haiti with the Covid limitations, also looking to establish long term routes for others to continue this in my absence.  Allegedly, the Health Department states that there have been over 5,000 cases and about 100 deaths, but how accurate that might be is a bit up in the air, as only government hospitals have limited testing supplies.  Dr. Moise and I contact each other regularly on WhatsApp, when the connection is reasonable, and things seem stable at the hospital, though volume is down due to the fears of Covid.  School kids are especially hard hit, as very few families have a computer or access to one and the last year of frequent rioting has made for little progress as classes frequently were cancelled for safety reasons, so the Covid only adds insult to injury to these struggling students. 

At present, our hospital uses masks, but I wonder how many people out in the villages have access to one or even the understanding of the need to wear one, etc.  Since clean water is scarce in the best of times, washing techniques are used in a limited sense.  Food supplies do go from the rural areas like ours to Port, etc, on trucks piled high with the containers full of food supplies, the vendors sitting on the top of the supplies (need to duck for trees/branches, etc) so social distancing and proper handling of the food is the proverbial “pie in the sky.”  Each vendor knows which sacks of cabbages, etc, belongs to him/her when they arrive at the market and off load them.  I am concerned that, in general, fear of evil spirits, etc is more prevalent in Haiti and the Covid pandemic will only increase their anxiety levels, more even than it is doing in the rest of the world. 

When I took over the leadership at CSL, now 17 yr ago, there were many areas that needed attention and direction.  I thank the Lord that, thanks especially to Ulrike Shaller, the German physiotherapist, the PT department is making great strides and progress.  That will leave only the dental department, a place where I am really in over my head.  Would you be so kind to pray that God would send a faithful, Christian dentist who could head up that department and be able to work with our limited situation and make it functional for the glory of God?  Another prayer request is that we can locate an experienced Christian ultrasound technician who could come out for 2 weeks or so and train Dr. William in doing and reading ultrasounds after he comes in October, Lord Willing, to join us full time.  Vi Anderson, who came out and taught Dr. Moise, is unable to come again due to health reasons, so looking for someone who could get Dr. William grounded in the technique and reading.  Moise is an excellent ultrasonographer and surgeon, but sometimes those who learn and can do things so quickly don’t necessarily make great teachers, shall we say.  Those of us donkeys, who are not necessarily the brightest and best, can plod along more slowly and accommodate pupils who learn at our own pace better. 

As always, thank you so much for your prayers, support and encouragement for us as we strive to serve our Saviour at Centre de Sante Lumiere for His glory. 

In His Service,

Bill, James, Jenn, Rachel and the rest of the Haiti Team

The Haitian Donkey Is Out Of Negative Pressure But Mourns The Loss Of Grandchild

Hi All:

We have been busy readjusting as a family to the changes the last few weeks have brought.  The Donkey had been off the IV antibiotics he had been on for 12 weeks for 10 days.  After 5 days, he began having spiking temps and rigors, a really nasty situation he has had for the last several years intermittently as his bloodstream repeatedly is contaminated, likely now from the ostomy situation in his lower abdomen, where there are skin cracks that bleed and undoubtedly act as 2 way streets, letting bacteria into the bloodstream via the same holes that let the blood out.  Seems like a no win situation.  I got blood cultures after the first spike, but the medication was $1000 daily and it took a bit to get the prior authorization from the insurance, who promises to pay for 6 days/week and I pay for the 7th.  I had started the antibiotic but it hadn’t kicked in yet and I was gasping for breath, so ended up going to the ER at Holland and being admitted on the 21st.  I was quite anemic so was given some blood and ended up spending 5 days in ICU in a Covid room (negative pressure with a 12 inch vacuum hose blowing air to the outside continuously), though my Covid test was negative and was moved the last day to another ICU room.  They changed my central line to one in my right arm (a PICC line) that does slow me down somewhat, but hoping the infection will be controlled, at least for a while.  For some reason, they had trouble getting my blood pressure up out of the 70s and so had a norepinephrine drip running in the line the whole time to keep it up, requiring me to stay in ICU for close monitoring.  Fortunately, Rachel was able to convince them to let her stay with me, a real blessing as they wouldn’t let me out of bed and just getting things, like the urinal, etc is a chore when you cannot get out of bed to reach the items.  You are supposed to call the nursing staff, but can have an accident while waiting as they are quite busy and have to gown and glove and wear masks to enter each room, slowing down things considerably.    

So, I am back home in my apartment with Jenn and Rachel helping in my care (Rachel actually did the ostomy changes in the hospital, they are tricky as I don’t have a traditional ileostomy or colostomy, normally the bowel protrudes from the belly wall and allows for the inside wastes to free fall away from the body into the bag, but mine are below the surface and more tricky to seal).  I have lost a bit of strength and am hoping to get up and outside as the weather allows some to build up some strength in my left leg especially.  Otherwise, we are stable, but looking into Hospice alternatives to help with the medical needs, etc.  

As many of you know, on Karen’s one year anniversary of her going to glory, a beautiful baby girl was born to a mother in Flint that didn’t want to see or even know the gender of her little one.  So, the next day, we got the call asking if we were interested.  James and Jenn went to Flint on Monday, the 18th, to get Willa Maren, the little one we were hoping to adopt.  The mom always has 28 days to change her mind and, much to our dismay, on the 22nd, the social worker picked up little Willa and took her back to her mother.  Admittedly, she got tons of attention from all the members of the family, but she was such a perfect baby and worked her way into our hearts and lives in just those 4 days and we all miss her terribly.  These emotional roller coasters have been hard on all of us, especially Jenn, and we appreciate your prayers as we adjust to life without her and consider what the Lord would have us do in the future, as this is the third time we have worked on an adoption, only to have it fall through.   

Covid seems to have given Dr. William some grief, I have heard that one of his fellow surgical residents has Covid so that has crippled their work at the government hospital a bit.  We have had some cases out in Cayes now, all is done through the government system, they have the testing kits, so hard to know what exactly is the incidence, but the country is also limited in supplies and ability to comply with the regulations.  It appears that there have been 2000 confirmed cases of Covid and 40 deaths, though likely there are considerably more cases due to the limited capacity to test individuals.  Haiti, with a population of 11 million, has only about 156 ICU beds and like 40 respirators, though the unreliability of electricity and shortage of oxygen tanks, etc, makes that option very limited.  Social distancing is rather impractical as the overcrowding that already exists makes it difficult to reduce population density.  The hospital has remained quite functional, though our volume of patients has reduced considerably due to Covid.  We are struggling a bit to find supplies, as sources in country are drying up and the borders are closed to outside sources at this point.  So, appreciate your prayers for wisdom for the hospital and staff/support personnel as we try to keep things functional for His glory at Centre de Sante Lumiere in Les Cayes, Haiti.

As always, thanks so much for your prayers, support and encouragement for our family and ministry in Haiti.

In His Service,  Bill for James, Jenn and Rachel

The Haitian Donkey Has A Short Update

Hi All:

Last time, I discussed that I would get 3 units of blood and have a stomach tube put in for a blow hole if the pressure builds up.  I got the blood, but the CT scan showed that my tiny stomach remnant was stuck to the posterior abdomen and thus not accessible.  After all my extensive surgeries, the tons of scar tissue would make an open procedure quite risky and I could have more grief, so we did this with needles and dilators under fluoroscopy.  There was a dilated loop of small bowel in front of it, so they placed a smaller tube into this, hoping it was not too far downstream.  It is small in diameter but has provided a fair amount of pressure relief.  I close it when I take medicines, etc for a bit, though have stopped any oral intake except maybe about 3 glasses of water each day and a few spoonfuls of blenderized whatever the kids are having.  This seems to have worked pretty well and I am thankful that I have less vomiting.  I still have a considerable amount of heartburn, so sleep in the upright recliner a lot to limit that. 

I now have an immobilizer for my gimpy left leg.  I cannot lift it up off the bed, etc, so presume the cancer (I have several palpable masses the size of golf balls and one the size of a baseball in my belly) has put pressure on my nerves that control my leg as it had been fine until 6 weeks ago and have had 6 falls since.  Now being careful but hate being limited.  The immobilizer helps a lot, though one has a stiff leg in it and slows me down.  Since it is my left leg, I am hoping I can drive some, as I feel decent otherwise.  The kids are not quite as enthusiastic about that as I am. 

Rachel flew back home to Arkansas to do some work at the university she cannot do on line, hopes to be back in 2 1/2 weeks.  She has been a great help and encouragement, keeps us all on our toes and has helped Jenn a lot with sharing the tasks of meal preparation and laundry, for which we are very thankful.  She sleeps in her bedroom in the basement, so if I vomit or have some grief in the night, she is right there.  Between the 3 kids, I am very well taken care of.

I have had regular contact with Dr. Moise, who tells me that the hospital is functioning fine but the patient load has tapered down to about a quarter of normal volume due to the Covid scares.  They persist in only having the government controlling testing, and that only a limited amount in Port au Prince, so one really has no good idea how many cases they have.  It is reported that they have 81 proven cases and only 8 deaths on the WHO site, but due to limited testing capacity, it is likely a lot more.  He said that, due to government regulations, they try to practice “social distancing” for the patients coming to the clinic and have spread them out over the hospital veranda, etc, but the patients have trouble comprehending what they are doing and cooperating.  Most of them were packed like sardines in the taxi getting there, so why do they have to stay apart.  Haitians tend to have a lesser concept of personal space than we do, they live under crowded conditions for the most part, so like the more cozy atmosphere.  No employees seem to be ill, thankfully, as they do wear masks and protective gear as much as possible.  I am continuing to look into avenues to get more supplies, including more surgical tools for the future as they are very expensive to buy and trying to get good used equipment where possible.  I have not had contact with Dr. William for several weeks, as the internet does not work well in Port, so only usually have contact with him when he is with his family in Cayes, but travel is very limited at present due to Covid. Pray that he will finish well and adjust well to reintegration at the hospital when he hopes to be done in October.

As always, thanks so much for your prayers, support and other encouragement for our ministry at Centre de Sante Lumiere. 

In His Service,

Bill, James, Jenn, Rachel and the rest of the Haiti Team

Brief Update On Haiti And It’s Donkey

Hi All:

The Haitian Donkey has been quite busy trying to stay healthy, so a bit behind on other things.  I have mentioned the distasteful flooding that has bothered me for the last month on an increasingly frequent basis.  I also have had a central line (for my TPN feedings) infection, again the fungus, likely the same species (they didn’t do the complete testing this time, not sure why).  So, back on the Sporonox, have 3 weeks down and 6 to go.  It is very tough on my already feeble intestinal tract, but no alternatives.   I had my central line changed last Friday, that went well, thankfully.  My 3 holes that are the cause of the flooding have been a struggle, Dr. De Cook took out the drain that has been there since the last surgery in August right after I got back from Haiti in December but the volume has not diminished and we are working on trying to put ostomy bags over them with varying amounts of success.  Rachel and Jenn have accompanied me to the Holland Hospital Wound and Ostomy Clinic to learn the technique as they give me a mirror but it is below the tiny bulge of my belly and hard for a donkey to do.  The largest hole has developed a fair amount of infection in the tissues around it, so Dr. De Cook is planning on trying to clean things up in hopes that the ostomy will be more manageable.  I have to be at Holland Hospital at 12:30 tomorrow, so likely will start the operation about 2 or a bit after, if all goes as planned.  For a time, I will have a larger yet hole, but hoping it will heal up and be smaller and more able to be sealed in the future.  Pray for wisdom for Dr. De Cook and healing for the Haitian Donkey. 

It has been a bit hard to juggle other activities around the work schedule and my at least weekly visits to Holland Hospital for the changes and adjustments to the ostomy.  Jenn has been doing the changes at home between the visits, she has a real aptitude and is greatly appreciated, though she is not enthused about the smelliness of the affair and, at times, we have to do this daily on one or both bags.  Hopefully things will smooth out over time, both in the irregularity of the belly wall (so the bags will stick better and not leak) and our skill in keeping the fluids where they are supposed to be.  I have eaten very little as the Sporonox inhibits any appetite, but we still have enough drainage from the sites to make it unpleasant. 

Dan, Duane, Jose and Kevin (another surgeon friend of Jose’s) will leave tomorrow for a week in Haiti.  It seems things are starting to settle down and we are praying that will continue and they can do the work they would like to get done.  Dan, Margie, Tabitha and I plan on going on the 14th of February for our week there, again, most delighted that our friend, Ken De Young, is willing to fly us in and out as he will be there with a team on their projects there.  What a blessing.  In addition to the other jobs she will do in the OR, Tabitha (and maybe Margie will need to help some) will do my ostomy changes and teach Miss Lisberthe and others to do them when I make my future trips. 

By God’s grace, we already have had some money promised towards the Solar Project and we are excited that things are progressing for that also.  Will keep you updated on all aspects of our work as time and new developments come out as we greatly appreciate all the prayers, support and encouragement you all are to us daily as we strive to serve our Savior at Centre de Sante Lumiere, Les Cayes.

In His Service,


Bill for Dan, Duane, Jose, Kevin and the rest of the Haiti Team