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  

Wednesday, August 30, 2017

Blog Aug 29, 2017

It has been an interesting week or so but also sad.   Danae, Addison, and Juniper arrived back here in Bere after we drove through the mud and water holes down the "road" to Kelo to pick them up from the bus.  Glad they are back.  Olen, Lyol, and Zane are not coming back until Sept 23.  They are staying with Kermit (Olen's dad) since RonnieLee (Olen's mom) passed away after her long battle with cancer.   All the family had gotten there in time to see her before she passed.   She was always so energetic and outgoing (life of the party) and will be greatly missed by everyone.  
The next night after they got back I was up about all night with a "maternity patient" they said was greatly distended perhaps an ectopic pregnancy.   When we opened her abdomen discovered strangulated internal hernia with dead sigmoid colon loop and dead 1 meter of terminal end of her small intestine.   Her other intestines were greatly dilated.  Resected the dead colon and reconnected and resected the dead small intestine and reconnected it.   We don't have fancy staplers so everything is sutured by hand somewhat tedious.  She aborted today which was expected.   Intestines still slow to function.   
The lady that we resected her dead 5th finger and metacarpal and stretched out her contracture claw hand about 2 weeks ago is doing well with no infection and with some physical therapy (I have to do it and teach her) I believe is going to be able to have a useful right hand.   
Also had a perforated intestine probable typhoid that had been several days so the abdomen was filled with dirty fluid and everything all stuck together.   Was able to find and close the hole and so far she seems to be doing ok.  Was not sure if there was other obstruction or not but she is passed flatus and not vomiting now.  
Sunday Zach and some volunteers went to Moundou with the little pickup to get some supplies but were late coming back.   It was after dark and had rained another inch on top of the saturated ground and full water holes and rice fields and he could not see where the solid middle of the "road" through the water hole was and got off the side into the mud.   Ten people from a nearby village were digging and pushing for 4 hours to try to get him out but only got in deeper.  The mud was even softer once you got through the semisolid crust.   There was almost no phone signal service where they were but finally managed to get a text and part of a call through to Dolores cell phone.  About midnight we (Dolores, night guard, and I) went our Toyota 4-runner with winch to try to pull him out.   It had a dead battery that Zach had taken with him to Moundou to get a new battery.  I had to borrow a battery from Olen's Toyota that I had just charged up a few days before.  I had just put on new calipers and pads (that Danae had brought back) on the front  and had not finished bleeding the lines but the brakes worked somewhat anyway.   My 4-wheel drive did not seem to work but we made it about 45 min to where they were stuck.  We finally were able to get the pickup jerked out of the mud.   The 4-wheel drive does not seem to be working on the pickup or my 4-runner or Olen's.  It was rice fields to the side of the "road" so almost everything covered with water.   We got back to Bere after 0100 by being very careful.   
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  

Sunday, August 20, 2017

Blog Aug 17, 2017
We have been back in Chad since Aug 3.  It is rainy season any "roads" are passable if you have 4 wheel high clearance .  We have had 6 inches (15 cm) rain this week so far on this very flat land.  It took us 11 hours to get the 350 km (about 200 miles) from NDJ to Bere over the very rough and slick mud and deep water holes.  We blew out one tire on the way.   We have since found another way that is a little bit faster.  The 42 km from here to Kelo normally takes about 2 hours if you hurry.  The government "has no money" so nothing is being done to any "roads".  We spent 13 days in France, Spain, Portugal, Andorra, and Monaco on the way back to Chad.  We had rented an RV and drove 5527km (about 3316 miles) and saw lots of interesting places including Paris, Chartres, Chateau de Chambord, Nimes (the best preserved Roman amphitheatre), Pont du Gard (well preserved longest Roman aquaduct), Josselin, Carcassone (old walled medieval city with turrets), Mont St Michel (abbey and fortress on a large rock away from shore in high tide), Dune du Pilat (the largest dune in Europe), the Normandy beaches ie. Omaha beach and museum, Giverny (home and gardins of Clalude Monet impressionist artist), Carnet (with alignment of old large stones over 200 years), etc.   The big problem was this was  "high season" meaning everyone is on vacation and on the road with much traffic everywhere.  We spent E400 (about $475) just on toll road fees and about $800 on fuel.  France is expensive although the bus and metro in Paris was not bad.
While in the USA we went to our oldest granddaughter's graduation from dental hygiene at LLU, California then visited my brother Reggie and family in Denver then to Hot Springs, S. Dak to visit Duane Smith (a friend and classmate of college, med school, and internship) that is not doing very well.   We were also at the Oklahoma campmeeting in July.  
Our hospital census is staying 50-60 since we got back with several long termers that are taking a long time to get ready to go home but Peds and Maternity have been busy.  We have had 5 c-sections this week.  We have had several still births since we got back.  We have had 2 typhoid perforation of small intestine, also a ruptured appendix with bowel leakage and 2 pelvic abcesses.  Dr. Debbie Mullins was here when we got here but left 2 days later after being here with Danae almost 2 weeks.  
Olen and Danae and kids are back in the USA as Olen's mom is expected to expire any time with cancer.  I think all the children and siblings are thee.  Is a very trying time for all of them as it has been coming on for quite a while.  We all take hope that the resurection and coming of Jesus will be soon.  Olen and Danae and kids left on the same plane that we came in on so we barely were able to say hello and good by.   They barely arrived in NDJ in time because their bus had problems and took 14 hours to get to NDJ from Bere.
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  

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