October 21, 2014

Now we hear there is another diagnosed with Ebola in the USA. One
death and 2 alive. Lots of media coverage and not much about the
1000’s that die from other causes such as traffic accidents.
Apparrently not much media attention to Enterovirus D-68 that has
paralyzed some and killed some others. Not many die from traffic
accidents here in Chad because we have no roads that you can travel
fast enough to do much more than break bones when motorcycles collide
etc. One certainly does not want to travel after dark at any speed
because of ox carts, stalled vehicles, goats, cows, pedestrians, etc
that would be in the road.

We just have the usual malaria and malnutrition that kills lots of
people because they don’t get treated in time. Mike and Chris Kelley
are trying to get nutrition center going but money or lack of is a
problem. They are still trying to get oriented on how to run it for
which patients. You cannot give free food to everybody so lots of
screening has to be done.

We see about one intestinal perforation from typhoid per week and
lately averaging about one amputation of either leg or arm per week
from various causes. There are a few more hernias and hydroceles
than there were before. The census especially surgery should be
picking up more as we get into the rice harvest. They are harvesting
their peanuts (groundnuts) and millet and sorghum grain now.
Danae had fever probably from malaria and is taking Malarone now.
Says she is feeling better now. Addison is feeling better and her
abcess is healing. We are fairly healthy otherwise. Now Dolores has
aching all over and temp of 100.5 so probably beginning malaria so
will take her meds..

Mason and Kim McDowell are going down to Moundou being that word that
the container with some of their things maybe is released from customs
and needs unloaded and stuff sorted out being that some things are
theirs, some are for Mike Kelley and some for Moundou and some for
James Appel.

Dry season maybe is finally arriving as I see that the humidity is
down near 50% for the first time in several months according to my
hygrometer.

Ever looking upward and forward.
Our emails are drbland@sbcglobal.net and dfbland01@gmail.com.
Love Rollin and Dolores

Oct. 12, 2014

We hear about how bad it is in the USA. Ebola has killed one and
another tests positive even though the 2nd one was wearing the
protective gear when treating the first one. We also hear about
West Nile virus and now Enterovirus D-68 that is killing some and
several having paralysis from it like the old polio and several
hundred being infected with it from coast to coast. Also the
Chikungunya virus is causing “growing concerns.” Maybe the countries
should not take flights from the USA to them. Maybe you should come
to Chad. We don’t have any of those that we know of and malaria is
at least treatable. Have even heard rumors that the US is about to
declare martial law in force doing away with most freedoms.

Our surgery patients are starting to increase in how many we operate
on. Perhaps doing more hernias but also have had several leg
amputations for necrossed foot or cancer. Also have had several
orchiectomies for pyocele (pus filled testicle). I am amazed what
can be done without x-ray. We do have an echo ultrasound machine
that is helpful sometimes especially for the OB-Gyn cases.

Sunday we had a typhoid perforation of terminal ilium then had a
intestinal obstruction secondary to a Meckel’s diverticulum band and
some adhesions.

Monday we had an intussisseption of cecum and terminal ilium into the
transverse colon in a 6 year old.  Also had another BKA amputation for
a rotten foot. Also did a scrotal reconstruction. (His testicles
were in the open after losing much of his scrotum from an infection),
also a hernia in a 3 yrs old boy.

Tuesday we took off a huge (about 10 cm) keloid from a man’s ear that
involved taking off part of his external ear.

Wednesday we had a lady with a mass in her right lower abdomen that
was mildly painful but had been there for years. She had a history
of surgery in 2008 and in 2004 including a hysterectomy and “cancer
metastasized all over.” She was in with probable malaria but a mass
palpable in her abdomen. We did surgery and found a walled off
abcess that was able to be dissected out although had to repair some
intestine. We opened the mass after it was removed and found that it
was a walled off abcess around a sponge that had been left in the
abdomen from a previous surgery. Each day we have had hernias and
hydroceles to do. We have also had three pyoceles that involved the
cord all the way up into the abdomen so did an orchiectomy through an
inguinal incision.

Wednesday Oct 8 was Olen and Danae’s 8th wedding anniversary
celebrated by working all day and having fruit jello for dessert that
Dolores made for them.

Thur we did a SIGN intramedullary nail on a fracture femur from Jan
2011 that was plated Jan 2011 but the femur had refractured and the
screws of the 2 plates had come loose although the screws were not
what they should have been. It had been broken loose apparently not
too long after it had been plated. There was lots of scarring and
was quite difficult to ream out the bone but we were finally
successful. He is doing well so far. The SIGN that we did last
week is slow to get moving. Maybe was not very active before.

Friday about midnight we had a man brought in with his penis skin
completely avulsed including the glans. Also the scrotum was
avulsed. They said the belt from some sort of thrasher had broken
when he was near by and the belt somehow caught him between his legs.
We reconstructed his urethra and penis and scrotum with the skin that
was still hanging on and seemed viable. Hopefully it will all
survive. We will leave his Foley in for at least a month. Almost a
Bobbet procedure done!!!

Sabbath I went out to the branch Sab School at 7:00, as usual taught
English SS class then preached for the 11:00 service on “Are we the
devils helpers?” Then Sab evening we had a motorcycle accident brought
that had been in a head on. One had a fracture arm, clavicle and
rib, another had a fx of a femur and a tibia/fibula fx.  Two others
had abrasions and superficial lacerations. We hope to put in SIGN
nails if they don’t go to the traditional healers.

Addison has had malaria but also an abcess on her behind the past week
but she remains happy most of the time. Had to drain the abcess so
it should be getting better. Otherwise we are all healthy.

We welcome volunteers or visitors. It just might be safer here than
you think. We all look forward when there will be no more death or
deadly viruses when Jesus returns to take his friends and children
home with Him.
Our emails are drbland@sbcglobal.net and dfbland01@gmail.com.

Love, Rollin and Dolores

October 3, 2014

No big rains this week and things are beginning to dry up somewhat.
Well, we had a quick 0.5 inch (about 12 mm) of rain today. Humidity
stays 80 to 90%. People are harvesting their millet and sorghum and
beginning to harvest peanuts (groundnuts). Water is decreasing in
the “roads” and business is picking up at the hospital especially the
surgeries. Classes are beginning this week at the school.
Temperatures have been nearly perfect in the 70’s F and low 80’s F.

One surgery was on a 16 yr girl with a bowel obstruction secondary to
cancer. We resected the obstructed part and put it back together
but she is going to die soon because the cancer was widespread
throughout the abdomen. There was a “moto” accident where a
motorcycle with 4 adults were riding on one and hit a pedestrian.
Lots of “road rash” and one had a fracture femur which we fixed the
next day with a intramedullary rod SIGN nail. The MCD brought them
all in. Apparrently the one with a fracture femur was somebody that
was supposed to be important as various chiefs were calling about him
but the MCD actually promoted us to do the surgery rather than they
going to a “traditional healer” or witch doctor. We have had 4

c-sections in the past 24 hours which is more than the previous 2
months. Maybe they were waiting for Danae to return but anyway they
were all indicated or necessary to be done. Danae did two during the
night. Had two orchiectomies for hard endurated testicles and cords
taking the cord also all the way into the abdomen doing the
orchiectomy through an inguinal incision.

We really enjoyed the DVD of our trip to Turkey in June that Ronnie
(Olen’s mom) made. We just got it and looked at it tonight. Maybe
some of the names of different places will help us remember what some
of our pictures were although we had taken a few notes.

Dolores keeps busy with the grandkids. They are very active. She
has also canned some more guava sauce which is very good. Addison is
so cute as she walks around all over. Of course Lyol and Zane are
everywhere also.

We hear that Ebola is in the USA now with one case in Texas and
perhaps 100 others exposed to him. We also hear about Enterovirus
B68 that has perhaps caused one death and some with paralysis. Of
course here they just die from malaria and malnutrition and some other
things also such as HIV.

We are in good health and hope to remain that way.
Our emails are drbland@sbcglobal.net and dfbland01@gmail.com.

Love, Rollin & Dolores

Sept. 25, 2014

Ah sweet sounds this week. Although the Beautiful Sunbird babies
have fledged so don’t hear them, but now we have the sounds of Lyol,
Zane, and Addison saying Nana and Papa. Also they want Papa to “be a
donkey” and ride the donkey which of course he was happy to do.
Olen, Danae, Lyol, Zane, and Addison all arrived today in N’Djamena
and then on down to Bere today. David our pilot picked them up in
NDJ in the little mission plane and they arrived back in Bere about
5:00 pm. It had been threatening to rain earlier in the day but
late afternoon it all cleared so they were able to fly easily.
Jonathan (the other pilot) will be bringing the luggage down tomorrow
in his new Land Cruiser that he just is picking up today in NDJ.

Addison has grown so much in the two months they have been gone. It
was so nice to hear the airplane as it came back and watch them land
on the little dirt strip. They all looked good but tired after the
long trip from Washington, D.C to Addis, to N’Djamena to Bere. The
dogs, Sheba and Midnight were glad to see them back also as they
barked their welcome. The kids were playing with Grace and Emma
here so they were enjoying their reunion.

The roads are beginning to dry up a little as rainy season is
decreasing now. People are harvesting their millet and sorghum grain
and feeding the cows whatever is remaining. The river has not
decreased much if any yet. The water table around here is less than
a foot below the top of the ground.

The electrical system is working well now after not working right for
several months and gradually getting worse. There was a short where
one wire had been connected or touching a ground wire but the main
problem was the generators needed cleaned out with new air filter,
fuel filter, and oil filter. The air filter was very much clogged
and of course a big diesel engine needs air and fuel. Nick is doing
a great job with plumbing and electricity. He has finished Mason’s
house and about finished Zach’s and Charis’s apartment so now they
have shower and toilets.

Kim is turning the nutrition program to the new director, Michael,
this week. I think they had 50 kids this week. They plan on
doing a lot of it as outpatient down at Bendele (about 2 miles away)

We had two more non-resectable cancers this week. One was another
bladder cancer and the other was an ovarian cancer that was spread
all over. We had a c-section for an arm presentation and another
vacuum extraction. Overall the surgery schedule has been slack.

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

Love, Rollin and Dolores

Sept. 19, 2014

Various sounds are heard. Some are pleasant and some not so
pleasant. We hear the crickets or some kind of insect very loud in
the evenings. Early mornings we hear the doves cooing and pecking on
the metal roof. During the night we hear the fruit bats making their
calls and noises. In the mornings and evenings we hear the children
playing on the swings at the school sometimes very late at night.
Some evenings and days we hear the drums and “music” for church but
sometimes hear it for the dancing. Especially early mornings we hear
the roosters crowing and maybe the dogs barking. Sometimes we hear
the babies crying at the hospital and sometimes we hear wailing or
crying of relatives as another has succumbed to their illness often
very soon after their arrival too late for medicine to benefit.

Sometimes at night I hear the “knock, knock” of a nurse at the door
wanting some help with someone at the hospital most commonly an
obstetrical problem. One may hear a motorcycle go by or may hear a
donkey bray. We have our fans going which helps muffle some of the
other sounds at night BUT may awaken me if the fan does not sound
right or the speed is being variable as when the generator is not
acting right. Prefer to hear the sound of the generator being steady
not being irregular or the sound of voltage regulator clicking a lot.
We have had lots of problems with our electricity even the main
switch of the generator going off so apparently a big short in the
system somewhere causing severe electrical drain. I have finally
disconnected the batteries of the “backup system” and so far the power
and generator are being very steady since then. So I think the
batteries were shorting out the system. 

We also have other sounds if you listen for them such as tweeting 

of fire finches and of sunbirds.  Found a neatly sewn pendulous nest 

quite small and heard the mother bird and father bird tweeting. 

It is a “Beautiful Sunbird” which is the name but also the description 

with scarlet chest with yellow sides and irredescent green over most

of it and long tail streamers. The nest is right in Danae’s yard in a thorn tree. 

Might hear the rattling sounds of the Buffalo Weaver bird or the staccato

noises of the gray shrikes and fiscals and sometimes the music of the African
thrush under our kitchen window.

This week has been sad for some people in that we have had 3 that we
opened in surgery that had inoperable cancer. Two were bladder
cancer and one was colon cancer with huge periaortic nodes. One
fortunately died the next day. Another was a huge mass in the
epigastrium that had the appearance of metastatic disease on echo.
Another boy became jaundiced after receiving a unit of blood for Hgb
of 4 but also receiving quinine and Fansidar which has sulfa so
possible GP6D deficiency or ? We had another 3 yr boy with a large
bladder stone and another man with prostatic urethra stones.

Mason and Kim’s house is getting closer to being finished with most of
the electric and plumbing in with the help of Nick from Moundou being
up here for a time while Scott and Bekki are back in the USA.

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

Sept. 10, 2014

Friday began as usual then about time the staff worship was over we
were told that a superfe or chief or government official was coming
to meet with us (not sure who all “us” were to be) about 10:00 so we
tried to get rounds done and cancel some surgeries so that we could
meet with them although not sure the purpose of the visit. Finally
about 1030 we were told that the meeting was cancelled. Then we did
so some surgeries in some that had not eaten yet including a man that
had blocked urethra since an accident Feb 2014 and had urine coming
out of a suprapubic incision that had been done elsewhere. Just
beyond the prostate was superdense scar tissue that I was unable to
tunnel through with a probe or whatever. I finally stuck a knife
blade somewhat blindly through the prostatic urethra into the super
dense scar tissue and finally was able to open it up enough to get a
probe and then a 22Fr 3way foley through into his bladder. I plan to
leave it there for at least a month to let it heal around it. We also
did a 4th ray amputation finger for necrotic finger that the infection
was back in the metacarpal and just packed it open then plan to close
later after the infection is gone.


In the late afternoon of Friday we went to Lai (about 12 kilometers away)
to get some supplies so that could do some electrical wiring and plumbing 

being that Nick was here from Moundou to do some of that
kind of work hopefully to finish Mason’s house. Most of the road was
not bad other than deep holes but was very muddy close to Bere. On
the way back there was a pickup stuck in a hole in the mud in the
road. We tried to pull him out forward but unable to so went around
and pulled him backwards with our winch and helped him out of the
mudhole.

Monday we had very heavy rain this morning with 3.4 inches (8.6 cm) in
about 4 hours. I’m sure the “road” is impassable now. The river was
24 inches over the road before so now I’m sure it is much more so the
only way to Bere is with canoe and motorcycle. We also had problems
with the electricity and generator so we cancelled one little boy
until sure everything is working right. Not sure if the problem
is the generators or the invertors or an intermittent short circuit
someplace. It seems if we switch generators and or reset the
inverters it is ok for awhile.

We finally did the 3 yr old boy with a huge mass in his belly Tues
that had been postponed Fri because of the “meeting” and Monday
because of the generator or electricity problems. It turned out to
be a huge 20 cm left cystic kidney that was resectable very easily did
a left nephrectomy. Wed we did a bilateral oophorectomy for huge
solid masses possibly cancer in a 16 yr old girl. 

We are still healthy with no Ebola or cholera around here that 

we know of.

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

4 Sept 2014 A day in Bere, although unusual

The day began as usual with breakfast then staff worship 0715 and
rounds with almost a full hospital of patients although Peds and
Maternity has been down somewhat. Then we had surgery. The first
was a little 5 yr boy with a mass at his umbilicus with drainage from
it that looked almost like bowel contents or drainage from an abcess.
We did a laparotomy and discovered solid mass that had almost
appearance of liver but very inflamed with intestines being stuck
into the mass all around. We finally got it dissected free and all
the adhesions freed but the rest of the abdomen was clean with no
adhesions. The liver itself appeared normal as did the spleen. The
mass itself was quite firm almost hard so I don’t know what this
about 10 cm mass was. Then we had another child with a large solid
mass of her eyelid (it closed her eye) which we dissected out. It
perhaps was glandular like some kind of tumor somewhat friable but did
dissect out fairly readily. Then had a man with a very large
inguinal hernia and bilateral hydrocele which turned out to be pyocele
so we did a orchiectomy and repair of the very large sliding hernia.

Then we had a call from Nick and Kelsey that they had tried to get
here driving their ambulance from Moundou but were stuck in the mud
about 15 km from Kelo (It is 45 km from Bere to Kelo) It had rained
much of the night before so the “road” was very muddy with deep water
holes and over 24 inches over the road going across the “hippo river.”
It is about a ¼ mile (about 500 meters) across. A large wave of
water would go in front of the car as we went across with boys running
ahead to show where the road was the most shallow (of course they
wanted a fee for their service). We finally got to where they were
stuck in the mud off the edge of the “road”. We were able to drag
them out with our winch on our 4 runner. The water hole in the road
by them was at least 18 inches deep. We made it back through the
mud and the river without incident to Bere. Nick and Kelsley came to
do some plumbing and electric wiring on some buildings especially
Mason’s house.

Then about midnight we had c-section for a ruptured uterus. Of
course the baby was dead. During the time we were doing the
c-section they brought in a man that was victim of a stabbing with
intestine coming out stab wounds so we had to do a laparotomy after
the c-section. We had to repair his colon and small intestine and a
large bleeder in his mesentery. His abdomen was pretty full of
blood. By the time we repaired everything it was beginning to get
daylight. Then time to start another day but maybe this one will be
quieter as they usually are.

We love to hear from each of you about your days.
Our emails are drbland@sbcglobal.net and dfbland01@gmail.com
Love. Rollin and Dolores