Tuesday, May 15, 2012

14 May 2012 Showers of blessings

Praises for some cool days and nights.  Maybe rainy season has begun.  We have had two real soaker rains this past week and it is much cooler.  This morning Dolores thought she needed a blanket because she was “cold”.  The temperature was 78.  At least now we are not wetting the bed with sweat.  The generator and invertors seem to like the cooler temps and are functioning better now.   
Zane is better now and has been afebrile past two days.  He is being treated with Flagyl for Giardia    Hopefully he will continue to do well.  Olen and Danae have also been taking meds for Giardia.   
Apparently our container with our goods has finally been shipped from Houston.  I’m still not sure what is happening about the battery situation.  I don’t think they were put in our container.  
I did a mastectomy today on a lady but did not get all the tumor but at least it was debulked and cleaned up where there had been fly larvae.  I have an amputation tomorrow of a leg with a tumor involving bone and has fly larvae in it.  Yesterday we had a ruptured appendix (doing well today) and a ruptured uterus with much loss of blood and baby floating in the abdomen  We did a Cesarian and hysterectomy on her.  She is still alive at least for the present.  Also we had a knife stabbing in the abdomen and testicle that came in with omentum coming out the abdominal wound and much clots around the testicle and much dirt and sand all over.  We explored his abdomen and apparently had no other injuries.     Last week we did a AKA (above knee amputation) on an old man with necrotic infected tumor of leg and he his feeling much better now.  We had another boy with an injury to abdomen by a cow horn but fortunately did not damage anything major.  Also had another little boy age 2 with a bladder stone size of hen egg.  Bladder stones are fairly common probably related to Schistosomiasis and chronic dehydration especially in the heat.    
What are complications of C-sections?  I have seen several and heard of a few others around since I have been here such as vesico-vaginal fistula,  high recto-vaginal fistula. Vesico-uterine fistula, even a vesico-uterine fistula with a pregnancy placenta in uterus and baby in bladder that died in bladder, ureter involvement in various ways, various sorts of infections, severe blood loss, evisceration because of not closing abdomen well, etc.   When surgeries are done by people with minimal training even in basic anatomy in some of these places with just a nurse or minimally trained “doctor” it is still better than dying.    

Of course there are the complications of ignorance.  People that refuse to do certain things even after it has been explained to them such as a lady past week that had a crushed index finger that had been crushed 2 weeks before and was severely infected and needed amputation but she refused.  The big problem is that people that come in to have things done until it is too late such as tumors or malaria or other things.  Most acute appendicites are ruptured before they come in or they have a large appendiceal abcess.  The knife stabbing wasn’t until the next day.  Sometimes there is the frustration of dealing with nurses that have little knowledge or are wanting to care for patients properly.  The “Oh well” attitude is too common when some medicine is not given as it should be.  Sometimes the patient has not bought the medicine which they have to do before the nurse will give it.  Sometimes the nurse has not signed that she has or has not given a certain med or given a reason for such.  So rounds is not just checking the patient but checking to see if the patient has bought their meds and if the nurse has given it or not and if the paper is done properly etc.  There is also the problem of thievery and bribery.  I’m glad that Olen has good knowledge of French so can deal with the politics and administration issues, firings, hirings, etc.  I’m very proud to be his father-in-law as he does such a great job.  Danae gets quite frustrated with some of the nursing issues at times.  One has to remember that many people are not that far removed from “dark ages ignorance” but some of our staff are very good and compassionate and want to help people all that they can.  It is hard to get some to plan ahead and order meds and supplies on time etc.  Currently we are short on suture esp. 0 Chromic and Vicryl and similar things and we have almost no antihypertensive meds.  What do you do for preeclampsia and eclampsia if you don’t have anything to treat them with but we do have some magnesium at least. Then there is my ignorance of the French language and maybe my slowness to catch on to some of the cultural things.  I have learned some but I seem pretty slow after all we have been here 3 months and should know more than we do.  

The pomegranites and figs that Danae brought back from Janelle’s are putting out shoots and looking like they will survive.  I have planted papaya seeds and currently have 24 transplanted to their places where I hope they will grow well around the edge of Danae’s yard.  We also have about 20 mango seeds (from large mangoes) germinated and starting to grow.  Not sure where we will plant them yet as some fences or walls are not built yet.
With the first rains the ants do their flying and come to lights etc and get in the house etc.   The farmers are getting out and working their ground by hand of course and planting peanuts and guinea corn and beans and will plant their rice later when it gets wetter.
Our email is:  drbland@sbcglobal.net and dfbland@gmail.com      
Your emails are more than welcome.  Our address is:  Hopital Adventiste de Bere,  Boite Postale 52, Kelo, Tchad, Afrique.  For snail mail or care packages which take about 3 weeks to get here.   

Also linked to Olen and Danae’s at   www.missionarydoctors.blogspot.com    
Love,   Rollin and Dolores

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