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