Blog 23 Nov 2017 Happy Thanksgiving

Our story begins 1 week ago on Thur Nov 16.   Olen, Christian (the new surgeon from Argentina) and myself had done rounds on in-patients and were doing surgery and consults.   Danae is back in USA preparing for Ob-Gyn oral boards that will be Jana 8.   Dolores is calling Olen say that the pet cat named Lucy was acting crazy and would not let anyone through the door of the house.   Lucy had scratched Lyol pretty badly that morning and could hardly get rid of her but she sometimes was a bit mean.   Then in the afternoon Lucy unprovoked bit and scratched Addison on her ear and neck and back while Addison was on her bicycle.   Dolores thought the cat was acting like rabies and had the kids stay away and climb trees and so Olen answered the call and came over and put the cat in a back room where she could not get out and all were told not to open the door.   Lucy was pregnant and had kittens Sat Nov 18 but she would not even clean them or pay any attention to them and maybe killed one of the four kittens.   Lucy would try to drink water but could not and her condition was deteriorating and not acting her old self.  By Sunday she was very weak and died Sun night.   Olen was on the phone texting and calling all evening until midnight trying to find rabies immunoglobuin.   Could find rabies vaccine but no immunoglobulin.   A friend, Ndilbe, in Cameroon said that a doctor there had told him that he could get the immunoglobulin at 0500 Mon and could get it to us in Bangor by 1000.   The doctor never showed up then Ndilbe tried many pharmacies and hospitals but ones that said they had it would turn out to be only rabies vaccine.   I drove the car with Olen, Lyol, and Addison leaving Bere 0600 and arriving Bangor at 1000.   We waited there 4 hours and started towards NDJ.    Olen was on the phone constantly all the time.   The evacuation insurance wanted to send them to Nairobi, Kenya but Olen found out they were going to use "alternative" treatment not the immunoglobulin so turned that down.   Remember that rabies is 100% fatal once you have symptoms and rabies immunoglobulin is the only treatment that is nearly 100% effective.   However the rabies immunoglobulin is $3500 per person if you can find it.  The SOS insurance found one dose in NDJ for $3500.   Also found that the US Embassy had a vial or two of rabies immunoglobulin but they were refusing to let anyone have any as it was "against their protocol".   IT was to be only for embassy personnel.   They were repeatedly begged to let enough go for a 4 yr American girl that had been bit by a rabid cat on her ear and neck and back and arms.   A friend, Josh Knowles, in Kenya found some of the real thing and Danae was about to spend many thousands of dollars to get a private jet to fly Josh and the meds to NDJ. Danae and Olen were in constant communication .   A doctor friend in Niger had 2 vials and told the embassy that he would overnight it to them if they would let us have it now.   Olen finally about 1600 got on his ER Facebook which has about 14000 ER physicians on it and posted about the situation.   Immediately various things began to happen.   One worked in the State Dept and some called the CDC (communicable disease center in Atlanta, USA).   Many began calling the embassy in NDJ and many were calling their senators and representatives about the situation and even called Fox news and CNN I am told saying how bad it would look if a 4 yr American girls would die from rabies when they had refused to give her the treatment that was needed.  The embassy was deluged with phone calls and within one hour the embassy told the SOS insurance people to come  get the vial of medicine and when Olen received the message he let out a big hurray and AMEN as we were still on the road to NDJ.   We arrived there after 2000.   The embassy gave (no charge) the vial (enough for all the kids).   Lyol and Addison got their immunoglobulin about 2100 Mon Nov 20  THANKS FOR A LOT OF ANSWERED PRAYERS.   Team mission let us stay thee and even gave us supper at 2200 and no charge for the night's room.   Tues Nov 21 we drove back to Bere after getting some supplies leaving NDJ about 1230 and arriving Bere about 2230.   Much of the main highway is so rough with potholes that 5-10 mph is top speed over part of it.   Actually the dirt ox cart roads are better a lot of the time.   Tues night Zane and Juniper got their rabies immunoglobulin.   They had gotten their first vaccine Mon night from some vaccine obtained from a neighboring hospital.   Most of Africa has no rabies immunoglobulin.   The only treatment available for most people would be rabies vaccine.   Of course part of the reason is the very high cost of rabies immunoglobulin.   
Thanksgiving is an American holiday but we are having a happy thanksgiving even if we did work most of the day.   Praise God from whom all blessings flow.   God shut the various doors so that finally we got the required meds given to us without having to pay many thousands of dollars.  
Again thank you for your support in various ways and prayers
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 Nov 3, 2017

We have had a run on intestinal surgery the past 2 weeks.   We have had 2 strangulated internal hernias with dead intestine that had to be resected.  One had dead sigmoid and  dead terminal 1 meter of ilium (small intestine)   Also 2 strangulated femoral hernias with dead intestine and a strangulated inguinal hernia with dead intestine.   Also a strangulated umbilical hernia but the intestine was still ok.   With dead intestine there is often infected wounds.   Also had a typhoid perforation of intestine.    We also had a new born with no rectum so had to put in an ostomy in the abdominal wall with a loop of intestine.   Yesterday we had a perforated gastric ulcer and a appendectomy and 2 c-sections and an ectopic pregnancy with lots of blood lost and a vacuum extraction of a baby.   We also have about 60 inpatients to try to see besides the consults etc.  Olen and Danae left 2 days ago for the airport for Danae returning to USA  for her oral Ob-Gyn boards and preparing for them.  She is return here mid Jan.   Olen is returning tonight (thur) with the new doctor from Argentina.  
I hear that back home they don't treat strept throat now but here you better.   We see rheumatic fever and kidney problems as sequelae to strept infections also severe cutaneaus infections.   Although we do not have proof culture evidence of which infection it is.  I just saw my third case of "NOMA" which is a necrosing full thickness infection of part of the face.   I'm not sure if it is "flesh eating" strept or what but it is bad.  One of them got over it and the defect has mostly filled in.   Another one just left so don't know what happened to it.  One was to return in Jan for a recontruction team that was going to come but now we hear that they are not coming.   
The "harmattan" dust was come in so everything is very dusty.  Visibility is down to less than a mile and everything gets covered with dust quickly.     Harmattan usually does not come until Dec or Jan.   Harmattan is the dust that blows in from the north in the Sahara.    Probably no more rain until next May.  There was lots of rain with flooding then it shut off like a faucet with nothing more since then.  I think the rice and ground nut harvest is fairly good this year and hopefully the cotton will be good .   They are harvesting rice now all by hand.   Lots of work.    Grass etc is starting to turn brown.  
Pray for the Lord's work here. 
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 Nov 2, 2017

IT has been busier the past several days.   Danae left Chad today for the USA where she will be  preparing for her oral OB_GYN boards .  She will be returning mid Jan.   Then we will be leaving in Feb.   A new surgeon from Argentina is arriving this week. His wife is a nutritionist and they have no children yet.   Another doctor family -practice with extra fellowship in OB is to arrive about Jan 1.   Our administrator resigned.  Olen now is the interim administrator as well as head of AHI (Adventist Health International) for this area.  He was doing a lot of the work anyway.  Ndilbe our head of the operating room is leaving next week to get further training in anesthesia in Cameroon and plans to be gone 2 years.   Olen and Danae plan to leave sometime next year also although their plans for what they will be doing keep changing.   There is a a Brazilian surgeon that wants to come perhaps next April or May.  Zach Gately just left and probably not coming back.  He will be in Cairo.    So lots of changes in the works.   
It is sort of sad for me as I probably won't be doing hardly any more surgery together with Danae but we have had most of 6 years together.   She is a fantastic surgeon and very compassionate doctor and has given away lots of money to help various patients and other people.   Even though she is OB-GYN she can do about any general surgery also and has done intestine resections and ureter reimplantations in bladder as part of fistula repair.  She has done several prostatectomies.  I may be biased but I think she is one of the best.  Pass or fail on oral boards I know she is very good and am very proud of her and Olen.   
Papa Danae as I am often called.  

Rollin and  Dolores Bland 
Hopital Adventiste de Bere
Boite Postal 52
Kelo, Tandjile,  Chad,  Afrique