August 31, 2014

We have had 3 days without rain except a little sprinkle this morning. There was thunder and lightning tonight but probably rain later. Maybe the mud and water will start to dry out a little bit. The water table is almost to the top of the ground so water can't soak away very fast. The crops are looking good with millet and sorghum headed out and cotton and peanuts blooming. The rice is beginning to head out. The rice fields are flooded like the local people like them to be. It is nice and green everywhere and the temperature has been in the 70's F most of the time. There is still plenty of water over the "roads". The main transportation is motor bikes or oxcarts In the early mornings one can hear the cooing of the doves or the singing of the gonalek or the rooster crowing somewhere or the dogs barking.

Yesterday we had a ruptured appendix then had a c-section for face presentation of the baby that was her first baby. All are doing well. It was our first c-section in a month which is unusual. We have had a few prostatectomies for urinary retention. Pediatrics is slowing down a little but Medicine service is full right now. Three people with large epigastric masses. One patient with edema, proteinuria, hematuria and a heart murmur. Of course there is malaria, typhoid, and HIV. Not sure why Pediatric malaria seems to be slowing down now at end of August. It was that way last year also. Mason is doing a great job on Pediatrics. I do the rounds on surgery, maternity, and medicine. Kim (Mason's wife) is doing a great job with the malnourished kids. It takes a lot of money to keep the program going. DONATIONS FOR MALNOURISHED KIDS WOULD BE HELPFUL.

We are all healthy. No Ebola or cholera in our area that is known. Pray that we remain healthy. Pray for Jamie Parker that had recent back surgery that he can have a rapid recovery and can get back to Bere for the maintainance and construction work that is so desperately needed.
Our emails are drbland@sbcglobal.net and dfbland01@gmail.com

Love, Rollin and Dolores

Hamangioma

What can be done except leave alone?

August 22, 2014

On this date 49 years ago, it was raining also when we got married that summer evening in Tulsa, Oklahoma.  It is raining again on us only now we are in Chad.  We got 3 in ches yesterday morning here.  The locals talk about how great this rain is for the rice.  Nothing special is planned for today. 

We have been blessed the past 49 years with 4 children (3 girls and 1 boy) and 9 grandchildren ages 1 yr to 21 yrs.  All the children and their spouses have at least a college degree or more and all are active in the church.  We are so proud of all of them.  Oh yes during the years we have had our differences of opinion. etc.  Dolores has been very tolerant of my crazy hours and other things but I am thankful for her.  We are still in good health other than passing things here in Chad.  What will we do to celebrate the big 50 mark next year?  Not sure yet.

I saw a man yesterday that had 14 wives and 41 children with 30 girls and 11 boys.  I suspect he does not remember any of the many anniversaries.  He had brought one of his wives in for a check up for an "ovarian cyst" that turned out today to be a bilateral pyosalphinx (pus in the tube).  His name was not Solomon. 

We had a boy with urinary obstruction but no stone visible in the bladder and unable to put in a Foley.  We did surgery and found a stone lodged in his proxiumal urethra which was a little difficult to get out but it finally popped out in h is bladder and we removed it.  We had another ovarian mass about 15 cm diameter.  A man had an ileostomy done somewhere else "for typhoid" but not sure what all the problems were.  We took down the ileostomy and reconnected the ileum to his transverse colon as the right colon seemed very scarred and adherent to surroundings.  He is doing well now.  We did a BKA leg amputation for a very large cancer of the foot.  Also did a 3rd finger and metacarpal amputation for osteomyelitis. 
Our emails are drbland@sbcglobal.net and  dfbland01@gmail.com.
Love    Rollin and Dolores

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

August 10, 2014

The big news has been Ebola. Apparently the media is spending lots
of time about it, at least in USA. The truth about it is being sifted
out and maybe it is not as contagious as some have said. It is
transmitted via body fluids ie blood, urine, feces primarily. It
still is only in Guinea, Sierre Leon, Liberia, and Nigeria so far as
is known. There is none in Chad according to communiqué from the
Ministry of Health Saturday. Resavoirs of infection can include
fruit bats, antelope, and monkeys. So if more or less same
precautions are used as for HIV it should be ok. There is probably
no real danger in the US in spite of all the media and government
talkings about it. We are safe here at least for the time being.
I gave a talk to the hospital staff on Thurs about Ebola, what it is,
signs and symptoms, etc. There is no treatment except fluids and
perhaps blood. They should report anyone that they hear of that has
high fever and bleeding from anywhere. We all hope that no one sees
anyone that way.

The hospital here is pretty slow right now. Surgery has been really
down. Still lots of kids with malaria and typhoid. We have a
tetanus patient now. We did an amputation of an arm above the elbow
because it was necrotic below the elbow after an accident which was 3
weeks ago! We have had a bunch of normal OB deliveries and no
c-sections for a while. The volvulus around a Meckels diverticulum
band is doing well now. No surgeries the past 3 days WOW!!

We had over 5 inches of rain the past week on already wet ground that
is very flat. “Roads” have quite a bit of water on them. Lots of
water holes over a foot deep across the “road.” It is really pretty
and green everywhere and the crops look pretty good for here. It
rains a little almost daily. The humidity stays very high all the
time.

There are always lots of malnourished kids. Kim (our anesthetist’s
wife) is really trying to help a lot of them with the feeding and
education program but it cost lots of money. Some are malnourished
because of ignorance and some just don’t have anything. We have 27
bags (about 75 kg each) of rice that was given by the previous MCD
from some government program for patients in the hospital that need
something to eat but what about the other kids and moms that have
nothing?? It is another 2 months before much is available from
harvest.

The papayas are setting on now on our trees by our house. I counted
about 50 so far. The guavos are beginning to come on now.

It has been announced that there is cholera in N’Djamena now.
Cholera has been in West Africa since 1970. It is treatable with
LOTS of fluids and antibiotics.

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

Continue to pray that ebola stays out of Chad and that we continue to
stay healthy.

August 3, 2013

It seems lonely around here without Danae, Olen, Lyol, Zane, and
Addison even though there are other people here. We got the new
medical students from Denmark and a nursing student from Poland here
Wednesday night. I drove to Kelo to pick them up from the bus which
arrived there about 1930. The “road” between Bere and Kelo was
almost all dry but now it has rained some more. They plan to leave
in a month so hope the road is open by then. They seem like nice
students.

The car battery would not hold a charge even when disconnected so had
to buy a new battery and it is fine now and the car starts good
although it still has the acceleration problems like lack of spark
advance or something.

We have Foley catheters that are defective and the balloons don’t hold
so now we test them before insertion but sometimes they explode even
after they have been inserted. This makes it very difficult when
this happens after a urethra stricture dilation then have to redo.
The dilation actually is tunneling a new channel sometimes so needs
the foley to remain for a long time. This new batch apparently were
imported from China and are very inferior quality. Maybe they got
too hot and the material was ruined that they are made of. We can
hardly use any insulin because of lack of good control of temperature
in transport and so the potency is highly variable. But then some
medicines are not available at all especially meds for hypertension.
Fortunately there is not much hypertension mostly in preeclampsia.
We did a hemithyroidectomy a few days ago for a large nodule that
seemed well encapsulated but it appeared to be papillary inside so
maybe was a cancer or ? Anyway she did very well and has gone home.
The hospital sponsored futbol (soccer) team won the final game today
to take the Tandjele (state) cup. Our hospital administrator was
there to accept the cup for the team.

What about Ebola that I’m sure you are hearing about in the news.
So far as is known it is still a long way from us over in Liberia,
Sierra Leone, and Guinea although one doctor came from Liberia to
Lagos, Nigeria collapsed at the airport and died in a hospital.
Ebola has symptoms similar to malaria but later they develope bleeding
from various places. There is not a good simple test for it that I
know about and there is no specific treatment except fluids and
symptomatic treatment. It is transmitted in body fluids such as
semen, urine, feces, salivia etc. so a casual contact should be safe.
Being in the same airplane etc should not be dangerous. It
apparently is closely related to Lassa fever virus that we had in
Nigeria in 1969. The doctor that was going to deliver our son Edwin
died with Lassa fever then. Ebola has been identified since 1976 but
the present outbreak is the worst one with over 1000 cases and over
700 deaths with a 70-90% mortality. There is lots of misinformation
out there about Ebola like there used to be about HIV. Some
villagers have said that they thought it was something brought in by
foreigners and have tried to block those that were coming to help
them. They are working on a vaccine for Ebola but none released yet
for humans although Ebola has been around for many years it is just
now getting attention. It is a long way from Chad and hopefully will
stay away from here. Some of you probably know more about Ebola than
we do. There is a NIH Ebola web page that has quite a bit of
information. Now President Obama has signed executive order that
allows personnel to quarantine you if they even “think” you have a
“respiratory illness” so don’t cough in public esp on an airplane or
airport. The Department of Defense says it has dispatched
biological detection kits to National Guard units in all 50 states
with the capability of “diagnosing the virus in infected patients in
as little as 30 minutes”. Isolation “would not be a voluntary
thing”. Now some are saying that Ebola can be transmitted by
aerosols ie coughing and can survive for days outside infected hosts.
What is the truth in all this? But the US government is using this
threat to virtual set up martial law and loss of freedoms according to
some sources.

Continue to pray for us and our various problems. The Lord will
take care of us.

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