Friday, November 3, 2017

Blog Nov 3, 2017

We have had a run on intestinal surgery the past 2 weeks.   We have had 2 strangulated internal hernias with dead intestine that had to be resected.  One had dead sigmoid and  dead terminal 1 meter of ilium (small intestine)   Also 2 strangulated femoral hernias with dead intestine and a strangulated inguinal hernia with dead intestine.   Also a strangulated umbilical hernia but the intestine was still ok.   With dead intestine there is often infected wounds.   Also had a typhoid perforation of intestine.    We also had a new born with no rectum so had to put in an ostomy in the abdominal wall with a loop of intestine.   Yesterday we had a perforated gastric ulcer and a appendectomy and 2 c-sections and an ectopic pregnancy with lots of blood lost and a vacuum extraction of a baby.   We also have about 60 inpatients to try to see besides the consults etc.  Olen and Danae left 2 days ago for the airport for Danae returning to USA  for her oral Ob-Gyn boards and preparing for them.  She is return here mid Jan.   Olen is returning tonight (thur) with the new doctor from Argentina.  
I hear that back home they don't treat strept throat now but here you better.   We see rheumatic fever and kidney problems as sequelae to strept infections also severe cutaneaus infections.   Although we do not have proof culture evidence of which infection it is.  I just saw my third case of "NOMA" which is a necrosing full thickness infection of part of the face.   I'm not sure if it is "flesh eating" strept or what but it is bad.  One of them got over it and the defect has mostly filled in.   Another one just left so don't know what happened to it.  One was to return in Jan for a recontruction team that was going to come but now we hear that they are not coming.   
The "harmattan" dust was come in so everything is very dusty.  Visibility is down to less than a mile and everything gets covered with dust quickly.     Harmattan usually does not come until Dec or Jan.   Harmattan is the dust that blows in from the north in the Sahara.    Probably no more rain until next May.  There was lots of rain with flooding then it shut off like a faucet with nothing more since then.  I think the rice and ground nut harvest is fairly good this year and hopefully the cotton will be good .   They are harvesting rice now all by hand.   Lots of work.    Grass etc is starting to turn brown.  
Pray for the Lord's work here. 
Our emails are  drbland42@gmail.com and  dfbland01@gmail.com  

Rollin and  Dolores Bland 
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile,  Chad,  Afrique

Thursday, November 2, 2017

Blog Nov 2, 2017

IT has been busier the past several days.   Danae left Chad today for the USA where she will be  preparing for her oral OB_GYN boards .  She will be returning mid Jan.   Then we will be leaving in Feb.   A new surgeon from Argentina is arriving this week. His wife is a nutritionist and they have no children yet.   Another doctor family -practice with extra fellowship in OB is to arrive about Jan 1.   Our administrator resigned.  Olen now is the interim administrator as well as head of AHI (Adventist Health International) for this area.  He was doing a lot of the work anyway.  Ndilbe our head of the operating room is leaving next week to get further training in anesthesia in Cameroon and plans to be gone 2 years.   Olen and Danae plan to leave sometime next year also although their plans for what they will be doing keep changing.   There is a a Brazilian surgeon that wants to come perhaps next April or May.  Zach Gately just left and probably not coming back.  He will be in Cairo.    So lots of changes in the works.   
It is sort of sad for me as I probably won't be doing hardly any more surgery together with Danae but we have had most of 6 years together.   She is a fantastic surgeon and very compassionate doctor and has given away lots of money to help various patients and other people.   Even though she is OB-GYN she can do about any general surgery also and has done intestine resections and ureter reimplantations in bladder as part of fistula repair.  She has done several prostatectomies.  I may be biased but I think she is one of the best.  Pass or fail on oral boards I know she is very good and am very proud of her and Olen.   
Papa Danae as I am often called.  

Rollin and  Dolores Bland 
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile,  Chad,  Afrique

Monday, October 16, 2017

Blog Oct 15, 2017

Today we did a long surgery a laparotomy for a strangulated internal hernia with necrotic sigmoid colon and a necrotic terminal ilium (about a meter) that had to be resected.   Last week in the same day we had two cancers that were not resectable.  One was to be a bladder stone but turned out to be a large cancer  and the other was a nonresectable cancer of the cecum already too far spread.  Both patients were teen agers.  I amputated the first toe and metatarsal for a dead toe a few days ago.  Tomorrow we have another amputation for cancer of the lower leg.  We had a huge molar pregnancy that was about size of 5 month pregnancy 3 weeks ago but now the uterus has not decreased as  much as it should so she probably needs a hysterectomy.   She already has 5 kids./  
Yesterday was a long day.   I got up at 0600 to go pick up some people for baptism from a group that was only 17 km away but took at least an hour each way.   Of course they were not ready to go when I got there.  Here in Bere they were having a district meeting for several churches and groups around here.   They had a baptism (we had to transport to the river) and Sabbath School and church in the morning (Olen was preaching for church) and also pastor appreciation day and food and cash etc were brought for the pastor.   I hauled it to his house during the "lunch break" then there was foot washing and communion in the afternoon which usually takes about 2 hours.   Then I took those people back to Delbian another hour each way.  It is peanut (groundnut) harvest time so pastor got lots of that.  
We finished mowing the "lawn" a few days ago.  It probably won't need it again before next June or July as dry season seems to have begun in earnest although did get 0.4 inches a few days ago.   It will take a while longer before the water holes in the "roads" dry up.
Events are transpiring all around the world.   Huge shooting massacre in Las Vegas, Nevada.  Huge wild fires with lots of deaths in California.  Russia is moving tanks and artillery into Serbia (we were there last year).  Venezuela is talking war with the USA.  North Korea keeps threatening with its nuclear capability.   Syria, Iran and Israel are on the edge.   Saudia Arabia is getting "defense material" from Russia.  A large truck bomb in Somalia.  A large hurricane heading to Ireland!!!   Who knows what President Trump0 will do besides twitter.   
Our emails are  drbland42@gmail.com and dfbland01@gmail.com  

Rollin and  Dolores Bland 
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile,  Chad,  Afrique

Sunday, October 1, 2017

Blog Oct 1, 2017

We have made it to the exclusive travel restriction travel ban club.  Trump put Chad in with North Korea, Iran, Libya, Somalia, Yeman, Syria, and Venezuela.   He dropped Sudan from the list.  We think it primarily restricts people from those countries from entering the USA.  We don't think it affects us.   There have been protests in Chad and the Chadian radio said something about the American embassy being closed but we have checked and it is not true.   We hear that there was an incident that a Chadian flew a plane with weapons for ISIS somewhere from Russia and not sure what all is involved so now the ban.   There could be repercussions later but don't know.  So far as we know the ones that already have visas etc are not affected so our replacements should be able to get here ok.   It would not affect the surgeon coming from Argentina anyway.   It is not clear what all the restrictions are for Chad yet.   
Rainy season from almost daily rains has totally shut off the past two weeks so the flood waters are receding.  Only one place now requiring a canoe to get from Kelo to Bere.  Vehicle travel should be able to go soon although will be deep water holes.   Hopefully the rains will not come much more so people can get to the hospital and also be able to harvest their crops esp rice before long.   September has been one of the slowest months for a long time for the hospital.   It should be picking up before long we hope.   We have had 2 with bladder stones, two prostatectomies,  a strangulated hernia with dead bowel resection,  a tubal abcess  and some routine hernias in the past 2 weeks.   
Our emails are drbland42@gmail.com and  dfbland01@gmail.com   
Rollin and  Dolores Bland 
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile,  Chad,  Afrique
Blog  www.weareamissionarybland.blogspot.com  

Monday, September 25, 2017

Blog Sept 24, 2017

This earth is "waxing old like a garment".  Three major earthquakes in a month hit Mexico.  Another earthquake hits northern California.  Even tremblors in Oklahoma.  Cyclone batters Japan.  Hurricanes Harvey, Irma, Jose, and Maria devastate the Carribean islands, Puerto Rico, Texas, Florida, etc with severe winds and severe flooding.  There have been many deaths in all these disasters.   It is hard to imagine 175 mile per hour (280 km/hr) wind and up to 40 inches (101 cm) rain from a single storm.   
Danae and Olen and kids are all back here now.  Danae is trying to spend as much time as possible preparing for her Ob-Gyn boards that she is to take in Jan.  Olen spent some extra time with his dad after his mom's funeral.  Olen and kids had to take a motorcycle then canoe over part of the "road" to get here.  They are doing some home school for Lyol and Zane.  We are basically isolated here with no "roads" out.   The water is still rising.   But the rainy season should be decreasing soon and then it will turn dry.  The water table is at the top of the ground meaning that the water is at the top of the wells.   We took a ride a little way in a Land Cruiser with Jonathan Dietrick today until the water was hip deep and there were a few km to go on to the main river stream so near the bridge is probably at least 2 or 3 meters (6-10 ft) deep.   Hopefully we won't need to go anywhere but that is probably the main reason the hospital is slow because the patients can not get here except by canoe or ox cart.   Motorcycles are ferried in canoes to where the water is more shallow.   They like lots of water for the rice crop but they say this too much and it is later this year.  Mud bricks don't do well either as the water is up around some houses.   I'm sure there are some people that die especially in some remote villages because they can not get out. 
We had a miracle.  A volunteer several months (last rainy season) had broken a piece on our only lawnmower then he had completely disassembled the motor and everything and left a pile of parts.  While I was home on annual leave I was able to order a gasket set so to make it possible to reassemble the motor but I did not realize that a piece was missing that holds the blade onto the shaft.   We found a piece among some other pieces of old lawn mowers that fit.  We put the motor back together and the piece that we found that holds the blade onto the shaft.   Eureka!!!   The lawnmower runs and cuts grass.  Apparrently the volunteer did not realize that the only thing wrong was the broken piece that holds the blade on.   I can get some exercise mowing grass now.   
Our Chadian medical student was here last month.   Hopefully he saw and learned a few things.   He scrubbed with me on a typhoid perforation that we repaired also a strangulated hernia that had to have some intestine resected.   Also some C-sections for various reasons.   He has now returned back to school.  We had a quite large tubal abcess that we opened today.   Danae and I have done some vesico-vaginal fistula repairs since she has gotten back.   
Our emails are  drbland42@gmail.com and  dfbland01@gmail.com.   

Rollin and  Dolores Bland 
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile,  Chad,  Afrique
Blog  www.weareamissionarybland.blogspot.com  

Friday, September 22, 2017

Blog Health Care in USA

I see an article about a proposal by Bernie Sanders for universal single payer health care for the USA.  To me it makes much more sense than any of the other proposals that I have seen lately.   If enough people would write their congressmen and senators maybe something could be done.  It should not make any difference whether Democrat or Republican.  It should be for the good of the country.  Of course it would be opposed by the insurance and pharmaceutical industries which have lots of your money to fight it.   Why should we be at the bottom of the industrialized world in health care.   We spend two times as much money per person as any other country on health care but what are we getting for it.  We are almost a third world country in life expectancy with 40+ countries above us in life expectancy.  There were formerly only 17 above us.   We are the only industrialized country in the world that does not have universal health care.   Part of our problem is the terrible life style eating so much junk food and being too sedentary that so many Americans do.  The fast food industry and the pop industry probably kills more people than tobacco.   We also need tort reform similar to other countries as well.   We need limits or set amounts per case for what the lawyer gets like other countries.   The pharmaceutical companies are gouging the American people.   Most medicines can be obtained in other countries for a fraction of what it costs in the USA.  We have great doctors and  hospitals but our system is rated the bottom of the industrialized by the World Health Organization.   If one has a major illness, it can bankrupt you for the rest of your life under the present system.  One big problem presently is lack of access to health care by millions in America.   His proposal basically would extend Medicare like coverage for everyone as I understand the proposal.   Several congressional people are backing it and cosponsoring the proposal.   Maybe they are finally getting the message that we need a change in our system.   The government people especially our senators and congressmen need to be on the same  system as everyone else.   I would think that most primary care health providers would back this.  Again we need to do something about the situation.   Post on face book or othe social media and write your senators and congressmen and congresswomen.   Everyone can make this a better healthier country if we all work together.  
Rollin Bland M.D. voter in Oklahoma, USA

Rollin and  Dolores Bland 
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile,  Chad,  Afrique
Blog  www.weareamissionarybland.blogspot.com  

Wednesday, September 13, 2017

Blog 13 Sept 2017

We are still in the heart of rainy season with rain almost every day.   It has rained 8.4 inches (21.3 cm) in the past 2 weeks.   It is great for the rice crop but bad if you want to go anywhere.   Some of the ground nuts (peanuts) are being harvested also some millet.   The countryside is pretty and green just don't want to try to drive anywhere much.  
Hospital business is somewhat slow this time of year although the census has stayed up pretty well partly because it is difficult to get here and partly no money until harvest time.   The pregnant lady that had sigmoid colon and some small intestine removed because of a strangulated internal hernia has aborted as expected but is doing well and went home yesterday.   Danae and I have done some vesico-vaginal (bladder to vagina) fistula repairs that so far appear to be holding and are dry.   Sometimes they can break down even after a month but hope they do ok with no complications.   We had a mid shaft femur fracture a few days ago that her family refused treatment here but took her to the "traditional healer" (witch doctor) instead.  Not sure why she was brought in.   The "traditional healers" have a lot of power over the people.  Spiritism and animism are still very strong.  Even some "Christians" believe and practice some of the "traditional" methods to keep the evil spirits away. etc.  
Danae is trying to study for her OB-Gyn boards that she is to take in Jan. so I am doing rounds most of the time so she can have more time.   Dolores takes care of the kids although this week she is recovering from malaria and a "cold".
We visited a nomad Arab group with Sarah Sexton, a midwife from the USA, that was visiting here for 2 days on her way to Rwanda and the Congo.   She wants to be a missionary to the nomads Arab and Fulani who are mostly Moslem and live with them.   We had to take a canoe across the river to their encampment.   They were very friendly and some have been to our hospital although the head of the group was reciting his prayers  while we were there.   They insisted we drink some warm fresh milk from the cows .   The milk was very rich.  
Haven't gone to the "bush church"  past 2 weeks because of the high water in the "roads"  We hear that a group of 200 that want studies and want to become SDA christians.  Pray for everyone that they may learn about salvation through Jesus and His grace.   There is a Fulani pastor who became a Christian, the first of his family or tribe.   It is very difficult for him as there is a death threat over him because of that.  His wife was taken away by his father-in-law and a son was also killed in front of him.  It is difficult for a Moslem to become a Christian.  He wants and needs more training but needs financial support.   He has a nice Nigerian wife now and now a new set of twins.  He wants to return to his own people and try to teach them about the love of God even though it may be dangerous to do so.   Pray for him
Our emails are  drbland42@gmail.com and  dfbland01@gmail.com  

Rollin and  Dolores Bland 
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile,  Chad,  Afrique
Blog  www.weareamissionarybland.blogspot.com