July 3, 2014

Blog July 3, 2014
It has been an interesting week. We had a lady referred here from
some other “santé” for lack of progress in labor. It was her first
pregnancy and she had been given 3 ampules (30 units) of oxytocin IM
!! The baby had been dead awhile. She went by home some hours before
coming here. Not sure if she got some witch doctors brew before
coming here. Danae did a destructive delivery and used forceps to
get the baby out. Some of the vagina and cervix appeared dead from
the prolonged labor or contractions putting pressure on the tissue.
Her abdomen was distended after the delivery so a laparotomy for
possible rupture uterus was done even though did not find any tear
from the internal exam. On laparotomy all clear except the uterus
was atonic and bladder was very poor circulation. She went into
apparent septic shock and was on medicine for that plus lots of
various antibiotics and seemed better during the night but the next
day she expired. 

 There was also a lady with a retained second breech
twin that had a heart beat and revived for awhile after delivery but
the 2nd twin died during the night. Another lady had a dead baby Sat
night that was a difficult forceps delivery but one does not want to
do a c-section for a dead baby if can do otherwise. 

We had another typhoid perforation of intestine and she is doing ok. Another one
that was possible acute abdomen turned out to be a pelvis full of
cancer of bladder. Another already dead baby was delivered by very
difficult (hard pull) forceps under spinal anesthesia Sat night.

Mason (our anesthetist) is really getting initiated into death this
week. We also had a 10 yr boy with malaria that had had artemeter
and fansidar given that went into respiratory distress and cardiac
arrest and did not survive.

We had an inch of rain (we brought a rain gauge with us) Sun afternoon
and another inch Wed night. The humidity is 80 % most of the time so
things do not dry very fast. It is green all around and people are
busy with their crops.

Our Loma Linda Univ medical students are getting experience in many
different areas including surgery, Ob, med and peds and living with
local people and experiencing the local cuisine. They are here for a
month. Next month we will have some from Denmark. We have had about
35-40 patients just on Peds lately mostly with malaria and
malnutrition. Kim McDowell, (our anesthetist wife) is really working
trying to help with the malnutrition children.

Jamie Parker, our maintenance and construction person that left here
April 1, is getting back surgery July 20 and does not plan to be back
here before the end of Oct. He has had a lot of pain in his back for
some time so that he can hardly sleep.

One night (about 0400) recently Danae had a difficult forceps delivery
and no lights in the hospital. I was trying to find the cause of no
lights. There was a short in one of the lights on Medicine ward
that made the breaker throw. I had to reset the inverters and found
the problem and turned off the circuit to that area so there were
finally lights. I put in a new light fixture the next day. She
had to use a flashlight in the dark until we finally got lights. I’m
glad it did not cause a fire in the ceiling.

The air conditioner in the OR ices over much of the time so does not
put out much cool air. It has been cleaned etc but still has that
problem with the extremely high humidity so it gets quite hot in the
OR.

Lyol has been getting quinine for malaria and he is better now.
Our emails are:  drbland@sbcglobal.net and dfbland01@gmail.com
Rollin and Dolores.

July 4, Adventure Ride

Olen and I had an interesting ride yesterday morning. Our car had
the head light covers broken out but the bulbs were still functioning.
New head light assemblies have been ordered. Olen was coming back
from NDJ and the bus was late so did not get to Kelo until 0130. I
was picking him up in the car. As we left Kelo a storm was coming
up with severe wind the same direction as the road and had severe dust
from the road so could not see hardly at all then the rain began and
really poured. Pretty soon the road was muddy and water filled holes.
The car lights kept working for a few kilometers but pretty soon the
water knocked out the lights. My Mag light flashlight was not very
bright but I had put in my pocket two new lithium AA batteries for
possible emergency and we put them in the flashlight and we had good
bright light while Olen held it outside the window as I drove trying
to stay in the middle of the road. There was lots of lightening so
could see part of the time with that. The road got slick and muddy
so put the car into 4 wheel drive which helped . Then we came to a
rain gate that was closed (road blocked about half way to Bere) but
Olen was able (with a little grease money ) to get a man to open the
gate to let us through. The flashlight held strong all the way home
to Bere, (40 kilometers Kelo to Bere . The rain slowed down by the
time we got to Bere. Our rain gauge only showed an inch here in Bere
but it seemed a lot more than that as we were driving. Olen’s arm
was a little bruised from holding the light outside the window as we
hit some holes in the road and bounced a little in the water.

Today we had a birthday party (a few days late) for Zane and celebrate
July 4 which of course is not a holiday here. No fireworks as don’t
want anyone to think we are starting a revolution. It is a nice
day about 85 degrees and about 85% humidity..
Our emails are:  drbland@sbcglobal.net and dfbland01@gmail.com .
Rollin and Dolores

June 28, 2014

It is a beautiful morning with temp in upper 70’s but it will be near 100 by afternoon. We are having occasional rains so everything is green. People are busy plowing with their oxen and planting

Friday was a busy day with several surgeries such as two prostatectomies but one was full of cancer so not able to take it out. One case of amputation of wrist and closure of a 1 yr old girl that necrosed the hand and wrist after an IV infiltrated whether it was from pressure or the medicine that caused the problem not sure. In the evening we had another child that had inhaled maybe a peanut . We were unable to get it out. Apparently down in the right bronchus. Maybe a bronchoscope, which we don’t have, would have helped. Maosn and I intubated and the larynx area was clear. We tried the various maneuvers such as the Heimlich also tried some steroids and Advair. There was a lot of bronchospasm not sure if actually a foreign body or not. Our suction is not very powerful either. Our only O2 is in the OR because the O2 concentrator is 110 volts only. One can only do what you can do. The medical students mentioned referring to NDJ or somewhere by helicopter but of course that is not an option here. It is 6-10 hrs by road to NDJ. Then not sure there is anyone or anything any better there. This is the middle of Africa. Some patients (esp GYN) come here from NDJ. It really got to Mason so he did not sleep well last night. The ruptured ectopic pregnancy and the typhoid perforation intestine have done well from last week.

There was a funeral this morning at Doubge (one of the branch Sab Schools). The mother died last night after giving birth to a child then apparently they let her bleed to death without bringing her to the hospital “because it was too far” although only 6 miles. The baby needs milk and maybe the relatives will take care of it.

Some of the expatriates have had the diarrhea bug but so far Dolores and I have escaped. Lyol has had a fever so is on quinine and Tylenol. The McDowells are fitting in very well and getting acclimated. Gary, Wendy and Cherise Roberts have left for USA and on to Indonesia where he is going to take over the work that his dad was doing there before his dad got killed in the plane crash.

To see a fresh look at what it is like here go to www.whyweshouldgo.blogspot.com from the McDowells that have just arrived here for 2 weeks. Good writers and describers. Our internet is not operative so far today so not sure when this will go. It usually works better on iphone than on the modem of the computer

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

June 15, 2014

We are safely in Bere having arrived here Friday the 13th. We had 2 surgeries today; one was a typhoid perforation of intestine and the other was a ruptured ectopic pregnancy with a lot of blood in the abdomen. Nice Father’s Day, I think there is a photo on Facebook of Danae and I in surgery today.

After leaving Oklahoma June 1 we arrived in Istanbul the next day afternoon. We had an overnight flight from DC to Istanbul. We had 6 bags instead of the permitted 4 and one of the extra was 70 lbs instead of 50. They suggested at the airport that we pay the minimal amount of $380 ($150 per bag plus $80 for the extra weight) but perhaps we may need to pay more at DC or Istanbul. But all of our bags checked through to Istanbul. We did not leave Istanbul til June 12, but Turkish Airlines let them go through on to NDJ without extra charge when we showed them the receipt from OKC). Kermit and Ronnalee Netteburg (Olen’s parents) were with us from DC onward. We spent one night in Istanbul then we drove a rental car to Izmir (Smyrna). It was a beautiful drive through some fertile valleys with lots and lots of fruit trees and farmland. The cherries and peaches and melons were delicious. They seem to be able to raise almost anything. There are miles and miles of olive trees in Turkey.

We went through Iznik (Nicea) on the way and saw where the Council of Nicea occurred although the church has had to be rebuilt since an earthquake many years ago. Now it is a mosque. We toured the seven churches area of Turkey during the next several days. Our Turkish guide was very good with lots of information that I cannot remember all of. Also Jon Paulien was very good with extra bits about each place and how it related to the 7 churches of Revelation. We also went one day out on a boat to the isle of Patmos which was quite interesting. It is larger than I had imagined it to be, 10 square miles. One story is that John may have gone there as a missionary rather than being banished there as a prisoner. Either way he received his visions and wrote books there. We were in a different hotel each night and had a good bus to take us to the different sites. We crossed the Dardanelles in a ferry then bussed to Istanbul. We toured some mosques and palaces there. Also had a 2-hr afternoon boat ride on the Bosporus, and the last evening in a restaurant that had beautiful evening views of lights on mosques and the bridge that crosses the Bosporus (similar to the Golden Gate Bridge). Turkey is a very modern country with good roads yet has many things that are thousands of years old. The ancient Hittite empire has been proved with archaeological findings which proves that the Bible was correct when it talked about the Hittites.

We left Istanbul for N’Djamena the evening of the 12th. It was over 90 degrees at night and high humidity especially as we got back to Bere but today we had a small shower and wind so tonight is cooler.

We have a lot more in my daily notes or diary also of our trip out west in the US to visit various relatives and see some of the national parks. We have taken many pictures on our vacation but now we have to get back to work. We enjoy all your emails. Some of you we missed visiting but you are in our thoughts. Continue to pray for us.

Our blog is: www.weareamissionarybland.blogspot.com

Our emails are: drbland@sbcglobal.net and dfbland01@gmail.com

May 30, 2014

We arrived in USA April 2 and have been busy but maybe not much accomplished.

The first weekend of April we were at Union College in Lincoln, Nebraska for my 50 year college class home coming and reunion. We saw some of my classmates that we had not seen for 50 years. Funny how most of them had aged but then of course I had not Ha! It was great to renew some old friendships and see what each other has done in life.

The 2nd weekend we were at home in Jay, Oklahoma and had the sermon in church. During the week we had to get some repairs done at home. The bladder in our pressure tank had ruptured and the pressure switch had gone out for our well pump. Our washing machine had quit. There was a leak in a toilet but only when it was flushed. The air conditioner in the pickup was not functioning even though it had supposedly been repaired the year before but wasn’t. The computer had viruses. The DISH TV receiver had gone out and had to be replaced and the 3 ABN dish had to be realigned. 

 
The third weekend we began an extended vacation down to Texas to see our son and his family then down in the hill country of Texas west of Austin which was very drought stricken but there were a few places with good blue bonnet flowers and Indian paint brush then out to Guadalupe Peak National Park then to Arizona through the Saguaro National Park. More saguaro were blooming east of Gila Bend rather than in the parks and lots of Palo Verde blooming. Then went through Joshua Tree National Park in California but the flowers were not very plentiful but some in the higher elevations. We visited Loma Linda and Riverside, California and stayed with Gloria, Dolores’ sister then on to the California Poppy Preserve by Lancaster, Calif. There were some great fields of poppies and Phacelia but it was cold with snow level down to 5500 feet with a storm that came through at the time we did. In fact almost the whole trip was cold. From there we camped one night at Trona Pinnacles which Olen and Danae can relate to and remember a few years ago. Then on to Death Valley National Park. There were several flowers at the 4-5000 ft level such as Prince’s Plume, several different cacti and others. Then on to Nevada and saw Badallet ghost town and on to Valley of Fire State Park which has many beautiful rock formations which are bright colored sandstone such as the Windstone Arch and the Elephant Arch and the Fire Wave. From there we went to Zion National Park in S W Utah but many people were there so one had to go on the shuttle to get into the main part. We spent more time on the back part at high elevation where the ground was still partly frozen. We camped by a spring on some Bureau of Land Management (BLM) lands that was quite nice. From there we went on to Cedar Breaks National Park (the road was closed with snow) then on to Red Rock Canyon and Bryce Canyon National Park all in Utah. There was still some snow there but not enough to make the various rock formations more contrasty. We camped just outside the park in some national forest. We went to Capital Reef National Park and drove through and camped in a field of Primrose flowers just at the edge of the Park not a “designated campground” but a very nice secluded spot. We also went to the Devils Garden south of Escalente, Utah and drove on the Devils Backbone where the highway is on a high ridge with drop off on each side of many hundreds of feet. Then we went to the Moab, Utah area and the Arches National Park and Canyon Lands National Park. Our time was running out so we did not spend as much time as we would have liked. From there we went to Denver, Colorado to see my brother, Reggie and his family. Then we went to Winona, Kansas to see some friends (the Headleys) and camped at Monument Rock near there. Then we went to central and SE Missouri to see some of Dolores’ relatives (Aunt Carol Sharon near Sunnydale Academy and Aunt Esther Trial near Van Buren) then home having driven over 5000 miles.

We have spent time visiting with various friends and family around home including Springdale, Arkansas and Ketchum, Oklahoma churches. Time has really gone fast. Some did not get visited and we are sorry for that.

We are leaving Oklahoma on June 1 heading back to Chad but spending some time in Turkey on the way visiting the 7 churches area with Kermit and Ronnalee Netteburg as leaders of a group. We want your prayers as we go back to Chad.

Rollin and Dolores Bland

drbland@sbcglobal..net and dfbland01@gmail.com

Our blog www.weareamissionarybland.blogspot.com

March 19

One man today had many (perhaps a 100) small stones in his bladder.
Many were embedded in the bladder wall and in the prostatic urethra
and were quite difficult to scrape out. Some of the stones were hard
and some were mushy. He previously had had a suprapubic
prostatectomy somewhere and since then he has passed some fairly large
stones in his urine that he showed me. Probably a result of
schistosomiasis which is very common here.

Another one was a 17-yr girl with bowel obstruction saying she had not
passed any stool for 3 weeks. She had a palpable soft mass in mid
abdomen that percussed to be hollow. It was not tender and she did
not complain of pain. Echo just showed a lot of gas in the abdomen.
So we did a laparotomy and found what appeared to be a
retroperitoneal mass being that we had two lymphomas retroperitoneal
that were unresectable the previous day. I kept exploring around
this mass and found that small intestine went into it and that the
colon was empty and found the cecum and appendix were normal as I
worked them out of this mass. Was able to free the final 15 cm of
terminal ilium but still had this thing that was thickened around a
loop of intestine. Some of the intestine felt like intussiception
or a soft mass in the lumen maybe. Finally was able to resect about
25 cm of small intestine (ilium) and reconnect it together Even
after surgery and examining the specimen still not sure what caused
the pathology and obstruction. It definitely was not a classic
intussiception. No evidence was found of abcess or infection.
Whatever it was it was taken out although I had almost closed her with
doing nothing at the beginning but something prompted me to keep
trying to find out the problem and keep probing and try to help the
girl. The spinal anesthetic ran out before finished and she had a
reaction to diazepam or fentanyl and quit breathing for a time just
as she was closed but thankfully no heart problem and was able to get
her going again. Thankful for Olen that came over to help when called. I'll be glad
when our anesthetist gets here in June.

Also saw a man today with some some kind of skin condition that he had
since birth. It look almost like grapes or condylomata or ? all over
his neck and on one side of his face. It is painless and has no
drainage from it. I don't know what it is but I may eventually try
to remove it and put on a skin graft perhaps after our anesthetist
gets here.

Mar 21 We had another ruptured uterus with a dead baby. Mother
had had 11 previous pregnancies so why did she not progress ? Did
she get some IM oxytocin at the "health center" before coming here?
We usually can not get good histories. I also took out a
intramedullary rod SIGN that was put in last June. The man had
chronic osteomyletis. His original injury was a very bad fracture of
femur, tibia-fibula and knee from a moto accidents. It had been
suggested that removing the rod might help get rid of the osteo. I
don't know if it will help or not.

The weather is warming up as it is 107 where we have pot lucks and 98
in the house but they say it will get warmer in April.
Dolores is still doing mangoes to can and to dry.

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

March 18, Hysteria or ???

The "epidemic" of mass hysteria or whatever has spread among the girls
all over the country. During these spells they can spread this
spirit by touching another girl. Then they also thrash around and look
wild eyed and fall down etc. Some have been brought into the
"Urgence" by ambulance. Olen and Danae have spent quite a bit of time
with some of them and their parents. Actually some of the parents
seem to be somewhat understanding. Some of the girls just try to
fake it to get attention but others seem to be really some kind of
psychosis or demon possession. The official government position
today is to close all the schools in the country for the rest of the
week and "let the evil spirits pass." Satanism or satisfying the
evil spirits is always just beneath the surface at least. Most
people wear some sort of amulets to keep the evil spirits from
disturbing them.

The people of Chad certainly need to know the God of love and their
Saviour. Please pray that the right spirit the Holy Spirit can take
possession of the people of Chad. When the Devil is really active it
must mean that he knows that God is going to do something special in
Chad and maybe many people will come to the knowledge of our wonderful
Saviour so the Devil is trying to get possession ahead of time. Very
few people in Chad truly know God. But then how many people in
America really know the Lord? Do you?

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