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.