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

July 15, 2014

The devil and the local “traditional healers” (witch doctors) still
have lots of influence and power. Also apparently they charge almost
as much for their services as we do. We see the results frequently.
But remember the devil has lots of power and can heal also sometimes.
We have had two tiba and fibula open compound fractures that had the
money to pay for the repairs but refused surgery and went to the
“traditional healers.” Both needed the SIGN intramedullary rods to
stabilize their legs. Sometimes people go to the “traditional
healers” then come to us later with severe infections needing
amputations etc. and want free care because they spent all their money
already.

Kim, our anesthetist wife, is really getting into the program for
malnourished kids program BUT there is a problem of lack of funds for
this. We need at least $600-$1000 per month to continue this. It
is helping kids to survive but have to keep buying supplies for the
program. She tries to teach them things that they can do without
very much money. A big item is to teach parents about birth control
so they can better take care of their children. The public health
people are working on that also.

Another problem we have is that we have these nice “one day” buildings
built 1 ½ yrs ago that are still unusable because the interior walls
and the plumbing and electric are not done in them. It would be nice
to use our new maternity and new OR someday. We are living in the
only “house’ that is finished although shelves are not up yet and no
screen on the porches to help keep the bugs out. The houses are not
bug tight. Now the flying ants are out by the hundreds or thousands
and are attracted to lights. They are considered a delicacy by the
locals to eat. They sweep them up from around the lights in the
hospital but to me the ants are a nuisance as they come into the
house. Not enough materials were sent to frame and screen the
porches for the new buildings. We are very thankful for what we
have. It is at least headed in the right direction although it may
take another year or two before the buildings are finished.

Jamie Parker, our maintainance and construction volunteer, has been
having back problems and is scheduled for back surgery the end of this
month so he will have been gone from here April through October to
allow time for his recovery and for his check ups. He has had
problems getting someone to take his insurance.

So far this week we have had a perforated gastric ulcer and another
perforation of small intestine secondary to typhoid. Today we had a
hemicolectomy for a cancer of the cecum. There were some mesenteric
nodes but no mets in the liver. He was almost completely obstructed.
Hopefully we help him for awhile at least. Also had a lipoma of a
thigh that weighed about one kilogram. Yesterday we had a ruptured
ectopic with about a 12 week pregnancy. Over the week end we had an
emergency hysterectomy for a post partum that would not stop bleeding.  She is recovering ok now.

Our Loma Linda University medical students got some good experience
the past month and have seen quite a bit of interesting pathology but
they left this morning to go back to the USA. They were good
students and I enjoyed having them. In two weeks we get two more
medical students coming from Denmark and a nursing student from
Poland.

Everybody (all of the expats) is relatively healthy today recovering
from various things.

Friday I was helping Scott Gardner at Moundou to do open reduction and
internal fixation of two fracture hips

Our emails are dfbland@sbcglobal.net and dfbland01@gmail.com
Love Rollin and DoloresBlog July 15

July 9

The headlight assemblies had been broken out for some time but the
lights kept working until the water got on the bulbs and "broke" them
out the other night. We had bought the assemblies to bring over here
just before we left home. One got partially broken and I repaired it
with “Gorilla glue” and some electric wire.  I took the old broken
ones out and put in the new ones Sunday afternoon. We have
headlights now that work maybe even in the rain and water. I also
repaired one taillight that was out and a front signal light. I
still have not figured out why the motor won’t run right. It won’t
accelerate when you push on the accelerator except very slowly just
sort of feathering it along. I had brought a OBD11 scan tool but
apparently I need an adapter for OBD1 for 1999 Toyota 4-runner so I
have not been able to use it yet to try to diagnose what is wrong such
as some sensor someplace or the electronic control module. Too bad
it is not like the old cars with carburetor and simple motor things.

This week we had two consecutive people with bladder stones. One was
a little 2 yr boy with a stone size of robin egg and other was a man
with small stones but one was obstructing his bladder outlet.
Another man had a severe stricture and scarring of most of his urethra
and an awful time reaming out a new urethra basically and hope to
leave his Foley at least a month for it to heal inside. The skin
graft we did a week looks good at 7 days post op. Did another vacuum
extraction of a dead baby. We have 3 others that need skin graft but
they don’t want to pay anything for it. We did one for free and I
guess they heard quickly. I know at least one of them has the money
to pay for it. For any surgery of whatever kind the most is about
$140.

One of our LLU medical students is sick with malaria even though they
all were taking prophylactic medicine to “prevent” malaria which in
our experience does not prevent it so most of us long termers don’t
take anything but just treat it when it comes. The medical students
are here for only a month and are going back to USA next week. They
have been good students and we have enjoyed having them here. We have
2 more medical students coming July 30 from Denmark and one from
Poland. They plan to stay about a month.

Our suction in OR is almost nonfunctioning but manage to get along
with it somewhat. Maybe someone will bring one over sometime. For
our air driven drills in orthopedic we have to bring over a compressor
from the shop or else use a hand drill. A gastroscope would be
helpful at times for lodged foreign bodies and of course for exams of
stomach and esophagus. Of course we would have to clean and maintain
it ourselves as none of our nurses knows anything at all about such
things. I take care of our dermatome myself. Also need a good
oximeter.

Some NGO (non governmental organization) has come in saying they want
to give training in OB to some health care workers. I don’t know
which NGO or who is paying but they are giving huge amounts of money
to people just for coming for two weeks. It has become a political
thing and not really related to who needs education but to certain
friends of certain officials. I don’t know what if anything is being
taught but a money making thing for their friends. They would
promise some that they could go they recant because some other friends
wanted to get the money even though they had been there before in a
previous year. So corrupt!!!. I think one of our nurses got to
go. Sometimes one can almost get discouraged when you see so much
corruption and thievery around. When some NGO doles out money that
way it does not help the situation. Instead of paying for extra
training they get paid in addition to their regular salary so of
course they want to go.

Zane is on IV quinine for malaria as he could not keep much down and
would not eat or drink enough. Danae stayed home with him today.
Pray that he recovers quickly. Lyol recently had it but was able to
get by on oral meds and is doing well now. They are all going back
to USA July 30 on annual leave

SDA hymnal #505 in English.
Love,  Rollin and Dolores

July 3, 2014

Blog July 3, 2014
It has been an interesting week. We had a lady referred here from
some other “santé” for lack of progress in labor. It was her first
pregnancy and she had been given 3 ampules (30 units) of oxytocin IM
!! The baby had been dead awhile. She went by home some hours before
coming here. Not sure if she got some witch doctors brew before
coming here. Danae did a destructive delivery and used forceps to
get the baby out. Some of the vagina and cervix appeared dead from
the prolonged labor or contractions putting pressure on the tissue.
Her abdomen was distended after the delivery so a laparotomy for
possible rupture uterus was done even though did not find any tear
from the internal exam. On laparotomy all clear except the uterus
was atonic and bladder was very poor circulation. She went into
apparent septic shock and was on medicine for that plus lots of
various antibiotics and seemed better during the night but the next
day she expired. 

 There was also a lady with a retained second breech
twin that had a heart beat and revived for awhile after delivery but
the 2nd twin died during the night. Another lady had a dead baby Sat
night that was a difficult forceps delivery but one does not want to
do a c-section for a dead baby if can do otherwise. 

We had another typhoid perforation of intestine and she is doing ok. Another one
that was possible acute abdomen turned out to be a pelvis full of
cancer of bladder. Another already dead baby was delivered by very
difficult (hard pull) forceps under spinal anesthesia Sat night.

Mason (our anesthetist) is really getting initiated into death this
week. We also had a 10 yr boy with malaria that had had artemeter
and fansidar given that went into respiratory distress and cardiac
arrest and did not survive.

We had an inch of rain (we brought a rain gauge with us) Sun afternoon
and another inch Wed night. The humidity is 80 % most of the time so
things do not dry very fast. It is green all around and people are
busy with their crops.

Our Loma Linda Univ medical students are getting experience in many
different areas including surgery, Ob, med and peds and living with
local people and experiencing the local cuisine. They are here for a
month. Next month we will have some from Denmark. We have had about
35-40 patients just on Peds lately mostly with malaria and
malnutrition. Kim McDowell, (our anesthetist wife) is really working
trying to help with the malnutrition children.

Jamie Parker, our maintenance and construction person that left here
April 1, is getting back surgery July 20 and does not plan to be back
here before the end of Oct. He has had a lot of pain in his back for
some time so that he can hardly sleep.

One night (about 0400) recently Danae had a difficult forceps delivery
and no lights in the hospital. I was trying to find the cause of no
lights. There was a short in one of the lights on Medicine ward
that made the breaker throw. I had to reset the inverters and found
the problem and turned off the circuit to that area so there were
finally lights. I put in a new light fixture the next day. She
had to use a flashlight in the dark until we finally got lights. I’m
glad it did not cause a fire in the ceiling.

The air conditioner in the OR ices over much of the time so does not
put out much cool air. It has been cleaned etc but still has that
problem with the extremely high humidity so it gets quite hot in the
OR.

Lyol has been getting quinine for malaria and he is better now.
Our emails are:  drbland@sbcglobal.net and dfbland01@gmail.com
Rollin and Dolores.

July 4, Adventure Ride

Olen and I had an interesting ride yesterday morning. Our car had
the head light covers broken out but the bulbs were still functioning.
New head light assemblies have been ordered. Olen was coming back
from NDJ and the bus was late so did not get to Kelo until 0130. I
was picking him up in the car. As we left Kelo a storm was coming
up with severe wind the same direction as the road and had severe dust
from the road so could not see hardly at all then the rain began and
really poured. Pretty soon the road was muddy and water filled holes.
The car lights kept working for a few kilometers but pretty soon the
water knocked out the lights. My Mag light flashlight was not very
bright but I had put in my pocket two new lithium AA batteries for
possible emergency and we put them in the flashlight and we had good
bright light while Olen held it outside the window as I drove trying
to stay in the middle of the road. There was lots of lightening so
could see part of the time with that. The road got slick and muddy
so put the car into 4 wheel drive which helped . Then we came to a
rain gate that was closed (road blocked about half way to Bere) but
Olen was able (with a little grease money ) to get a man to open the
gate to let us through. The flashlight held strong all the way home
to Bere, (40 kilometers Kelo to Bere . The rain slowed down by the
time we got to Bere. Our rain gauge only showed an inch here in Bere
but it seemed a lot more than that as we were driving. Olen’s arm
was a little bruised from holding the light outside the window as we
hit some holes in the road and bounced a little in the water.

Today we had a birthday party (a few days late) for Zane and celebrate
July 4 which of course is not a holiday here. No fireworks as don’t
want anyone to think we are starting a revolution. It is a nice
day about 85 degrees and about 85% humidity..
Our emails are:  drbland@sbcglobal.net and dfbland01@gmail.com .
Rollin and Dolores