Death Under the Mango Treee

    Mangoes taste so good and anyone knows that the best fruit of whatever tree is way up towards the top such as cherries, apples, or peaches. But there is a problem with mangoes. The trees get quite large ie. 60 feet tall and the limbs are very brittle. Sometimes they break off spontaneously. If someone climbs a tree the limbs can break off without warning. More people die from falling out of a mango tree than from hippo bites at least around here. Incidentally our two men with hippo bites on their thighs are doing ok and appear that they will survive. We have had two injured from mango trees today one with minor cuts and the other with bilateral fracture radius and ulna and fracture distal humerus in the elbow and fracture of skull in the frontal area. Don’t know if he will survive or not. We recently had another that died from a fall from a mango tree. I love good juicy mangoes but I won’t climb a tree to get one to prevent it from getting bruised. It can just get bruised when it is knocked off the tree. People have very long poles or sticks with a hook on the end to knock a mango off the tree. But remember even the mango tree can be deadly and needs our respect. They are the best shade trees around with the most dense shade.
   Our 3 partial thyroidectomies or goiters and two thyroglossal duct cysts have all done well and have gone home.
   We had a fatality in the OR recently in a young lady that had a large perforation of terminal ileum from typhoid. We did the full “code” in the OR but no go. She waited too long to come to the hospital. In retrospect did we not give her enough IV fluids or not enough of ? or was there an anesthetic problem or too much sepsis. We don’t have the luxury of consulting with infectious disease specialist or cultures or x-ray or whatever. We are it. Someday we hope to at least have a digital x-ray. It sure would help especially with the bone cases. Our lab is pretty minimal also. We have to depend on physical diagnosis the most and most of the time we are right we think.
Life is tough here in Chad. The life expectancy here is one of the lowest in the world at 47. Death is very much a part of life here.
   We are certainly looking forward to that better land wherein dwelleth righteousness and there will be no more death or sorrow As one sees the events of the world surely the Coming of Jesus can’t be too long away.
Our emails are drbland@sbcglobal.net and dfbland01@gmail.com
Love Rollin and Dolores

Update on baby elephant 4-6-13

     The baby elephant died thurs night in spite of valiant efforts by Gary Roberts and many others. Everyone knew that the chances were slim but it was worth a try to save it. They say elephants are very emotional animals. This baby had lost his family when the slaughter occurred and then had been tied up for a week before Gary obtained it and flew it over here from an area Out of a heard of over a hundred elephants near the Cameroon border about half of them were killed in a massacre recently. This one baby was saved temporarily but he succumbed to depression and loneliness. We put in a feeding tube and it seemed to revive perhaps a day. They say even in elephant orphanages the success rate is only about 50%. He was a cute affectionate little guy only about 200 lbs.
     Our second man in a week to be bitten by a hippo came in Friday.  His bite was not quite as massive as the first one but it was through and through his left thigh. The previous was also left thigh. The previous one tore out a bunch of muscle which we tried to repair but part of it appears that it will need to be debrided some more. What bacteria does a hippo mouth have? We don’t know so we are giving lots of antibiotics to both men.
     Today, Sunday, after doing rounds on patients I worked on cement mixers. One had a bearing completely “frozen” and would not turn so had to be torn apart.  No new parts so have to make this work. It apparently had not been greased in a long time so had grooves in the shaft etc but with some filing to knock off the roughest spots we put it back together and it worked and grease was put in. Gary Roberts came down to work on the other one that was diesel motor. Apparrently dirty fuel had clogged the filter and the pump and the injector nozzle. It has been cleaned out now and it runs. Perhaps the compression is not as good as it should be. It had been run some with no air filter. Some of these locals just don’t understand how important clean fuel and lubrication are. Maybe sabatoge was involved also as a piece of cement sack paper about 6 inches size was found in the fuel tank the other day. Cement does not work good in fuel system. Don’t know how much was on the piece of paper. Anyway they are operative now.
     It is still hot and Zane is still having an elevated temp but not last night as he was in an air conditioned room down to 88 degrees. Whether he has some infection or some problem with temperature regulation we don’t know. He acts pretty normal most of the time. Pray that it is nothing of consequence.
Our emails:      drbland@sbcglobal.net and dfbland01@gmail.com
Love, Rollin and Dolores

OUT OF ORDER: Sudan not meant to be

     I had planned to go with Gary Roberts our mission pilot to South Sudan this past week but apparently it was not meant to be. There was a schedule problem then early one morning as we took off a warning light came on showing the alternator was not operating properly but as we landed it seemed ok. Played with some connections all seemed ok so tried again and had to land again then it finally was consistent and he finally found a broken wire but too late to go as it is a 10 hr flight with almost no place to land most of the way. Much of the way is over Central African Republic (CAR). Next day we took off early but an indicater showed one of the magnetos was not functioning as it should. (The plane has two magnetos so it can still run ok but not quite full power) so aborted the trip and came back after 45 minutes into the flight. His overflight permits over CAR were expiring etc after all the delays. He found the problem was a condenser in the magneto which he replaced. The plane is fine now He says he never has had 2 mechanical problems in the same week before. I later saw a internet headline that 150 were killed in some fighting in south Sudan but I think in a different part from where we had planned to go. We were to visit some government officials and see and evaluate 2 hospitals in northeast South Sudan but maybe some other time when everything is calm. Maybe the Lord made the wire break or the condenser quit. We were never in any danger so far as the plane was concerned. Gary is a very careful pilot and mechanic and has extra safety equipment on the plane to detect problems like that. 

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

Medical student orientation

     A senior medical student, Jonathan Martin, from Loma Linda University arrived in Bere Tues night April 2 then Wed am he began his “orientation” by going with Dr. B. down to where the baby elephant is. They were wondering if Dr. B could put in a feeding tube either surgically or what as the elephant was deteriorating and refusing to eat much and so a last ditch effort to save him. We got the tube down through the mouth but had to put a hand and arm into the mouth and throat to direct the tube. A monkey was caught and hanging over a wall so the student rescued him. 

    Then back to humans and saw the MCD and then at the hospital he saw a large bladder stone in a 3 year old boy then a boy with huge abcesses in buttocks that when the incision and drainage was done the pus actually came out spurting under pressure with about a liter of purulence. Then there was a ruptured ectopic pregnancy with quite a bit of blood in the abdomen. Also some head trauma cases with lacerations of the scalp that we sutured up. One was about 5 inches laceration and down to the bone.
     On the 2nd day he was helping with a C-section for ecclampsia and a case of a bone tumor on the distal radius and a curettage (D & C) and we unwrapped a skin graft that we did 10 days ago and it looks as if it all took on the lady that we had amputated the arm at the shoulder because it was necrosed in a reaction to a penicillin shot. Part of the skin around the shoulder also was necrosed but had finally granulated in and now the skin graft looks good. He saw our Easter hippo bite of a man’s thigh. So far the man is doing ok but still has some drainage as would be expected.
     He is matched to a surgery residency program in Detroit, Michigan then hopes to go somewhere as a missionary surgeon. He is a deferred mission appointee. Maybe he could come to Bere after his residency who knows. He graduates from LLU May 25. He is very likeable and nice to work with.
     We are doing well other than it is hot about like Okla summer.

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

Easter Holiday

      The ambulance rolled in bringing two patients from Kelo Hospital about 25 miles from here. One was a strangulated hernia and the other was a ruptured ectopic pregnancy. I’m not sure why no doctor would see them there or why they got charged for the transfer that was supposed to be free. Someone probably pocketed some money which is common here in Chad. The strangulated hernia was in time so did not have to remove any bowel that was stuck in the hernia. The ruptured ectopic pregnancy would have died had it been much longer. Her abdomen was full of blood and was hypotensive yet was sent with the diagnosis of possible threatened abortion and nothing was being done for her. She survived the trip and the surgery here and is doing well now 2 days later. 

     Later in the day a man was brought in with a huge bite almost down to the bone out of his thigh by a hippo where he had been fishing in the river. We, Danae and I, spent quite a bit of time cleaning it and trying to put it back together and draining it. They say there are more people killed in Africa from hippos then from lions or elephants. A big danger yet is from infection as the hippo mouth probably not very clean and the river water not very clean either. It was the first hippo bite that either of us had seen. 

      And did I say that the first case on Easter was a huge liver abscess that we drained about a liter of purulence from. 

     The baby elephant that has been here a little over a week is not doing very well. He has diarrhea again and is not eating very well and had a seizure Monday. Probably his electrolytes are not good. We have the “elephant lady” from Malawi here now. Packages are arriving with different things for the elephant. He needed enzymes for digestion and stiff nipples and bottles for him to eat from. They are here now. They say there was only about 30% chance of surviving his loss of family, trip to here, and not feeding well and his diarrhea but it was certainly worth a try. Some elephant specialists from Kenya say that for baby elephants under a year old even in the best of circumstances have only about a 50% survival rate. Of course we all hope for better.
      Last week we did a skin graft on a shoulder of an Arabic lady. We had amputated actually disarticulated it at the shoulder because the entire arm was necrotic and infected also quite a bit of the shoulder skin was bad also. We debrided it and tried to pull some muscle over the area when we amputated then let it wait to granulate in for about 10 days. We took split thickness skin from her thigh and placed it over the shoulder area and so far it looks good. She lost her arm because of a benzacaine penicillin injection in the arm that was apparently dirty needle. Still not sure what the injection was for. She has lost also the vision in her eye of the same side, don’t see how they are related. When she first came in I thought she was going to die but now with the infection gone she looks and acts so much better. The family has been very nice and attentive.

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