Blog Mar 31, 2017
Hotter than ...well anyway it is hot.  The humidity is coming up in the 30% range whereas before it usually was 8-10%.   The temperature outside is 106+ but also in the OR was at least that.   The A/C was not working but yesterday it was cleaned or recharged and it is working fairly well now.  It is fairly comfortable in the OR with temp in the low 90's ((we brought a thermometer over) now.   The low last night in the house was 91F but it was 99F at 2200.  We soak the bed with perspiration so have to keep drinking lots of water during the night.   Last night I finally decided to "sleep" on the floor which seemed a little cooler.   A lot of the patients  sleep outside under the trees and on the ground.  How do you tell if a new baby has a fever if the ambient temperature is 106 or more.  The only A/C is in the OR.   Actually there is one in Danae and Olen's house but we are not using it.  I don't want to be too privileged more than the rest of the missionaries. 
The MCD came today and scrubbed in for a few cases of surgery.   He actually has been quite nice so far.   He wanted to see what was happening on our "freebie" cases that had been advertised.   We are doing lots of hernias and hydroceles for "free" but have to pay for the materials meds and suture so the price can be adjusted somewhat.  We have done 24 "freebies" so far this week and have done 30 procedures in the past 3 days.  This offer was good for only this week but we will have quite a few that were signed up to carry over into next week before we get them all done.  Our surgery load was quite low so we offered free hernia or hydrocele surgery this week only.   The price figures out to be about half price.   
The generators are being worked on.  I"m thankful for the little 12KVA generator so we can keep water and lights going.   The new water pump is working well so far..   We have got work started on the new water tank on the new tower that was built about 3 years ago by the well that was done about 4 years ago.   They are building scaffolding now.  The old water tank is really leaking a lot.  The tank labor and materials will cost about USD3000.  Then we hope to get the old tank repaired etc.   We need a new blood bank refrigerator which will cost about USD500.   The OR A/C seems to be cooling fair now so that USD500 maybe can wait awhile.  The generator work will be another about USD700 maybe more.  
We are having lots of maternity cases lately.   Most of them are normal deliveries but we are also having quite a few that arrive with fetal demise before or after delivery.  
We are hoping some of our "bush churches" will become churches but will need church buildings.  There is about enough to qualify for a shipment of "one day church" materials.   They can send materials for 30 in a container.   
This hot season is only March, April , and May.   The rest of the year is not too bad in fact may get down in the 50's in Dec and Jan.  
Pray for us
Love  
Rollin and  Dolores Bland 
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile,  Chad,  Afrique
Blog  www.weareamissionarybland.blogspot.com  

I was going to write this yesterday but found we had no water so had to tend to that before breakfast.  Our water pump had quit, apparently burned out or worn out.   "We pump many thousands of gallons of water daily.  They tell me that people from Bere town are coming to get water because wells are going dry.   Our last rainy season did not fill the water table up to near the top as usual.   It is a long time before there will be any water from the sky to put water in wells again at least until June or July..  It will take a lot of rain to soak this dry sandy ground again.   It is about 108F (about 42C) day and only 85 or 90F (72C) at night.  It was 92F last night in our bedroom at 2200.   We had a water pump to put in but did not have the proper connectors here or in Lai.   We bought another pump and finally found enough of the right fittings to connect it and had to redo the wiring somewhat.   That took most of the day.   Fortunately no real emergencies came in yesterday.   We plan to get proper fittings for the other pump so that when we need it we will have it.   There is another well that had not been used but recently had a pump put in it but not connected to the system or to its own water tower tank which is not built yet.   We made a connection from that pump ;into our main system so that hopefully now we can have back up system somewhat .  We really need the water tank built on top of the tower that is already built.  
A few days ago our blood bank refrigerator quit so we let them borrow our little one until another one can be bought.   Hopefully the blood was not damaged too much.   It will cost about USD500 or 600 to replace it.  It was about USD350 to fix the water pump.   I got word today that our generator has been repaired and will be brought back maybe tomorrow so I will need to spend some time helping or putting it back together connecting back to the motor and the electric system.   It cost about USD1000 for that besides our labor for everything.  
Our hospital census and our surgery load has decreased markedly this month.   Revenue is much decreased.   Money is scarce as had poor crops and low prices, prices are low for the country.   They say there is some kind of problem getting cattle across the border into Cameroon and Nigeria where they usually sell them.  
We have another lip to repair after a fight with another woman 10 days ago.  I saw a huge goiter but I don't want to tackle it unless we have better anesthesia and have Danae here to help and still may not as it is HUGE.   We did a mastectomy and axillary node dissection recently and she did well.   We recently had a man with severe right heart failure with very distended neck veins and short of breath even sitting up although his lungs were clear but very distant eart sounds .   We think he had a cardiomyopathy.   We don't have much to work with for cardiac patients.   He wanted to go see a "cardiologist" in NDJ.   I don't know if he made it there or not.   We had a placenta previa recently with mother and baby doing ok after c-section.  We also had a retained head with rest of baby hanging out and she walked in.  Of course baby was dead.   Was able to manipulate the head and extract it without too much problem.  
We have Staci Davenport MD here on visit and plans to be back long term in  less than 2 years from now.   Vadym Korzhos surgeon from Ukraine that is to be in Moundou wants to be here for a month or two to get some experience with me before he is on his own.   We visited him in Ukraine when we were there last August.   We also have two senior medical students here from Loma Linda Univ .  Tyler and Melissa Pender.   She is interested in internal medicine and infectious disease and he in general surgery.  Another doctor Sarah will be visiting here in May and hopefully will come back long term maybe about the  time we leave PR.  
Our emails are drbland42@gmail.com and dfbland01@gmail.com
Love ,   Dolores and Rollin

Rollin and  Dolores Bland 
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile,  Chad,  Afrique
Blog  www.weareamissionarybland.blogspot.com  

March 1, 2017

I was beginning to write this evening then the electricity went off.  Our electricity is supplied by our Perkins 28 KV generator which we run 24/7.  We have two of them but one is not functioning now.  The one that has been running now had to have the generator part taken off ( it weighs about 500 lbs) and taken to Moundou where there is someone who can rebuild them.   Now the other one has had to  have the generator part have the same thing.  Hopefully the one that has been rebuilt will continue to operate all right.   Apparrently the life span is about 14000 hours  at least that is about when each has gone out.   It costs a lot or money to get them rebuilt (about $700) .   Tonight the problem was a broken fan belt and a sensor detected it getting hot so shut down the monitor.  We took a fan belt from the one that has the generator off and got this one going again so were were without electricity less than 2 hours.  We have also  an old Caterpillar 12KV generator which we can use if no big items are being used such as AC or blenders but can handle the water pump.   The Caterpillar is the one that was the only source of power before the present Perkinss generators were donated 4 yrs ago by Garwin McNielus of "one day church" fame.  Since all the new buildings were built there are a lot more lights than there were formerly.  When we first came here the generator was only run part time and only used very low wattage light bulbs ie. 5-10 watts and used battery power to run the lights when the generator was not running but would have to run the generator to pump the water to fill our water twoer tank.  We would be out of water frequently.   Now we have a float switch which automatically turns on the water pump when the water gets below a certain level in the tank.  Fuel for the present 24/7 operation costs a large percentage of the budget.  Recently the electricity went off early am Sabbath but the problem was the fuel tank was empty and someone had not ordered the barrels of fuel to keep it going .   Usually get several barrels of fuel at a time.  
Our business seems to be slowing a little except maternity is still about the same.  We had about 165 surgeries in Jan and 135 in Feb.  March will probably be less.   We have had lots of hernieas, hydroceles, prostatectomies and urethral strictures, and hysterectomies and some vesico-vaginal fistulas.   The fistulas are the most challenging.   Danae and I always do them together.  Some are repaired trans-abdominally,and some vaginally and some both.  We have an ovarian mass or cyst and ectopic pregnanciies fairly often also.  C-sectons and sometimes ruptured uterus also.  Yesterday one of our patients returned for check up that was very rewarding.   She had had a superior mesenteric volvulus with dead intestine requiring at least 7 ft (about 2 meters) of small intestine removed.  She almost died following surgery having to have a repeat surgery etc and was very emaciated but now she is doing quite well.  She even denied having diarrhea or  other symptoms of short bowel syndrome and had gained weight.   She is happy and we were ecstatic.   We recently had another psoas abcess which we drained and she did very well.   We have different kinds of cancers that come too late for anyone to do much for them.   Probably the most common are bladder cancer, ovarian cancer, cervical cancer, breast cancer, Prostate cancer, Burkit's , etc.   
This coming weekend is alumni weekend at Loma Linda Univerisity.  I graduated 49 years ago from medical school.  I plan to be at our 50th year class reunion next year.   
Our emails are drbland42@gmail.com  and  dfbland01@gmail.com.  

Rollin and  Dolores Bland 
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile,  Chad,  Afrique
Blog  www.weareamissionarybland.blogspot.com