Wednesday, May 17, 2017

Blog May 17, 2017
The previous blog of May 7 somehow did not get sent.  
It has cooled down slightly but still no significant rain.
Some days are more busy than others.  The hospital census was 60 a few days ago but today was 45.  One day we had a prostatectomy, a typhoid perforation of small intestine, a hernia repair, an ectopic pregnancy, and a c-section all in same day.  Today we had a laparotomy for a twisted intestine which caused a small part to die which we had to take out and reanastomise and then a  c-section on a lady with a very small pelvis and a large baby that we thought was dead but we did the c-section anyway and the baby is surviving and looks ok..  really a miracle.   
Dolores has had spells of "heart racing" and "heart pounding" usually at night since her episode of a-fib April 8.  Usually the rate is 80-100 when her usual at night is about 60.  The sensation and rate have been fairly well controlled with deltiazem which we were finally able to get from NDJ (took 3 days).  She has an appointment with the chief cardiac electrophysiologist Dr. Mandipati at Loma Linda after we arrive there this next weekend May 26.  We were going to be at Loma Linda anyway for Rachel's graduation from Dental Hygiene school.  Nothing serious is found.   Dolores had a cardiac workup Feb 2015 for chest pain which was chest wall pain and the heart was fine.   
Danae and Olen left our pickup camper at Gloria's (Dolores sister in Riverside) so we will have wheels.  Hoping to spend a few days in the desert and mountains on the way to Denver and S. Dakota and finally back to Oklahoma.   Olen and Danae are now in the air on the way back to Chad.  
I think we will finish getting the new pump in the new well tomorrow as we have now waterproof splice for the electric wire going down into the well.  For the low voltage 195 instead of 220 we have some new wire that we hope to run from generator to the well shorter distance so hopefully increase the voltage somewhat.
   
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  
Blog May 7, 2017
It is still hot and no more rains have come.  The green that was beginning to come up has dried up.  The low in our bedroom has been 85-93F (30-34C).  It gives a different meaning to a hot steamy bedroom.  The humidity is up so now a free sauna.  So thankful for the A/C in the OR which cools it down to 85-90F.
We still don't have the new pump in the well yet as need waterproof splicing for the electric wire going down into the well to the pump.  The wire on the pump is not long enough to reach the top.  It is difficult to find waterproof splicing in this country.  The pump on the new well would greatly relieve the load on the present system that runs almost constantly.  We have the new tank on the tower built by the new well.  
Friday we had a lapartomy on a lady that had a c-section 3 weeks before in another hospital.   She had a semiacute abdomen so we opened her.  It was a terrible mess inside and a large abcess in her pelvis and left side abdomen with over a liter of purulence.  We washed her out and put in a drain.  We have had a few breech babies lately that amazingly have done pretty well except for those that come in with the body of the baby hanging out.  In two weeks Danae will be back so she can do the maternity cases.  
We will be going on our annual leave in two weeks first going to Loma Linda Univ. California for our oldest granddaughter's graduation from Dental Hygiene school.  Maybe spend a few days in the desert and mountains on our way to Denver to see my brother Reggie and his family and to S. Dakota. to see Duane Smith (a friend and classmate of college and med school.  He is not doing well then we have a bunch of appointments for medical and dental etc in Okla.
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, April 24, 2017

Blog April 23, 2017
It is still hot season.  It was 111F (43.3C) yesterday in the shade where we had our potluck lunch.  It is slightly cooler after a few drops of rain last evening.   We had rain on the 1st, 8th, and 14th so we thought maybe rainy season was beginning but does not appear that way now.  It was beginning to get  green in a few places but that may change if we don't get more rain soon.  Last year there was not much rain until late May.   A lot of newborns get treated with antibiotics for "fever" when actually it may be just heat intolerance.  
A few days ago we had no water at the hospital.  The water pump was not working so went to Lai ( a neighboring town) to get another pump and get ready to pull the other one from the well.   That night it was discovered that the wire connectors at the top of the well had been tampered with and disconnected one wire.   This was reconnected and presto we had pump working and water and not have to pull the pump from the well.   Great relief!!.  Don't know if this was a deliberate act or just some kids to close to it.   We had a new well drilled 4 years ago in another part of the compound but no pump put in until a few months ago but it does not work so it needs pulled .   Last week the water tank on the tower for that well was finished so hopefully will get a pump working on that one so have back up and not work the present one so hard.   It presently has to run almost constantly.   A lot of people get water from our system as their wells have gone dry also our water is ok to drink direct from the system.   
We had a big wedding Friday.   A wedding here lasts about all day.   There is a civil ceremony early in the day then the church part which lasts over 2 hours in the afternoon then a feast after that.   It was a pretty wedding.  She had 7 bride's maids.  The bride is not supposed to smile in a wedding here.   
So far this month our surgery numbers are ahead of last month.  We have had a lot of c-sections for various indications.   We took out a thyroid mass last week also a parotid mass.   We did a mastectomy for a cancer also a bilateral mastectomy for large gynecomastia which he insisted was causing him problems.  We had another man with prominent breast that actually was a large deep abcess.  We had 4 bladder stones in one week.   One boy had two stones each over 3 cm in diameter.   
We are healthy and Dolores has had no more major problems with her heart
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  

Sunday, April 9, 2017

A weekend in Bere
We thought we were going to have a slow Friday but then a girl came in "acute ill" with distended abdomen.   We operated and found that she had some kind of retro peritoneal cyst that obviously had been there a long time but needed drained.   It had the appearance of chyle fluid and had about 1500 ml of fluid and we put in a drain.  Then we had another little girl about 10 that had acute abdomen peritonitis with lots of purulence when we opened her but could find no source for it.   No perforation, no lier abces, no pelvic infection etc.  We washed out her abdomen and put in a drain and now 2 days later she is doing well.  What was it??  Then a "maternity case" term pregnancy placenta previa bleeding so a c-section.  
Friday evening about 2300 the lights all went out.   The generator had quit because someone did not keep diesel in the tank.  We got diesel in it then about 0030 lights out again.   The battery was dead and was not being charged.  Actually we jumped it to start it when the diesel was out.  Somehow when the guys were putting the generator back together they did something so that the alternator is not charging the battery and it has to have battery power to run.  Somehow they did that to both Perkins generators and one of them had not had a problem before they began doing their thing.  So after that I started the little Caterpillar generator and it runs fine.  
Then about 0100 or a little after when I had gotten back to bed Dolores said her heart was pounding and racing and irregular and "felt as if I am going to die" and did not want to go to sleep.  The next few hours checked her frequently heart beat etc and used defibrilator as an EKG (we don't have an EKG machine) and she had atrial fibrillation with rapid ventricular rate of 150+.   We don't have adenosine or deltiazem or propranolol so I gave her atenolol 50 mg pill (only thing we had) and her rate gradually slowed somewhat.   I would check her frequently to be sure she was still alive etc.  I had texted Olen who is in Hawaii and we agreed there was not much else we could do except to pray.   I was to go at 0600 to pick up some people for a baptism from Delbian a village 45 min away or more.  I normally go to a "bush church" at 0730.  I got Vadym (a doctor here from Ukraine) to go to those places so I could stay with Dolores.  She was feeling better by church time here so we went to church.   Then there was baptism at the river after church.  She rested in the afternoon.   Sometime in the evening her heart converted back to sinus rythm with rate 64.   What caused all this???   Maybe took an extra dose of thyroid accidentally or electrolytes off with the high heat or ??   She just had her heart checked out 2 years ago with imaging, stress test, etc, and all was good.   At that time she had costochondritis chest pain .  
After we got back from the baptism (18 were baptized) there was a strangulated hernia to do then there was a repeat c-section that was real mess with rupture uterus and bladder and various adhesions everywhere but baby is doing well then after that there was another repeat c-section with uterus beginning to rupture.   Mother and baby are doing well.   About 0300 the lights out again.  Someone had not refilled the diesel in the little Caterpillar generator.  I jumped the Perkins generator and started it (someone had filled the diesel in it)  then ran an extension cord from a transformer for 110v out to my chager and put it on the battery for the Perkins and has been running ok with that.   I have had to see every patient in the hospital each day also as Dr. Tirmo(the Chadian doctor who usually sees the med and ped patients) has been gone since Wed am to NDJ.   We have Vadym and two medical students here.   Vadym can do some surgery and had him do some hernias and hydroceles this past week.   His main interest is surgery.   He is to be in the Moundou center as soon as he feels more comfortable with surgery maybe another week.   Dolores is working on mangoes today.  
This evening a man was brought in with a large hippo bite in his proximal thigh.  One side just missed his scrotum and femoral artery although he had bled a lot and the other side took some muscle from his ilium area.  We closed the torn muscle and packed the wounds with antiseptic.  Hippos kill more people in Africa than lions do.  They can run fast even though they appear otherwise.   
We all seem to be healthy now so keep praying for us.  
Our emails are drbland42@gmail.com  and  dfbland01@gmail.com
Love

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

Friday, March 31, 2017

Blog Mar 31, 2017
Hotter than ...well anyway it is hot.  The humidity is coming up in the 30% range whereas before it usually was 8-10%.   The temperature outside is 106+ but also in the OR was at least that.   The A/C was not working but yesterday it was cleaned or recharged and it is working fairly well now.  It is fairly comfortable in the OR with temp in the low 90's ((we brought a thermometer over) now.   The low last night in the house was 91F but it was 99F at 2200.  We soak the bed with perspiration so have to keep drinking lots of water during the night.   Last night I finally decided to "sleep" on the floor which seemed a little cooler.   A lot of the patients  sleep outside under the trees and on the ground.  How do you tell if a new baby has a fever if the ambient temperature is 106 or more.  The only A/C is in the OR.   Actually there is one in Danae and Olen's house but we are not using it.  I don't want to be too privileged more than the rest of the missionaries. 
The MCD came today and scrubbed in for a few cases of surgery.   He actually has been quite nice so far.   He wanted to see what was happening on our "freebie" cases that had been advertised.   We are doing lots of hernias and hydroceles for "free" but have to pay for the materials meds and suture so the price can be adjusted somewhat.  We have done 24 "freebies" so far this week and have done 30 procedures in the past 3 days.  This offer was good for only this week but we will have quite a few that were signed up to carry over into next week before we get them all done.  Our surgery load was quite low so we offered free hernia or hydrocele surgery this week only.   The price figures out to be about half price.   
The generators are being worked on.  I"m thankful for the little 12KVA generator so we can keep water and lights going.   The new water pump is working well so far..   We have got work started on the new water tank on the new tower that was built about 3 years ago by the well that was done about 4 years ago.   They are building scaffolding now.  The old water tank is really leaking a lot.  The tank labor and materials will cost about USD3000.  Then we hope to get the old tank repaired etc.   We need a new blood bank refrigerator which will cost about USD500.   The OR A/C seems to be cooling fair now so that USD500 maybe can wait awhile.  The generator work will be another about USD700 maybe more.  
We are having lots of maternity cases lately.   Most of them are normal deliveries but we are also having quite a few that arrive with fetal demise before or after delivery.  
We are hoping some of our "bush churches" will become churches but will need church buildings.  There is about enough to qualify for a shipment of "one day church" materials.   They can send materials for 30 in a container.   
This hot season is only March, April , and May.   The rest of the year is not too bad in fact may get down in the 50's in Dec and Jan.  
Pray for us
Love  
Rollin and  Dolores Bland 
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile,  Chad,  Afrique
Blog  www.weareamissionarybland.blogspot.com  

Wednesday, March 22, 2017

I was going to write this yesterday but found we had no water so had to tend to that before breakfast.  Our water pump had quit, apparently burned out or worn out.   "We pump many thousands of gallons of water daily.  They tell me that people from Bere town are coming to get water because wells are going dry.   Our last rainy season did not fill the water table up to near the top as usual.   It is a long time before there will be any water from the sky to put water in wells again at least until June or July..  It will take a lot of rain to soak this dry sandy ground again.   It is about 108F (about 42C) day and only 85 or 90F (72C) at night.  It was 92F last night in our bedroom at 2200.   We had a water pump to put in but did not have the proper connectors here or in Lai.   We bought another pump and finally found enough of the right fittings to connect it and had to redo the wiring somewhat.   That took most of the day.   Fortunately no real emergencies came in yesterday.   We plan to get proper fittings for the other pump so that when we need it we will have it.   There is another well that had not been used but recently had a pump put in it but not connected to the system or to its own water tower tank which is not built yet.   We made a connection from that pump ;into our main system so that hopefully now we can have back up system somewhat .  We really need the water tank built on top of the tower that is already built.  
A few days ago our blood bank refrigerator quit so we let them borrow our little one until another one can be bought.   Hopefully the blood was not damaged too much.   It will cost about USD500 or 600 to replace it.  It was about USD350 to fix the water pump.   I got word today that our generator has been repaired and will be brought back maybe tomorrow so I will need to spend some time helping or putting it back together connecting back to the motor and the electric system.   It cost about USD1000 for that besides our labor for everything.  
Our hospital census and our surgery load has decreased markedly this month.   Revenue is much decreased.   Money is scarce as had poor crops and low prices, prices are low for the country.   They say there is some kind of problem getting cattle across the border into Cameroon and Nigeria where they usually sell them.  
We have another lip to repair after a fight with another woman 10 days ago.  I saw a huge goiter but I don't want to tackle it unless we have better anesthesia and have Danae here to help and still may not as it is HUGE.   We did a mastectomy and axillary node dissection recently and she did well.   We recently had a man with severe right heart failure with very distended neck veins and short of breath even sitting up although his lungs were clear but very distant eart sounds .   We think he had a cardiomyopathy.   We don't have much to work with for cardiac patients.   He wanted to go see a "cardiologist" in NDJ.   I don't know if he made it there or not.   We had a placenta previa recently with mother and baby doing ok after c-section.  We also had a retained head with rest of baby hanging out and she walked in.  Of course baby was dead.   Was able to manipulate the head and extract it without too much problem.  
We have Staci Davenport MD here on visit and plans to be back long term in  less than 2 years from now.   Vadym Korzhos surgeon from Ukraine that is to be in Moundou wants to be here for a month or two to get some experience with me before he is on his own.   We visited him in Ukraine when we were there last August.   We also have two senior medical students here from Loma Linda Univ .  Tyler and Melissa Pender.   She is interested in internal medicine and infectious disease and he in general surgery.  Another doctor Sarah will be visiting here in May and hopefully will come back long term maybe about the  time we leave PR.  
Our emails are drbland42@gmail.com and dfbland01@gmail.com
Love ,   Dolores and Rollin
Rollin and  Dolores Bland 
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile,  Chad,  Afrique
Blog  www.weareamissionarybland.blogspot.com  

Monday, March 6, 2017

March 1, 2017
I was beginning to write this evening then the electricity went off.  Our electricity is supplied by our Perkins 28 KV generator which we run 24/7.  We have two of them but one is not functioning now.  The one that has been running now had to have the generator part taken off ( it weighs about 500 lbs) and taken to Moundou where there is someone who can rebuild them.   Now the other one has had to  have the generator part have the same thing.  Hopefully the one that has been rebuilt will continue to operate all right.   Apparrently the life span is about 14000 hours  at least that is about when each has gone out.   It costs a lot or money to get them rebuilt (about $700) .   Tonight the problem was a broken fan belt and a sensor detected it getting hot so shut down the monitor.  We took a fan belt from the one that has the generator off and got this one going again so were were without electricity less than 2 hours.  We have also  an old Caterpillar 12KV generator which we can use if no big items are being used such as AC or blenders but can handle the water pump.   The Caterpillar is the one that was the only source of power before the present Perkinss generators were donated 4 yrs ago by Garwin McNielus of "one day church" fame.  Since all the new buildings were built there are a lot more lights than there were formerly.  When we first came here the generator was only run part time and only used very low wattage light bulbs ie. 5-10 watts and used battery power to run the lights when the generator was not running but would have to run the generator to pump the water to fill our water twoer tank.  We would be out of water frequently.   Now we have a float switch which automatically turns on the water pump when the water gets below a certain level in the tank.  Fuel for the present 24/7 operation costs a large percentage of the budget.  Recently the electricity went off early am Sabbath but the problem was the fuel tank was empty and someone had not ordered the barrels of fuel to keep it going .   Usually get several barrels of fuel at a time.  
Our business seems to be slowing a little except maternity is still about the same.  We had about 165 surgeries in Jan and 135 in Feb.  March will probably be less.   We have had lots of hernieas, hydroceles, prostatectomies and urethral strictures, and hysterectomies and some vesico-vaginal fistulas.   The fistulas are the most challenging.   Danae and I always do them together.  Some are repaired trans-abdominally,and some vaginally and some both.  We have an ovarian mass or cyst and ectopic pregnanciies fairly often also.  C-sectons and sometimes ruptured uterus also.  Yesterday one of our patients returned for check up that was very rewarding.   She had had a superior mesenteric volvulus with dead intestine requiring at least 7 ft (about 2 meters) of small intestine removed.  She almost died following surgery having to have a repeat surgery etc and was very emaciated but now she is doing quite well.  She even denied having diarrhea or  other symptoms of short bowel syndrome and had gained weight.   She is happy and we were ecstatic.   We recently had another psoas abcess which we drained and she did very well.   We have different kinds of cancers that come too late for anyone to do much for them.   Probably the most common are bladder cancer, ovarian cancer, cervical cancer, breast cancer, Prostate cancer, Burkit's , etc.   
This coming weekend is alumni weekend at Loma Linda Univerisity.  I graduated 49 years ago from medical school.  I plan to be at our 50th year class reunion next year.   
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