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
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