22 Dec. 2013

Only two more shopping days until Christmas!  Ha!   Not much to shop around here but one saves money that way.   One has to plan months in advance for such things such as when you are home or before someone else is coming so they can bring something.  Most people here are more interested in how to survive or where the next meal is coming from.  Most live in mud walled grass thatched roof houses and depend on what they can raise during rainy season mainly rice, millet, and peanuts and beans with a few other things such as tomatoes or cucumbers occasionally.  

Friday we had a volvulus or torsion of the sigmoid colon that was very distended and almost dead but did pink up after we untwisted its pedicle and I think he is going to be all right.  Also had a c-section for too large baby for pelvis.  We have had lots of hernias and hydroceles and prostatectomies.  We had another boy with infected clavicle fracture so we took out part of the clavicle as one does not have to have a clavicle and so far he is doing well.  

Sabbath we went to the Bendele church instead of Bere and had the lesson while Dirk had the sermon.   It is a little challenging to adapt concepts to their level of understanding even about the plan of salvation and the origin of sin and the great controversy between God and Satan and especially emphasize the love of God that He is not some vengeful tyrant that has to be appeased.   In the afternoon we went out in the bush to see a lady with some neurological problem and movement disorder.  We think she has some problem with the basal ganglia but not sure what.   It began when she was age 20 about 7 yrs ago.  She has never had any children and began about the time her husband left her because she was not having children.  Her history is not consistent.   Don’t know if she had any kind of trauma or not although no history of such is given.  On the way through the bush we saw some parakeets and some red billed hornbills.  

THINK!!   What can I do for someone this Christmas that they would not have or have done otherwise?

Matt 1:21; 2:2  Have you thought who were the wise men from the East that knew the prophecies so well and knew to look for a king or Saviour and followed the star?  Probably descendents of Abraham also through Ishmael.

Love,   Rollin and Dolores

27 Dec. 2013

We have had two volunteer doctors the past two weeks that were very helpful.   Dirk the neurosurgeon from Germany did a lot of organizing that needed done and helped with some of the surgeries and did some sorting of instruments and other things.  Vadym the surgeon from Ukraine that had not had much hands on experience got lots of exposure and hands on with various things the past two weeks, much more than he would get at home in a long time.   He is interested in becoming a long term missionary but will need a sponsor.   He is still unmarried and has not found a woman that would share this experience with him.   He is an only child and has parents and grandparents back in the Ukraine.  They have a family business of an orchard of apples and pears.  

Christmas day we had breakfast together having pancakes and various toppings and kids opening presents then in the afternoon we all got together in the open pavilion even though it was about 100F but about the same everywhere else.   Also in the morning some of them drove out in the town and gave away small trinkets and soap bars just throwing things out from the back of the pickup other wise might have a stampede trying to get things.  We had plenty to eat at lunch time.  We did have a strangulated hernia to do that morning.  It was fun watching the grandkids open their gifts.  The Parkers had a surprise for their Christmas.  Their children are here for the Christmas vacation and especially Tammy had no idea that they were coming courtesy donation from someone.    

Tues we had a fractured patella that turned out to be difficult because there was also a fracture of the lateral femoral condyle (part of the knee joint) that was displaced and the knee was partially dislocated so had to reduce the displaced fracture segment and put in a screw to hole it then could repair the comminuted fracture of the patella (knee cap).  This is all done without any x-ray but he looks good so far and hopefully eventually get an x-ray to confirm.  We also did endoprosthesis of the head of femur part of the hip joint on a lady that had fractured the neck of femur about 2 years ago but her son was insisting that it could be fixed.  We had been trying to get some surgical tools to be able to do it for many months and finally get some from Germany with Dr. Dirk Wonderlich.  (He also brought out a lot of other surgical instruments in his suitcase as he came to visit) I was surely thankful for that.  I hope that it works ok.  The son is one of our employees.  There was also another vacuum extraction on Christmas eve but the baby does not look healthy seems to have some kind of neurological problem, ”floppy baby.”  

Dolores made five insulated holders for water bottles that would hold ice all day and gave them to  the student missionaries and two other volunteers.  I got an i-phone for Christmas.  I had in mind to order one through Kermit (Olen’s dad) but I guess Dolores had already done that through Danae or Olen and brought out with the Parker children.  I’m sure Cathi was in on it also to send the check.  I’ve got to learn how to use it.  These smart phones are maybe smarter than me.   IT is really nice.   Hopefully it will help with emails or text messages.  The little Nokia cell phone had almost quit entirely.  Danae made some Christmas stockings for the student missionaries and Tammy and family made a bunch of “snow” (cut out paper snowflakes) during the night of Christmas eve and scattered them in front of Danae’s house so that we all could come through the snow as we went to breakfast. 

Thur  we had two hernias and a ruptured appendix that was very retrocecal.  We have a lady that has the most fluid in her abdomen that any of us has ever seen.  Drained off about 3 or 4 gallons and can hardly tell the difference in her appearance.   Not sure the cause yet.   She has no edema. We have a man with a intertrochanteric fracture of his hip that we hope to do an internal fixation tomorrow (Friday).  Also a little girl that fell out of a mango tree and suffered a multi fracture of skull with some brain matter came out and has a fracture femur.  She is awake and eating and looks like she might survive so will need traction on her leg or a plate on the femur try to keep it simple until we know she is going to survive.  

Have a happy and prosperous new year and keep your priorities straight ie keep the Lord as first priority.

Love, Rollin and Dolores

Dec. 12, 2013

We have been busy and I did not realize it had been so long since I have written anything. Since the beginning of the month the surgeries have suddenly increased markedly now up to 6-8 per day. We have done two brachial cleft cysts this week and saw yet another one to be done when they pay something for it. These were all very large
cysts in the neck under the mandible but involving the whole left side of neck. They were all three left sided.

This past Sunday I did a fracture tibia SIGN nail that had been fractured 6 months before
and very scarred and also a fracture femur that was in three pieces with two pieces stuck together that involved about 4 cm below the greater trochanter and the 2nd break about 10 cm below that. It was quite difficult but I think we got good results with the SIGN nail
system and no x-ray, but of course it was an open reduction. The man’s other fracture femur (just a short distance above the knee) we had done the previous Sunday in Moundou. Also did a 12 yr boy fracture of femur through the growth plate and almost through the skin the previous Sunday. I had to plate it then immobilize it.

Most of our volume of surgeries involves hernias and hydroceles but a few ovarian cysts, hysterectomies, and prostatectomies. I just assist Danae on the GYN cases. We work well together. She has been doing some of the surgery rounds while I do surgery on the days when we have so many to do. OPEN FOR SUGGESTIONS.

The little baby that had severe burns of hands and chest that lost his fingers of one hand is doing well otherwise. We did a pilonidal cyst today.

We have all three been busy lately with the hospital stuff and now we have visitors which makes it more interesting. We have a couple from France here for a month. She is a “midwife” and homeopathy and he is a mountain rescue and ski person. He is helping Jamie some with construction.

We have Mason McDowell here now with two of his anesthesia students.  Mason will be moving here long term next May or June to be teaching anesthesia to students out here so that more Africans can have good anesthesia care. His wife and two children ages 8 and 10 have not been here yet. They are very nice and a joy to have around. The
brachial cleft cysts went much better with their help for anesthesia. His students that came with him from the USA are learning some things about anesthesia in not so ideal conditions.

It is not supposed to rain in December but the past two weekends we have had some showers around in fact Dec 1 it rained hard in Moundou while I was there. It is about 70 at night and about 90 in day so pretty nice.

Last Sunday Dec 8 it was dark on the way back from Moundou and the road from Moundou to Kelo (about 60 miles) is paved good road but lots of pedestrians, goats, cows, ox carts, stalled vehicles, dogs, etc on the roadway so it is very stressfull driving after dark. Especially one time a woman and child ran across the road and we just missed them
by inches as we swerved the car and the guardian angel helped I am sure so that we missed.

Dirk Wunderlich a neurosurgeon is here from Hamburg, Germany for 10 days. He was here last Dec also. He brought some surgical instruments with him especially orthopedic.

Our emails are drbland@sbcglobal.net and dfbland01@gmail.com
Our phones are 235-90627822 and 235-62674586
Rom. 8:28 and Phil 4:13
Love Rollin and Dolores

Nov. 30, 2013

We hear of the snow and ice back in the USA and we shiver in the “cold” here.   It gets down to 75 F in the mornings. It is pretty nice here with dry air and ground and highs only in the 90’s.  Hope each of you have had a happy Thanksgiving and “black Friday” holiday. On Thurs all of the expats got together and we ate very largely of all the good food that various ones had made.  No TV or football or other things like that. Of course it is not a holiday here like there. In fact we did two surgeries in the morning.  

Today Dolores and I went out in the bush for church and took a patient with us returning to her home there about 45 or 60 minutes (only about 16 miles) from here if you did not stop. The “road” through the brush is sort of hard on side mirrors on the vehicle but overall smoother than the “main road." A one day church had been built there about a month ago and they now have 40-50 adults and about that many children that come to hear Bible stories.  The church is not finished on the floor and besides it is cooler under the mango trees now in dry season.  They have no medical care or clinic in that village.   We may start an occasional clinic there to try to help them.  Gary Roberts is marking out an air strip there and they are favorable towards that and hopefully any government officials are ok with it then it would be only a few minutes away even in rainy season whereas could not drive there in rainy season.  

Have repaired two meningoceles in the past week.  Yesterday (Friday) was one meningocele, a strangulated hernia, vesico-vaginal fistula, mastectomy, hydrocelectomy,  prostatectomy, and an ordinary inguinal hernia. This past week we drained a liver abcess with about 2 liters of pus.  Last Tuesday I did a SIGN nail (intramedullary rod) on an open fracture of a lower leg but also the knee was totally messed up and laying open for 3 days with lots of gravel and dirt in the wounds.  The lateral tibia plate was partly absent and little small pieces and fracture patella and the ligaments all torn apart. Hopefully it is repaired somewhat and hope for a good stiff leg without too much infection.  Putting in the nail was the easy part. Tomorrow I have a bilateral femoral fracture to repair but the accident was one year ago.  One side is loose and the other has healed together but much shorter so have to take it apart and will put in SIGN nails in both.  Both SIGN cases are in Moundou as I am covering for James Appel for those while he is in the US for a month. Tonight we had a man with fracture of tibia and fib about 2 or 3 inches above the ankle but was refusing treatment at first but finally let us cast it I think in fair position and it had no skin breaks.  We had one other vesico vaginal fistula this past week.  Both cases were redo that had not quite held with the previous surgery.  No one wants to pay for those fistula repairs as the woman is sort of an outcast with leaking urine and can’t have sex etc and chronic urine smell.  If the repairs work it gives the woman a new lease on life.  We need a large fund to cover the cost of those repairs.  

I think it is official now that Dr. Scott Gardner (Olen’s uncle) will be coming to Moundou.  He previously was going to be in Koza, Cameroon.  Dr. James Appel is going to Abeche, Chad to get some work going there that has been minimal thus far and Dr. Roger (Congolese doctor) is moving from Moundou to Bature in southern Cameroon. 

We love to hear from any of you.   

Our emails are drbland@sbcglobal.net and dfbland01@gmail.com

Nov. 18, 2013

Well I just got another year younger or older.  Anyway Dolores had the expats over for cake and home made ice cream Wed evening for my birthday.  Thank you to each one of you that sent birthday greetings via email.   I am not that old although next year will be my 50 year college class reunion at Union College in Lincoln, Nebraska.  We are planning to be there for that.

The birthday was just another day at the hospital.  We did a bilateral orchiectomy and amputation of scrotum for necrosis and necrotizing fasciitis of the perineum.  Hopefully he will live but it is looking doubtful as his necrotizing fasciitis or whatever has extended up through his cord and now today appears to be into his abdomen in spite of every antibiotic we could give him.  The relatives are wanting to take him home to die there as I think he is dying anyway.  Also did a partial amputation of clavicle for severe osteomylelitis from a previous fracture.  He  also had an old healed fracture of his femur that was shorter.  Another little boy has osteo of his clavicle and osteo of his femur and of one metatarsal and they claim there was no trauma.  Tues I had to redo the girl with the fistula but appears to be holding this time.  We also did another skin graft on a leg.  Sun we had a strangulated hernia and another one today.  We had another lady with kerototic 1 or 2 mm nodules only in the folds of her palmar skin.  I am told that these are benign and there is nothing to do for them.  

We have Hector, Kathy, and Michelle Figoroa from Florida here for two weeks.  Michelle was a student missionary here a few years ago.  Hector is an anesthetist.  

I don’t know what you hear in the media but BBC reported about a priest that was abducted in Koza, Cameroon and has not been heard from since.  The following is an email from Bekki and Scott Gardner (Olen’s uncle) who had been planning to go to Koza as a surgeon there.  They are presently in France studying French for another month then??    

“I don’t know what all you hear in the media but  I guess the first requirement to be a missionary is 'flexibility.' It is still very disappointing. We don't know what the GC will tell us or what will happen with the governments and the Boko Haram. The priest definitely needs our prayers. I read on the BBC website that he had emailed or texted the french embassy 4 hrs before he was kidnapped and must have been in the process of evacuating when they came. His empty suitcase was found on the side of the road the next day. The BH has been pretty active the last 6 mos. They went into a mosque and killed a bunch of people, pulled kids out of a school and set them on fire, attacked and massacred students in their dormitory at a government agriculture school and then set the buildings on fire, they dressed up in Nigerian military uniforms and set up a checkpoint (from the description in the news I think it was on the road between Koza and Ndjemena) anyway they stopped cars, pulled the people out and started shooting and hatcheting the people until they got a call on their cell phones that the real military was on the way, then they took off on their motos. It doesn't appear that they stole anything or that they even wanted the cars. They are a very strange group. They don't seem to have much of an agenda except to kill, destroy, control and terrorize. They do want money for weapons but they don't really seem to be stealing much. I suppose they don't bother with petty theft when all they have to do is kidnap a few westerners a year to collect millions so they can go back to terrorizing and killing.

The couple from Jengre had to leave early this yr. They actually didn't tell anyone they were leaving. They had a moving truck show up. Literally threw their things in and left with out saying good bye or anything. They had spent the better part of the last 20 yrs there and felt that was a horrible ending but felt for their own safety that was the way it had to be.

Thank you for keeping us in your prayers.

Bekki "

The Boko Haram has been officially declared a terrorist organization similar to Al Queda by the US state department.  They are the ones that were making trouble in Mali and Niger and northeast Nigeria and now Cameroon.  There was a French couple abducted a few months ago in Cameroon also.  They have especially been active in northeast Nigeria and in Mali.  Jengre, Nigeria is where we were 40+ years ago and we had once thought of visiting there but that looks unlikely now.  

So far here in Chad it is quiet and no evidence of their activity here that we know about.   I have not heard of any problems here other than frequent military check points when traveling on a main road and if one travels anymore it is helpful to have a letter of explanation from your organization such as hospital of why you are going to wherever so that they let you through faster.    We are way out in the bush and in no danger.  

Continue to pray for all missionaries of all kinds.    The devil is active trying to keep people from learning about the Saviour.

Our emails are dfbland01@gmail.com and  drbland@sbcglobal.net  

Love,   Rollin and Dolores

Nov. 12, 2013

    We have about finished moving all our stuff out of the apartment and
to our “new house." There are some other volunteers coming that will
need to stay in the apartment in a few days. It seems we have
accumulated more stuff in the last two years. Of course we have put
some stuff that we are not using right now back into the container.
   Friday we had a strangulated inguinal hernia but the intestine was
still viable so no problem.
   Sabbath was busy as I taught English Sabbath School class then
preached a sermon that was translated into French and Ngere. In the
evening we had two maternity cases with one that was dead baby before
she arrived that delivered and then had to have a manual removal of
the placenta and the other was a very difficult forceps delivery with
baby that had a heart beat but never responded otherwise to
resusitation. Then about midnight a man presented with a
strangulated inguinal hernia but when we operated he had about 10 feet
of dead small intestine from a strangulated volvulus which we removed
and reanastamosed to about 6 inches of terminal ileum . The
strangulated hernia had also necrosed his cord and testicle on that
side so had to remove that but that made his hernia repair easier
His hernia incision had to be extended cephalad quite a way to get
enough exposure to figure out the problem. 

   Sun we had what appeared to be a perforated ulcer but turned out to 

be acuteappendicitis. Also saw lady that had burns on her face and arms 

from boiling oil thrown on her by her husband then he would not let her
come in for treatment for two days but she finally got away and he is
in jail. Often times when a husband abuses his wife nothing will
happen to him. Also saw a girl with edema, ascites, shortness of
breath, pulsating neck veins, and a severe systolic heart murmur heard
over most of chest but more in left mid axillary line. Also on
Sunday put in a chest tube for empyema. We had another cancer of
cervix and uterus (not sure which was primary) that we debulked but
not cured.
   As we think of this holiday season time of year we turn to
thankfulness. We are thankful for the plan of salvation that Jesus
has provided for us with his perfect life and sacrifice. We are are
thankful for the friends and relatives that think of us and continue
to pray for us. We are thankful for the emails and notes that some
send us. We are thankful for the donations that have been provided
so that various projects can continue. We are thankful for the
Adventist Service Industries, Maranatha, and Adventist Health
International that have provided many new building shells but now we
need to finish them up on the inside with interior walls and plumbing
and electric wiring, etc. We are thankful for the large and small
donations that have been made to help provide equipment and interior
necessities such as sinks and stoves. More are needed. We are
thankful for the volunteers that have come and that will come to work
to make this place a better place with their various talents. We are
thankful for the Parkers that have done so much to direct the
construction and help with the school. We are thankful to be able
to work with Olen and Danae in the mission hospital work and of course
to be with the grandkids here (now three). Much more is needed to
make everything useable. We are thankful that Bere Adventist
Hospital is one of the better hospitals in the country (but still has
lots of room for improvement). We do more surgical procedures than
any other hospital in the country (will be over 1200 this year). We
are thankful for your prayers for each patient and employee. We are
thankful for the buildings that have the shells for the volunteers
that will come. They need to be finished with walls, plumbing, sinks,
toilets, stoves for cooking meals, etc. For instance a cook stove
for each place is over $300 plus $150 for gas tanks, gas and hook ups
need about 12. We need interior walls for the private wards,
maternity and OR areas. We need fans for each of the volunteer
buildings, as well as the private wards and other places. The new
buildings are designed with lots of ventilation so that air
conditioning is not really an option except hopefully in the OR.
Besides air conditioning takes lots of electricity which we have only
so much generation capacity. There is not and will not be any
public power available in the forseeable future. I am amazed at how
much is done with so little to work with. I am thankful for how
much the Lord has blessed the work here in Bere, Chad.
   Be sure to read the blogs on www.missionarydoctors.blogspot.com
Keep looking up "for our redemption draweth nigh" but there are still
many people in the world that do not know the love of Jesus. God
is waiting for all of us to let them know Do your neighbors and
friends know Him?

Our emails are drbland@sbcglobal.net and dfbland01@gmail.com
Love, Rollin and Dolores

November 7, 2013

We are going batty. Dolores found a bat in her skirt when she put it
on after she had brought it in and layed it with the clothes. She
had taken it off the clothes line the day before.

Past Wed we had a very large ovarian tumor that came out easily but
there were inguinal and periaortic nodes so I’m not sure if cancer or
just lots of inflammation. Then I did a myomectomy of a 12 cm
fibroid from the apex of an uterus (she wanted more children) and
amazingly the uterus looked nearly normal when we got done with it
also normal tubes and ovaries. Then had a hematouterus with lots of
old blood in the enlarged uterine cavity but no products of conception
but appeared to be old retained menses. Her internal os of cervix was
stenosed closed so opened it and did a curettage and found nothing
else. In the past week we have had two sets of twins and one set of
triplets then another set of twins two weeks before which was from a
lady with ecclampsia so she was delivered by c-section and did ok but
the others were all vaginal deliveries. We now have 3 that have the
abdominal wounds packed open. One was a previous c-section that had
gotten severely infected and another was a typhoid perforation that
had multiple perforations repaired but developed another or else we
missed one so repeat surgery closing the fistula and packed her open.
The third one was a previous that was infected and now is almost
closed.

We are moved into our “new house” although nothing is organized yet.
We don’t have hardly any shelves up yet so we can put stuff away.
We are able to sleep in the bed there and it is much quieter than
where we were in the apartment for the past two years. We now don’t
have the roosters crowing under our window or the dogs barking at the
door or someone sweeping the yard by the door all of which usually
began about 5:00 am. I still wake up with daylight anyway. We
have spare beds in the other bedrooms so come visit us. Although the
bed rooms may have to act as storage places for awhile. Of course we
still have the shipping container that we are using for storage of
some things. It seems that the bugs moved in with us so I now have
sprayed pyrethrin around the outside and inside where the metal walls
are sitting on the cement and around the windows and will see if that
helps. We have our kerosene refrigerator going and it keeps stuff
real cold and we have our large freezer running that is supposed to
use no more power than a 100 watt bulb or max of 140 watts. We are
also using our new stove from America that was in our container that
even has electronic ignition and a large oven. Dolores really likes
it as compared to the one burner stove and small oven that we have
been using the past two years. Dolores is trying to get some
curtains made for the windows for looks as the windows are semi-opaque
anyway. She is even making some ice cream and some smoothies (all
vegan). They really taste good esp on hot evenings.

Zane and Lyol already have malaria with fever and are taking quinine.
There has also been some GI bug maybe Giardia or some virus going
around. So far Dolores and I are healthy. Two of the student
missionaries have malaria again.

We enjoy emails even if we might be slow answering sometimes. Our
internet service is only part time and very slow and costs as much as
back home would be for good service.

Our emails are: dfbland01@gmail.com and drbland@sbcglobal.net
Love Rollin and Dolores

Oct 28, 2013

So glad to have Danae, Olen, Lyol, Zane, and Addison here with us.  Addison is so cute.  We drove to N’Djamena Wed leaving here about 0415 and getting to the edge of town about 1115 which was really pushing to get there that fast and then on to the airport at the opposite side of town by noon.   It is only 250 miles but part of it is through mud holes and water and much of the rest that once was paved now has huge pot holes about a foot deep in places.  One place on the main highway had two huge semi-trucks stuck in the mud and barely room between them to get on through.  We did get to the airport before their plane arrived and then waited for them to get off, clear immigration, customs and claim baggage and strap the baggage on the 4 Runner what would not go inside.  We got registered with the police and got a few things to eat and went out to the Lutheran mission hostel for the night and rested until almost noon Thurs.  They were very tired after the long ride with the kids on the plane and spending 2 or 3 nights packing before they left D.C.  Thur we did some shopping.  There are no refrigerators or air conditioners available in the country until the trucks can start bringing things in after rainy season which is ending now.  We left about 0715 Fri and got back into Bere about 1545 with our load. The road is drying some now.  Danae and Olen were happy with the new cement kitchen counter tops and the newly painted house that Dolores spent so much time doing.  

Sabbath was communion in church and then we visited in the afternoon.   Sun after rounds in the hospital we gathered the pumpkins out of their “garden."  Danae and Olen are still trying to get stuff unpacked and put away. They brought some new nice surgery instruments that was given to them from Brother's Brother in Pittsburg and a bunch of suture.   We still don’t have much Ortho plates and screws yet but hoping for some.   Dr.  Dirk Wunderlich from Germany is going to bring in December some intramedullary rasps that should be very helpful.

Monday we had a severe peritonitis from typhoid perforations (six of them) which we repaired and irrigated out her abdomen.  Hopefully she will do ok.  We also had another C-section for CPD and fetal distress and mother and baby appear ok.   We had another complication of Penn shot.  A little boy’s foot necrosed and so I did an above ankle amputation.   The shot was given apparently to close or in the femoral artery.  Previously we had had a little girl that lost her arm from a Penn shot with a dirty needle.  Our nurse “surgeon” did a C-section, 3 hernias, and drainage of an abcess in abdomen while we were gone to N’Djamena.   We have a huge breast mass mastectomy to do but she does not have enlarged axillary nodes.  She previously had a “lumpectomy” 2 yrs ago for a “fibroadenoma." We had another orchiectomy for a large testicular mass today.  

It is nice to have the kids around.  It makes life more interesting.   Also we will be having various volunteers coming in the next 3 months or so which hopefully will help get some things finished on the new buildings etc.   A nurse midwife, 3 or 4 doctors, 2 anesthestists at different times will be coming besides the Maranatha group.

Our emails are: drbland@sbcglobal.net and dfbland01@gmail.com  

Love, Rollin and Dolores

21 Oct 2013

We are in keen anticipation of the coming of Addison and of course Zane, Lyol, Danae, and Olen which will be later this week.  We are driving to N’Djamena Wednesday to pick them up from the airport (about an 8-9 hr from here).   They will be bringing with them lots of different things for the hospital as well as other things.  We will have lots of rope and strapping to tie bags and suitcases on to the car.  

Dry season is on with temps in the 90’s although the humidity is very high and not many days ago we had a good rain. 

The malaria and typhoid has been fairly steady.  Surgery has been pretty slow although have had two strangulated hernias in the past few days.  The ecclampsia lady with c-section twins last week is doing ok and the twins so far are ok so let them go home today.   Kids are like kids at home in that they put things in orifices such as nose or ears.   Took a peanut out of a nose yesterday.  I did a skin graft today over an area on a lady’s thigh that had had a deep burn.  The man that I did a cystostomy and dilation of urethra for urethra obstruction last week succumbed to his malaria and typhoid and apparent stroke.    Had a little boy with white hair probably kwoshiokor and said he only ate white rice with no sauce or anything on it except sugar.  

Hopefully we all have as much anticipation for the coming of Jesus as we do for our loved ones and family.   As you see events in the world especially the USA surely the Lord can’t delay much longer.  

Our blog is:  www.weareamissionarybland.blogspot.com

Our email is:  drbland@sbcglobal.net  and  dfbland01@gmail.com

Love,  Rollin and Dolores  

Oct. 15, 2013

Another week has passed and we are still getting big rains including today and Friday night.  I’m hoping dry season will get started pretty soon.   It is about 25 miles to the post office in Kelo but it takes 2 hrs to drive it if you hurry through the mud holes.   Of course when it dries up there will still be the holes and very rough road.  

The hospital keeps busy with the malaria and typhoid and occ snake bite and occ tetanus.   The lady with the ruptured uterus that got severely infected that we have had to pack her abdomen open is now beginning to progress and look better and probably will live.   The man with the gunshot to his mandible is doing ok and taking food and liquids and looks as if he is going to live, however there is a different story now as compared to last week.   Instead of being he defending his wife from rape, now the story is that he was a thief and a policeman shot him.  However the policeman had said that he would pay for everything and also that it was said that the policeman was going to prison makes me think the first story was probably more nearly correct but probably some money changed hands so who knows what the real story was.   Here it is who you know and there is little system of justice and women have almost no rights.  Maybe the policeman was trying to steal the woman…

We have had two strangulated hernias lately including today.   Both did not require bowel resection.   We had a c-section Fri night and again Sun night.  Fri night was previous c-section and suspect uterine rupture but was not ruptured but baby was dead but very small pelvis and minimal dilation.   Sun night was for ecclampsia with seizures and edema and increased blood pressure but the twin babies are doing ok so far.   Today we did a cystostomy on a severely tight bladder that was hemorrhagic and severe urethra stricture especially in the prostatic portion with lots of scarring that we were able to open and put in a large Foley.   

Both of the SIGN nail patients were sent for x-rays but they were able to walk and have not returned with x-rays so that I can report them to the SIGN people.   It is about 3 or 4 hours especially now with the bad roads to the nearest x-ray unit.   Hopefully someday we will have some sort of x-ray capability so that does not happen and so we can better serve the patients.   The one with a ovarian mass probably cancer that involved a loop of bowel that had to be resected did well and was discharged.   Not sure if it was really a cancer as it was quite well encapsulated and somewhat cystic almost like an old ectopic.  Our supply of misoprostol apparently got stolen recently.   Maybe someone is doing their own abortion clinic or ?  We were keeping it in the office as it would disappear from some other places but still happened.  We recently had an incident of a Foley coming out (somehow the bulb deflated)of a man then the nurse putting another one only part way then inflating the 30 cc bulb which caused severe pain and bleeding and obstruction.   I was able to get one in with a guide wire and it is functioning well now.   I hope the nurse got the point of my remarks that a foley should always be put in all the way before the bulb is inflated

We got the freezer lid straightened up using some clamps and hammer etc so now it seals and is working.   It was actually amazing that it came through the rough treatment on the way here as well as it did.   The electric lights are all in our house now but waiting for some things to be brought from USA by Olen and Danae when they come back next week.   We are planning to drive up to N’Djamena (about 8 hrs from here)to pick them up from the airport on Wed.  We will stay overnight in N’Djamena then come back to Bere on Thurs

The devil is working overtime.   Our school here needs your prayers to deal with a principal and a pastor. 

Several of the expats have been sick lately with malaria or typhoid but so far Dolores and I are well now. 

Continue to pray for us and the work here.

Love,   Rollin and Dolores

Oct 7

We are doing ok.  Dolores and I are not sick.  I had a problem with my shoulder for a while but doing ok now and I guess I strained my back but it is better now.  I got over my bronchitis and malaria finally.   Two of the volunteers that came 3 weeks ago now have malaria.  One of my helpers in surgery, Simeon, has malaria today.  Jamie had it a few days ago but is ok now. 

The hospital is still somewhat slow although it should be picking up soon as rainy season starts winding down and people start harvesting their crops and have more money but today Monday we had a huge rain for about 3 hrs.  They have harvested their millet and sorghum grain already but their main crop rice will be another month yet.  The “roads” are still very bad with deep holes and water.  Jamie went to Moundou thurs and water came over the hood of his pickup in a place or two.  Sabbath we had a man with a shattered jaw and most of his teeth missing on the left side from a gun shot.  He was trying to prevent his wife from being raped by a “policeman” and the policeman shot the man.  He was fortunately hit in the mandible instead of a little bit higher up.  The bullet entered at the angle of the mandible and went out through his mouth knocking out teeth and shattering the mandible on the left.  I don’t know anything to be done for him except try to prevent infection and we are keeping his mouth shut with a band around his head vertically.  Strangely the man who shot him was around today and said he would pay for whatever the hospital charges were.  Others say that he will be going to prison.
We also had two little girls age 9 or 10 in the past two weeks with large masses.  One was a dermoid cyst with hair and bone in it and the other was an ovarian mass maybe a cancer.  Each mass was about 7 inches or more diameter.  We have had 3 abd hysterectomies for huge fibroid uterus recently including one today.  All 3 were very obese also.  

The kitchen sink is hooked up in our new house and we moved some stuff from our container to our house yesterday including our freezer, bed frame, chest of drawers, dresser and mirror (amazingly it did not get broken).   The bathroom is not hooked up yet and still some wiring to finish but it is looking more and more like a house that we might be able to live in eventually.  There are always so many things to get done or things that need repaired etc. There was a man by here today looking for some glasses (about 5.0) we had only some 3.25 which he said helped some.  He said he was the one that planted the mango and Niem trees here over 30 yrs ago.  

Olen, Danae, Lyol, Zane, and Addison should be arriving here about Oct 23.  Of course we are looking forward to that.  They will have been gone from here for 3 months.  Olen and Danae’s wedding anniversary is tomorrow their 6^th.  They are celebrating in the Virgin Islands.   

It is a little different here to get a car license renewed.  We started the paper work 2 months ago and have paid almost $400 and still don’t have all the paper work and new tag yet.  The old one expired end of August.  

Our emails are: drbland@sbcglobal.net  and dfbland01@gmail.com   

Love,  Rollin and Dolores

Sept 22, 2013

It definitely is raining less now than it was and things are beginning to dry up a bit. It is possible that the bus service to Bere  may start again in perhaps 2 weeks if the road continues to dry up somewhat. We have not been anywhere but that is what we are told.  

People are getting out into the fields more or the snakes are beginning to move around more as we seem to have someone with snake bite in the hospital most of the time now.  I lanced a big toe this am to drain off some fluid that was tight. The toe had been biten a few days ago.  

I did a c-section for a baby that I knew was dead but was unable to get it out with a vacuum or with forceps even though it was her 7^th pregnancy.  She had been referred from another clinic than I finally got the information that she had been given IM oxytocin.  The light finally clicked on my mind so I knew what the problem was.  It was as suspected a ruptured uterus with lots of blood in the abdomen.   I’m glad I was not successful with vacuum or forceps.  I think she will survive but we did a tubal ligation on her.  We considered doing a hysterectomy but was able to repair the uterus ok. That makes the 5^th ruptured uterus I have had since December.  I did have two others that were beginning to rupture when we did the c-section but I did not count them.  I often wonder how many babies and perhaps mothers that have died because of being given IM oxytocin before the baby is born.  Oxytocin is a uterine stimulant to make it contract more. 

Sometimes you think what if I had done whatever or maybe I should have. I had a girl that had swallowed a candy stick and was having severe laryngeal stridor. I could not find any foreign body with the laryngoscope.  She was getting better on IV steroids in fact she went home then they apparently took her to Moundou a day or two later and got an x-ray and went to a clinic there then developed worse stridor and died there. They did not do anything for her there they say.  I wonder if I had done a tracheostomy here maybe that would have been  prevented. Hindsight is always better.

I sometimes wonder what kids have been told or what they are thinking about the “nasara” (white people).  When I was coming to the Ped ward to make rounds this am one 5 year girl went screaming to the other end to her mother when she saw me in the doorway.  Maybe she thought I was a ghost or that the “nasara” would get her.  Almost everyone on the ward was laughing at the incident but she kept with her mom and would not look up.  

Dolores has canned a few tomatoes and continues to paint trim etc. There are 4 banana trees that are blooming and putting on bananas in Danae’s yard now.    

Donations for the project here can be given to the Jay Seventh Day Adventist church and marked for the  “Bere Chad Project”      The address is 13717 East 390 Road, Jay, OK 7436.

Our emails are: drbland@sbcglobal.net  and dfbland01@gmail.com   

Love,  Rollin and Dolores

15 Sept. 2013

Nothing too exciting the past week except that we have been ill.  Dolores had chills and fever and aching Friday so began her Malarone and took her Fansidar today.  She is feeling better today and back to sanding and painting.   Neither of us felt like going to church Sabbath also we were the only “nasaras” (white people) on the compound.  Jamie and Tammy are in N’Djamena to meet some new people that are coming, three public health workers and three student missionaries.  Hopefully they can get through the road.  It takes about 1 ½ to 2 hours to go the 25 miles to Kelo.  It has very deep holes and water  over parts of the road.  Last year it was totally impassable for some months so it is not as bad as last year.

I had some kind of “cold” with cough and sinus drainage the past 3 weeks then a week ago had fever to 101.4 so began Malarone but did not improve so began quinine.  I also began some Augmentin for the sinusitis about that time.  Someone thought I had typhoid even though I have had the typhoid vaccination.  The typhoid test was positive but it should be with the vaccination.  But vaccinations are not 100% so I began the Cipro along with the quinine.  The respiratory and sinus thing has cleared. I think I have had several of the side effects of quinine such as palpatations, tinnitus, partial deafness, stomach upset, crazy dreams, not able to sleep well, bitter taste in mouth, no appetite, etc. but today I’m beginning to feel better as now I am off the quinine.  I ate well at noon and supper or at least better.  Maybe the “cold” was actually malaria coming on or something and should have begun the medicines sooner.  I did not see patients for 3 days but did do rounds today and probably will do some surgeries tomorrow if I feel like it. I still have weakness but hopefully will get a good night’s rest tonight and be stronger tomorrow. This is the first time that malaria if that was what it was has bothered me much.   Maybe it was the combination of that with the respiratory infection as I had a productive cough which has now cleared.  Fortunately the hospital census is low now.  Maybe the malaria epidemic has subsided. 

All four children and their families got together this weekend in Oklahoma.  The two oldest grandchildren were off to college, Rachel at Southern Adventist University and Robby at Southwestern Adventist University. They did email some pictures of the grandkids to us.  Of course they are all beautiful and handsome and very intelligent.  Little Addison is so cute and chubby.  We are looking forward to seeing her next month along with the rest of her family. 

Continue to pray for us and the hospital project.   

Our emails are:  dfbland01@gmail.com and drbland@sbcglobal.net 

Love, Rollin and Dolores

Sept 5, 2013

My shoulder is much better now although still a twinge of pain if in wrong position ie. extend it back too far.   I’m not taking any more ibuprofen for pain now.  Have been able to do surgeries ok.  Have you ever tried to play volleyball with only your left hand when you are right handed?   Not trying to do much of that although I have learned to serve a fair left-handed serve.  

The hospital work seems to be ho-hum or same things recurrent.  Oh yes we had a 3 inch bladder stone the other day, several prostatectomies and urethral stricture dilations.   A c-section every so often for various indications including two the past week that the uterus was beginning to rupture.  One had a live baby and the other baby had been dead for awhile.   One patient was quite different.  A lady had an apparent mass in the abdomen that turned out to be a greatly enlarged hypertrophied stomach and almost no visible intestines; very atrophic.  I was not sure what to do so I did a pyloroplasty opening up the outlet of the stomach (the duodenum was visible).   Amazingly she is recovering and eating and the abdomen appears more nearly normal now so we let her go home today.  We had a ruptured appendix a few days ago doing well and went home today.  The malaria and typhoid seems to be letting up a little bit although we are still getting rain almost daily.   

Today was a different kind of day. We got a call about 0800 wondering if there was some way we could help the MCD (district medical officer, the guy that has given so much problems to the hospital in the past).  He had taken the 4-wheel drive high clearance ambulance with its driver out to a remote village and got stuck in the mud.  He spent the night out in the bush with the mosquitoes etc.  Several people had tried to get it out of the mud but it was pretty thoroughly buried when we got to it.  Jamie took the hospital pickup and I took our Toyota 4 runner (which has a winch) out to where they were at.   If one got off the “road” at all it was like quicksand very soft mud.  We had to go through water was almost to the top of the wheels especially the last kilometer.  We fastened the back of my car with chain to a nearby tree and hooked the winch to the ambulance and we were able to pull him out with some difficulty.  Jamie had to be pulled out also as he had gotten out of the “road” slightly.  Then we had to back up through the deep water to a place where we could turn around.  After that I got in a soft spot and had to winch ourselves out.  We had just gotten back to Bere when there was a call that Augustine with his car and a pickup bringing a bunch of pipe to the hospital were stuck near Kelo so we took off again.  It turned out that the pickup had worked out of the mud when we got there but Augustine had run out of gasoline.  His gauge does not work.  I had my gas can with me so we went back to a spot that had some gasoline and bought some and took it back to Augustine.  The trip back to Bere was uneventful other than the deep belly dragging holes and water over the road in places.  The MCD now says that I am his best friend and was very profuse in his thanks.

Dolores has been busy painting the walls and rough cement floors of Danae and Olen’s house. It involved a lot of stuff moving so could do all the floors.  She painted the shelves under the kitchen counter tops in our new house one day this week.

We are in good health other than minor aches and pains sometimes. 

Our emails are drbland@sbcglobal.net and dfbland01@gmail.com

Love,  Rollin and Dolores

26 Aug. 2013

It seems as though there is nothing new but as we listen about various ones back home having heart attacks and having stents put in and having cancer surgery and some dying from their heart problems maybe it is safer here than there.  We just have to be concerned about malaria and parasites mainly.   Oh yes there are people here with cancer also usually too advanced to do much about.  Although I recently saw one that I had done a mastectomy and axillary node dissection a year ago and she still looks good with no sign of recurrence yet.  No chemo or radiation available here.  

Today we had the 4^th little boy with a calculus lodged in his penis in the past two weeks.   Also had one 3 days ago.   Last week we had a c-section for prolapsed cord and the baby lived amazingly.   Also had a c-section for footling breech (foot waving at us ) but she had twins the second baby was transverse and they both lived and went home ok.   Also a c-section for an arm waving at us and only 4 cm dilation cervix.  They did well also.  The Pediatric census has decreased the past few days.  It seems the malaria and typhoid tends to come in waves.  

Sabbath evening we had some unusual cloud formations.  The sun was getting low in the west and there were some very large thunderheads but above them were these bright clouds coming over them like over a mountain top and they had various colors of the rainbow in them.  They also had like waves in them.  We did get pictures of them.  They were very beautiful.  There was even some lightning to the side but did not get any pictures of that.  Then during the night it rained very hard all night

Dr. James Appel was here this weekend with two senior students from the Union College Physician Assistant program.  I did not know I was supposed to speak for church until just as we were ready to go up front.  I thought they wanted me to have prayer or something until I was asked what my text was for the  message.  Fortunately I had some notes in my Bible.  I preached on “The Bride of Christ” and Dr. Appel translated Into French.  I guess it went ok.  With translators you have a little time to think between each sentence.  

My right shoulder has been almost immobile the past week since apparently injuring it playing volleyball last weekend.  I still can not abduct it but minimally but it is a lot less painful than it was.   I’m not sure if it is a pulled muscle or stirred up arthritis or possibly a partial torn rotator cuff.  Maybe I will get a MRI next April when we come homeon annual leave as there is none available in this country and it is getting better so maybe by then I won’t need anything hopefully.  We are in good health otherwise.

Progress report:  we have electricity in our new house although not all finished yet.  Jamie plans to have the electric and plumbing done in it by next week.  Dolores has been busy painting in Danae’s house also cooking meals for a German boy here the past month but he left today.  

Our emails are:  drbland@sbcglobal.net  and  dfbland01@gmail.com  

Love, Rollin and  Dolores