Easter Holiday

      The ambulance rolled in bringing two patients from Kelo Hospital about 25 miles from here. One was a strangulated hernia and the other was a ruptured ectopic pregnancy. I’m not sure why no doctor would see them there or why they got charged for the transfer that was supposed to be free. Someone probably pocketed some money which is common here in Chad. The strangulated hernia was in time so did not have to remove any bowel that was stuck in the hernia. The ruptured ectopic pregnancy would have died had it been much longer. Her abdomen was full of blood and was hypotensive yet was sent with the diagnosis of possible threatened abortion and nothing was being done for her. She survived the trip and the surgery here and is doing well now 2 days later. 

     Later in the day a man was brought in with a huge bite almost down to the bone out of his thigh by a hippo where he had been fishing in the river. We, Danae and I, spent quite a bit of time cleaning it and trying to put it back together and draining it. They say there are more people killed in Africa from hippos then from lions or elephants. A big danger yet is from infection as the hippo mouth probably not very clean and the river water not very clean either. It was the first hippo bite that either of us had seen. 

      And did I say that the first case on Easter was a huge liver abscess that we drained about a liter of purulence from. 

     The baby elephant that has been here a little over a week is not doing very well. He has diarrhea again and is not eating very well and had a seizure Monday. Probably his electrolytes are not good. We have the “elephant lady” from Malawi here now. Packages are arriving with different things for the elephant. He needed enzymes for digestion and stiff nipples and bottles for him to eat from. They are here now. They say there was only about 30% chance of surviving his loss of family, trip to here, and not feeding well and his diarrhea but it was certainly worth a try. Some elephant specialists from Kenya say that for baby elephants under a year old even in the best of circumstances have only about a 50% survival rate. Of course we all hope for better.
      Last week we did a skin graft on a shoulder of an Arabic lady. We had amputated actually disarticulated it at the shoulder because the entire arm was necrotic and infected also quite a bit of the shoulder skin was bad also. We debrided it and tried to pull some muscle over the area when we amputated then let it wait to granulate in for about 10 days. We took split thickness skin from her thigh and placed it over the shoulder area and so far it looks good. She lost her arm because of a benzacaine penicillin injection in the arm that was apparently dirty needle. Still not sure what the injection was for. She has lost also the vision in her eye of the same side, don’t see how they are related. When she first came in I thought she was going to die but now with the infection gone she looks and acts so much better. The family has been very nice and attentive.

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

March 23, 2013

All things continue about the same except today we had a visiting pachyderm.  Early this morning Gary Roberts, our mission pilot for Adventist Medical Aviation brought a small elephant, perhaps a year-old, in his small plane from about an hour away.  He was from a herd that had about half of the 120 elephants killed by poachers.  Gary heard about it, found it, rescued it, and brought it to the air strip here.  He has been in touch with various agencies and elephant specialists and a vetanarian.  Some people from Malawi are supposed to arrive here in a few days to care for it and get it moved to somewhere.  The elephant was dehydrated and having diarrhea.  The village where he got the elephant had been giving it cow's milk which elephants don’t do well on.  Imagine carrying an elephant like this in a small plane which was actually quite a dangerous to do.  He made it to here, but Gary said he would not go any long distance with the elephant unless he was sedated well.  The little guy is cute and affectionate maybe hungry.  He gets diluted baby formula now.  He had some infection on his neck where he had been tied up by the village.  Apparently government officials at several levels were involved or at least not preventing the killing then the villagers cleaned up all the meat and only bones left in a pile that Gary saw.  Eventually he will be in a park in the eastern part of the country next to Sudan.  

We had a volvulus of the terminal ilium and cecum that had been too long so we had to do a bowel resection and reanastamosis.  We took out about 4 ft of bowel.  He is doing well now 4 days post op eating and drinking and walking.  We had two fistula repairs this past week.  One was a vessico-uterine fistula with urine coming out her cervix and another was a vessico-vaginal fistula that we had reconstructed a urethra and tried to close her fistula before but this time only a small hole so hopefully it will hold this time.  

We were privileged to have a student anesthetist (almost ready to graduate) and his professor here for a few days this past week.  They both seem interested in coming back on a more long term basis.  The student’s wife is a family practice physician.  

We had a rain shower last night that made it very muggy today.  We also had a nice rain March 1 which it is not supposed to rain in March so strange weather.  It is still warm with lows about 85 to 90 and the humidity is up now. 
Love,  Rollin and Dolores
Our emails are  drbland@sbcglobal.net  and  dfbland01@gmail.net  

Things get interesting Feb. 19, 2013

If you are non-medical you may want to skip to the last few paragraphs.

Yesterday we removed a 16 kg (35 lb) ovarian tumor from a lady that was weak and short of breath. She had almost no room for her other abdominal organs. The omentum had grown over it and had veins the size of your fingers. We did not think we could remove it at first but we decided to try and so far post-op she is doing well. The tumor appeared benign but there were lots of adhesions all around it so it was somewhat difficult. She looks good today.

Today we did a “vesico-vaginal fistula” but actually it was a bladder reconstruction.   Part of the urethra and much of the bladder was gone secondary to birth trauma a few yrs ago. One ureter was plainly visible as it squirted urine but we never could find the other ureter. The back side and bottom of the bladder was all we had to work with. We put in a ureteral stent in the ureter so that we would stay away from the ureter. Probably only one kidney functioning. We don’t have CT, or IVP or any kind of x-ray. We managed to free the edge of the remainder of the bladder and urethra and connected it all up. We have a foley and the ureteral stent through the urethra and hope everything holds. It took quite awhile just to figure out the anatomy and what to do. Danae and I do all such things as this together.

I did another SIGN nail last week but this time of a femur that had been fractured a few years ago but healed about 4 inches shorter. We had to remove the part that was healed together the old callous etc then put the ends of bone together and try to stretch out the muscles and tendons etc. We finally got the bone reamed out and the SIGN nail put in place but the leg is still a little shorter than the other but much better than before as now straight and solid. Previous sort of solid but crooked, so he is happy now.
Also last week we had a large (over 1 cm) ureteral stone that somehow made it down to the end of the ureter but would not go into the bladder. On ultrasound it was thought to be a simple bladder stone but when we got into the bladder we could feel the hard nodule posterior to the bladder. We threaded a ureteral stent and the stone moved back up toward the kidney but it floated back down finally. We dilated the ureteral opening much and finally was able to grasp it with forceps although it broke up in the process. He is doing well now.

We had two perforated gastric ulcers Fri and Sat night which we repaired and they are doing ok now. Today we had a large midline mass in a lady that had delivered a baby last month supposedly. We opened the mass after aspirating pus with a needle. There was a large amount of purulence that was greenish colored and not the usual e-coli smell but was inside the abdomen walled off. We drained and packed it. 

 
Friday we did an AKA (above knee amputation) for gangrenous leg that supposedly began only two weeks ago as an infection in his foot and his blood sugar was normal. Even with the mid thigh amputation there was still some necrotic parts of muscle which we had to debride yesterday. We have not closed the amputation yet to be sure we have gotten rid of the infection and dead tissue. 

 
Had a meningocele which we closed about 3 weeks ago and is now doing ok. It had a very large fluid filled sac that was irritated and about ready to rupture. The baby was about a month old. 

 
We have had lots of hernias, hydroceles, and prostates and urethra strictures to do as many as 10 in a day. We have a fractured patella that we need to repair tomorrow. 

 
I wish we had some more orthopedic equipment to work with. Need plates and screws. Need a intramedullary rasp so can place endoprosthesis for fracture neck of femur and need more variety of endoprosthesis to put in. They are not hard to do if one has the stuff to work with. Also need some sort of fixation devices for intertrochanteric fractures. Presently our main option is to put them in traction for prolonged time. Another advantage is you can put them in traction even without x-ray and still be correct. I had one with a shattered distal femur (we had an x-ray on her) that we placed in traction that is amazingly healing according to palpation and a xray in Moundou. She is moving her leg and wanting to walk and go home!

Today I saw one of my post-op mastectomy and axillary node dissection patients that was done in Sept and she feels good and I could not find any evidence of masses yet. She was happy and came from quite a few miles away. 

 
We have a man with a unilateral III nerve oculomotor nerve palsy. He seems relatively good health otherwise. He was recently treated for malaria. Anyone with suggestions on that?

Scott and Bekki Gardner (Olen’s aunt and uncle) were here the past 3 weeks. He was trying to learn some OB-GYN from Danae. He is a general surgeon that is closing his practice and moving to Koza, Cameroon in a mission hospital there. They both got malaria while here but were feeling better when they left. 

 
Dolores has malaria this week with a temp of 103.4 two days ago but seems a little better tonight. She also has had nausea, vomiting and diarrhea. So far I am in good health. 

 
Hospital and housing construction has progressed a lot. Maybe when someone comes to visit we will have a place for them to stay. Our house is not finished yet but maybe will before we take our annual leave April 24. We plan to go through Thailand, Cambodia, Philippines, and Korea on the way home. Don’t have exact dates yet as only in the planning stage. Rachel, our granddaughter, is a student missionary in Thailand this year.
Our emails are drbland@sbcglobal.net and dfbland@gmail.net
Love, Rollin and Dolores.

No violence?

Our MCD (the district medical officer) has been giving us trouble again. He came in and told Scott Gardner, board certified surgeon, that he was not allowed to touch a patient without some signature somewhere or something. Scott had all his paper work with him including his diploma and board papers, etc. The MCD has tried to change protocols for treatment that would make it more expensive for patients, etc. Our hospital is a non-government private hospital. He has a severe ego problem, maybe psychotic.  There are rumors that he has killed the fiancé of his daughter because he did not like him. The workers of the hospital have threatened to go on strike if the MCD is not disposed of. During a meeting on Wednesday the MCD had publicly stated that we were killing patients in the OR. No one has died in the OR from the surgery. Yes there have been some that were operated on and found to have non-resectable cancer and later died, and perhaps two that died with apparent PE post op. Scott has been here for awhile trying to gain some OB-GYN experience from Danae. He is scheduled to move to Koza hospital in north Cameroon where he would be working along with a Congolese doctor. Scott is in the process of closing his practice in Washington state. Most of this has come up since last Wednesday. The next day Scott was sick with malaria so couldn’t see patients anyway. Thursday (Valentine’s day) all the other doctors (Danae, Olen, and myself) and expatriates (five couples all together) “were on strike” but actually had previously arranged to be gone all day (did not leave til noon) for a picnic on the sandy beach of a river about 2 hours away. Also another government official had stated that there was no violence in Bere. While we were gone on Thurs a lady was brought in that had been stabbed in the abdomen in the liver.  Samedi, our Chadian nurse surgeon, operated on her and she is now doing well.  It is rumored that this lady had killed someone. Her assailent (a woman) is in jail “to protect her” from possible retribution. There was a very large group of people at the hospital gate and on the grounds Friday. The police had to be called in to clear them out. Olen has spent a lot of time in various meetings.
There was some concern about security issues but we believe we are safe.
Love, Rollin and Dolores

Maranatha Jan 31, 2013

Thank you everyone for all of your prayers. All of the containers finally cleared the various obstacles (mostly people wanting bribes) and arrived here this month. The last container arrived about a week ago. So the materials for the new buildings are here but there was some stuff that was apparently not put in the containers although I think they were about maxed out in terms of weight. I believe they are going to send some more material via another container that hopefully will arrive before rainy seasons when the roads become impassable. Some materials for electrical are going to be sent as well as some insulation.
A maranatha group just left after being here for two plus weeks. They got a lot done erecting frames, roofing, and siding on new buildings. Not all got done. There is still much work to be done on the inside to finish the buildings. Our house is to be one of the first ones to be completed along with a “hotel,” a 4-plex so that people will have a place to stay when they come. The private wards for patients who want to pay extra for special room will be finished before the rest. This will bring extra revenue for the hospital and give us more bed space as we are almost always full and having to make some patients stay on the veranda or under the mango trees.. WE WILL STILL NEED MORE PEOPLE TO FINISH THE PROJECT. There is still more steel work to be done as well as the electrical and plumbing that has not been started. The aerial view is certainly different than it was when we arrived.
It has been interesting trying to sort through some of the things in our container although we do not have a house to put things in yet. We have brought a few things over to the little apartment we are living. Our soft couch, love seat, and chair are certainly more comfortable than the hard benches we were sitting on before. We got some of the CD’s out and playing them on our little CD stereo player and are enjoying some good music. So far we have found very little breakage. The mirrors are ok and only one broken jar and 2 plastic platters. Some of the boxes were very mutilated but the contents still ok. The freezer has the top bent in but I think we can eventually straighten it out as it is not very bad.
Of course the hospital has been busy. 

Nearly all the beds are full most of the time, especially post op. We have in the books over 140 procedures for Jan. In general if a patient can eat, drink, walk and be afebrile he/she is discharged or at least sent out under the mango trees. We had a run on ruptured uteri and c-sections while Danae and Olen were on leave during Nov and Dec but have had none since they got back except one c-section. I had a urethra stricture and fistula in a man today that was quite difficult. His prostatic urethra was very scarred and stenosed but finally got a foley in and then did the fistula repair. Two days ago we had a foul smelling necrosed part of scrotum and necrosed mushy testicle that we cleaned out and packed it open perhaps to be closed after the infection is cleared. Also did a hernia repair and amputation of part of his scrotum that was necrosed on a man that insisted that it be done even though it was dangerous with edema and an ejection fraction about 20%. He has done very well so far post op. A few days ago we drained a liver abscess and obtained about a pint of purulence from it and so far is doing ok.
Scott and Becki Gardner, Olen’s uncle and aunt, were here this past week and will be here next week. They are over at Koza, Cameroon this week where they are planning to be long term after Dec. He is a surgeon and she a nurse. One of the Maranatha group is an anesthetist and is staying an extra week to do some anesthesia and teach some also.
Lyol and Zane are very active and “get into everything” and keep Dolores busy during the day. Today is Lyol’s birthday and we had a birthday party for him inviting the expats over. He got several gifts and of course birthday cake. He had fun opening his various gift packages. We had to help him assemble his new wagon that will hold two people. Lyol calls this his home rather than America. I guess we all long for that land above that is fairer than day. This definitely does not feel like home here but we make the best of it and hope the love of Jesus will shine to these people.
Love, Rollin and Dolores

Jan 14 Containers arrived Jan 6

The containers have arrived on Jan 6 except one of the containers with construction materials is still in Cameroon. Supposedly it is on the way now and will be here by end of this week but we have heard that before. Apparrently someone took the payment and disappeared that was supposed to be for the truck fuel etc. It is difficult to do business when it seems almost everyone is corrupt. If your skin is white it means that you have unlimited money although they extort from blacks also.
Our container also arrived here Sun Jan 6 and was unloaded from the truck with some big equipment from the cotton company. The other containers were offloaded then also. The boxes etc. in our container were unloaded in Moundou the container lifted onto a truck by 80 men then the boxes thrown back into the container and then the truck driven here. It would cost another $1800 to get the crane to lift it onto the truck so lots of man power cheaper. So far we have not found much if any damage in spite of the way it was thrown in. Maybe we had the boxes packed pretty well. The glass jars we have not gotten to yet. We won’t unload most items until we have a house to put them in. We did unload our comfortable couch and chair and desk and a folding table and a few other boxes. A case of corn chips was so stale that they are not edible. So far the nuts and grain that was sealed in plastic buckets seem very fresh and ok. No worms. A few small items that had been opened and put in at the last minute such as oats, spice, etc were not good. It has been a year since it was packed. It gets extremely hot inside the container when it is sitting in the hot sun.
Construction is moving along. Our house has been framed outside walls and a roof on it. The maternity, surgery, and private wards have been framed and roofed. There is still a lot more to be done. We desperately need some plumbers and electricians . There is enough work to keep them busy for quite a while. All the construction is steel so no termites can eat it down. We need painters and general fix er uppers to refurbish some of the older buildings. Mission work is not just for preachers and medical people but for lots of others as well. There are some Maranatha volunteers coming in 3 days for 2 weeks to do some of things that need to be done.
Business is picking up for the hospital as well. The next 3 or 4 months are our busiest time of the year. People have more money now after harvest and travel is easier so they can get their elective surgeries done. We had 10 procedures today. One was hysterectomy for probable endometrial carcinoma. One was a mass that perhaps was an old walled off ectopic pregnancy or endometrial cyst. We had several hernias and hydroceles, lipoma, etc. It is certainly nice to have Danae and Olen back but it is only about 4 months until we will take our annual leave in May and June.
Our emails drbland@sbcblobal.net and dfbland@gmail.com
Love, Rollin and Dolores

Jan 1, 2013 Danger?

Wow, it does not seem we have been here Bere, Chad, Africa for almost a year.  We are still deficient in French but have weathered 2 months of being the only doctor here.  Olen, Danae, Lyol, and Zane are back arriving  here the end of last week.  We are so glad.  Hope to get an end of year letter done and sent soon.  
This month is the crescendo of our big hospital construction project.  People are starting to come in as volunteers to do various things of the project.  Large amounts of concrete have been poured already for various buildings so that when the containers arrive with the rest of the materials hopefully by the end of this week at latest word.  They are moving now but one truck had a break down on the “great roads” but supposedly they are moving again and maybe cross the border into Chad tonight or tomorrow.  The last 25 miles to here would be expected to take at least 4 hours but there is really good highway with pavement the previous 70 miles.  I don’t know what it is like coming up through Cameroon from the port at the coast.  
New  Years day is a big deal here with drums all night.  We had a group serenade us at 0630 with drums, dancing, “singing” and “bonne annie” whereas Christmas was just another day.except no scheduled surgeries. 
Contrary to what is said to be in the news, Chad IS NOT the same as Central African Republic.  Americans are not being evacuated from Chad.  In fact more are coming in.  Yes there is an uprising in CAR with rebels heading toward the capital, Bangui but that is to the south of us.  Besides even if there was something here in Chad, we are so isolated that probably no one could find us.    No, we are not in any danger.  But we do appreciate everyone’s prayers and concerns and emails.Our emails are  drbland@sbcglobal.net  and  dfbland@gmail.com  
Love,  Rollin and Dolores