Oct 28 Update on prayer needs

     Keep praying for us as the hospital containers still haven’t been released yet and if they aren’t released very soon the whole project will be postponed at least a year apparently. Olen spent most of last week as well as one day the previous week in N’Djamena trying to influence the right people to help the situation.  It is hard to get appointments with some of the officials. They want to charge an unrealistic amount of import tax.  We simply do not have the funds to pay the exorbitant tax.
     The weather should be drying up the mud fairly quickly as the temp is in the 90’s and only cools down in the mid 80’s at night. I see on the news that Nigeria also had floods from the excessive rainy season.  I don’t know how far west the rains went, such as Niger, Mali, etc. No appreciable rain the past two weeks. We are out of sacks of cement for the building projects but hope to get more tomorrow.  The “roads” are getting more passable.  The “road” from here to our post office in Kelo only takes about 1 ½ hours to go the 25 miles now. The bus goes over it every day now to go from here to N’Djamena which takes about 10 hours on the bus.  
     One week ago I went to Moundou in our car (about 2 ¾ hrs) to get some supplies.  It was Friday so one has to have business done by noon as many of the businesses close at noon on Friday for the Moslem sabbath.  At 12:30 Danae called wondering how soon I would be back as there was a baby that needed a colostomy because it had no anus or rectum so I rushed back and we did put in a loop colostomy.  Imperforate anus are fairly common here. We also had a 7-month pregnancy in the abdomen with placenta attached to bowel and end of tube.  The uterus was very small.  The woman said she had felt movement until 2 months ago when someone had hit her in the abdomen and then no movement afterwards.  There was minimal old blood in the abdomen.  Perhaps it would have gone on to become a calcified fetus but she saw someone who thought it was a molar pregnancy and needed attention. I had seen two calcified fetuses about that size when I was in Nigeria 40 yrs
ago. Read more in Danae’s blog under “misdiagnosis” at www.missionarydoctors.blogspot.com 
     Danae left here with Lyol and Zane early Thurs morning on the bus to N’Djamena to leave that night with Olen to go to Paris for the weekend then on to the USA maybe arriving there before Hurricane Sandy in the D.C. area.  They are to be back here the end of December.  They deserve a good vacation but they will be missed greatly.
     It seems that OB has gotten busy since Danae left.  I have already done 4 C-sections and a normal delivery.  There was another normal delivery done by the nurses also.  One C-section was for transverse presentation with hand sticking down and unable to change it as the uterus was very clamped down.  This was because the lady had oxytocin elsewhere, clamping down the uterus which resulted in a dead baby.  Another C-section was for a footling breech and previous c-section with nice live baby.  Another was for CPD (lack of room in the pelvis) and failure to progress and dead baby.  Another was for a previous C-section and head very high and live baby.  I had another lady with a large (about 25 cm diam) mass in her right broad ligament with the round ligament over the top of it.  The mass was multicystic and some cartilage like material in it but no hair.  I’m not sure what it was but at least it came out fairly easily once I incised the peritoneum and peeled it off.  
     I had a visitor today who was a governor of another state.  He brought a patient-friend of his with some x-rays wondering if I could fix his hip.  Dr. James Appel had referred them here.  The patient had had a fracture of his right hip 7 yrs ago and had had a surgery of some sort apparently removing part of the proximal femur at least the trochanteric area. The x-ray was not the best quality so difficult to tell the condition of the head and acetabulum.  We have some endoprosthesis here of varying sizes but don’t have a good intramedullary rasp to prepare the bone for the stem of the endoprosthesis. The slide to put the head into the acetabulum would be nice also. It would be difficult to make it work at best. The leg is about 2 inches shorter.  He really needs a total hip.  I wish we had more orthopedic equipment to work with.  A good fracture table would be helpful at times.  Hopefully we will have new OR tables  etc. when we get our new OR and OB maternity built and continue to pray that it will be soon and not a year from now.  

     Pray more than ever for our situation that the officials will do what they are supposed to do soon.

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

15 Oct 2012 Problems

The devil is still actively trying to delay work here at Bere. Maybe the rainy season is about over. The rains have lasted longer than normal so the “roads” are still with large water holes and very, very rough. We drove towards Lai on the main “road” for almost 10 miles 2 days ago in the afternoon which took over an hour each direction.  Some of the holes are 3 foot deep. It is impossible to get the containers here for at least another 2 or 3 weeks.  BUT we need everyone’s prayers besides praying for roads to dry up, we now need prayer for the government people to let the containers through with the building materials for the hospital. Apparrently the duane (customs) is trying to get 40 million francs ($80,000.00) for that which is supposed to be no charge or at most very minimal.  The donor states that if it can’t be cleared properly soon he will divert the material to Zambia for a building project there. There is supposed to be a contract with the government to let it go through because we are a non-profit, non-government organization trying to help the people of Chad but so far they don’t want to honor their word. The Chad government is known as one of the most corrupt in the world. We need the OR, surgical care area, maternity and private ward beds.  Also housing is needed for volunteers to stay in. Some of the concrete slabs for the various buildings have already been poured and work has been progressing in spite of the difficulties. Some of the Chadian workers were laid off today as they were caught trying to steal some of the cement powder.  Pray that the devils road blocks would be overturned and that the work can proceed. Olen may have to spend a few days in N’Djamena seeing various government ministries such as the Minister of Health, Minister of NGO’s, Minister of Finance, etc. Olen is optimistic that some higher up official can turn it around.  

Also the customs people are trying to get more money for our container which supposedly had been cleared as we got our vehicle out of it already but we are unable to move the container to Bere because the trucks are unable to get through yet especially the big semi that would be required to move the 40 ft container. Olen and Danae are supposed to leave on annual leave next week for 2 months.  They both have not been well lately but are improved now.  Dolores and I feel inadequate but I’m sure the Lord will provide.  Olen is so good with languages and we seem to be very slow.  Pray for our situation in all your prayer circles. Thanks.

Love,  Rollin and Dolores
Our emails are: drbland@sbcglobal.net and dfbland@gmail.com
Our blog is: www.weareamissionarybland.blogspot.com  

3 Oct Wheels

     We have wheels!!  Our container has been released from customs and we have our Toyota 4 Runner 4-wheel drive with heavy bumper and winch on front. Jamie Parker went to Moundou, got supplies and our vehicle. Tammy (his wife) drove it back through a back “road” about 4 hours to get it here.  We really won’t be driving it a whole lot but it is nice to have when we need or want to. The stuff that was in the vehicle and the vehicle made  it through just fine.  Hopefully the roads will eventually dry up so that our 40-foot container can be moved to Bere. I’m not sure where we will put stuff when we unload it. Our house is just starting to get foundation etc.   There is no way to off load the container here in Bere except by just pulling it off the truck so probably has to be emptied before taking the container off the truck. There is a lift in Moundou that can load the container on the truck. It is beginning to dry up some now. 
     Ron (Dolores’  brother) made it to his knap-in this past week end.  We did not know if he could make it but some of his knapper friends put him in a motel for the week-end and had a raffle for him.  His cancer has been growing pretty fast but we are glad he made that.  That was one of his final things he wanted to do.  

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

Back in home in Chad

     We are finally back in Chad after our saga with my kidney stone leaving here Aug 21, spending our wedding anniversary (Aug 22) mostly in the air, partly in Paris (layover in the airport) and arriving in Oklahoma City the evening of Aug 22 and getting a CT the next morning and seeing the urologist.  Apparrently the stone passed about the time we got to Oklahoma but there was still hematuria which cleared after a few days.  Maybe the vibrations and changes in cabin pressure etc helped the stone to pass besides the pain meds.  At least I did not have to have lithotripsy  (special ultrasonic blasting of the stone) or surgery for it.  
     We got to see Ron (Dolores’ brother) while he is still alive but his condition is terminal with throat cancer (squamous cell carcinoma of the tonsil primary).  He is now on hospice and taking huge amounts of morphine for his pain.  He probably won’t live past 2 months.  He has a tracheostomy and a gastrostomy feeding tube.  He is a knapper (person who makes arrrowheads from rock) and is trying to go to one last knap-in this weekend to see some of his knapper friends (“his other family”).  We were trying to help him make some final arrangements for some of his equipment and materials while we were home and to be sure his wife had some different arrangements.  She does not want to stay where he was.  They were living in our house.  We have made arrangements for and paid for cremation and he wants some of his ashes scattered in a certain place on his folks old place on the hillside.  We plan to have a memorial service for some of his friends and family when we come home again next June.  The service will be probably the last weekend of June 2013.  We hope to get pictures from some of his friends to put together for that.  It was hard to leave him knowing we will not meet again on this earth but as we parted we said that we plan to meet again when Jesus comes again and sounds that trumpet and calls forth the dead to meet in the air to go to heaven where there will be no more pain, suffering, or death.  
     While at home I went to Pasco, Washington for a orthopedic course on SIGN fracture which is a system for internal fixation of long bone fractures even without the C-arm capability esp for use in developing countries but is being introduced in the US now also.  There are some who have put in a few hundred of them in high trauma areas such as Bagdad, Manila, and a few other places.  Dr. Lewis Zirkle developed the system and distribution of it and relies a lot on donations so that it can be available in the poor areas of the world.  Many areas of the world have a per capita income of less than $2/day but yet they have broken bones that need quality care.  It costs a few thousand dollars to sponsor a system someplace.
     Our trip here was a bit different.  We flew OKC, ATL, Paris, N’Djamena ok then took an 8 hour bus ride over very rough highway (the only “paved” road in the country) to Moundou with our baggage.  There was miles of water covered countryside and lots of people camped on the edge of the highway to get out of the water.  Many mud brick grass thatch roof “houses” have literally melted down in the water.  Different organizations are doing relief efforts for food for some of these people.  There are villages near here in Bere that have been staying in Bere to get out of the water.  They say it is the most rain of rainy season in at least 50 years.  Thurs we left our baggage in Moundou with Dr. Appel. We had 6 checked bags and each had 2 carry ons.  We had weighed our bags carefully and each weighed 51 lbs which the check in person said was ok then when I began to give my credit card to pay for the extra bags, only allowed 2 each or one on Air France, she said there was no charge and “have a good day”.  Normally would have been a few hundred dollars for extra baggage. 
     We got a ride to Kelo then we got on motorcycle taxis to come to Bere.  Dolores got her leg burned on the exhaust pipe of the cycle.  Along the way we had to cross some open water over the road in a canoe for perhaps a half mile.  There were many other areas where the water was only a foot deep or less so the motorcycle could get through.  Also several small detours through fields.  The road from Kelo to Bere has not seen a grader or any type of repair for many years so the water holes get deeper and deeper.  It is possible to get stuck in the mud even in 4 wheel drive.  Anyway we finally made it back to Bere.  It is supposed to be about the end of rainy season now but it has rained hard Fri and Sat nights which will prolong and make it more difficult for people to get in and out.  The water level has gone down some from its high point.
     It was good to see Lyol and Zane and hear “nana” and “papa”
     Friday I did some surgeries including a mastectomy, some hernias, bladder stone removal and helped Danae with a C section (another partial ruptured uterus).  They said these all just came in and that surgery and the whole hospital has been quite slow because people have not been able to get here.
     The construction project is coming along in spite of much rain.  Part of the slabs have been poured after the dirt work was done.  We are certainly looking forward to when all the buildings will be completed including our house which is not started yet.  Lack of roads have been hampering the project.  Apparrently there is a back way that sometimes can be navigated to Moundou without having to take the canoes.

Our emails are: drbland@sbcglobal.net and dfbland@gmail.com
Pray for us.
Love, Rollin and Dolores

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