Same old thing 22 July 12

     Some times you get used to certain things so that they seem like the same old things monotonous or ho hum but then you may miss things that are interesting to others.  Sometimes you think things are understood but maybe they are not. The diet may be rice and beans and sometimes beans and rice but in actuality Dolores does a great job of putting variety in the diet.  We had lots of mangoes for a while which the season is now gone but guavas are coming on now and tomatoes beginning to come to market.  Occasionally we get a coconut, papaya, banana, okra, some greens such as spinach or lettuce, or avocado so we are not starving even though we have lost weight which we sort of needed to lose. We are healthy with a little less fat. We had no refrigerator past month or so but we managed to purchase one about size or one in our camper this past week.        Before we had to be sure we ate everything as soon as it was cooked because it would spoil in this warm humid weather but now we can keep some fruit or tomatoes or bread for a few days.
     It rains frequently but that provides some beautiful clouds for photography and one day even a rainbow.  What was brown everywhere is now green and the grass thatch houses look sort of pretty with the greenery and clouds and occ dark clouds for background which make it very beautiful. Yes, I do occasionally get out and take a few pictures which I wish I could share but maybe when we come home on annual leave which probably will be next June and July. Our oldest grand daughter, Rachel, will be in Ubon, Thailand this coming school year.  We hope to be able to visit there as we come home and maybe do a little sight seeing such as Angkor Wat, Cambodia or maybe see the Great Wall and the Forbidden city of China. We don’t know yet. Ubon is close to the border of Laos.  Maybe next year we will miss out on some of the mud and heavy rains here.  Apparently the western US would like to have some heavy rains.  Maybe it is too late for the corn and soybeans already. 
They raise lots of peanuts here in this sandy soil so we eat lots of peanut butter which is not very expensive.  
     We try to do everything with nothing it seems sometimes. How do you take care of preecclampsia or ecclampsia with only diazepam, nifedapine, atenolol. They may need rapid delivery but the nifedapine for decreasing blood pressure may also cause uterine atony. Danae is a great Ob-Gyn. Patients may not get their meds because they didn’t buy them, or the nurses did not give them, or maybe the “pharmacie” was out and no one told you so one has to check these things besides seeing if the patient is getting better or worse when one makes rounds. Our usual Friday eve or weekend urgent surgery was Fri  eve with perforated intestine probably from typhoid. We had to repair the hole. We also had a case of Gangrene, probably Clostridium of the neck with gas in tissue and terrific foul odor with small amount of purulence and clots when we opened the neck. Thankfully both are looking better today ( Sunday).  A lot of our instruments do not function very well especially scissors.  If anyone ever says in the OR that some instrument is not working as it should so “give it to Jesus and send it to Africa” please knock them out.  Actually we need better instruments because we are not as “expert” and work under worse conditions.  How do you take care of a diabetic ketoacidosis with almost no lab and minimal medicine.  Perhaps some insulin that is not consistant because it has been kept cool and some glyburide only. (Olen does a great job taking care of such things and the peds).  Or various ones that need antibiotics or blood pressure meds but say “I don’t have any money to buy food or meds”. There are lots of various abcesses anywhere from top of head to toes and at any age.  Pediatrics is very busy now with mostly malaria and lots of malnutrition.  Sometimes there are as many as 10-12 admits of little ones per day. Our peds ward is not big enough (only 30 beds).
     Sometimes 2-3 die in a day as some get there and die before meds have time to help and of course sometimes we don’t know the problem.  We had an intussusseption and perforation (apparently from typhoid) in the same patient (a little 8 year old girl) and had to resect a portion of small intestine about 2 weeks ago.  She did well and has gone home.  A few days ago we had a necrosed (dead) testicle apparently torsion (twisted and shut off blood supply) and he had a small hernia also on the same side. 
     Sometimes one thinks that the patient or nurse have understood what you have instructed and they have not or have chosen to ignore so that what was clear to you did not get done. I still have some language barrier also although it is improving a little. The language problem is not just my lack of French but many that don’t know French and speak only Arabic or one of several local languages.  All hospital employees speak at least 2 or 3 languages and some know many more.  Sometimes I think I am linguisticly stupid. 
     Zane had a fever 1 day so he has been started on quinine and seems to be doing ok.  Some have caught colds in these “cold” nights when it is down to below 75.  We are all in relatively good health.

Our emails are  drbland@sbcglobal.net and dfbland@gmail.net
Our address is: Hopital Adventiste de Bere, 52 Boite Postale, Kelo, Tchad, Afrique
Love, Rollin and Dolores

Rocks in the head, 6 July, 2012

Some people have “rocks in the head” but how about a real rock in the head.  A little boy was brought in yesterday that had put a rock in his ear and someone else had tried to get it out so it was wedged down as deep as it could get.  We gave him some Ketamine (something to make him sleep for awhile) and tried various things to try to get it out but were unsuccessful. We told them to bring him back tomorrow and we would try again. We gave Ketamine again today. Samedi tried for awhile. He had found another metal instrument, a probe that might help. Danae also tried. Olen was in N’Djamena.  By now we were sure that the ear had been severely damaged but we still need to get the rock out. I said that I would try one more time before we gave up. I cut in the canal, (probably a no no) and tried some more with a little thumb forceps. The rock moved a little! then I twisted it around a little and voila it finally came up and out.  We put it in a little bottle and gave it to the father who was very grateful.  We packed the ear with iodoform gauze and gave the boy antibiotic and hope he doesn’t get severe infection in his head.    


Today is also a “crappy” Friday. The main toilets or latrines for the hospital caved in about 4:00 a.m. today. It appeared that they had not been built very strong and now the walls caved in and the floor all broke apart and the roof fell to one side. It has been enough of a problem anyway to get people to use the latrines instead of just doing it in the hospital yard in the grass or somewhere besides in the latrines. There is still another set of latrines by the Tb ward that they can use. The employees have a different toilet to go to that has water. Most people here don’t have any concept of how to use a flush toilet.

We have also had problems with our electricity. The fuel line to one generator somehow got severed and drained the tank dry. I put the line back together and filled the tanks with fuel but then the battery to start the generator was dead after I had bled the lines etc. The other generator has a “reverse power” signal that shuts off the generator and so far we have not found what is causing it.  It is not consistent as it works ok at times.  (Sunday  Gary Roberts brought over a battery for the Cat generator and it starts and runs ok now)

We have a little girl that had a “limb fall on her head” and has been unconscious or partly conscious for the past two weeks. We “observed” her for several days then decided to drain the “hematoma” on the top of her head as it seemed that she had a depressed skull fracture also. With almost no anesthesia we shaved her head and opened the area involved. When we opened it there was some bloody fluid and brain material that came out. The stellate fracture was minimally depressed. We irrigated and put in a drain which has drained clear serosanguinous fluid since but minimally yesterday so removed the drain.  Prognosis is grim for her.  She has been able to swallow a little liquid. 

It is malaria season now with all the rain.  There are lots of sick kids especially and often they are brought in just before they die. Sometimes 3 or 4 may die in one night.  Hey this is a hospital where we are supposed to save people but...  


How do you treat diabetic ketoacidosis with no lab and minimal meds. Sometimes the insulin works and sometimes it seems it has been in the heat too long. We have no metformin and only glipizide to treat with. Fortunately there are not very many diabetics (probably most have died off).  We also have problems with hypertension but have only propranolol and nifedipine to try to control the blood pressure. It seems that the most common hypertension is preeclampsia or ecclampsia but there are some others.


It is raining a lot lately and is nice and cool, 70’s and 80’s. The roads are hardly passable much of the time. Olen and Danae finally have their car, a Toyota Forerunner diesel 4 wheel drive. It was being driven home and got stuck on the main road from Kelo to here and had to be dug out.  Perhaps it was off the side of the road somewhat but it is difficult to tell where to drive in the deep water and mud sometimes. 

Kristin, Olen’s sister, came and is to arrive here in Bere today on the little plane with Olen and Gary Roberts coming from N’Djamena where she arrived yesterday from the US. This is her first time to be in Africa

Now it is Sunday, 8 July. It rained more last evening but the clouds were dark and beautiful and made a very nice background for some pictures around Bere. It had sunlight in the foreground at least part of the time and had houses, cows, goats, guineas, etc in the foreground.  I got back to the house about the time it began to rain.  Today there are nice puffy clouds. We had our usual week end, c-section yesterday afternoon. It seems there are more on Saturday than other days. 

We will miss going to Oklahoma Adventist campmeeting this year as it begins next week end. It was always such a great place to meet old friends as well as great spiritual meetings. 

Love,  Rollin and Dolores
Emails:  drbland@sbcglobal.net and dfbland@gmail.com 
Mail:  Hopital Adventiste de Bere, 52 Boite Postale, Kelo, Tchad, Afrique

Happy Birthday Zane, written on July 1

     Zane was one year old June 25 and is taking more steps.  Of course we all had a party for him. It makes a good excuse to get together and have cake or something. He is growing and doing well. Thanks for all the prayers for him when he was ill and no one could figure out was wrong.
     The birthday of our country is here also. In spite of the fact that we are losing many of our freedoms we still have a fantastic country that is beautiful and has helped many others in the world.  I’m still proud to be an American in spite of its defects.  We still care. So many countries have a government that is so corrupt that the common people do not receive much if any of the country’s help.  Many still live the way they did a 1000 years ago except cell phones are much more common and some have a motorcycle or bicycle. They still plow by oxen and live in mud brick houses with grass thatch roof. Here in Chad there is almost a 50% mortality of children before age 5. Malnourishment partly from ignorance and partly from lack of means is common.  Malaria takes many. There is a cultural thing about not giving babies anything but water for a few days and that somehow colostrum is bad because it does not look like regular milk.  All rice diet does not help either.
     One baby was born by C-section one week ago at 27 weeks wt 1.3 kg because of placenta previa and abruptio. We thought the baby would die very soon as he had quite a bit of retraction and no suck reflex but amazingly he did not die.  So they began feeding him with an NG tube q 2 hrs and had warm water bottles to keep him warm in a little box.  Apparently he did not get all his feedings etc yesterday and he died this morning.  One of the problems we have is that nursing is not what we would like to have.  Actually we were surprised that he lived as long as he did with no NICU, no oxygen, no fancy formulas, and minimal nursing.  He was actually appearing to have a chance at surviving before yesterday.
     Everything is not bigger in Texas. This past week we took out a bladder stone that was about 7 cm diameter and weighed over a pound.  We also had a huge extraperitoneal abcess that was making her abdomen appear about 20 wks pregnant but when we cut into the abdomen we found purulence around the rectus muscles and down into her pelvis that apparently did not go inside her abdomen.  We took out about a liter of purulence from down in her sacral area. She was eating and drinking fine with only “some constipation.” I never saw one like it before. It seems lately the main thing we have had surgically has been abcesses of various sorts.  Also a week ago we had a huge huge brachial cleft cyst that we took out with the aid of endotracheal anesthesia  from a visisting nurse anesthetist and Dr. James Appel from down at Mondou. She has done well and now gone home. The bladder stone man did well and has gone home; but the huge abcess lady is still here and draining some. Overall the surgeries are less now than earlier but the peds and med wards are almost full with lots of malaria etc.  There are a lot more mosquitoes now that rainy season is here and therefore more pools of stagnant water.
     I was to help Dr. Appel with hip Friday down in Mondou.  It was a “dislocation” of 6 months but a preop xray showed that the acetabulum was basically gone with the rim knocked off and the head of femur malformed also. The man was able to walk with a cane and do his prayer kneelings, ie he could flex his hip which he said was very important to him. A total joint was not available in this country. We could perhaps have done a fusion but then he would not be able to flex his hip for his prayers so I was in Mondou without any case to help on but that was ok. I was glad that Gary Roberts decided that he needed to go to Mondou in his plane so I got a ride in it instead of having to take the motorcycle taxi through the mudholes to Kelo, then a bus to Mondou. I was supposed to drive Olen’s car back but the paper work still was not finished and the tags were not on it yet.
     Our oldest granddaughter, Rachel, is going to spend this coming year in eastern Thialand. She is leaving this month. She is to be a student missionary teaching English there.  We are hoping to be able to go by there perhaps on our annual leave on the way to or from home. 
     We are so proud of our doctor daughter and doctor son-in-law.  They are great to work with, really have that missionary spirit, and are fantastic doctors! They can do anything to get money well almost.  A little boy was brought in that had swallowed a coin two months before and an old x-ray taken 2 months ago was with him that showed the coin in the upper chest either esophagus or trachea.  It was flat view so probably esophagus and he was breathing ok except this week he was having some cough.  We had no recent xray and our film was 8 yrs old and not working even though we have an x-ray machine.  Olen had remembered reading about getting something out of the esophagus with a foley catheter and asked what I thought.  Let’s try! nothing to lose.  So Jana, ped’s nurse put down the 8Fr foley through the nose and into the esophagus. Then the 3cc bulb was inflated and the catheter was pulled up.  It had very severe resistance at the upper esophagus. Olen was looking ith laryngoscope and saw the edge of the coin popping up and grasped with a long forceps removing the coin.  The father of the child was very amazed as was everybody else that heard about it. You can read a more detailed description on their blog:   www.missionarydoctors.blogspot.com .    


Our address is:  Rollin and Dolores Bland, Hopital Adventiste de Bere, 52 Boite Postale, Kelo, Chad, Afrique.    Our emails are:  drbland@sbcglobal.net  and  dfbland@gmail.com .  We try to answer everyone that writes us at least by email.

Love,  Rollin and Dolores

Taking life easy on my birthday

Yummy ball cakes

With brother Lyol and friend Cherise

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