Wednesday, January 3, 2018

Blog Jan 1, 2018

Happy New Year!
I watched the new year in by doing a c-section soon after midnight transverse presentation then another one today for CPD big baby.   She had come from Bao about 2 hours away on a motorcycle which is the most common ambulance service.   The first one was from another hospital as well.   The Chadian doctors apparently don't work Christmas and New Years and so the abnormal OB's come here.   Another patient came in after midnight with ecclampsia (convulsions and elevated blood pressure etc)  Baby was born with vacuum extraction soon after arriving.   The baby had a good heart beat but never made any respiratory effort.   I breathed for it over an hour and finally gave up.   Mother is doing ok now.  We had 6 c-sections over Christmas weekend patients referred from other hospitals.   Nearly all got here too late to save the baby.   Two had ruptured uterus.  
Yesterday we had a typhoid perforation intestine and she is doing ok today.    Also had a bowel obstruction secondary to large 6-7 cm polyp mass in descending colon and a 3 cm mass in small intestine and she had a 10 cm mass on ovary and multiple nodes in the mesentery.   We took out the masses from this 19 year girl.   Also the mesentery and peritoneum was hemorrhagic.   We knew she would die eventually but not as soon as today.   
We had a nice bon fire yesterday evening that we gathered around for awhile.   Most of the other expats stayed up until midnight or after watching a movie but I had gone to bed just barely asleep when was awakened to see the maternity cases.   
Christian (the Argintinian surgeon) is sick with malaria so not working yesterday or today.   
Dolores keeps busy with the kids and with cooking for Olen and the kids and us.   
Danae's oral Ob-Gyn boards is Jan 8 next monday so please pray that it goes very well there in Dallas then she will return to Chad.   
Love
Rollin and  Dolores Bland 
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile,  Chad,  Afrique

Thursday, December 28, 2017

Blog Dec 25, 2017

Christmas has passed and the grandkids all had fun opening their presents.   Christmas is somewhat low key here in Chad.  New Year's is the main holiday.  But it is getting "cold" down in the low 60's.  
This past weekend has been busy with maternity cases.  The doctors at the other hospitals in Lai and Kelo apparently were not working even though there are a lot more of them than of us.  I think there are about 6 doctors in each place government hospitals but they are on salary and no incentive to work  and are not mission oriented.  We had 7 c-sections this past week about equal from each place with one being our patient from before.   Two were for ruptured uterus, one abruptio placenta with severe bleeding, one for placenta previa with severe bleeding, one for ecclampsia and baby with severe hydrocephalus, one for severe small baby but good baby, and one for prolonged labor but got here too late and baby died after delivery.   So not a good weekend with only one good baby out of those.  
We have had a lot of prostatectomies and urethral strictures and bladder stones this past two weeks.  Overall business at the hospital has increased a lot this past month with a lot of hernias being done and various other things as well.  We have had two large psoas abcesses  that we drained.  We reduced a dislocation of a jaw.  A boy fell from a mango tree and has two broken arms.  A drunk lady  had an accident on a motorcycle and had an open fracture tibia-fibula which I could have fixed easily with a SIGN nail (an intramedullary rod system that does not require an x-ray to do) but the family took her apparently as usual to the local "traditional healer" (witch doctor) by morning so she probably will lose her leg.  
Greg Shank M.D. was here the past 3 weeks.  He is a surgeon from Lakeside, Ore that has spent 5 years previously in Koza, Cameroon so he knows the language and ways of this part of the world.  He has been a great help so I could do some other things.   Christian Stoletnly M.D. our surgeon from Argentina is really stepping in and doing well.  I still help on some of the bigger cases and my "experienced fingers" still help some in diagnosis.  I have been working some in getting a house ready for a new doctor that is coming.   Getting the house ready means doing electrician and plumbing work and directing some other work being done.  Sara Balensky M.D. a family practice with 1 year OB fellowship will be arriving next week.   She has been in France for language school the past 3 months.  
We trust everyone had a wonderful Christmas and remembering the real reason.  Surely Jesus is returning soon as  you see all the events that are transpiring.   May the New Year bring joy and happiness to all and closer to Jesus and to each other..
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

Tuesday, December 12, 2017

Blog Dec 12, 2017

The ordeal with the rabid cat is over and so far all the kids are ok except now they are all recovering from malaria taking their quinine,  Danae is still in the USA preparing for her oral Ob-Gyn boards which will be Jan 8.   Continue to pray that the boards will go well.
Christmas this year will find us here in Chad with Olen and Lyol, Zane, Addison, and Juniper but Danae will be in the USA.   Danita, Edwin and Janelle and families will meet at Janelle's Dec 22 in OKC.   It does not seem possible that it is almost Christmas.   It is 100F days and in 60's nights so does not feel like Christmas.   New Year is more of a holiday here.   
Dr. Greg Shank surgeon is here until Dec 21.   He previously had served 5 years in Koza, Cameroon.   We have Christian Stoletnly a new surgeon from Argentina here for one year hopefully more.  Maybe I can sort of relax part of the time and do some other projects.   Still have maternity to do.   The hospital is getting more busy now with more surgeries to do now that rice harvest is about over and people have some money and can get their elective surgeries done.   We have a variety being done such as bladder stone, prostate, urethra stricture, abd hysterectomy, vaginal hysterectomy, La Fort procedure, myomectomy, c-section, curettage for incomplete miscarriage, some intestinal resections, strangulated hernia, repair typhoid perforation, repair perforated gastric ulcer, large neck mass, anal fistulectomy, leg amputation or cancer, finger or toe amputation for cancer or severe infection, psoas abcess, large lipoma,  lots of hernias of various kinds, and hydrocelectomies.   We have something new almost daily for Christian to see.   We had one mother die after finally having a live baby after having 5 dead ones.   She developed severe heart failure with normal blood pressure and almost no edema except at the end
Today i operated on hernias on the old chief from Moundgala which is the village where we have a nice group studying the Bible and this past week they signed a paper and marked off the land that is to be "given forever" for a church to be there.   Nice site next to the school and up a little from where water comes out of the ground into a swamp and the "hippo river".   The chief is almost as old as I am.   He comes to the Bible study and church.  I showed the "Jesus movie" in the local language Sunday night there but the devil did not like it.   When we got there the security system on the Toyota 4 runner would not disarm so the lights were flashing and the horn blaring, disconnected the battery so stopped the noise as nothing else seemed to work.   (It would finally stop after a minute or two so was able to drive it home but still would not disarm but it finally disarmed next day at home)   Then it was also market day and there were several that had had too much alcohol and were making lots of noise and fighting and distracting people but finally some were able to quiet them and get them away.   The generator and screen and computor worked fine and showed the movie to about 250 people.   I don't know how many were able to listen to it.   Next time it will not be same night as market day.   We only show the first hour (half) the next time the other part.   Also broke a lens filter on my camera at the same time.   Hopefully no more problems.   There are several different groups in different villages that are trying to grow.   Continue to pray for the mission projects and for the hospital.   
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

Friday, November 24, 2017

Blog 23 Nov 2017 Happy Thanksgiving

Our story begins 1 week ago on Thur Nov 16.   Olen, Christian (the new surgeon from Argentina) and myself had done rounds on in-patients and were doing surgery and consults.   Danae is back in USA preparing for Ob-Gyn oral boards that will be Jana 8.   Dolores is calling Olen say that the pet cat named Lucy was acting crazy and would not let anyone through the door of the house.   Lucy had scratched Lyol pretty badly that morning and could hardly get rid of her but she sometimes was a bit mean.   Then in the afternoon Lucy unprovoked bit and scratched Addison on her ear and neck and back while Addison was on her bicycle.   Dolores thought the cat was acting like rabies and had the kids stay away and climb trees and so Olen answered the call and came over and put the cat in a back room where she could not get out and all were told not to open the door.   Lucy was pregnant and had kittens Sat Nov 18 but she would not even clean them or pay any attention to them and maybe killed one of the four kittens.   Lucy would try to drink water but could not and her condition was deteriorating and not acting her old self.  By Sunday she was very weak and died Sun night.   Olen was on the phone texting and calling all evening until midnight trying to find rabies immunoglobuin.   Could find rabies vaccine but no immunoglobulin.   A friend, Ndilbe, in Cameroon said that a doctor there had told him that he could get the immunoglobulin at 0500 Mon and could get it to us in Bangor by 1000.   The doctor never showed up then Ndilbe tried many pharmacies and hospitals but ones that said they had it would turn out to be only rabies vaccine.   I drove the car with Olen, Lyol, and Addison leaving Bere 0600 and arriving Bangor at 1000.   We waited there 4 hours and started towards NDJ.    Olen was on the phone constantly all the time.   The evacuation insurance wanted to send them to Nairobi, Kenya but Olen found out they were going to use "alternative" treatment not the immunoglobulin so turned that down.   Remember that rabies is 100% fatal once you have symptoms and rabies immunoglobulin is the only treatment that is nearly 100% effective.   However the rabies immunoglobulin is $3500 per person if you can find it.  The SOS insurance found one dose in NDJ for $3500.   Also found that the US Embassy had a vial or two of rabies immunoglobulin but they were refusing to let anyone have any as it was "against their protocol".   IT was to be only for embassy personnel.   They were repeatedly begged to let enough go for a 4 yr American girl that had been bit by a rabid cat on her ear and neck and back and arms.   A friend, Josh Knowles, in Kenya found some of the real thing and Danae was about to spend many thousands of dollars to get a private jet to fly Josh and the meds to NDJ. Danae and Olen were in constant communication .   A doctor friend in Niger had 2 vials and told the embassy that he would overnight it to them if they would let us have it now.   Olen finally about 1600 got on his ER Facebook which has about 14000 ER physicians on it and posted about the situation.   Immediately various things began to happen.   One worked in the State Dept and some called the CDC (communicable disease center in Atlanta, USA).   Many began calling the embassy in NDJ and many were calling their senators and representatives about the situation and even called Fox news and CNN I am told saying how bad it would look if a 4 yr American girls would die from rabies when they had refused to give her the treatment that was needed.  The embassy was deluged with phone calls and within one hour the embassy told the SOS insurance people to come  get the vial of medicine and when Olen received the message he let out a big hurray and AMEN as we were still on the road to NDJ.   We arrived there after 2000.   The embassy gave (no charge) the vial (enough for all the kids).   Lyol and Addison got their immunoglobulin about 2100 Mon Nov 20  THANKS FOR A LOT OF ANSWERED PRAYERS.   Team mission let us stay thee and even gave us supper at 2200 and no charge for the night's room.   Tues Nov 21 we drove back to Bere after getting some supplies leaving NDJ about 1230 and arriving Bere about 2230.   Much of the main highway is so rough with potholes that 5-10 mph is top speed over part of it.   Actually the dirt ox cart roads are better a lot of the time.   Tues night Zane and Juniper got their rabies immunoglobulin.   They had gotten their first vaccine Mon night from some vaccine obtained from a neighboring hospital.   Most of Africa has no rabies immunoglobulin.   The only treatment available for most people would be rabies vaccine.   Of course part of the reason is the very high cost of rabies immunoglobulin.   
Thanksgiving is an American holiday but we are having a happy thanksgiving even if we did work most of the day.   Praise God from whom all blessings flow.   God shut the various doors so that finally we got the required meds given to us without having to pay many thousands of dollars.  
Again thank you for your support in various ways and prayers
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

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