I was listening to some Christmas music here at the house this Sabbath afternoon and played the Messiah done by the London Philharmonic Orchestra and choral. In my mind’s eye I was back in the community chorale in Grove, Oklahoma doing our Christmas program that we did each Christmas for several years. I especially remember one with our leader, Jim Boles. He was very patient with me as he gave me the tenor solo at least one year even though Mr. Wilhelm had a better tenor voice I think. I had problems counting or staying with the right timing with the orchestra, but Jim helped me with that and I made it through. I enjoyed the chorale each year made up of members from several different churches. We had to begin practice in September to be ready for the December program that was usually in the Methodist church. Nancy Lundgren had such a beautiful soprano voice and she also led the chorale a few times after Jim passed away with heart problems.
There were many very beautiful voices and wonderful people in that group. The chorale did not perform the past few years. It seems everyone was too busy especially leadership. Not everyone has the capability to conduct a music group. Back home in America there is lots of music and decorations everywhere but here in Chad there are none. The weather is cool (it might get down to 60 at night) so definitely no snow although this is the coolest time of the year. The people don’t have money to waste on things that are only glitter. They are more concerned with survival and where is the next meal going to come from and will the little child die from malaria or parasites. Almost half of children die before age 5. In the western world esp America we spend so much money for things that really don’t matter very much. Here children make their own toys from whatever they can find although most don’t have much of anything but helping to care for siblings or working in the fields as soon as they are old enough at all.
There was a first here last night. One of the student missionaries helped with Tammy Parker put together a Christmas program for the church school which they never had before. There are almost 300 in the school. Dolores spent lots of time making costumes for the program. The program was held outdoors and many of the community were there. Maybe some of them will get a little glimpse of the Christmas story and the Saviour that came to save us from our sins. There are so many in the world that know almost nothing of the good news of salvation and the Saviour.
Many of you will spend time together with families this holiday season. Our family met together except we were here in Chad and they were together in Oklahoma. Danae, Olen, Lyol, and Zane will be back here in a few days so we are looking forward to that.
We hear that the containers that you have been praying for will be coming in a few days. We hope that is a fact. It would really be Christmas if our container and the containers for the hospital construction arrive here this coming week. Our container was packed 1 year ago. We have lived out of our suitcases and what we could get here so maybe we didn’t need as much as we thought. There are a few things in it that is supposed to help with hospital stuff. There are some books and music and different kinds of food and a kerosene refrigerator and some other things for the house that is supposed to be built for us eventually.
May each of you remember this season what is REALLY important. We are certainly looking forward to the return of our Jesus when all this poverty and suffering will be no more.
Love, Rollin and Dolores
Our emails are drbland@sbcglobal.net and dfbland@gmail.com The internet here is very intermittent and slow.
Sunday, December 23, 2012
Friday, December 14, 2012
Death Angel stays close Dec 13
When a patient dies one always wonders what could have been done different to avert death. One died this am that was one day post-op prostatectomy that was uneventful and he was doing well at 0700 then at 0730 he suddenly got short of breath and died unexpectedly. Possibly a pulmonary embolus (blood clot to the lung) and I am still not sure what we could have done differently. We don’t have anticoagulants here other than aspirin but he was a low risk for problems. The other one was a large abcess and infection of jaw and neck and possibly the mediastinum. We had drained a large amount of purulence from the neck but she was not improving much then died this pm. I don’t know if a trach would have benefited or not but it is difficult to get good nursing for a tracheostomy. We have little children that die almost upon arrival from malaria fairly frequently.
We have had 4 ruptured uteruses recently but so far all have survived. But the death angel was really close esp for one of them that was having gasping or agonal respiration as we were beginning her c-section but with lots of IV fluids and blood and getting her bleeding stopped and emergency hysterectomy. She is doing well today. Not sure but we think all the ruptured uteri had been given IM oxytocin (medicine give to have the uterus clamp down to prevent bleeding) before they were referred here. One of the ruptured uteri even had a live baby. Miracles still happen. Another c-section for prolonged labor, dead baby, now has had some sloughing of her vagina and urethra. Not sure how much repair she might require later. We had also a severely necrotic (mostly dead) prolapsed uterus that was very very large. We had amputated it basically and it did not involve the bladder however the infection apparently ascended up the stump and inside the abdomen. We had to open her abdomen a few days ago and there was much purulence in the abdomen but no perforation of bowel so she was irrigated out and drained and so far the death angel is holding back.
Recently a liver abcess ruptured and patient was very ill and painful. The laparotomy for acute abdomen was done and the abcess was found and drains placed and now patient is doing ok and the death angel holding back.
We have 3 “in house” now with cancer of the bladder that could not have anything done. Today there was a 6 month boy with a huge mass in the upper abdomen (filled most of abdomen) growing rapidly past 3 months mass that is. Probably a large cancer. Parents decided against surgery which might not have helped anyway so the death angel will have that one soon.
Here in Chad almost half of children die before age 5 mostly from malaria, malnutrition, and parasites. So the death angel visits most families fairly frequently. Malaria especially can be very deadly.
We are all in good health except I recently had a “cold” but am recovered. Dolores is working long hours making costumes for a bunch of school children for their Christmas program which is next week.
We covet your prayers and emails.
Our emails are: drbland@sbcglobal.net and dfbland@gmail.com Our internet is operative only occasionally but we eventually get the emails. Unable to get on Facebook or Linkedin.
Love Rollin and Dolores
We have had 4 ruptured uteruses recently but so far all have survived. But the death angel was really close esp for one of them that was having gasping or agonal respiration as we were beginning her c-section but with lots of IV fluids and blood and getting her bleeding stopped and emergency hysterectomy. She is doing well today. Not sure but we think all the ruptured uteri had been given IM oxytocin (medicine give to have the uterus clamp down to prevent bleeding) before they were referred here. One of the ruptured uteri even had a live baby. Miracles still happen. Another c-section for prolonged labor, dead baby, now has had some sloughing of her vagina and urethra. Not sure how much repair she might require later. We had also a severely necrotic (mostly dead) prolapsed uterus that was very very large. We had amputated it basically and it did not involve the bladder however the infection apparently ascended up the stump and inside the abdomen. We had to open her abdomen a few days ago and there was much purulence in the abdomen but no perforation of bowel so she was irrigated out and drained and so far the death angel is holding back.
Recently a liver abcess ruptured and patient was very ill and painful. The laparotomy for acute abdomen was done and the abcess was found and drains placed and now patient is doing ok and the death angel holding back.
We have 3 “in house” now with cancer of the bladder that could not have anything done. Today there was a 6 month boy with a huge mass in the upper abdomen (filled most of abdomen) growing rapidly past 3 months mass that is. Probably a large cancer. Parents decided against surgery which might not have helped anyway so the death angel will have that one soon.
Here in Chad almost half of children die before age 5 mostly from malaria, malnutrition, and parasites. So the death angel visits most families fairly frequently. Malaria especially can be very deadly.
We are all in good health except I recently had a “cold” but am recovered. Dolores is working long hours making costumes for a bunch of school children for their Christmas program which is next week.
We covet your prayers and emails.
Our emails are: drbland@sbcglobal.net and dfbland@gmail.com Our internet is operative only occasionally but we eventually get the emails. Unable to get on Facebook or Linkedin.
Love Rollin and Dolores
Monday, December 3, 2012
Thankful Dec 2
It is a time of thanksgiving at least for the American holiday. All the expatriates had Thanksgiving meal together which was very nice. We are thankful for good health although I did have malaria last week but I am ok now. I began my quinine early so as not to miss any days work. Dolores had a “cold” and sore throat. How do you get that with 65 to 90 temperature weather and dry? As everyone in America gears up for the “holiday season” we don’t have a Thanksgiving holiday here but it is Chad Independence Day on Nov 28. Christmas is not much of a holiday here either. We will try to make it a little festive with some decorations around the house of Danae’s. We often think about how thankful we were born in USA rather than here. People here often have very little to look forward to but a short hard life with many episodes of malaria and parasites and loss of perhaps half of their children. I am thankful that I was not born a Chadian in some remote village with no knowledge of the outside world or of Jesus. Especially I am glad that I was not born a female in Chad as many of them are not given opportunity to be educated and have to look forward to just having babies and being a wife of some man that may beat her up every so often if she does not please him just right. Be thankful for your rights and privileges in America even though they are being eroded.
The French doctor that was supposed to be here for a week did not come but we now have a very nice German neurosurgeon that has come here for 3 weeks to experience “mission medicine”. Actually he has spent time in Rwanda about the time of the genocide, also spent time in New Guinea and 3 years in Australia. He speaks good English but not much French. His wife left him 2 years ago.
I have been busy with hospital rounds and surgeries. I have done about 120 procedures since Oct 26. I did two SIGN nails or intramedulary rods on open fracture tibia last week. One of them has no x-rays yet. The other had one preop before arriving here a few days after the accident. We had another bladder stone and another mastectomy recently.
We have had no internet service most of the time the past two weeks but are thankful when we can get on for a few minutes and perhaps send email or read one of yours. Even when it works it is very very slow. We appreciate your notes when they come through like a breath of fresh air with your news bits.
Love, Rollin and Dolores
Our emails: drbland@sbcglobal.net and dfbland@gmail.com
The French doctor that was supposed to be here for a week did not come but we now have a very nice German neurosurgeon that has come here for 3 weeks to experience “mission medicine”. Actually he has spent time in Rwanda about the time of the genocide, also spent time in New Guinea and 3 years in Australia. He speaks good English but not much French. His wife left him 2 years ago.
I have been busy with hospital rounds and surgeries. I have done about 120 procedures since Oct 26. I did two SIGN nails or intramedulary rods on open fracture tibia last week. One of them has no x-rays yet. The other had one preop before arriving here a few days after the accident. We had another bladder stone and another mastectomy recently.
We have had no internet service most of the time the past two weeks but are thankful when we can get on for a few minutes and perhaps send email or read one of yours. Even when it works it is very very slow. We appreciate your notes when they come through like a breath of fresh air with your news bits.
Love, Rollin and Dolores
Our emails: drbland@sbcglobal.net and dfbland@gmail.com
Muder??? Dec. 2
Last week we had two ruptured uteri with dead babies. Both had been given large doses of oxytocin (medicine to make uterus contract) IM by someone in a village clinic before arriving here. The first one was her 9th pregnancy so it would have been easy to have missed the diagnosis but the uterus just didn’t feel right. When we opened her abdomen there was lots of blood and baby and placenta through the ruptured uterus in the abdomen. The bladder also had a large tear in it way down by the cervix. We repaired the bladder hopefully not getting the ureter. The urine cleared and she is doing ok now. The second one was similar but no bladder involvement but the uterus was split open vertically. We tied the tubes of the first one but the husband would not let us do the second one as it was only her 3rd pregnancy with one living child.
Apparrently some of the “midwives” have been told by some Chadian doctors that it is ok to give IM oxytocin. Danae was recently in a conference about OB care before she went on annual leave and there was discussion about this practice. She tried to point out the dangers of this practice but apparrently they get away with it part of the time but here were two dead babies and could have been dead mothers because of this practice. We might call this murder or manslaughter if we did this at home. What does it take to get better medical practice going? How many die that we never hear about that ruptured and bled out and died before arriving here? We don’t know. Meaningful statistics are nonexistent here as they don’t put down true numbers at all and some of the people doing them are not able to do basic math.
I have had at least 14 C-sections and 4 vacuum extractions since Danae left on annual leave Oct 25. We also have had 3 molar pregnancies and a vaginal hysterectomy and abdominal hysterectomy during that time and have a very large tumor prolapsed uterus for tomorrow and a mass about 7 months size that maybe is a large ovarian cyst.
Life is interesting for OB-Gyn. Continue to pray for our patients.
Love, Rollin and Dolores
Our emails: drbland@sbcglobal.net and dfbland@gmail.com
Apparrently some of the “midwives” have been told by some Chadian doctors that it is ok to give IM oxytocin. Danae was recently in a conference about OB care before she went on annual leave and there was discussion about this practice. She tried to point out the dangers of this practice but apparrently they get away with it part of the time but here were two dead babies and could have been dead mothers because of this practice. We might call this murder or manslaughter if we did this at home. What does it take to get better medical practice going? How many die that we never hear about that ruptured and bled out and died before arriving here? We don’t know. Meaningful statistics are nonexistent here as they don’t put down true numbers at all and some of the people doing them are not able to do basic math.
I have had at least 14 C-sections and 4 vacuum extractions since Danae left on annual leave Oct 25. We also have had 3 molar pregnancies and a vaginal hysterectomy and abdominal hysterectomy during that time and have a very large tumor prolapsed uterus for tomorrow and a mass about 7 months size that maybe is a large ovarian cyst.
Life is interesting for OB-Gyn. Continue to pray for our patients.
Love, Rollin and Dolores
Our emails: drbland@sbcglobal.net and dfbland@gmail.com
Friday, November 16, 2012
Nov 13, 2012
The proverbial three score and ten that the Bible talks about has been reached today. I’m still in good health and have been busy here in Chad, Africa and plan to be here for the next 5 years. I used to think 70 was old but your prospective changes with time and it definitely is not old. I can still do most of what I could do 40 years ago although I need to be doing more physical exercise to keep in better shape. Sometimes one thinks about what they have accomplished in life. Of course I hope there is still lots of life remaining. It is easy to get on the treadmill of life doing the daily work and chores and not taking enough time to “smell the roses” and enjoy your friends and family. One may someday wish they had spent more time with someone; but very unlikely to wish that one had worked later a few more times. The amount of money one has is not as important as the relationships with our family and friends and especially our relationship with our Lord.
The people here in Chad cultivate relationships a lot better than Americans even though they have almost no hard assets. They always take time to greet and find out how the other person is doing. The extended family system perhaps can prevent one from getting ahead but they have plenty of relationships. Almost everyone is very poor so all are the same. Are we fullfulling the Great Commission that Jesus gave us to tell everyone the good news of salvation that He has provided for us if we will accept and do what He tells us? Do we show our love in our relationships?
The past two nights I have watched the stars in the middle of the night and could see the familiar Orion, the Pliadeas, Artaurus and the Milky Way that appear straight over head here but would be in the southern sky at home. We don’t have the light pollution here that is in the USA.
I celebrated today by getting up at 2:00 am for an OB to remove a dead baby's head that was stuck. The baby had come breech. Then at 5:00 am we had a C-section for a CPD (failure to progress), but a nice living baby. Then after all the rounds, I did a hernioraphy, then excision of a very large bunch of masses from the perineum and perirectal area. I think they were huge lymphogranulomata vererum (sp?) which weighed almost a pound. Tonight about 11:00 pm we had another shoulder presentation OB which required a C-section and the baby is living. We had another imperforate anus yesterday. The end of the rectum was about an inch up inside the newborn baby. We opened the anus (where it should be) and probed and finally found the rectum and brought it down and opened it and sutured it to the anus opening. We recently had a colon-colic intussisseption with transverse colon going inside the spleenic flexure down almost to sigmoid and had been that way a few days. Had to resect the spleenic flexure and part of the descending colon and then reanastamose the colon. He has done well post op. Also last week we had a very large fibroid uterus that weighed over 5 lbs. We have done over 65 procedures since Olen and Danae left on annual leave Oct 28 so have been busy.
We still don’t have the containers with construction materials, so continue to pray for them to be released. It has been promised that they will be freed this week. We will see. This has had a big ripple effect in that various groups have had to change their schedules or cancel. Our container is still sitting in Moundou but possibly can come here next week.
We are to have a French doctor Nov 18 – 29. He has been here before but not while we were here. We are to have a neurosurgeon here from Germany Nov 27 – Dec 18. He wants to experience mission medicine and heard that Bere Adventist Hospital in Chad is the place to do that. So we will have some help part of the time that Olen and Danae are on annual leave.
It is not supposed to rain in November but we had about ½ inch Nov 6 but the hot sun is drying things rapidly. Any garden has to be watered in this sandy soil. I don’t think it has been over 95 yet but has been about 90 in the house.
We hear that Lyol and Zane want “to go home” and “why are we here” and they have been told they are on vacation in America. Of course we miss them also.
We love each one of you but have to respond via email as it is almost impossible to get facebook to download on our very slow and intermittent internet.
Love, Rollin and Dolores
Emails: drbland@sbclobal.net and dfbland@gmail.com
The people here in Chad cultivate relationships a lot better than Americans even though they have almost no hard assets. They always take time to greet and find out how the other person is doing. The extended family system perhaps can prevent one from getting ahead but they have plenty of relationships. Almost everyone is very poor so all are the same. Are we fullfulling the Great Commission that Jesus gave us to tell everyone the good news of salvation that He has provided for us if we will accept and do what He tells us? Do we show our love in our relationships?
The past two nights I have watched the stars in the middle of the night and could see the familiar Orion, the Pliadeas, Artaurus and the Milky Way that appear straight over head here but would be in the southern sky at home. We don’t have the light pollution here that is in the USA.
I celebrated today by getting up at 2:00 am for an OB to remove a dead baby's head that was stuck. The baby had come breech. Then at 5:00 am we had a C-section for a CPD (failure to progress), but a nice living baby. Then after all the rounds, I did a hernioraphy, then excision of a very large bunch of masses from the perineum and perirectal area. I think they were huge lymphogranulomata vererum (sp?) which weighed almost a pound. Tonight about 11:00 pm we had another shoulder presentation OB which required a C-section and the baby is living. We had another imperforate anus yesterday. The end of the rectum was about an inch up inside the newborn baby. We opened the anus (where it should be) and probed and finally found the rectum and brought it down and opened it and sutured it to the anus opening. We recently had a colon-colic intussisseption with transverse colon going inside the spleenic flexure down almost to sigmoid and had been that way a few days. Had to resect the spleenic flexure and part of the descending colon and then reanastamose the colon. He has done well post op. Also last week we had a very large fibroid uterus that weighed over 5 lbs. We have done over 65 procedures since Olen and Danae left on annual leave Oct 28 so have been busy.
We still don’t have the containers with construction materials, so continue to pray for them to be released. It has been promised that they will be freed this week. We will see. This has had a big ripple effect in that various groups have had to change their schedules or cancel. Our container is still sitting in Moundou but possibly can come here next week.
We are to have a French doctor Nov 18 – 29. He has been here before but not while we were here. We are to have a neurosurgeon here from Germany Nov 27 – Dec 18. He wants to experience mission medicine and heard that Bere Adventist Hospital in Chad is the place to do that. So we will have some help part of the time that Olen and Danae are on annual leave.
It is not supposed to rain in November but we had about ½ inch Nov 6 but the hot sun is drying things rapidly. Any garden has to be watered in this sandy soil. I don’t think it has been over 95 yet but has been about 90 in the house.
We hear that Lyol and Zane want “to go home” and “why are we here” and they have been told they are on vacation in America. Of course we miss them also.
We love each one of you but have to respond via email as it is almost impossible to get facebook to download on our very slow and intermittent internet.
Love, Rollin and Dolores
Emails: drbland@sbclobal.net and dfbland@gmail.com
Sunday, October 28, 2012
Going to the river 28 Oct
One week ago on Sabbath afternoon we decided to drive to the river with Olen, Danae, Lyol, and Zane in our 4-Runner. We were following the Parkers in the Land Cruiser. Both have 4 wheel drive. They drove through just fine but I got off the road about 6 inches in one place and suddenly went axle deep in the mud and 4 wheel drive would not make. Our winch was able to be connected to a small palm tree and we winched ourselves out of the mud and drove the rest of the way without any problem even though part of the trail was a foot deep in water. This way we got to try out our new winch that we had put on before we left home. It worked great. The trail was solid under the water. The Land Cruiser never had any problems. The kids enjoyed the river which was still bank full.
Along the way we saw where they were beginning to cut the rice and shock the rice bundles. All the harvesting is done by hand of the rice, millet, corn, peanuts, or whatever. The dogs, Sheba and Midnight, really enjoy the water and swimming in the river.
Wed eve before Danae left for furlough, we drove around a few trails south of here and saw some areas we had not seen before even though it is close by. Actually we had not been anywhere until now. Now we have a possibility even though we may not have time to do much esp the next two months. At least the “roads” are getting drier and better so that some villages may actually be accessible. It is pretty lonely here with Lyol and Zane gone and don’t have Danae to do surgery with her.
They say the main “road” is not under water anymore. Where the road was under water was also the area where there are hippos at least in dry season. One place on the main “road” there is a large tree across the road and one has to go around it off the road. There are not many chain saws and it is difficult to cut a large log with a machete. It would make someone a lot of firewood if they could cut it up.
Our emails are drbland@sbcglobal.net and dfbland@gmail.com and sometimes we even answer .
Love Rollin and Dolores
Love Rollin and Dolores
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
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
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