Addison is eating more different things as they are introduced to her. She does not seem to be a picky eater. All of us are healthy presently.
We had an interesting surgery Friday. A lady with diffusely mildly tender abdomen that we finally opened had what looked like typhoid perforation with lots of yellowish material in the abdomen but could not find a perforation in the usual place so we looked around more and found a ruptured liver abcess which we cleaned out and debrided and stuck a drain into. We had two other typhoid perforations of terminal ilium this past week. One had been operated on elsewhere then referred here as the person was not improving and had a large amount of stool like drainage from the drains that they had wisely put in. Apparrently the repair was not sufficient and the bowel totally came apart so we had to take out a small segment of intestine and put it back together. He seems to be doing ok now although he seems to have an infected incision as might be expected. So far our three vesicovaginal fistula ladies that were repaired last week are doing well. We have two men with osteomyelitis of the temporal mandibular joint and are unable to open their mouth or jaw. They can eat between their teeth. Unable to pry open their jaw. What do you do for them besides antibiotics and drain purulence. Unable to get to the infected tooth that needs extracted.
Last Sunday I went down to Moundou to help Scott Gardner on a couple of bone cases. One was a proximal tibia and tibia plateau fracture comminuted so it was quite difficult to get the pieces to go in place and put screws in and a plate with long screws. The other was a fracture neck of femur. Was able to put in a steel piece something like a Jewett nail. The hardware for both cases had just been brought here from Germany by the German doctors visiting from there. They brought a good supply of orthopedic hardware and two good hyfercator monopolar and bipolar so good for stopping little bleeders. They also brought a perfusion pump that would be good for being more precise regulating fluids such as oxytocin drips. We did not have any before.
We have had a few sets of twins lately. One recent was C-section because of transverse lie and did well. Also a recent c-section for abruptio placenta and the baby lived. We have had 4 maternal mortalities so far this year with malaria and ecclampsia etc. The treatment for malaria, quinine, causes hypoglycemia especially in pregnant ones. We had a c-section Sat for ecclampsia with dead baby and no labor and minimal dilation then another ecclampsia Sun but delivered with forceps and a living baby. One recently was reported as being dead but was given dextrose and she came to life however she died two days later. We don’t have good nursing with close observation and vital signs being taken regularly unless you call vitals once daily as regular. Sometimes can get them two times per day. We need a nursing director that can teach them what real nursing is but they know they can go work in a government hospital where they don’t have to be very responsible.
Dolores has been drying some mangoes on a big screen mesh in our living room with the fan going and the very dry air. They dry very rapidly maybe one day. The humidity is less than 20 percent all the time. She is trying to get some done before we go on annual leave in April and May.
Our emails are: drbland@sbcglobal.net and dfbland01@gmail.com
phone: 235 91453226
Love, Rollin and Dolores
Valentine's Day has passed. Dolores gave me a nice Chadian outfit
to wear for Valentine's day. We had a special supper and vespers
about love. It was very nice.
Addison has passed her six months mark and is now starting on solid
foods. She chowed down quite well her first solids as we watched.
She has two teeth now also.
Todays sermon in church (by a local Chadian pastor) was about fighting
the good fight of faith with the fruits of the spirit comparing that
to members of a football (soccer) team which was quite good.
We had a recent unusual case of a 9-year-old girl that came in with right
lower quadrant pain, but she also a very large mass in her upper abdomen.
She had been told almost a year ago that she had a mass, possibly
ovarian that needed removed, but did not. Now at surgery she had a
torsion of a right ovarian mass that apparently was this same mass
that was seen a year ago. Surgery was quick and simple.
Another little boy hardly a year-old came in with severe shortness of breath
and stridor. We could hardly feel a soft mass in his neck slightly
to right of midline. We aspirated some purulence which seemed to
help some, but next day he was worse so had to do something more
drastic. We stuck a knife in his neck hoping to not hit any major
blood vessels. At first got nothing so stuck it deeper yet and got a
large amount of purulence out. After a few days he is breathing
normally now and has minimal drainage but apparently it was pressing
on his airway.
Another little girl about age 1-yr had an epigastric hernia we thought,
but when we operated there was no hernia but still a mass so
opened still farther and found pus between her fascia and
peritoneum. So we cleaned that out and packed it open, possibly closing
later after the infection is gone. It sometimes seems surgery rounds
is abcess rounds. We are still doing lots of hernias and hydroceles.
We have logged about 85 procedures so far this month but there are
a lot waiting to be done.
We should be starting home in about six weeks. We plan to be in
Oklahoma by April 2 and plan to drive up to Union College April 3 for
the Alumni weekend than begins that night. We have a room reserved
for April 3, 4, 5 in Rees Hall thanks to Gary Gray (another 50-yr
Unionite that plans to be there). We plan to be in Jay, Ok the 2nd
weekend for a baptism at the Adventist church there. We probably
will be in Texas the 3rd weekend to visit Edwin and family and Harold
Wallar and go see the Texas bluebonnets in the hill country then
meander west to Ariz and Calif to see Gloria (Dolores ' sister) and
others; enjoying the desert along the way, perhaps even up into Utah.
On the way back to Chad we leave about June 1 and plan to tour Turkey
a little with Olen parents (Kermit and Ronnalee Netteberg) seeing
the 7 churches area etc.
Looking forward to see some of you along the way.
Our emails are drbland@sbcglobal.net and dfbland01@gmail.com
Love, Rollin and Dolores
It seems that I have been too busy or else not inspired to write but
some of you may be wondering if we are well and we are well. We have
had a gastrointestinal bug of some sort going around but have
recovered. It is warming up somewhat as it is in the 90's and over
100 a few days only 99 today but it cools down in the 70's at nights.
It seems we have accidents coming in almost every evening lately.
The road through town has been graded so people are going much faster
in their vehicles including their motorcycles and there are always
lots of pedestrians and cows and oxcarts etc on the road so it is
dangerous to go very fast especially after dark. When the "road" was
very bad then there were not so many accidents but we are also having
more that fall out of mango trees now that the mangoes are beginning
to get ripe in some places. Many are just now blooming.
Today we went out in our 4-Runner to try to find this one Fulani
village way out in the bush through some trails that had not seen a
car maybe never before. But we did not find the village; maybe we did not go
far enough but did see some beautiful birds including carmine bee
eater and Abysinian roller, some parrots (not sure what kind), some
swifts (not sure what kind ). The birds were around a grass fire
catching insects as they came up away from the fire. There are some
beautiful yellow flowers coming up in some burned over areas.
Olen has been very busy with administrative issues lately including
replacing the administrator. Olen's parents were here and recently
went back home to DC area.
We now have two doctors visiting for 3 wks here from Germany, a Ob-Gyn
and a hand and foot specialist. They also brought some nice equipment
and instruments with them for us including a fetal monitor and a
electrocautery machine.
During Dec and Jan we logged in about 350 procedures including 202 for
Jan. Did lots of hernias and hydroceles and prostates and incision
and drainage of huge abcesses; also some hysterectomies, ovarian
masses, ectopic pregnancies. We had another ruptured uterus recently
(pt lived but of course baby died). Recently a ruptured spleen but
fortunately we did not have to remove the spleen and patient is doing
well post op. Recently had an HIV positive patient with a rectal fistula
and a hemoglobin of 6, but relatives refused to give blood for him and
in fact just took him home when surgery and blood donation were
suggested. We recently had a not so good result with avesico-vaginal
fistula that involved also the uterus. We had what appeared to be a
great repair then she had a cardiac arrest and we were unable to resuscitate her.
She expired probably an anesthetic death as the blood loss was not much.
That was the second one in 3 yrs. Will be glad when our full time anesthestist
gets here in May or June. We have quite a few cases waiting to be done
as I was not the usual full of energy this past week.
I am going to Moundou to help Scott Gardner do a couple of SIGN cases
on old femur fractures tomorrow. Scott is new in Chad and presently in Moundou.
James Appel is moving to another place (Abeche, Chad) to start some work
there. Every year the surgeries here in Bere have increased considerably
over the previous year. However there is a limit how much can be done in one OR.
It will probably be another year or so before the new buildings will be usable;
then we will have 2 OR's and a few more beds although we will still be short of bed space.
Looking forward to seeing some of you in April and May when we will be
home on annual leave.
Our emails are drbland@sbcglobal.net and dfbland02@gmail.com
The iphone 235 91453226
Love, Rollin and Dolores Philippians 4:13
