Update 10 Sept 2012

     It seems we keep busy but don’t get everything done that we want to do. Of course we want to spend time with Ron and communication is slow as he is unable to talk so has to write everything that he wants to say. He realizes now that his time is short and is accepting of it and says he is ready for whenever and whatever happens. His tumor mass is growing rapidly and one can almost see a difference each day.  Even with his tracheostomy he gets short of breath very easily. His oncology team at OU Health Center finally got together with him and Lisa (his wife) Sunday 9-2-12 and spelled it out that the chemo had not really helped and that radiation would not be beneficial and were recommending hospice and we brought him home that same day. I had talked to the oncologic radiologist the previous Thurs and Fri after we had seen Ron’s condition and asked that someone besides family needed to discuss end of life issues with him and Lisa.  Perhaps everyone was in denial to what was really happening but it is very obvious now and they are accepting of it. Ron says he is ready. Jesus' coming can’t be too soon when death and pain will be no more. Ron was a great knapper (a person that makes arrowheads from rock like the native Americans).  He has quite an inventory of different rocks that he was planning to use but now will have to sell in next few days. Some other arrangements for various things are being made including cremation after death.  He is requiting a lot of pain meds and is feeling lots of pressure in his neck. It is closing in on his carotids and jugular. It is possible he would pass before we go back to Chad but I expect a little later.
     Dolores and I are in good health and eating huge amounts. It is almost overwhelming to go into a store and see so many different choices. We have been drinking large amounts of fresh squeezed orange juice. So good!!!  Also eating lots of fresh grapes and apples and strawberries.  Dolores has been working on stuff in the house that we did not have time to do before we left in Jan. I have repaired a barn roof, repaired fence, and various odd jobs around the house such as cleaning out freezers that somehow got unplugged etc.  Of course we have spent time with each of our kids.  
     Just two weeks we will be headed back to Chad. It has been about 100 degrees since being here except the past 2 days in the 50’s to 80’s and the grass growing again since we got some rain the past 2 weeks after almost none the previous 2 or 3 months.  I have had no more pain or other symptoms from the renal stone.
Hopefully the rain is slacking up back in Bere, Chad so that the roads can be opened again. They have had the wettest rainy season in 40+ years. Our container with our things is at Mondou, Chad waiting for the roads to dry up so it can be transported to Bere.  
     Continue to  pray for us
Our emails are: drbland@sbcglobal.net and dfbland@gmail.com  
Snail mail: Hopital Adventiste de Bere, 52 Boite Postale, Kelo, Chad, Afrique
Love,Rollin and Dolores

Date: Sunday, September 2, 2012, 10:14 PM

     We stopped by the Okla Health Science Center in Oklahoma City today on the way back from Edwin's
and saw Ron and talked to one of the ENT residents about Ron.  The chemo really did not do much and
they do not believe radiation would do much good but maybe make him sicker.  Ron had a trach placed Thurs because his airway was becoming quite constricted with tumor. If you read our blog it was rumored Friday that Ron had died so we had to make several phone calls and found out he was doing ok and was being
transferred to from the ICU to a regular room Fri afternoon. I had talked to the oncologic/radiologist Thur and again Friday and told him and his office that I thought someone needed to discuss end of life issues with Ron and Lisa.   Apparrently the team got together and talked to them this morning and Ron and Lisa now seem to have a better picture of what is really going on.  
     Ron does not want any more treatment and is ready for hospice care.  He probably will come come Tues or Wed.   We probably will go back to OKC to pick him up and bring him home. I had already contacted the hospice used to work some for last Monday.  One or two of them already know Ron and one only lives about a mile away. We will get a hospital bed set up in the family room so it will be close to the bathroom and not have to climb stairs.  
     Today he is on O2 and PCA morphine and is fairly comfortable. The mass hasn't broken through the skin yet but could almost any day.  The radiologist sent some notes which showed the tumor is actually bilateral and has encased his carotid and jugular on the right and his larynx.   There is also a mass by his carina in the mediastinum.  Ron was asking today "How long do I have?"   The ENT gave a vague answer like few months to yr. I really doubt he lives past Christmas and almost certainly not until next June when we were planning to come back on our annual leave. 
     I believe my kidney stone was providencial so we would come home and help in this situation. Hopefully the rains begin to slack off there a little so the water can go down.  They finally had a rain here 1 wk ago and again yesterday and it is beginning to green up a little bit.
   Love ,  Dad (Rollin) and Mom (Dolores)

Rumors 31 Aug 2012

Today we got a phone call that Ron, Dolores brother, had died but it was not from the hospital and was from the pastor of Jay church. He had been told that by some other people and was calling us to see if indeed it was true.  We had not heard anything like that before. We had talked to him at the house as he was leaving to drive to Oklahoma City for check up and probably get a tracheostomy as the tumor was incroaching on his airway. So it would have been possible to be true. We immediately called several people to find out. Dolores’ sister had not heard anything either.  We did not have the phone number of the OU Health Science Center or know which place to call but I did have the phone number of his oncologic radiologist and called there. His office was very helpful.  I had talked with him the day before. They said according to the hospital census he was still alive and transferred me to the hospital ICU and found that Ron had a trach done Thur. and was being moved to regular room 426 today. He is scheduled for some palliative radiation Sept. 4. Through various phone calls we did trace where the rumor came from, an older person that gets a bit confused sometimes. So Ron is still alive but needs our prayers. We had thought we would have to cut short our visit to Texas with our son in order to go back and help take care of arrangements but was not the case.
There was another rumor that we came home because I was dying with malaria which of course was not true at all. I had had malaria in April but recovered with treatment. We are alive and well now. There was another rumor previously that I had malaria and was too sick to be moved home. When I had malaria I continued to work doing surgeries while I was taking the treatment. 
We are still planning to head back to Chad Sept 24.  Be sure to look at recent blogs at  www.missionarydoctors.blogspot.com to see what it is like there now with floods.
Love,  Rollin and Dolores
Our emails are: drbland@sbcglobal.net and dfbland@gmail.com 
Our address:  Hopital Adventist de Bere, 52 Boite Postale, Kelo, Chad, Afrique 

Gospel 30 Aug 2012

Gospel means “good news” so we have gospel.  Apparently the kidney stone that began being very painful Aug 14 probably passed about the time we got to Oklahoma City the night of Aug 22 after flying from Africa. We had a CT and urology appt the next day—no stone seen but still hematuria. Today there is no pain and the appointment with the urologist yesterday was all clear. Even the hydrocele that had come up has now gone away spontaneously.      
We are glad we came home though because Ron, Dolores’ brother, is doing poorly with his squamous cell carcinoma of tonsil that is causing airway and swallowing problems.  He has a stomach feeding tube so he can get some Ensure feeding.  He is to get some palliative radiation beginning Sept 4. We did not have any specific reports before so we did not know how extensive it is.  He is still upbeat that “I am going to beat it” but realistically prognosis is very poor.  He and his wife are still in denial it seems. I did have a discussion with his oncologic radiologist yesterday so have a better picture of what is going on.  Ron probably soon will get a tracheostomy to facilitate his breathing. He has quite a bit of pain and is taking morphine.  He and his wife are staying in our house while we are in Chad. I wish there was more we could do. They really need everyone’s prayers. 
We are leaving Oklahoma City to go back to Chad Sept 24. We have seen our children and grandchildren since we arrived in the USA one week ago except the oldest grandchild that is in Ubon, Thailand. We plan to go by there on our way home from Chad next May when we get an annual leave and will be home next June. The present trip home was not scheduled but necessary. When we left Oklahoma in Jan we were busy packing things in the shipping container and did not have time to do anything to our house etc as we left in quite a hurry to make the schedule for Mission Institute in Nairobi then on to Chad. They were needing us in Bere, Chad as soon as possible as it was their busy season although even now it is quite busy. The surgeries are a little bit less but there is more malaria etc during the rainy season. Olen and Danae will be taking their annual leave in Nov. and Dec. 
Love,  Rollin and Dolores
Our emails are: drbland@sbcglobal.net and dfbland@gmail.com
Our address:  Hopital Adventiste de Bere, 52 Boite Postale, Kelo, Chad, Afrique

23 Aug 12

     Good news!!!  I had the CT this morning and a consultation with the urologist, Dr. Richard Herlihy, this afternoon.  I am not having the pain as before but there is still some microscopic hematuria but not grossly bloody as it was a week ago. The  CT did not show a stone!!!!  The urologist is a very busy man but made arrangements to see me almost immediately.  He also gave me some special gadgets to help dilate strictures which I’m sure we can use fairly frequently in Bere.  We got into Oklahoma City last night at 10:00 pm.  Yesterday was our wedding anniversary and we spent nearly the whole day in the air leaving N’Djamena, Chad Tues. night. We were thankful for the Adventist Medical Aviation plane and pilot Gary Roberts who was able to fly us to N”Djamena on Monday.  All the “roads” around Bere are impassable because of high water and mud.  They say it is the most rain in 40 years. The internet service has not been functional for the past week and the phones don’t work much of the time.  The last phone call from there today said the hospital census was low and little to do for patients as no one can get in or out.    
     Now that we are here we plan to stay about a month to be sure all is well and do some visitation and relaxation. I am to see Dr. Herlihy again in a week to see if the hematuria has cleared and how I feel. There are some things we need to do at home that we did not have time to take care of at all before we left in such a hurry in Jan.  No, we still have not received our container of goods from here yet but it is impossible to be delivered for at least 2 months until the rains let up and it begins to dry up somewhat. Olen and Danae plan to take their annual leave during Nov and Dec.  My French needs to improve a lot yet.  We plan to take our annual leave next June and July and go home via East through Thailand, Cambodia, and China.  Our oldest granddaughter, Rachel, is in Ubon, Thailand as a student missionary teaching English as a 2nd language.  
     Maybe I am a “slacker” but the pain was so intense and we found a way home to get it checked out.  See Danae’s blog.  Maybe this week at church I can give a talk about a moving stone versus the solid Rock and Matt 16 etc.  Moving stones can be very painful but Jesus wants to be broken on the Solid Rock and be ready to meet Him when he comes for His children.  
Our email is: drbland@sbclobal.net and dfbland@gmail.com  
Our address  is: Hopital Adventiste de Bere, 52 Boite Postale, Kelo, Chad, Afrique. 
Love,  Rollin and Dolores

DANGER 11 Aug 2012

     One of our volunteers (Minnie Pardillo from the Philipines) died last Sun a.m. from cerebral malaria and her memorial service was this afternoon.  She worked in public health and was involved in trying to help people in preventive care.  She was a very caring person yet very quiet.  She made a good impression in the area while she was here.  Several of the local people gave testimonies about what she meant to them.  A little 9-yr-boy said she loved the children like God loves.  Even the MCD who has been a problem for the hospital in the past came this afternoon to the memorial and gave a testimony about how Minnie had helped many people and that he had talked with her several times. This same MCD also had an uncle by marriage that I had operated on after he had been operated on in N’DJamena for a “strangulated hernia” and didn’t do well there.  Apparently they got the repair too tight and necrosed the cord and testicle which I removed.  He did very well and became pain free so apparently that also affected the MCD in a positive way.  I was invited over to the uncle’s brother this evening and visited with the MCD and his uncle.  Lots of children die with malaria especially in combination with malnutrition.  Some adults die also especially if they don’t begin  treatment in time. There is a movement to try to get DDT instituted to use to spray around peoples huts to kill some of the mosquitoes that carry malaria. I have mixed feelings on that.  I am aware of the envirionmental problems in America and how it affected the eagles, etc., but . . . out here it is possible it could save thousands of human lives.  I think every missionary out here has had malaria at least once and some have had it several times and have been in Chad for several years.  One has to be sure you take the treatment as soon as you realize that it could be malaria with various aches and pains and weakness and especially if there is a fever.  Being a missionary is a bed of roses with lots of thorns. There is also lots of HIV infection, so especially there is some danger from needle sticks.  Of course there are other problems.  The devil knows how to attack and try to make people discouraged or try to make discord among God’s people so we need your continued prayers that we will continue to be healthy and united in our efforts to bring the good news of salvation to the people here.  
     The “roads” are swamps and huge water holes but apparently are best negotiated on motorcycles.  It is interesting to see the motorcycles used as ambulances as they bring various ones into the hospital even unconscious persons or even convulsing ones.  We do see occ tetanus so one should always keep their tetanus vaccinations up to date to prevent that danger.  This is supposed to be cholera season although I don’t think I have seen any yet so one should always be sure all food is disinfected and have frequent hand washing  to prevent that danger.

Our oldest grand daughter Rachel Norman is in Thailand and her blog is: www.celestlamarie.wordpress.com .    And her email is: rnorman1993@yahoo.com  
Olen and Danae’s blog is:  www.missionarydoctors.blogspot.com  
Our email is: drbland@sbcglobal.net and dfbland@gmail.com and our phone is:  62674586      
Rollin and Dolores

An unusual case 6 Aug 12

A five-month-old girl was brought in with history of not being able to have bowel movement for 3 weeks but was eating (breast feeding) ok and no vomiting but a huge distended abdomen and large veins on the epigastrium.    Rectal exam was normal except one could feel a mass at the tip of the finger outside of the rectum.  Foley was placed with difficulty and noted that the catheter bulb was felt in the large umbilical hernia.  She appeared overall malnourished.  No fever, and did have a small stool after the rectal exam.  An ultrasound revealed a large mass in the abdomen but could not tell what it was attached to.  The patient was brought in Fri evening and the abdomen did not seem tender but was very tight.  We were thinking of partial bowel obstruction secondary to??  Family was told that she needed a surgery but it would be a very high risk with high probability of dying but even higher probability of dying without surgery.   The next morning they were gone so thought they just went home to let her die; but they showed up again Sunday eve and again it was discussed but there seemed to be no change in the baby’s condition.  Father said, "lets take the risk and whatever is the will of Allah would be."   Monday morning we opened the abdomen under Ketamine anesthesia.  The bladder was up in the umbilical hernia and the “uterus” was up above the umbilicus.  The “uterus” was part of a huge mass or cyst that was filled with over 350 cc cloudy fluid.  Ovaries and tubes were present but only the top part of the uterus.  The rest  and the top of the vagina was part of this huge cyst.  I think it was a Mullerian duct malformation.  We removed the “uterus” but left the ovaries and removed most of the sac wall and allowed some of the bottom part to be open with hemostatic suture around the top of the small amount of remainder.  We repaired the large umbilical hernia removing the bladder from it and allowing it to be where it should be.    Pre op we were afraid we would never be able to close the abdomen but it closed nicely.  We had minimal blood loss and the baby is recovering well so far.  I had begun the  case but when I saw what it was, I knew Danae (Ob-Gyn) would want to see this very uncommon abnormality so she got in on it also.  It is great to be able to operate and see unusual things with our daughter.
Our email addresses are:  drbland@sbcglobal.net  and  dfbland@gmail.com  
Our address is:  Hopital Adventiste de Bere,  52 Boite Postale, Kelo, Tchad, Afrique
Love, Rollin and Dolores