23 Aug 12

     Good news!!!  I had the CT this morning and a consultation with the urologist, Dr. Richard Herlihy, this afternoon.  I am not having the pain as before but there is still some microscopic hematuria but not grossly bloody as it was a week ago. The  CT did not show a stone!!!!  The urologist is a very busy man but made arrangements to see me almost immediately.  He also gave me some special gadgets to help dilate strictures which I’m sure we can use fairly frequently in Bere.  We got into Oklahoma City last night at 10:00 pm.  Yesterday was our wedding anniversary and we spent nearly the whole day in the air leaving N’Djamena, Chad Tues. night. We were thankful for the Adventist Medical Aviation plane and pilot Gary Roberts who was able to fly us to N”Djamena on Monday.  All the “roads” around Bere are impassable because of high water and mud.  They say it is the most rain in 40 years. The internet service has not been functional for the past week and the phones don’t work much of the time.  The last phone call from there today said the hospital census was low and little to do for patients as no one can get in or out.    
     Now that we are here we plan to stay about a month to be sure all is well and do some visitation and relaxation. I am to see Dr. Herlihy again in a week to see if the hematuria has cleared and how I feel. There are some things we need to do at home that we did not have time to take care of at all before we left in such a hurry in Jan.  No, we still have not received our container of goods from here yet but it is impossible to be delivered for at least 2 months until the rains let up and it begins to dry up somewhat. Olen and Danae plan to take their annual leave during Nov and Dec.  My French needs to improve a lot yet.  We plan to take our annual leave next June and July and go home via East through Thailand, Cambodia, and China.  Our oldest granddaughter, Rachel, is in Ubon, Thailand as a student missionary teaching English as a 2nd language.  
     Maybe I am a “slacker” but the pain was so intense and we found a way home to get it checked out.  See Danae’s blog.  Maybe this week at church I can give a talk about a moving stone versus the solid Rock and Matt 16 etc.  Moving stones can be very painful but Jesus wants to be broken on the Solid Rock and be ready to meet Him when he comes for His children.  
Our email is: drbland@sbclobal.net and dfbland@gmail.com  
Our address  is: Hopital Adventiste de Bere, 52 Boite Postale, Kelo, Chad, Afrique. 
Love,  Rollin and Dolores

DANGER 11 Aug 2012

     One of our volunteers (Minnie Pardillo from the Philipines) died last Sun a.m. from cerebral malaria and her memorial service was this afternoon.  She worked in public health and was involved in trying to help people in preventive care.  She was a very caring person yet very quiet.  She made a good impression in the area while she was here.  Several of the local people gave testimonies about what she meant to them.  A little 9-yr-boy said she loved the children like God loves.  Even the MCD who has been a problem for the hospital in the past came this afternoon to the memorial and gave a testimony about how Minnie had helped many people and that he had talked with her several times. This same MCD also had an uncle by marriage that I had operated on after he had been operated on in N’DJamena for a “strangulated hernia” and didn’t do well there.  Apparently they got the repair too tight and necrosed the cord and testicle which I removed.  He did very well and became pain free so apparently that also affected the MCD in a positive way.  I was invited over to the uncle’s brother this evening and visited with the MCD and his uncle.  Lots of children die with malaria especially in combination with malnutrition.  Some adults die also especially if they don’t begin  treatment in time. There is a movement to try to get DDT instituted to use to spray around peoples huts to kill some of the mosquitoes that carry malaria. I have mixed feelings on that.  I am aware of the envirionmental problems in America and how it affected the eagles, etc., but . . . out here it is possible it could save thousands of human lives.  I think every missionary out here has had malaria at least once and some have had it several times and have been in Chad for several years.  One has to be sure you take the treatment as soon as you realize that it could be malaria with various aches and pains and weakness and especially if there is a fever.  Being a missionary is a bed of roses with lots of thorns. There is also lots of HIV infection, so especially there is some danger from needle sticks.  Of course there are other problems.  The devil knows how to attack and try to make people discouraged or try to make discord among God’s people so we need your continued prayers that we will continue to be healthy and united in our efforts to bring the good news of salvation to the people here.  
     The “roads” are swamps and huge water holes but apparently are best negotiated on motorcycles.  It is interesting to see the motorcycles used as ambulances as they bring various ones into the hospital even unconscious persons or even convulsing ones.  We do see occ tetanus so one should always keep their tetanus vaccinations up to date to prevent that danger.  This is supposed to be cholera season although I don’t think I have seen any yet so one should always be sure all food is disinfected and have frequent hand washing  to prevent that danger.

Our oldest grand daughter Rachel Norman is in Thailand and her blog is: www.celestlamarie.wordpress.com .    And her email is: rnorman1993@yahoo.com  
Olen and Danae’s blog is:  www.missionarydoctors.blogspot.com  
Our email is: drbland@sbcglobal.net and dfbland@gmail.com and our phone is:  62674586      
Rollin and Dolores

An unusual case 6 Aug 12

A five-month-old girl was brought in with history of not being able to have bowel movement for 3 weeks but was eating (breast feeding) ok and no vomiting but a huge distended abdomen and large veins on the epigastrium.    Rectal exam was normal except one could feel a mass at the tip of the finger outside of the rectum.  Foley was placed with difficulty and noted that the catheter bulb was felt in the large umbilical hernia.  She appeared overall malnourished.  No fever, and did have a small stool after the rectal exam.  An ultrasound revealed a large mass in the abdomen but could not tell what it was attached to.  The patient was brought in Fri evening and the abdomen did not seem tender but was very tight.  We were thinking of partial bowel obstruction secondary to??  Family was told that she needed a surgery but it would be a very high risk with high probability of dying but even higher probability of dying without surgery.   The next morning they were gone so thought they just went home to let her die; but they showed up again Sunday eve and again it was discussed but there seemed to be no change in the baby’s condition.  Father said, "lets take the risk and whatever is the will of Allah would be."   Monday morning we opened the abdomen under Ketamine anesthesia.  The bladder was up in the umbilical hernia and the “uterus” was up above the umbilicus.  The “uterus” was part of a huge mass or cyst that was filled with over 350 cc cloudy fluid.  Ovaries and tubes were present but only the top part of the uterus.  The rest  and the top of the vagina was part of this huge cyst.  I think it was a Mullerian duct malformation.  We removed the “uterus” but left the ovaries and removed most of the sac wall and allowed some of the bottom part to be open with hemostatic suture around the top of the small amount of remainder.  We repaired the large umbilical hernia removing the bladder from it and allowing it to be where it should be.    Pre op we were afraid we would never be able to close the abdomen but it closed nicely.  We had minimal blood loss and the baby is recovering well so far.  I had begun the  case but when I saw what it was, I knew Danae (Ob-Gyn) would want to see this very uncommon abnormality so she got in on it also.  It is great to be able to operate and see unusual things with our daughter.
Our email addresses are:  drbland@sbcglobal.net  and  dfbland@gmail.com  
Our address is:  Hopital Adventiste de Bere,  52 Boite Postale, Kelo, Tchad, Afrique
Love, Rollin and Dolores