December 27, 2015

Most people here don't pay much attention to Christmas but we took the day off other than making hospital rounds. Thanks to all of you who sent Christmas notes to us. On Christmas Eve the expats got together and took turns reading the story in Matthew and Luke and sang Christmas carols. On Christmas morning we had "snow" (white paper cut outs on the front porch) and temperature down to "cold" 59F.  Dolores and I ate breakfast with Danae, Olen, Lyol, Zane, and Addison then watched the grandkids open their gifts. They get so excited. The afternoon all the expats had a potluck meal together then had a "white elephant" gift exchange. Each one brought one wrapped gift to put on the table then numbers were drawn for order of choosing as each one got to choose either one gift from the table or to "steal" one from someone who already had one. A gift could only be "stolen"no more than 3 times. 

Choir with new robes

 
Several surgeries were done the day before Christmas including two for ruptured uteri. 

Dolores spent the previous almost two weeks working most of night and day making about 25 choir robes for the church. She measured each person in the choir so the robe would be right for them. I made a closet 48 inches x 80 inches x 22 inches for the choir robes to be hung in. The wood boards are rough and crooked so require lots of trimming and planeing to get the boards to fit together to look decent. I sprayed some insecticide especially on the bottom hopefully to prevent termites eating it up quite so fast. They had a "concert" yesterday with their new robes and loud drums and steel guitar that you could probably hear for a kilometer with lots of joyous dancing in the church. I think they had religious words but I have not learned to appreciate their music style. 

The main holiday here is New Year which the "fet" lasts for several days. Often there is no internet or telephone about that time also.

May all have happy and prosperous new year. We are now one year closer to when Jesus will return to claim His children and take them home. Matt 24:14

Our emails are drbland@sbcglobal.net and dfbland01@gmail.com.
Love, Rollin and Dolores
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile, Chad, Afrique

Written December 14 (posted Dec. 22)

The "harmattan" dust blew in Friday night so now the air is brown but it is cooler. The "harmattan" is north wind that sweeps down from the Sahara usually in December or January with lots of a very fine dust that gets into everything but the dust shields out some of the heat from the sun so it is cooler now. We did not have much harmattan dust last year but did have a very cool spell about this time with lows down in the low 50's F. It isn't that cold yet this year. Dry season began a little earlier this year as last year we had a shower even the first weekend of December whereas this year the last rain was in October.

We are just beginning to get some papayas off the trees we planted about a year ago. We are letting them ripen on the tree (most locals pick them before they are ripe so someone else does not get them) and they are much sweeter when tree ripened. The mangoes, guavas, avocados, cashews, citrus, and pomegranites that we planted will probably need a few years before they produce. The bananas seem a little slow also. Maybe whoever comes; after us will get to enjoy them. 

Our Toyota 4-Runner runs much better now after Jamie showed me where to plug in the diagnostic tool I had which then gave a few options as to the problem. The place to plug it in was not to the left of the steering or of the dash as was told but sort of behind the ash tray about in the middle. We had thought the problem was the control module (computor) and even had one bought and brought out but we never used it or opened it. The problem turned out to be the MAF (mass air flow meter and sensor) which I cleaned carefully and now the car runs fine with no additional cost. 

Gasoline has become more available and is down to 750 cfa per liter or about $6.00 per gallon here in Bere. I understand it is down to 490 cfa per liter or about $3.92 per gallon in N'Djamena so maybe it will come down some more here.

We have had some unusual appendix presentations the past few days. One was a large appendix in an inguinal hernia. One was a retromesenteric presentation that had necrosed and part of the small intestine was obstructed and blood supply severely compromised to the point that we had to take out about 60 cm of small intestine after a lot of careful dissection. Another was ruptured appendix one or two weeks or more previous with almost the entire abdomen intestines all stuck together and obstructed and had to take out about 70 cm of small intestine also. We also had an elderly lady with very large masses about 10 cm diameter in her femoral and inguinal areas that I guess were lymph nodes filled with soft black tumor like material although did not find any other that this might have metastasized from. We had a boy with a mass (probably a cancer) right over his brachial artery of his arm but got it off without sacrificing his artery. We had an elderly man with a 6 month posterior dislocation of his hip which we tried unsuccessfully to reduce then tried to reduce it with; open surgery and still could not even after considerable dissection. The head of femur was very soft and osteoporotic and the acetabulum was almost flat so we cut off the head of femur, closed the wound and put in a tibial pin for traction and he is now in traction and amazingly this morning his legs are almost equal length. Oh yes we still have some hysterectomies for large fibroid uterus, some hernias and hydroceles and yesterday a strangulated hernia but was in time so did not have to resect any intestine. Danae even did a c-section on a woman that had just died and got a living baby. We have interesting lives to some people.

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

Rollin
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile, Chad, Afrique

Good gifts

Our papaya tree

Thanksgiving in Tchad

The Parkers leave, leaving us with big needs

It was a sad day Monday as Jamie and Tammy Parker said good bye to everyone and left for the USA and not planning to return. Actually they left Mar 31 and returned here about a month ago to pack and make various arrangements to return permanently to the US. They had been living here the past 5 years as volunteers on donations. They had helped a lot of kids and he had done a lot of maintainance and construction work. I guess we are the ones for maintaining now. We could certainly use some people to do construction especially plumbing and electrical work on our new buildings so they can be used. If you are interested send an email. We can use short term or longer term people. 

We have had 3 colon resections during the past week. One was a right hemicolectomy for obstruction because of a cancer of the ascending colon. Unfortunately he also has some metastasis in the liver. He is doing well eating and walking post op. Another partial colectomy was for an obstruction of the transverse colon because of a cancer but also had metastasis to the liver. He also is doing well post op. Both had palpable masses similar to walled off appendiceal abcess. The transverse colon was very redundant and was down low in the abdomen. Of course no CT or even x-ray so rely on physical diagnosis. Yesterday we had a right hemicolectomy for an intussisseption that we could not reduce. We also had another urinary obstruction because of much scarring and probable cancer of the prostate which we were unable to resect but was able to dilate the urethra enough to get in a 24F Foley which we plan to leave for a long time.

I was supposed to do a study for prayer meeting past evening but was doing the intussisseption case about that time so Olen filled in for me. Yesterday morning I took some photos of a Bible training group that is being conducted in a new church in Doubge about 6 miles from here. The 20 attendees then are expected to conduct outreach in their various villages. One man bicycled 75 kilometers to attend. 

Our emails are: drbland@sbcglobal.net and dfbland01@gmail.com.
Love, Rollin and Dolores
Rollin and Dolores Bland
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile, Chad, Afrique
Blog www.weareamissionarybland.blogspot.com

Nov. 21, 2014

"Fall is in the air". The mangoes are beginning new growth and blooming and the old leaves are falling off. There is more dust in the air and it is cooling down so now it is only low 90's day and low 60's early morning. The ground is dry and hard. Rice harvest is well under way and the millet and sorghum grain has been done. They should be picking cotton soon. Last year we had some rain in November but there has been none this year.

The fuel situation continues about the same. There is no internet or phone much of the time, perhaps related to lack of fuel for the cell towers so don't know when you can read this. The hospital has enough diesel to last for some time. I just bought gasoline 20L for 1100 cfa per liter or about $8.80 per gallon, so slightly improved.

The surgery schedule is still somewhat slow but have had some interesting ones. We had a torsion of a 12 lb ovarian cyst. Also two different ones with cancer of their mid thigh. Both were resectible. Both were anterior and medial so was difficult to remove but both have full function of their legs and feet now which was amazing. No pathology to send to so don't know what kind they were. One especially was deep inside the muscle. Took about 2 liters from a little girl's chest a few days ago. She still has the chest tube but seems to be breathing better. Probably related to tuberculosis. Her relatives say that some of their cows are dying with a cough and maybe have tbc. We have the girl on tbc meds now. We had a little 10-yr-old boy that was having vomiting after eating but could keep water down. We could feel a mass in his mid abdomen and at surgery his mesentery was full of tumor and partially obstructing his first part of intestine. We dilated the obstructed area somewhat but unable to resect the whole mesentery. Perhaps it will respond to cyclophosphomide which is all we have to offer.

Hope all of you enjoy your Thanksgiving weekend in the US with lots to eat and have family and friends and football. We all have lots to be thankful for especially all our gifts from our Heavenly Father.

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

Your tax deductible gift can be sent to the Jay Seventh Day Adventist Church, Jay, Okla.. 74346 or to Adventist Health International, Loma Linda, Calif 92505 Either should be marked "Bere Hospital Project"

Love, Rollin and Dolores Bland

Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile, Chad, Afrique

Blog www.weareamissionarybland.blogspot.com

Gasoline shortage AND personnel shortage

The hospital has been somewhat slow although Danae seems to be keeping busy with Ob-GYN. There have been several prematures and several babies that were dead before the mother got here. One does not like to do c-sections for dead babies but sometimes it has to be done. Also has had several curettages for incomplete abortions or retained placenta fragments with lots of bleeding.

One big item now is lack of gasoline or very expensive if you can find it. They say there is rioting and people even being killed in NDJ and Moundou because of the lack of gasoline. If it can be found some places are charging up to 4000 or 5000 cfa per liter (about $32 to $40 per gallon). They say there is still diesel for some reason but lack of gasoline which really affects the motorcycles and small cars. My Toyota 4-runner takes gasoline. It is quiet here in Bere and I don't need to go anywhere. Some of the government employees are going on strike also some of the taxis are on strike. It has been rumored that war could break out if it does not get better soon. I think the military has pretty tight control. We are so far out that here should be no danger here. Hopefully they get their refinery or whatever repaired soon.

The REAL BIG item is that Jamie and Tammy Parker arrived back last week BUT they came only to pack their things and sell or give away almost everything and return to the USA. They will really be missed. Hopefully a replacement can be found soon so that construction and maintainance can be continued. They left here April 1 and just now are saying they are leaving permanently. He had back surgery while he was home this time and still is having problems. They had served here 5 years and had done a lot of good work. They had been serving as volunteers living on donations from their home church in Tennessee. They could not accept the salary and terms that AHI had offered. The Lord works in mysterious ways so maybe something will come of all this and the construction project etc. will continue.  Money is in short supply as well as personnel.

Tax decuctible donations can be made to Adventist Health International Bere Hospital Project, Loma Linda, California and 100% goes to the project. They get their operating expenses from other sources.

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

Rollin and Dolores Bland
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile, Chad, Afrique

Look out for horned bulls!

Thur Oct 31 we had our 2nd penile denuding (the skin being peeled off). This one was from a bull horn that caught the man in his scrotum and peeled the skin but the meatus still seems intact. The previous one lost all his skin and his meatus from his penis when it got caught in a belt to a rice thrasher. The skin all necrosed when we tried to save it but I think this one has a fair chance of living as we put it all back together. We hope to do some grafting on the first one before too long or maybe create a flap from his scrotum to cover at least part of his remaining penis. Would a full thickness graft or split thickness skin graft work best? 

 Also Danae and I did a perineal and anus reconstruction on a lady that had had a 4th degree vaginal tear from her first baby 7 years ago and amazingly she had two babies since then. Hopefully there was still a little muscle remaining so tht she can have some anal continence. We had a c-section for placenta previa (placenta over the cervix) which was bleeding a lot. Danae picked her up by herself and carried her in a hurry from the delivery room to the OR. Everyone is doing fine now. 

We had a lady that died in spite of all the medicines for the infection. Danae had paid for part of the medicines. They had no money to pay for transportation of the body back to her village so Dolores and I took the body out to her village about 35 km out in the bush with some of her family members. We had to buy some gasoline (which is very scarce but we found some) for 1250 cfa per liter (about $10 per gallon). It was a nice trip although we got back after dark. They seemed to appreciate it. Did not have time to do any birding or much picture taking along the way as we left Bere too late. The trail was pretty narrow but the water holes were pretty well dried up. It was only about 1 1/2 hours each way. 

It is getting drier and hotter in the day time usually about 95-98F in the day but cools down in the 70's at night. Humidity is down in the 40% range now.

Fuel is hard to get or very expensive so business is slower at the hospital. Much less vehicle traffic.

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

Love Rollin and Dolores

Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile, Chad, Afrique

October 25, 2014

Thu. night was to be a surprise for Danae but it turned out differently than we had anticipated. Olen was returning from some Adventist Health International meetings in California Thu. to NDJ and was to return to Bere on Friday, but he decided to take a late evening bus to Kelo and we were to pick him up there and bring him back to Bere to surprise Danae. However we did meet him in Kelo but later than expected (the bus was going very slowly from NDJ). Mason went with me to pick up Olen and Zachary Gately that was coming at the same time. When we left Bere Mason asked if my fuel gage was correct. It was. Was there enough to get back from Kelo. Affirmative, I think. Actually I had thought maybe we could get more gas in Kelo. We found out there is no gasoline in Moundou or Kelo at any price. Stations are closed because of no fuel. We picked them up at the bus station and drove back through some deep mud holes where water is still crossing the road although most of the road is drying up but very rough with deep holes. The gas gauge was on the warning light about half way TO Kelo. It only takes about 1 1/4 hours to go there now from Bere. On the way back from Kelo the gauge was below empty and I kept praying that somehow we would make it back to Bere. We made it back without running out of fuel. The Lord must have added some fuel. We hear that gasoline is being sold to motorcycles for about $16 US per gallon if you can find it at all. Road side stands that sell it by the liter are closed. I found one place Friday that still had some and I was able to get 20 liters (about 5 gallons) for $40 (about $8 per gallon). Previously it was about $4 per gallon. I know that in Europe and Turkey it is about $2 or $3 per liter routinely. We hear that a pipeline had burst or maybe an explosion at the refinery in NDJ. The oilfields are in southern Chad. There is a lot less traffic now.  Diesel (gazoil) was still available. Have no idea how long this problem will last. With no fuel it may not be long until there is no internet or cell phone service if no fuel to run the generators at the towers. The oxcarts are the most reliable I guess. When we got back to Bere (about 0300 am) 

Danae was in surgery repairing a stabbing victim that had come in about 0200. The victim had intestines hanging out with some holes in the intestines that had to be repaired. So she knew we were gone and that Olen was coming with us. I also heard that there was tribal fighting in Lai (about 10 miles away) with some decapitations but don't know for sure if this is fact.

On Friday we had two c-sections. One was for placenta previa and mother was bleeding a lot and had a hemoglobin of 4 so was given 4 bags of blood and is doing ok post op. The other was prolapsed cord and transverse presentation of baby. Both babies had been dead for some time and the cervix on each was only about 4-5 cm dilation.

Dolores has a sore throat past few days after taking the Malarone for the malaria. Also had a cough but is feeling better. We are healthy otherwise.
Our emails are drbland@sbcblobal.net and dfbland01@gmail.com.

Love Rollin and Dolores

Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile, Chad, Afrique
Blog www.weareamissionarybland.blogspot.com

October 21, 2014

Now we hear there is another diagnosed with Ebola in the USA. One
death and 2 alive. Lots of media coverage and not much about the
1000’s that die from other causes such as traffic accidents.
Apparrently not much media attention to Enterovirus D-68 that has
paralyzed some and killed some others. Not many die from traffic
accidents here in Chad because we have no roads that you can travel
fast enough to do much more than break bones when motorcycles collide
etc. One certainly does not want to travel after dark at any speed
because of ox carts, stalled vehicles, goats, cows, pedestrians, etc
that would be in the road.

We just have the usual malaria and malnutrition that kills lots of
people because they don’t get treated in time. Mike and Chris Kelley
are trying to get nutrition center going but money or lack of is a
problem. They are still trying to get oriented on how to run it for
which patients. You cannot give free food to everybody so lots of
screening has to be done.

We see about one intestinal perforation from typhoid per week and
lately averaging about one amputation of either leg or arm per week
from various causes. There are a few more hernias and hydroceles
than there were before. The census especially surgery should be
picking up more as we get into the rice harvest. They are harvesting
their peanuts (groundnuts) and millet and sorghum grain now.
Danae had fever probably from malaria and is taking Malarone now.
Says she is feeling better now. Addison is feeling better and her
abcess is healing. We are fairly healthy otherwise. Now Dolores has
aching all over and temp of 100.5 so probably beginning malaria so
will take her meds..

Mason and Kim McDowell are going down to Moundou being that word that
the container with some of their things maybe is released from customs
and needs unloaded and stuff sorted out being that some things are
theirs, some are for Mike Kelley and some for Moundou and some for
James Appel.

Dry season maybe is finally arriving as I see that the humidity is
down near 50% for the first time in several months according to my
hygrometer.

Ever looking upward and forward.
Our emails are drbland@sbcglobal.net and dfbland01@gmail.com.
Love Rollin and Dolores

Oct. 12, 2014

We hear about how bad it is in the USA. Ebola has killed one and
another tests positive even though the 2nd one was wearing the
protective gear when treating the first one. We also hear about
West Nile virus and now Enterovirus D-68 that is killing some and
several having paralysis from it like the old polio and several
hundred being infected with it from coast to coast. Also the
Chikungunya virus is causing “growing concerns.” Maybe the countries
should not take flights from the USA to them. Maybe you should come
to Chad. We don’t have any of those that we know of and malaria is
at least treatable. Have even heard rumors that the US is about to
declare martial law in force doing away with most freedoms.

Our surgery patients are starting to increase in how many we operate
on. Perhaps doing more hernias but also have had several leg
amputations for necrossed foot or cancer. Also have had several
orchiectomies for pyocele (pus filled testicle). I am amazed what
can be done without x-ray. We do have an echo ultrasound machine
that is helpful sometimes especially for the OB-Gyn cases.

Sunday we had a typhoid perforation of terminal ilium then had a
intestinal obstruction secondary to a Meckel’s diverticulum band and
some adhesions.

Monday we had an intussisseption of cecum and terminal ilium into the
transverse colon in a 6 year old.  Also had another BKA amputation for
a rotten foot. Also did a scrotal reconstruction. (His testicles
were in the open after losing much of his scrotum from an infection),
also a hernia in a 3 yrs old boy.

Tuesday we took off a huge (about 10 cm) keloid from a man’s ear that
involved taking off part of his external ear.

Wednesday we had a lady with a mass in her right lower abdomen that
was mildly painful but had been there for years. She had a history
of surgery in 2008 and in 2004 including a hysterectomy and “cancer
metastasized all over.” She was in with probable malaria but a mass
palpable in her abdomen. We did surgery and found a walled off
abcess that was able to be dissected out although had to repair some
intestine. We opened the mass after it was removed and found that it
was a walled off abcess around a sponge that had been left in the
abdomen from a previous surgery. Each day we have had hernias and
hydroceles to do. We have also had three pyoceles that involved the
cord all the way up into the abdomen so did an orchiectomy through an
inguinal incision.

Wednesday Oct 8 was Olen and Danae’s 8th wedding anniversary
celebrated by working all day and having fruit jello for dessert that
Dolores made for them.

Thur we did a SIGN intramedullary nail on a fracture femur from Jan
2011 that was plated Jan 2011 but the femur had refractured and the
screws of the 2 plates had come loose although the screws were not
what they should have been. It had been broken loose apparently not
too long after it had been plated. There was lots of scarring and
was quite difficult to ream out the bone but we were finally
successful. He is doing well so far. The SIGN that we did last
week is slow to get moving. Maybe was not very active before.

Friday about midnight we had a man brought in with his penis skin
completely avulsed including the glans. Also the scrotum was
avulsed. They said the belt from some sort of thrasher had broken
when he was near by and the belt somehow caught him between his legs.
We reconstructed his urethra and penis and scrotum with the skin that
was still hanging on and seemed viable. Hopefully it will all
survive. We will leave his Foley in for at least a month. Almost a
Bobbet procedure done!!!

Sabbath I went out to the branch Sab School at 7:00, as usual taught
English SS class then preached for the 11:00 service on “Are we the
devils helpers?” Then Sab evening we had a motorcycle accident brought
that had been in a head on. One had a fracture arm, clavicle and
rib, another had a fx of a femur and a tibia/fibula fx.  Two others
had abrasions and superficial lacerations. We hope to put in SIGN
nails if they don’t go to the traditional healers.

Addison has had malaria but also an abcess on her behind the past week
but she remains happy most of the time. Had to drain the abcess so
it should be getting better. Otherwise we are all healthy.

We welcome volunteers or visitors. It just might be safer here than
you think. We all look forward when there will be no more death or
deadly viruses when Jesus returns to take his friends and children
home with Him.
Our emails are drbland@sbcglobal.net and dfbland01@gmail.com.

Love, Rollin and Dolores

October 3, 2014

No big rains this week and things are beginning to dry up somewhat.
Well, we had a quick 0.5 inch (about 12 mm) of rain today. Humidity
stays 80 to 90%. People are harvesting their millet and sorghum and
beginning to harvest peanuts (groundnuts). Water is decreasing in
the “roads” and business is picking up at the hospital especially the
surgeries. Classes are beginning this week at the school.
Temperatures have been nearly perfect in the 70’s F and low 80’s F.

One surgery was on a 16 yr girl with a bowel obstruction secondary to
cancer. We resected the obstructed part and put it back together
but she is going to die soon because the cancer was widespread
throughout the abdomen. There was a “moto” accident where a
motorcycle with 4 adults were riding on one and hit a pedestrian.
Lots of “road rash” and one had a fracture femur which we fixed the
next day with a intramedullary rod SIGN nail. The MCD brought them
all in. Apparrently the one with a fracture femur was somebody that
was supposed to be important as various chiefs were calling about him
but the MCD actually promoted us to do the surgery rather than they
going to a “traditional healer” or witch doctor. We have had 4

c-sections in the past 24 hours which is more than the previous 2
months. Maybe they were waiting for Danae to return but anyway they
were all indicated or necessary to be done. Danae did two during the
night. Had two orchiectomies for hard endurated testicles and cords
taking the cord also all the way into the abdomen doing the
orchiectomy through an inguinal incision.

We really enjoyed the DVD of our trip to Turkey in June that Ronnie
(Olen’s mom) made. We just got it and looked at it tonight. Maybe
some of the names of different places will help us remember what some
of our pictures were although we had taken a few notes.

Dolores keeps busy with the grandkids. They are very active. She
has also canned some more guava sauce which is very good. Addison is
so cute as she walks around all over. Of course Lyol and Zane are
everywhere also.

We hear that Ebola is in the USA now with one case in Texas and
perhaps 100 others exposed to him. We also hear about Enterovirus
B68 that has perhaps caused one death and some with paralysis. Of
course here they just die from malaria and malnutrition and some other
things also such as HIV.

We are in good health and hope to remain that way.
Our emails are drbland@sbcglobal.net and dfbland01@gmail.com.

Love, Rollin & Dolores

Sept. 25, 2014

Ah sweet sounds this week. Although the Beautiful Sunbird babies
have fledged so don’t hear them, but now we have the sounds of Lyol,
Zane, and Addison saying Nana and Papa. Also they want Papa to “be a
donkey” and ride the donkey which of course he was happy to do.
Olen, Danae, Lyol, Zane, and Addison all arrived today in N’Djamena
and then on down to Bere today. David our pilot picked them up in
NDJ in the little mission plane and they arrived back in Bere about
5:00 pm. It had been threatening to rain earlier in the day but
late afternoon it all cleared so they were able to fly easily.
Jonathan (the other pilot) will be bringing the luggage down tomorrow
in his new Land Cruiser that he just is picking up today in NDJ.

Addison has grown so much in the two months they have been gone. It
was so nice to hear the airplane as it came back and watch them land
on the little dirt strip. They all looked good but tired after the
long trip from Washington, D.C to Addis, to N’Djamena to Bere. The
dogs, Sheba and Midnight were glad to see them back also as they
barked their welcome. The kids were playing with Grace and Emma
here so they were enjoying their reunion.

The roads are beginning to dry up a little as rainy season is
decreasing now. People are harvesting their millet and sorghum grain
and feeding the cows whatever is remaining. The river has not
decreased much if any yet. The water table around here is less than
a foot below the top of the ground.

The electrical system is working well now after not working right for
several months and gradually getting worse. There was a short where
one wire had been connected or touching a ground wire but the main
problem was the generators needed cleaned out with new air filter,
fuel filter, and oil filter. The air filter was very much clogged
and of course a big diesel engine needs air and fuel. Nick is doing
a great job with plumbing and electricity. He has finished Mason’s
house and about finished Zach’s and Charis’s apartment so now they
have shower and toilets.

Kim is turning the nutrition program to the new director, Michael,
this week. I think they had 50 kids this week. They plan on
doing a lot of it as outpatient down at Bendele (about 2 miles away)

We had two more non-resectable cancers this week. One was another
bladder cancer and the other was an ovarian cancer that was spread
all over. We had a c-section for an arm presentation and another
vacuum extraction. Overall the surgery schedule has been slack.

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

Love, Rollin and Dolores

Sept. 19, 2014

Various sounds are heard. Some are pleasant and some not so
pleasant. We hear the crickets or some kind of insect very loud in
the evenings. Early mornings we hear the doves cooing and pecking on
the metal roof. During the night we hear the fruit bats making their
calls and noises. In the mornings and evenings we hear the children
playing on the swings at the school sometimes very late at night.
Some evenings and days we hear the drums and “music” for church but
sometimes hear it for the dancing. Especially early mornings we hear
the roosters crowing and maybe the dogs barking. Sometimes we hear
the babies crying at the hospital and sometimes we hear wailing or
crying of relatives as another has succumbed to their illness often
very soon after their arrival too late for medicine to benefit.

Sometimes at night I hear the “knock, knock” of a nurse at the door
wanting some help with someone at the hospital most commonly an
obstetrical problem. One may hear a motorcycle go by or may hear a
donkey bray. We have our fans going which helps muffle some of the
other sounds at night BUT may awaken me if the fan does not sound
right or the speed is being variable as when the generator is not
acting right. Prefer to hear the sound of the generator being steady
not being irregular or the sound of voltage regulator clicking a lot.
We have had lots of problems with our electricity even the main
switch of the generator going off so apparently a big short in the
system somewhere causing severe electrical drain. I have finally
disconnected the batteries of the “backup system” and so far the power
and generator are being very steady since then. So I think the
batteries were shorting out the system. 

We also have other sounds if you listen for them such as tweeting 

of fire finches and of sunbirds.  Found a neatly sewn pendulous nest 

quite small and heard the mother bird and father bird tweeting. 

It is a “Beautiful Sunbird” which is the name but also the description 

with scarlet chest with yellow sides and irredescent green over most

of it and long tail streamers. The nest is right in Danae’s yard in a thorn tree. 

Might hear the rattling sounds of the Buffalo Weaver bird or the staccato

noises of the gray shrikes and fiscals and sometimes the music of the African
thrush under our kitchen window.

This week has been sad for some people in that we have had 3 that we
opened in surgery that had inoperable cancer. Two were bladder
cancer and one was colon cancer with huge periaortic nodes. One
fortunately died the next day. Another was a huge mass in the
epigastrium that had the appearance of metastatic disease on echo.
Another boy became jaundiced after receiving a unit of blood for Hgb
of 4 but also receiving quinine and Fansidar which has sulfa so
possible GP6D deficiency or ? We had another 3 yr boy with a large
bladder stone and another man with prostatic urethra stones.

Mason and Kim’s house is getting closer to being finished with most of
the electric and plumbing in with the help of Nick from Moundou being
up here for a time while Scott and Bekki are back in the USA.

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

Sept. 10, 2014

Friday began as usual then about time the staff worship was over we
were told that a superfe or chief or government official was coming
to meet with us (not sure who all “us” were to be) about 10:00 so we
tried to get rounds done and cancel some surgeries so that we could
meet with them although not sure the purpose of the visit. Finally
about 1030 we were told that the meeting was cancelled. Then we did
so some surgeries in some that had not eaten yet including a man that
had blocked urethra since an accident Feb 2014 and had urine coming
out of a suprapubic incision that had been done elsewhere. Just
beyond the prostate was superdense scar tissue that I was unable to
tunnel through with a probe or whatever. I finally stuck a knife
blade somewhat blindly through the prostatic urethra into the super
dense scar tissue and finally was able to open it up enough to get a
probe and then a 22Fr 3way foley through into his bladder. I plan to
leave it there for at least a month to let it heal around it. We also
did a 4th ray amputation finger for necrotic finger that the infection
was back in the metacarpal and just packed it open then plan to close
later after the infection is gone.


In the late afternoon of Friday we went to Lai (about 12 kilometers away)
to get some supplies so that could do some electrical wiring and plumbing 

being that Nick was here from Moundou to do some of that
kind of work hopefully to finish Mason’s house. Most of the road was
not bad other than deep holes but was very muddy close to Bere. On
the way back there was a pickup stuck in a hole in the mud in the
road. We tried to pull him out forward but unable to so went around
and pulled him backwards with our winch and helped him out of the
mudhole.

Monday we had very heavy rain this morning with 3.4 inches (8.6 cm) in
about 4 hours. I’m sure the “road” is impassable now. The river was
24 inches over the road before so now I’m sure it is much more so the
only way to Bere is with canoe and motorcycle. We also had problems
with the electricity and generator so we cancelled one little boy
until sure everything is working right. Not sure if the problem
is the generators or the invertors or an intermittent short circuit
someplace. It seems if we switch generators and or reset the
inverters it is ok for awhile.

We finally did the 3 yr old boy with a huge mass in his belly Tues
that had been postponed Fri because of the “meeting” and Monday
because of the generator or electricity problems. It turned out to
be a huge 20 cm left cystic kidney that was resectable very easily did
a left nephrectomy. Wed we did a bilateral oophorectomy for huge
solid masses possibly cancer in a 16 yr old girl. 

We are still healthy with no Ebola or cholera around here that 

we know of.

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

4 Sept 2014 A day in Bere, although unusual

The day began as usual with breakfast then staff worship 0715 and
rounds with almost a full hospital of patients although Peds and
Maternity has been down somewhat. Then we had surgery. The first
was a little 5 yr boy with a mass at his umbilicus with drainage from
it that looked almost like bowel contents or drainage from an abcess.
We did a laparotomy and discovered solid mass that had almost
appearance of liver but very inflamed with intestines being stuck
into the mass all around. We finally got it dissected free and all
the adhesions freed but the rest of the abdomen was clean with no
adhesions. The liver itself appeared normal as did the spleen. The
mass itself was quite firm almost hard so I don’t know what this
about 10 cm mass was. Then we had another child with a large solid
mass of her eyelid (it closed her eye) which we dissected out. It
perhaps was glandular like some kind of tumor somewhat friable but did
dissect out fairly readily. Then had a man with a very large
inguinal hernia and bilateral hydrocele which turned out to be pyocele
so we did a orchiectomy and repair of the very large sliding hernia.

Then we had a call from Nick and Kelsey that they had tried to get
here driving their ambulance from Moundou but were stuck in the mud
about 15 km from Kelo (It is 45 km from Bere to Kelo) It had rained
much of the night before so the “road” was very muddy with deep water
holes and over 24 inches over the road going across the “hippo river.”
It is about a ¼ mile (about 500 meters) across. A large wave of
water would go in front of the car as we went across with boys running
ahead to show where the road was the most shallow (of course they
wanted a fee for their service). We finally got to where they were
stuck in the mud off the edge of the “road”. We were able to drag
them out with our winch on our 4 runner. The water hole in the road
by them was at least 18 inches deep. We made it back through the
mud and the river without incident to Bere. Nick and Kelsley came to
do some plumbing and electric wiring on some buildings especially
Mason’s house.

Then about midnight we had c-section for a ruptured uterus. Of
course the baby was dead. During the time we were doing the
c-section they brought in a man that was victim of a stabbing with
intestine coming out stab wounds so we had to do a laparotomy after
the c-section. We had to repair his colon and small intestine and a
large bleeder in his mesentery. His abdomen was pretty full of
blood. By the time we repaired everything it was beginning to get
daylight. Then time to start another day but maybe this one will be
quieter as they usually are.

We love to hear from each of you about your days.
Our emails are drbland@sbcglobal.net and dfbland01@gmail.com
Love. Rollin and Dolores 

August 31, 2014

We have had 3 days without rain except a little sprinkle this morning. There was thunder and lightning tonight but probably rain later. Maybe the mud and water will start to dry out a little bit. The water table is almost to the top of the ground so water can't soak away very fast. The crops are looking good with millet and sorghum headed out and cotton and peanuts blooming. The rice is beginning to head out. The rice fields are flooded like the local people like them to be. It is nice and green everywhere and the temperature has been in the 70's F most of the time. There is still plenty of water over the "roads". The main transportation is motor bikes or oxcarts In the early mornings one can hear the cooing of the doves or the singing of the gonalek or the rooster crowing somewhere or the dogs barking.

Yesterday we had a ruptured appendix then had a c-section for face presentation of the baby that was her first baby. All are doing well. It was our first c-section in a month which is unusual. We have had a few prostatectomies for urinary retention. Pediatrics is slowing down a little but Medicine service is full right now. Three people with large epigastric masses. One patient with edema, proteinuria, hematuria and a heart murmur. Of course there is malaria, typhoid, and HIV. Not sure why Pediatric malaria seems to be slowing down now at end of August. It was that way last year also. Mason is doing a great job on Pediatrics. I do the rounds on surgery, maternity, and medicine. Kim (Mason's wife) is doing a great job with the malnourished kids. It takes a lot of money to keep the program going. DONATIONS FOR MALNOURISHED KIDS WOULD BE HELPFUL.

We are all healthy. No Ebola or cholera in our area that is known. Pray that we remain healthy. Pray for Jamie Parker that had recent back surgery that he can have a rapid recovery and can get back to Bere for the maintainance and construction work that is so desperately needed.
Our emails are drbland@sbcglobal.net and dfbland01@gmail.com

Love, Rollin and Dolores

Hamangioma

What can be done except leave alone?

August 22, 2014

On this date 49 years ago, it was raining also when we got married that summer evening in Tulsa, Oklahoma.  It is raining again on us only now we are in Chad.  We got 3 in ches yesterday morning here.  The locals talk about how great this rain is for the rice.  Nothing special is planned for today. 

We have been blessed the past 49 years with 4 children (3 girls and 1 boy) and 9 grandchildren ages 1 yr to 21 yrs.  All the children and their spouses have at least a college degree or more and all are active in the church.  We are so proud of all of them.  Oh yes during the years we have had our differences of opinion. etc.  Dolores has been very tolerant of my crazy hours and other things but I am thankful for her.  We are still in good health other than passing things here in Chad.  What will we do to celebrate the big 50 mark next year?  Not sure yet.

I saw a man yesterday that had 14 wives and 41 children with 30 girls and 11 boys.  I suspect he does not remember any of the many anniversaries.  He had brought one of his wives in for a check up for an "ovarian cyst" that turned out today to be a bilateral pyosalphinx (pus in the tube).  His name was not Solomon. 

We had a boy with urinary obstruction but no stone visible in the bladder and unable to put in a Foley.  We did surgery and found a stone lodged in his proxiumal urethra which was a little difficult to get out but it finally popped out in h is bladder and we removed it.  We had another ovarian mass about 15 cm diameter.  A man had an ileostomy done somewhere else "for typhoid" but not sure what all the problems were.  We took down the ileostomy and reconnected the ileum to his transverse colon as the right colon seemed very scarred and adherent to surroundings.  He is doing well now.  We did a BKA leg amputation for a very large cancer of the foot.  Also did a 3rd finger and metacarpal amputation for osteomyelitis. 
Our emails are drbland@sbcglobal.net and  dfbland01@gmail.com.
Love    Rollin and Dolores

August 16, 2014

Sabbath has been a beautiful day with a bright moon during the
night (even at 0200 when had to get up and do a surgery) then this
morning fairly dense fog early then bright sunshine with puffy clouds
all around. Late this afternoon it has clouded up with dark clouds
and now a gentle rain as it is ending the day. It looks as if it
could rain all night.
I drove a few miles south of Bere this morning because I had told a
surgery patient yesterday I would be going to Gissi village but the
boy that was going to go there was a camporee in NDJ but I took the
lady and her load of stuff and 5 other people so had a carload. I
did not see any car tracks or see any vehicles going or coming that
way except oxcarts but made it through about the same as before. I
don’t think any water holes were over 18 inches (45 cm) deep. I went
to the Dobge church where Jonathan was giving the talk. There is a
“one day church” building there. The millet, cotton, peanuts, etc
are growing well with all this rain that we are getting daily. Some
villages are accessible only by foot not even by motorcycle east of
here I am told.
What do you do when you can’t get the meds you need to treat a
condition. We don’t have any tetanus antitoxin so can not treat
tetanus adequately. One patient was holding stable but not
improving on antibiotics and diazepam then the family took her to
Moundou to see if they could get the antitoxin there. A man with DVT
and probable pulmonary embolus has been on Lovenox for awhile but now
they say there is not more even in N’Djamena. We can’t use warfarin
because can’t do INR’s so just take aspirin. Sometimes have to
discharge patients with blood pressure very high because can get only
atenolol which is not enough. Now no more injectable Reglan
(metaclopropamide) for vomiting but we do still have promethazine
which is what Dolores took for her vomiting. Some meds “are
finished” because someone here did not order them in time and
sometimes they just are not available in the country.
This past week we had a typhoid with several perforations so had to
resect about 12 inches (30 cm) of her terminal ilium. Another man
had a bladder stone about the size of a large hen egg. It is still
“slow season” at the hospital. We don’t have as much children with
malaria as did last year.
Dolores had fever, vomiting, and severe diarrhea last week probably
malaria and Guardia , Several of the expats had the nausea and
diarrhea including myself but all have recovered now. There is no
Ebola in Chad that is known. We hear there is Cholera in
N’Djamena but nothing unusual here. We are healthy now.
Our emails are drbland@sbcglobal.net and dfbland01@gmail.com.
Love Rollin and Dolores

August 10, 2014

The big news has been Ebola. Apparently the media is spending lots
of time about it, at least in USA. The truth about it is being sifted
out and maybe it is not as contagious as some have said. It is
transmitted via body fluids ie blood, urine, feces primarily. It
still is only in Guinea, Sierre Leon, Liberia, and Nigeria so far as
is known. There is none in Chad according to communiqué from the
Ministry of Health Saturday. Resavoirs of infection can include
fruit bats, antelope, and monkeys. So if more or less same
precautions are used as for HIV it should be ok. There is probably
no real danger in the US in spite of all the media and government
talkings about it. We are safe here at least for the time being.
I gave a talk to the hospital staff on Thurs about Ebola, what it is,
signs and symptoms, etc. There is no treatment except fluids and
perhaps blood. They should report anyone that they hear of that has
high fever and bleeding from anywhere. We all hope that no one sees
anyone that way.

The hospital here is pretty slow right now. Surgery has been really
down. Still lots of kids with malaria and typhoid. We have a
tetanus patient now. We did an amputation of an arm above the elbow
because it was necrotic below the elbow after an accident which was 3
weeks ago! We have had a bunch of normal OB deliveries and no
c-sections for a while. The volvulus around a Meckels diverticulum
band is doing well now. No surgeries the past 3 days WOW!!

We had over 5 inches of rain the past week on already wet ground that
is very flat. “Roads” have quite a bit of water on them. Lots of
water holes over a foot deep across the “road.” It is really pretty
and green everywhere and the crops look pretty good for here. It
rains a little almost daily. The humidity stays very high all the
time.

There are always lots of malnourished kids. Kim (our anesthetist’s
wife) is really trying to help a lot of them with the feeding and
education program but it cost lots of money. Some are malnourished
because of ignorance and some just don’t have anything. We have 27
bags (about 75 kg each) of rice that was given by the previous MCD
from some government program for patients in the hospital that need
something to eat but what about the other kids and moms that have
nothing?? It is another 2 months before much is available from
harvest.

The papayas are setting on now on our trees by our house. I counted
about 50 so far. The guavos are beginning to come on now.

It has been announced that there is cholera in N’Djamena now.
Cholera has been in West Africa since 1970. It is treatable with
LOTS of fluids and antibiotics.

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

Continue to pray that ebola stays out of Chad and that we continue to
stay healthy.

August 3, 2013

It seems lonely around here without Danae, Olen, Lyol, Zane, and
Addison even though there are other people here. We got the new
medical students from Denmark and a nursing student from Poland here
Wednesday night. I drove to Kelo to pick them up from the bus which
arrived there about 1930. The “road” between Bere and Kelo was
almost all dry but now it has rained some more. They plan to leave
in a month so hope the road is open by then. They seem like nice
students.

The car battery would not hold a charge even when disconnected so had
to buy a new battery and it is fine now and the car starts good
although it still has the acceleration problems like lack of spark
advance or something.

We have Foley catheters that are defective and the balloons don’t hold
so now we test them before insertion but sometimes they explode even
after they have been inserted. This makes it very difficult when
this happens after a urethra stricture dilation then have to redo.
The dilation actually is tunneling a new channel sometimes so needs
the foley to remain for a long time. This new batch apparently were
imported from China and are very inferior quality. Maybe they got
too hot and the material was ruined that they are made of. We can
hardly use any insulin because of lack of good control of temperature
in transport and so the potency is highly variable. But then some
medicines are not available at all especially meds for hypertension.
Fortunately there is not much hypertension mostly in preeclampsia.
We did a hemithyroidectomy a few days ago for a large nodule that
seemed well encapsulated but it appeared to be papillary inside so
maybe was a cancer or ? Anyway she did very well and has gone home.
The hospital sponsored futbol (soccer) team won the final game today
to take the Tandjele (state) cup. Our hospital administrator was
there to accept the cup for the team.

What about Ebola that I’m sure you are hearing about in the news.
So far as is known it is still a long way from us over in Liberia,
Sierra Leone, and Guinea although one doctor came from Liberia to
Lagos, Nigeria collapsed at the airport and died in a hospital.
Ebola has symptoms similar to malaria but later they develope bleeding
from various places. There is not a good simple test for it that I
know about and there is no specific treatment except fluids and
symptomatic treatment. It is transmitted in body fluids such as
semen, urine, feces, salivia etc. so a casual contact should be safe.
Being in the same airplane etc should not be dangerous. It
apparently is closely related to Lassa fever virus that we had in
Nigeria in 1969. The doctor that was going to deliver our son Edwin
died with Lassa fever then. Ebola has been identified since 1976 but
the present outbreak is the worst one with over 1000 cases and over
700 deaths with a 70-90% mortality. There is lots of misinformation
out there about Ebola like there used to be about HIV. Some
villagers have said that they thought it was something brought in by
foreigners and have tried to block those that were coming to help
them. They are working on a vaccine for Ebola but none released yet
for humans although Ebola has been around for many years it is just
now getting attention. It is a long way from Chad and hopefully will
stay away from here. Some of you probably know more about Ebola than
we do. There is a NIH Ebola web page that has quite a bit of
information. Now President Obama has signed executive order that
allows personnel to quarantine you if they even “think” you have a
“respiratory illness” so don’t cough in public esp on an airplane or
airport. The Department of Defense says it has dispatched
biological detection kits to National Guard units in all 50 states
with the capability of “diagnosing the virus in infected patients in
as little as 30 minutes”. Isolation “would not be a voluntary
thing”. Now some are saying that Ebola can be transmitted by
aerosols ie coughing and can survive for days outside infected hosts.
What is the truth in all this? But the US government is using this
threat to virtual set up martial law and loss of freedoms according to
some sources.

Continue to pray for us and our various problems. The Lord will
take care of us.

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

July 24, 2014

In the afternoon of 21 July there was a very difficult “hernia” that
presented as a mass in an umbilical or incisional hernia and a hard
mass in an inguinal hernia. There was an abcess in the pelvis and
apparently the cecum had necrossed into the inguinal hernia. Almost
the entire abdomen contents were adhered to each other. It took a
long time to lyse the adhesions and figure out the anatomy and repair
the intestine and clean out the abcess. It was worse because I
developed a case of diarrhea so had to leave and then scrub back in in
the middle of the case. I did make it to the bathroom in time.
There are no bathrooms in the hospital OR or even nearby. 

During 22 July we had a vessico-cervical fistula. She developed this tract
from her bladder to her cervix and vagina after a c-section at another
hospital. The transabdominal repair went real well so we hope she
will be normal again. She has had many pregnancies so a tubal
ligation was done. Also had a large mass in a man’s thigh that we
thought was a cancer but we thought was resectable. It turned out
to be a very large hematoma with a ruptured femoral artery. He
denied any trauma and he had had it for several months. Possibly a
femoral artery aneurysm that ruptured but remained contained under the
muscle next to the femur bone. It was removable quite easily but had
to tie off the artery that was not functioning anyway Today we had
another ruptured uterus. She came from another hospital then
demanded to come to Bere. They said that nurses at the other
hospital had pushed on her abdomen very hard when she was having some
contractions even though she was only 2-3 cm dilation. Of course the
baby boy was dead and the small mother lost a lot of blood but it
appears that she is going to be ok. We have another urinary retention
with a large stone lodged in his urethra at the base of his penis.
We are having problems with our electricity which makes the generator
shut down. Apparrently intermittent short someplace but not sure
where again not all the time . But maybe problem with the generator
itself not sure yet. Maybe problem in back room of Olen and Danae’s
house or maybe in the underground wire or cable from the generator
building to the OR building where the inverters and switches are. Or
? ? ?

My car is having problems with something making the battery run down
when not being used a few days. The car runs better or faster since
a new fuel filter but still problem with acceleration if one tries to
push on the accelerator but will gradually increase speed if one sort
of feathers it along to 50 mph if one had smooth road. I took the
film crew to Kelo past evening. It was dry at this end but muddy and
slick the other half of the way. Had a rain yesterday that we did
not get. The film crew was meeting the vehicle from Moundou at Kelo.
It is raining here tonight but had a small shower this morning.

Olen, Danae, Lyol, Zane, and Addison will be leaving next week on
their annual leave in USA.  They will be greatly missed. Addison is walking 

some now and is so cute and intelligent of course! ! 

I am thankful for the McDowells that are here now. He does anesthesia 

and Kim is helping a lot with malnutrition program etc.

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

July 21, 2014

A man had urinary retention intermittent for past 12 yrs. He had
been to several hospitals and had Foley’s put in and treated for
infections but still had the problem except this time unable to get a
Foley placed. So it was thought it was urethra stricture but could
not get even a filiform inserted. So we opened his bladder and his
prostate was small but about 3 cm down his urethra from the bladder
could feel something very hard and at first thought it was scar tissue
but with a metal probe could feel something like a rock and finally
with a forceps that is used for removing gall stones from the common
duct was able to remove a 1.5 x 1.0 cm stone from the urethra that was
wedged in very tightly.

We have been having electrical problems. We have two almost new
generators that came with the construction materials for the new
buildings. One was having irregular voltage output so have been
using the other generator primarily during the last 4 months.
Apparrently the oil level was not checked as it should be and it
quit this morning. On further inspection it was found today to be ok
after changing the oil and oil filter. The oil level barely touched
the end of the dipstick. The oil filter for my 4-runner fits so we
used one of those as everything seems to be locked up and our
maintainance man did not leave us a key for some things or else we
don’t know where to look. We were using the other generator today
but it quit tonight when an airconditioner was turned on. Not sure
what the problem is yet but the other generator is now working all
right. Usually we have the generator on 24/7 which costs about
$1200/month just for fuel.

The film crew from Loma Linda University is here for a few days to
film a documentary about Bere and LLU graduates that are involved here
and in Moundou and Abeche in Chad. They are getting to see some of
the problems that we face such as the electric problems, lack of
housing for volunteers or visitors because of unfinished buildings,
and equipment problems. We did repair one oxygen concentrator today
(just needed a fuse down inside it.) They are to be here 5 days
then on to Moundou and Abeche. Dr. Scott Gardner, also a LLU grad, is
at Moundou and Dr. James Appel, also a LLU grad, is starting a new place
in Abeche eastern Chad.

We also had a moto accident come in last night with a fracture
We had a C-section Fri eve, and again Sun evening another tibia-fibula and 

laceration of head. They have not given us permission to repair the fracture yet. 

Woops, this morning they took her to the “traditional healer” (witch doctor) 

like the previous two fracture legs were taken. 

The film crew have interviewed Danae and Olen and Samedi so far but plan 

more before they leave. Also they plan to get some stories of patients and how 

life is lived locally.  Also problems with Foley Catheters that the balloons 

leak or explode even with the correct amount of fluid in them. That sometimes 

is a great problem if the Foley comes out too soon especially if it was a
very difficult stricture.or a fistula repair.

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