Wednesday, November 23, 2016

It is holiday time back in USA with Thanksgiving tomorrow and Christmas in a month but it does not feel like holiday time here.   It is about 100F in the daytime and dry and dusty although we had a 0.3 inch shower a few days ago which it is not supposed to do in dry season so for a few days humidity is high.   We are going to have a Thanksgiving meal about 1500 tomorrow with several local people invited.  
Danae and Juniper are back here now as is Zach Gately.   They all seem to be in good health.  Danae still cannot see part of visual field right eye in bright light but otherwise ok.   She did surgery today with no problems.  The problem affects only the cones of the lateral part of her right eye.    All the big specialists and tests in the University of Maryland in the US did not find a cause or treatment "possibly a virus".  Anyway we are glad it was not a tumor or aneurysm or anything real serious.   Not enough problem for disability.  Ha!!
Last week we had a ruptured spleen from a moto accident that we did a spleenectomy on but now is doing well in fact eating and drinking and walking on 2nd post op day.   He lost a lot of blood.  The man with two gun shot wounds through his left chest now has a severe infection draining lots of purulence but I think he will survive.   Today Danae and I had a hysterectomy also a myomectomy (taking out large fibroids from her uterus so hopefully she can have a baby being she has not had one).  We also had another mastectomy for cancer last week.   Today we had a child with severe respiratory problems with wheezing etc. that would not respond to steroids, ceftriaxone, magnesium, albuterol, oxygen, ketamine, IV fluids, etc.  Don't know if she will survive but appears doubtful.
  
Have a happy Thanksgiving and don't watch too much football or spend too much on "black Friday".   We do have a lot to be thankful for. 
 
Our emails are  drbland42@gmail.com and  dfbland01@gmailcom.  
Continue to remember us in your prayers.

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

Friday, November 11, 2016

9 Nov 2016
Danae and Juniper left early Sunday on a bus to  NDJ to catch a flight to DC, USA because Danae noticed a medial visual field defect in bight light Sat in her right eye.  
Olen and I did not detect anything unusual in her fundiscopic exam but it was non-dilated exam.   They arrived in DC early yesterday Tuesday morning and appointment to get MRI of head.  She is to get results today Wednesday and see a neuro ophthamologist today(Thursday).   Meantime Juniper is sick and was admitted to the hospital with fever,  possible malaria  They are at the University of Maryland hospitals  (later: MRI is normal, no evidence of MS or tumors)
Since Sat night we have had lots of Gyn cases here.  I have done 2 ectopic pregnancies, 2 c-sections (one for ruptured uterus and completely open bladder and one for transverse lie), 4 curettages (one for one of the largest molar pregnancies with over 4 liters of material), 2 for incomplete abortios, one for retained placental fragments ).  
The for 3 day post partum superior artery part of intestine volvulus that was necrotic and was resected is not doing well.  
Recently we had a man with left chest gunshot entrance and exit wounds x2 (somehow missed his heart) with pneumothorax and lots of subcutaneous emphysema (air under skin)   A chest tube was placed and he is doing well.  He was shot by police when he was "in a fight with someone".  
We recently had an AKA amputation above knee on lady that had just had bare bone below her knee.   She had gotten her leg caught in a belt on a power thrasher a few months ago and had been in another hospital.   Also recently had a ruptured gall bladder that had a very thin wall but necrotic part of wall that at first thought was from a perforated gastric ulcer but could find none and patient did well post cholecystectomy.  We did have a perforated gastric ulcer yesterday.  We have an ileiopsoas abcess to drain. 

Today we saw a boy with a hernia from a bicycle handle bar jabbing him in the abdomen.   
We have had a lot of abcesses lately in various places including neck, chest, thigh, labia, leg, arm, etc.  One boy died today with abcess of arm and thigh that began bleeding various places apparently septic in spite of antibiotics.
   
Dolores has had pain in her right knee that extends into her thigh and inner lower leg almost the whole time since we have been back here.   It gets better with rest and less pain if standing.  It seems muscular but sometimes it seems to be joint.   Is taking ibuprofen and paracetamol to rest.
Today our computer system has totally quit.  Olen has tried different things but no avail.  Zachary Jensen maybe can help via phone as he helped install it and to fix problems before.   He is 9 time zones away.
Today is a bad day with computer system failure, Juniper and Danae not well and long way distant, and Trump elected president of USA.  He seems to me to be the most vulgar, anti-religous freedom, bellicost, isolationist, anti-minority, non loyal to international friends, etc. man ever to be in that position.  
The "last day movements will be rapid ones" 
 
Our emails are drbland42@gmail.com  and  dfbland01@gmail.com
Continue to remember us in your prayers.

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

Wednesday, October 26, 2016

Blog 23 Oct 2016

We have been back in Chad over 2 weeks and have been busy although not sure what has been accomplished some times.   Our hospital census has been 80-90 esp this past week.  The government employees have not been paid all their salaries so post office, hospital and health care, courts and various government offices are on strike.   Of course the military is getting paid so they are not on strike and there are still many military check points.  Some of our increased census from that and some from this time of year when they are harvesting their crops and have a little more money to spend.   Some of you saw some of our pictures from Europe on Facebook that Dolores posted.  
It has not rained more than a few drops this month and we don't expect any until next May.  It has been in the 90's most days and 80's at night.   The rice crop does not look very good as rainy season was not as much as usual.   Everything is drying up rapidly.  
A few days ago we had a lady with acute abdomen 3 days post partum and resembled a ruptured uterus but when we opened, the entire intestine appeared dead at first but more exam revealed that it was a volvulus (twisted bowel so no circulation) involving the entire superior mesenteric pedicle.   We took out the dead intestine and reconnected the jejunum to the terminal ilium (upper intestine to the lower part).   So far she is doing well but not sure what will happen with the "short bowel syndrome".   We had a 10 yr girl with 3 typhoid perforations and abdomen full of bowel contents.   We repaired and irrigated a lot and so far it appears that she will live.   We have had some bladder stones one that was 6-7 cm (about 2.5 inches) diameter.  We took out a prostate that was same size as my fist and so far doing ok.   We did a BKA (below knee amputation) on an old man that previously had a partial foot amputation but now foot all dead.   He has given up and refuses to eat or drink.   We have had a ruptured uterus recently.   Danae and I did a vesico vaginal fistula (hole from bladder to vagina) repair that was quite challenging.   We always do those together.  
The brakes went out on our Toyota pickup Sab while I was driving back from branch Sab School.  Today I took it apart and found that the wheel cylinder and caliper are bad.  The sandy much and water really does a number on vehicles.  IT only has 45000 km (about 28000 miles)   I need to check all the other wheels also.  
We have two family practice doctors here from Juneau, Alaska for this week.   They were in Moundou last week.  One of them had been here before.  
Our emails are drbland42@gmail.com and dfbland01@gmail.com  
My yahoo account got messed up and can no longer access it.  
Rollin and  Dolores Bland 
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile,  Chad,  Afrique
Blog  www.weareamissionarybland.blogspot.com

Sunday, October 9, 2016

Arrive

We have arrived in Bere. The rainy season is about over and the roads are drying up although we did have one water hole in the road that the water went over the hood of the pickup. 

It is 95 today. It probably got down to 90 last night in NDJamena. We left Jay Monday afternoon and drove to OKC and stayed at Janelle's place; then Bob Schaefer took us to the airport in OKC Tues. We arrived in WDC 9:00 pm stayed in Holiday Inn and left Wed on Ethiopian Airlines arriving in NDJamena via Addis Ababa Thur noon. We stayed overnight in NDJ after changing some money to cfa (francs) and doing some shopping.  We took the bus today Friday Oct 7 to Kelo where Olen met us, and brought us to Bere.   

The trip was unremarkable other than TSA (probably the one in WDC) went through at least two of our suitcases spilling nuts out of a double bagged sack etc all through the clothes and did'nt close the duffle bag properly. Not sure if much is missing but seems like most things are present. Of course we had to pay for extra baggage (two each allowed for international) $200 each for two plus $200 for the extra 16 lbs that one was overweight. 

We are in good health and Olen and Danae and kids are ok now also.  All government employees except the military are on strike so schools and hospitals etc are closed except non-government ones. The strike is because the government has not paid them and says there is not enough money. Don't know how long that will last. Could get interesting.  

They say the rains were late coming so the rice crop is spotty. Some fields look ok and some not. 

They say the problems with the "prefet" are being resolved. He has irritated enough people including his superiors so maybe they will get rid of him or transfer him somewhere else. 

Please note that my email has changed to: drbland42@gmail.com  
Thanks for your prayers
Rollin and Dolores Bland
Hôpital Adventiste de Bere
52 Boîte Postale
Kelo, Chad, Africa

Monday, July 25, 2016

The life of a foreign missionary is often glorified in various stories and problems are not mentioned. Yes there are rewards sometimes but sometimes one does not see results that are good. Sometimes it just seems like "work". We see lots of interesting pathology in the medical work but after 100's of hernias and hydroceles, etc it becomes a blur. A "missionary" in a foreign country has to be adaptable, flexible, patient, and know why you are there. 

One has to deal with thieves that were people you had trusted. It seems that some think that foreigners are made out of money. Loans often become gifts because they usually are not repaid. Some steal from school accounts as parents pay for their kids school. Some try to take bribes from patients at the hospital. Often in the government hospitals patients have to pay extra to the nurses and lab people to get the care that is already paid for and we try to prevent that here. Since we computerized the med ordering here we think it has decreased some of the bribery and stealing. It seems crazy that they can sue you for lots of money after they were fired for stealing lots of money or not doing their work. 


One has to make do with equipment that does not operate properly. Many of the surgical instruments don't clamp or hold as they should. Many drapes have holes that we try to match with other drapes with holes in different places. The good drapes tend to develope legs. The autoclave sometimes will burn the cloth wrappings. The electric autoclave takes so much power to use so is not hooked up yet. One has to be inventive at times to get things done with equipment that was supposed to be for something else. We do have an operating room light now whereas initially we had to use a head light which gets very hot and uncomfortable. There is no public power so one has to hope that the generator keeps working but sometimes it does not. If no electricity then no water as the water pump is electric. It is difficult to get parts for generators and other things. Sometimes people send stuff that didn't work properly for them so "donate it to Jesus". "Junk for Jesus" which unfortunately costs good money to get shipped here. Our gloves often have seen too much heat or something on the way to Chad and tear easily or stick together or were defective manufacturing. Almost everything comes from China or France. 

Communication is a problem although now we do have some semblance of phone and internet service part of the time, but very slow. Some places in the cities have good phone and internet but not good here in the rural area. Not able to get on most web sites and not able todownload pictures unless they have been downsized a lot. Not being able to communicate with the many different languages here is a problem but I have not even learned well the official language French either, so I am handicapped.

Then there are the various diseases that you don't have to think about back home. Of course malaria is the big one in the tropics and can be fatal if not taken care of properly. Typhoid is common but there is vaccine for it but it is not 100% effective. Most of the locals have not had the vaccine. There are many different parasites and bacteria that can give diarrhea or many other problems. One has to take these awful tasting meds every so often for the various problems. HIV is very common so if one gets a needle stick may need to take the HIV meds for awhile which make you feel bad. 

Transportation can be a problem as there are almost no roads that have ever ever been graded here in Chad and central Africa. There are just ox cart trails and if there is much traffic the water holes in the trails get pretty deep especially in rainy season. Often in rainy season one cannot go on the "roads". The "moto" (motorcycle) is probably the most dependable to in some places other than ox cart especially in rainy season. Large trucks can go only in dry season. 

Getting meds is a problem much of the time. In Chad the government mandates that all meds come through the central government pharmacy which often does not have sufficient in stock and lots of meds not available at all. We are not permitted to import our own. Also the government mandates that all medicines that are past date or even short dated be thrown away which is crazy. Even though lots of studies including the US military show that most medicines are good for years past their dates. Lots of perfectly good meds have been dumped but they come around inspecting to see if you have any expired meds. There are very few blood pressure or diabetes meds even available. I've even heard that in some other countries perfectly good donated food was dumped because it "might be contaminated with GMO food" instead of giving it to people to keep them from starving to death. Ignorance kills so many people. 

Nursing is not what you would expect. They often or usually sleep on the job esp at nights. There is almost no communication between shifts. Hopefully, meds will be given the same day as ordered but often is not.  Knowledge is very basic or minimal. When a patient leaves the OR they are almost on their own but usually have relatives to help care for them. Basic math is lacking in many staff. 

But in spite of the problems it still is a great and challenging life and helps to develope your character . The Lord does truly take care of us through various problems. The Lord is good. 

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

July 17, 2016

It has been relatively quiet this past week. Although two of the volunteers were detained and had to pay 3000 cfa "fine" for riding as 2nd passenger on a moto. They had walked almost to the market then was offered a ride then was stopped at the market. Later Olen was talking to the commissair (head of he area police) and found out that the ones who collected the "fine" did not have authority to do so. The commissair was going to "talk to the prefet about it" Haven't heard any more. Incidentally the "prefet" is still around so the rumor that he was sacked was not true.

We had a man come in with a partial obstruction intestine with history of previous surgery elsewhere for a "cancer of the cecum". Not sure what surgery was done. Did not find any evidence of cancer anywhere even though he had been told it was in his liver and kidney also. But now he was obstructed at the cecum and had lots of adhesions. Probably was appendecitis and now was scarred down. We took out his cecum and terminal ilium short amount and reconnected his ilium to his ascending colon. He is doing well post operative. The other man with strangulated hernia and dead intestine that we had to remove is doing well. A man with a neck abcess that was actually improving just gave up and refused to eat and drink even with IV fluids and finally died. We had a thyroidectomy and some hernias and prostatectomies that are all doing ok. We had another 1.7 inches (about 42 mm) 2 days ago so over 3.3 inches this past week.

Dolores has an eye infection that has been painful but hopefully is improving. Addison and Juniper had some sort of eye irritation also.
Our emails are drbland@sbcglobal.net 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
July 25, 2016

Monday the 18th we had a strangulated inguinal hernia (did not require intestine resection) and also had strangulated internal hernia that had dead intestine that had to be removed. Also had a sigmoid colon volvulus (colon twists on itself and shuts itself off) All that was besides a scheduled hernia repair. This past week we also had a parotid mass that was mushy and very vascular and we did not get it all out as too involved with other structures and probably was a cancer. We had done her thyroidectomy previous that was possibly malignant and she had done well with that. In general the hospital has been slow except Pediatrics but even that is not as much as some previous years. We have a Pediatrician from Brazil that is taking care of Pediatrics for the next 2 months. We have a couple (Eddie and Carolina Perry) here this past week that want to start a clinic in the Congo. She is finishing a FP residence with some tropical medicine and he is doing ER work. They hope to go in the next year or so. 

Our computor system has quit working so have had to go back to the writing out things on paper. Olen has spent lots of time with it and texting Zachri Jensen in Washington to try to get it going again. The computer that was using for server does not seem to cooperate. I am computer challenged so am no help.

Our generators all seem to be in good working order now. Had problems with a frequency sensor that was not adjusted right also a fuel filter problem but all seems ok now.
Everything is pretty and green now. Dolores' eye infection is much improved. 

Putin recently signed into law that no Christian Bible studies were to be allowed even in homes. The window of opportunity for Russia is almost closed. The USA recently passed laws that will make it difficult for Christian schools and institutions to operate. Many of the Moslem countries have laws against Christianity and so difficult to tell the story of Jesus. We hear various ones talking about possible world financial collapse. The end surely must be near. What are you doing to let people know about the soon coming of Jesus? "Even so come Lord Jesus"

We will be gone on vacation annual leave the next 2 months leaving July 29.
Our emails are drbland@sbcglobal.net 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