Sept. 25, 2014

Ah sweet sounds this week. Although the Beautiful Sunbird babies
have fledged so don’t hear them, but now we have the sounds of Lyol,
Zane, and Addison saying Nana and Papa. Also they want Papa to “be a
donkey” and ride the donkey which of course he was happy to do.
Olen, Danae, Lyol, Zane, and Addison all arrived today in N’Djamena
and then on down to Bere today. David our pilot picked them up in
NDJ in the little mission plane and they arrived back in Bere about
5:00 pm. It had been threatening to rain earlier in the day but
late afternoon it all cleared so they were able to fly easily.
Jonathan (the other pilot) will be bringing the luggage down tomorrow
in his new Land Cruiser that he just is picking up today in NDJ.

Addison has grown so much in the two months they have been gone. It
was so nice to hear the airplane as it came back and watch them land
on the little dirt strip. They all looked good but tired after the
long trip from Washington, D.C to Addis, to N’Djamena to Bere. The
dogs, Sheba and Midnight were glad to see them back also as they
barked their welcome. The kids were playing with Grace and Emma
here so they were enjoying their reunion.

The roads are beginning to dry up a little as rainy season is
decreasing now. People are harvesting their millet and sorghum grain
and feeding the cows whatever is remaining. The river has not
decreased much if any yet. The water table around here is less than
a foot below the top of the ground.

The electrical system is working well now after not working right for
several months and gradually getting worse. There was a short where
one wire had been connected or touching a ground wire but the main
problem was the generators needed cleaned out with new air filter,
fuel filter, and oil filter. The air filter was very much clogged
and of course a big diesel engine needs air and fuel. Nick is doing
a great job with plumbing and electricity. He has finished Mason’s
house and about finished Zach’s and Charis’s apartment so now they
have shower and toilets.

Kim is turning the nutrition program to the new director, Michael,
this week. I think they had 50 kids this week. They plan on
doing a lot of it as outpatient down at Bendele (about 2 miles away)

We had two more non-resectable cancers this week. One was another
bladder cancer and the other was an ovarian cancer that was spread
all over. We had a c-section for an arm presentation and another
vacuum extraction. Overall the surgery schedule has been slack.

Our emails are drbland@sbcglobal.net and dfbland01@gmail.com.

Love, Rollin and Dolores

Sept. 19, 2014

Various sounds are heard. Some are pleasant and some not so
pleasant. We hear the crickets or some kind of insect very loud in
the evenings. Early mornings we hear the doves cooing and pecking on
the metal roof. During the night we hear the fruit bats making their
calls and noises. In the mornings and evenings we hear the children
playing on the swings at the school sometimes very late at night.
Some evenings and days we hear the drums and “music” for church but
sometimes hear it for the dancing. Especially early mornings we hear
the roosters crowing and maybe the dogs barking. Sometimes we hear
the babies crying at the hospital and sometimes we hear wailing or
crying of relatives as another has succumbed to their illness often
very soon after their arrival too late for medicine to benefit.

Sometimes at night I hear the “knock, knock” of a nurse at the door
wanting some help with someone at the hospital most commonly an
obstetrical problem. One may hear a motorcycle go by or may hear a
donkey bray. We have our fans going which helps muffle some of the
other sounds at night BUT may awaken me if the fan does not sound
right or the speed is being variable as when the generator is not
acting right. Prefer to hear the sound of the generator being steady
not being irregular or the sound of voltage regulator clicking a lot.
We have had lots of problems with our electricity even the main
switch of the generator going off so apparently a big short in the
system somewhere causing severe electrical drain. I have finally
disconnected the batteries of the “backup system” and so far the power
and generator are being very steady since then. So I think the
batteries were shorting out the system. 

We also have other sounds if you listen for them such as tweeting 

of fire finches and of sunbirds.  Found a neatly sewn pendulous nest 

quite small and heard the mother bird and father bird tweeting. 

It is a “Beautiful Sunbird” which is the name but also the description 

with scarlet chest with yellow sides and irredescent green over most

of it and long tail streamers. The nest is right in Danae’s yard in a thorn tree. 

Might hear the rattling sounds of the Buffalo Weaver bird or the staccato

noises of the gray shrikes and fiscals and sometimes the music of the African
thrush under our kitchen window.

This week has been sad for some people in that we have had 3 that we
opened in surgery that had inoperable cancer. Two were bladder
cancer and one was colon cancer with huge periaortic nodes. One
fortunately died the next day. Another was a huge mass in the
epigastrium that had the appearance of metastatic disease on echo.
Another boy became jaundiced after receiving a unit of blood for Hgb
of 4 but also receiving quinine and Fansidar which has sulfa so
possible GP6D deficiency or ? We had another 3 yr boy with a large
bladder stone and another man with prostatic urethra stones.

Mason and Kim’s house is getting closer to being finished with most of
the electric and plumbing in with the help of Nick from Moundou being
up here for a time while Scott and Bekki are back in the USA.

Our emails are drbland@sbcglobal.net and dfbland01@gmail.com
Love,  Rollin and Dolores

Sept. 10, 2014

Friday began as usual then about time the staff worship was over we
were told that a superfe or chief or government official was coming
to meet with us (not sure who all “us” were to be) about 10:00 so we
tried to get rounds done and cancel some surgeries so that we could
meet with them although not sure the purpose of the visit. Finally
about 1030 we were told that the meeting was cancelled. Then we did
so some surgeries in some that had not eaten yet including a man that
had blocked urethra since an accident Feb 2014 and had urine coming
out of a suprapubic incision that had been done elsewhere. Just
beyond the prostate was superdense scar tissue that I was unable to
tunnel through with a probe or whatever. I finally stuck a knife
blade somewhat blindly through the prostatic urethra into the super
dense scar tissue and finally was able to open it up enough to get a
probe and then a 22Fr 3way foley through into his bladder. I plan to
leave it there for at least a month to let it heal around it. We also
did a 4th ray amputation finger for necrotic finger that the infection
was back in the metacarpal and just packed it open then plan to close
later after the infection is gone.


In the late afternoon of Friday we went to Lai (about 12 kilometers away)
to get some supplies so that could do some electrical wiring and plumbing 

being that Nick was here from Moundou to do some of that
kind of work hopefully to finish Mason’s house. Most of the road was
not bad other than deep holes but was very muddy close to Bere. On
the way back there was a pickup stuck in a hole in the mud in the
road. We tried to pull him out forward but unable to so went around
and pulled him backwards with our winch and helped him out of the
mudhole.

Monday we had very heavy rain this morning with 3.4 inches (8.6 cm) in
about 4 hours. I’m sure the “road” is impassable now. The river was
24 inches over the road before so now I’m sure it is much more so the
only way to Bere is with canoe and motorcycle. We also had problems
with the electricity and generator so we cancelled one little boy
until sure everything is working right. Not sure if the problem
is the generators or the invertors or an intermittent short circuit
someplace. It seems if we switch generators and or reset the
inverters it is ok for awhile.

We finally did the 3 yr old boy with a huge mass in his belly Tues
that had been postponed Fri because of the “meeting” and Monday
because of the generator or electricity problems. It turned out to
be a huge 20 cm left cystic kidney that was resectable very easily did
a left nephrectomy. Wed we did a bilateral oophorectomy for huge
solid masses possibly cancer in a 16 yr old girl. 

We are still healthy with no Ebola or cholera around here that 

we know of.

Our emails are drbland@sbcglobal.net and dfbland01@gmail.com
Love Rollin and Dolores 

4 Sept 2014 A day in Bere, although unusual

The day began as usual with breakfast then staff worship 0715 and
rounds with almost a full hospital of patients although Peds and
Maternity has been down somewhat. Then we had surgery. The first
was a little 5 yr boy with a mass at his umbilicus with drainage from
it that looked almost like bowel contents or drainage from an abcess.
We did a laparotomy and discovered solid mass that had almost
appearance of liver but very inflamed with intestines being stuck
into the mass all around. We finally got it dissected free and all
the adhesions freed but the rest of the abdomen was clean with no
adhesions. The liver itself appeared normal as did the spleen. The
mass itself was quite firm almost hard so I don’t know what this
about 10 cm mass was. Then we had another child with a large solid
mass of her eyelid (it closed her eye) which we dissected out. It
perhaps was glandular like some kind of tumor somewhat friable but did
dissect out fairly readily. Then had a man with a very large
inguinal hernia and bilateral hydrocele which turned out to be pyocele
so we did a orchiectomy and repair of the very large sliding hernia.

Then we had a call from Nick and Kelsey that they had tried to get
here driving their ambulance from Moundou but were stuck in the mud
about 15 km from Kelo (It is 45 km from Bere to Kelo) It had rained
much of the night before so the “road” was very muddy with deep water
holes and over 24 inches over the road going across the “hippo river.”
It is about a ¼ mile (about 500 meters) across. A large wave of
water would go in front of the car as we went across with boys running
ahead to show where the road was the most shallow (of course they
wanted a fee for their service). We finally got to where they were
stuck in the mud off the edge of the “road”. We were able to drag
them out with our winch on our 4 runner. The water hole in the road
by them was at least 18 inches deep. We made it back through the
mud and the river without incident to Bere. Nick and Kelsley came to
do some plumbing and electric wiring on some buildings especially
Mason’s house.

Then about midnight we had c-section for a ruptured uterus. Of
course the baby was dead. During the time we were doing the
c-section they brought in a man that was victim of a stabbing with
intestine coming out stab wounds so we had to do a laparotomy after
the c-section. We had to repair his colon and small intestine and a
large bleeder in his mesentery. His abdomen was pretty full of
blood. By the time we repaired everything it was beginning to get
daylight. Then time to start another day but maybe this one will be
quieter as they usually are.

We love to hear from each of you about your days.
Our emails are drbland@sbcglobal.net and dfbland01@gmail.com
Love. Rollin and Dolores