15 July 2013

Olen, Danae, Lyol, and Zane left on the bus this morning at 0630 to go
to N’Djamena. Fortunately it is a cool cloudy day (only in the 70’s)
with a little bit of rain (an answer to prayer) so maybe Zane would
not get too hot on the way. Danae has to get some special papers
filled out so she will be allowed to ride the plane home on Wed. It
involves paying some money to the right people. She is “27 wks” but
actually about 36 wks pregnant. She hopes to deliver this one in
Springfield, Ma and not on the way somewhere (ie Zane was born in New
Jersey). They were all in good health as they left here. It will be
awful quiet here in evenings without Lyol and Zane. We like their
noise a lot better than the roosters crowing under our windows every
4:00 am. Perhaps sleeping in their place will be quieter unless the
nurses want too much.

We have two freshman med students that will be
here two more weeks and a nurse practitioner that will be here another
month then it is just us and the Parkers here at Bere and the Roberts
down at Bendele and Bronwyn at the Nutrition center. Gary Roberts had
a severe cellulitis of a leg after a scrape on the shin from a motor
cycle. He is much improved now in spite of the fact that some had
heard a rumor that he was about to die from??? He apparently had
malaria at the same time.

Last week we did two vesico vaginal repairs. They were repeats.
Previous attempts apparently got ruined when drainage tubes got kinked
so this time we just put in the foley with NO connection tubing. I
understand that is the way some fistula speciality hospitals do it
realizing that poor nursing can ruin an otherwise good surgery. We
think we got a good repair on each and so far they look good. We
also debulked about 35 lbs of abdominal ovarian cancer mass and fluid. 

She looks good today. We lost a girl from probably perforated typhoid 

bowel a few hours after I had decided not to operate. Maybe I
should have anyway but she might have died on the table. I am not
perfect. The bowel resection we did after we got here is coming
along ok although quite weak. He had had 3 previous surgeries and
his problems apparently began with unable to urinate with a urethra
stricture but previous surgery had accidentlly cut the bowel and a
subsequent attempt to repair did not hold but praise the Lord he is
eating and improving now. We recently had a man with a bladder
diverticulum larger than his bladder. His main problem was a urethra
stricture and prostate hypertrophy. The med students were happy to
do a delivery past evening.

One good thing about the prolonged time here for therapy at the 

nutrition center for one of the fistula ladies is that she has learned 

about Jesus while at the hospital and the nutrition center and would 

like a church built in her village.

There are military or police check points along main roads. They say
that it is because Chadians helped get rid of Al-Queda in Mali and now
that group wants to get revenge in Chad> I don’t know if that is
true or not. If one travels anywhere much you need to have your
passport or ID card along even the locals have to have their ID along.
I have not heard of any uprising or problems in this country but
maybe the government is a little paranoid.

As always we covet your prayers.that Jesus will be glorified in all
the work that we do and that we will maintain good health.

Our internet is very sporadic so not sure when this will get posted
Our phone is 235 62674586
Our emails are drbland@sbcglobal.net and dfbland01@gmail.com ,
Love, Rollin and Dolores

Blog July 6, 2013

We arrived back in Chad Wed July 3 and took the long bus ride (about 8 ½ hrs) back to Bere. The road was dry but we have had a rain today that is very refreshing and temperature about 80. It is muggy when not raining. They had had some severe winds while we were gone that blew off some roofs but they have been repaired.  Some of the buildings maybe were not braced sufficiently.  Even part of  a brick wall was blown over.  It is nice and green and the corn and other crops are coming along.  Lots of plowing with the oxen is being done.  But up at Ndjamena it was barely beginning to green up.  Apparently not much rain there yet. 

Yesterday we did a bowel resection (took out about 20 cm small intestine) on a man that came here from CAR (Central African Republic). He previously had had surgery for urethra stricture through the bladder but apparently had cut into the intestine in the process so he had draining intestinal material coming through a drain.  We took out the involved intestine that was very adherent to the abdominal wall and cleaned it out as best we could then reconnected the small intestine. He was very skinny but hope he will do okay now. He had had 3 previous surgeries.  I’m glad Danae insisted we do the surgery that I was considering postponing for a time.  We also did an eye enucleation for an eye that was blind and bulging out greatly. Possibly was retrobulbar tuberculosis with white cheesy material there.  Don’t think it was a cancer. Also did a removal of a parotid tumor yesterday.  His facial nerve still functions. Last night did a C-section for a shoulder presentation that I was unable to get the position changed. It was a second twin. The first is fine but the second one was dead. I let Danae rest last night. 

We left Jay area last Sunday afternoon and drove to Janelle’s in Oklahoma City and repacked some things there and left there Monday morning. Our flight from DFW was cancelled to IAD in Washington DC so had to get another flight arranged but still got there by 3:30 pm.  Kermit and Ronnalee Netteburg picked us up and we stayed the night at their place and packed in some more things that had arrived there for us such as our new SIGN orthopedic equipment  and some ureteral stents.  We left DC on Tues and arrived back in Chad Wed.  We had to pay for some extra baggage but we expected to. 

Sometimes one wonders why one would leave all the comforts of home and the family and friends there but when one sees the need here and the friends here it becomes more evident. Of course we also have family here although they will be back in the USA the next 3 months.  Another family member will be coming about Aug 12. Danae and family will be coming back here in Oct.  

Thanks to everyone for their donations and prayers.

Pray for our health and everyone here.

Our blog is:    www.weareamissionarybland.blogspot.com  

Danae’s blog is:   www.missionarydoctors.blogspot.com

Our email’s  are   drbland@sbcglobal.net    and   dfbland@gmail.com 

Love,   Rollin and Dolores

Women fight April 20

A woman brought a piece of old dried up piece of ear and asked if we could repair her ear or reattach this piece of ear to her remaining ear. We almost laughed but she was serious. She had been in a fight with another woman and the other woman bit off part of this woman’s ear a few days previous. It was not a sword injury, she is not Malchus and I am not Jesus. The injured remainder of ear was already beginning to heal. We had to explain to her that it was not possible for us to reattach her ear part and have it live again. When women fight they can really get pretty gruesome and in the past I have seen various injuries from women fighting.
We are leaving April 24 and going home on annual leave via Thailand, Laos, Cambodia, and Philipines and will be back in the USA (s. Calif) May 12 and back to Oklahoma May 15. We leave July 1 to head back to Chad.
Our emails are drbland@sbcglobal.net and dfbland01@gmail.com
Love, Rollin and Dolores

Death Under the Mango Treee

    Mangoes taste so good and anyone knows that the best fruit of whatever tree is way up towards the top such as cherries, apples, or peaches. But there is a problem with mangoes. The trees get quite large ie. 60 feet tall and the limbs are very brittle. Sometimes they break off spontaneously. If someone climbs a tree the limbs can break off without warning. More people die from falling out of a mango tree than from hippo bites at least around here. Incidentally our two men with hippo bites on their thighs are doing ok and appear that they will survive. We have had two injured from mango trees today one with minor cuts and the other with bilateral fracture radius and ulna and fracture distal humerus in the elbow and fracture of skull in the frontal area. Don’t know if he will survive or not. We recently had another that died from a fall from a mango tree. I love good juicy mangoes but I won’t climb a tree to get one to prevent it from getting bruised. It can just get bruised when it is knocked off the tree. People have very long poles or sticks with a hook on the end to knock a mango off the tree. But remember even the mango tree can be deadly and needs our respect. They are the best shade trees around with the most dense shade.
   Our 3 partial thyroidectomies or goiters and two thyroglossal duct cysts have all done well and have gone home.
   We had a fatality in the OR recently in a young lady that had a large perforation of terminal ileum from typhoid. We did the full “code” in the OR but no go. She waited too long to come to the hospital. In retrospect did we not give her enough IV fluids or not enough of ? or was there an anesthetic problem or too much sepsis. We don’t have the luxury of consulting with infectious disease specialist or cultures or x-ray or whatever. We are it. Someday we hope to at least have a digital x-ray. It sure would help especially with the bone cases. Our lab is pretty minimal also. We have to depend on physical diagnosis the most and most of the time we are right we think.
Life is tough here in Chad. The life expectancy here is one of the lowest in the world at 47. Death is very much a part of life here.
   We are certainly looking forward to that better land wherein dwelleth righteousness and there will be no more death or sorrow As one sees the events of the world surely the Coming of Jesus can’t be too long away.
Our emails are drbland@sbcglobal.net and dfbland01@gmail.com
Love Rollin and Dolores

Update on baby elephant 4-6-13

     The baby elephant died thurs night in spite of valiant efforts by Gary Roberts and many others. Everyone knew that the chances were slim but it was worth a try to save it. They say elephants are very emotional animals. This baby had lost his family when the slaughter occurred and then had been tied up for a week before Gary obtained it and flew it over here from an area Out of a heard of over a hundred elephants near the Cameroon border about half of them were killed in a massacre recently. This one baby was saved temporarily but he succumbed to depression and loneliness. We put in a feeding tube and it seemed to revive perhaps a day. They say even in elephant orphanages the success rate is only about 50%. He was a cute affectionate little guy only about 200 lbs.
     Our second man in a week to be bitten by a hippo came in Friday.  His bite was not quite as massive as the first one but it was through and through his left thigh. The previous was also left thigh. The previous one tore out a bunch of muscle which we tried to repair but part of it appears that it will need to be debrided some more. What bacteria does a hippo mouth have? We don’t know so we are giving lots of antibiotics to both men.
     Today, Sunday, after doing rounds on patients I worked on cement mixers. One had a bearing completely “frozen” and would not turn so had to be torn apart.  No new parts so have to make this work. It apparently had not been greased in a long time so had grooves in the shaft etc but with some filing to knock off the roughest spots we put it back together and it worked and grease was put in. Gary Roberts came down to work on the other one that was diesel motor. Apparrently dirty fuel had clogged the filter and the pump and the injector nozzle. It has been cleaned out now and it runs. Perhaps the compression is not as good as it should be. It had been run some with no air filter. Some of these locals just don’t understand how important clean fuel and lubrication are. Maybe sabatoge was involved also as a piece of cement sack paper about 6 inches size was found in the fuel tank the other day. Cement does not work good in fuel system. Don’t know how much was on the piece of paper. Anyway they are operative now.
     It is still hot and Zane is still having an elevated temp but not last night as he was in an air conditioned room down to 88 degrees. Whether he has some infection or some problem with temperature regulation we don’t know. He acts pretty normal most of the time. Pray that it is nothing of consequence.
Our emails:      drbland@sbcglobal.net and dfbland01@gmail.com
Love, Rollin and Dolores

OUT OF ORDER: Sudan not meant to be

     I had planned to go with Gary Roberts our mission pilot to South Sudan this past week but apparently it was not meant to be. There was a schedule problem then early one morning as we took off a warning light came on showing the alternator was not operating properly but as we landed it seemed ok. Played with some connections all seemed ok so tried again and had to land again then it finally was consistent and he finally found a broken wire but too late to go as it is a 10 hr flight with almost no place to land most of the way. Much of the way is over Central African Republic (CAR). Next day we took off early but an indicater showed one of the magnetos was not functioning as it should. (The plane has two magnetos so it can still run ok but not quite full power) so aborted the trip and came back after 45 minutes into the flight. His overflight permits over CAR were expiring etc after all the delays. He found the problem was a condenser in the magneto which he replaced. The plane is fine now He says he never has had 2 mechanical problems in the same week before. I later saw a internet headline that 150 were killed in some fighting in south Sudan but I think in a different part from where we had planned to go. We were to visit some government officials and see and evaluate 2 hospitals in northeast South Sudan but maybe some other time when everything is calm. Maybe the Lord made the wire break or the condenser quit. We were never in any danger so far as the plane was concerned. Gary is a very careful pilot and mechanic and has extra safety equipment on the plane to detect problems like that. 

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

Medical student orientation

     A senior medical student, Jonathan Martin, from Loma Linda University arrived in Bere Tues night April 2 then Wed am he began his “orientation” by going with Dr. B. down to where the baby elephant is. They were wondering if Dr. B could put in a feeding tube either surgically or what as the elephant was deteriorating and refusing to eat much and so a last ditch effort to save him. We got the tube down through the mouth but had to put a hand and arm into the mouth and throat to direct the tube. A monkey was caught and hanging over a wall so the student rescued him. 

    Then back to humans and saw the MCD and then at the hospital he saw a large bladder stone in a 3 year old boy then a boy with huge abcesses in buttocks that when the incision and drainage was done the pus actually came out spurting under pressure with about a liter of purulence. Then there was a ruptured ectopic pregnancy with quite a bit of blood in the abdomen. Also some head trauma cases with lacerations of the scalp that we sutured up. One was about 5 inches laceration and down to the bone.
     On the 2nd day he was helping with a C-section for ecclampsia and a case of a bone tumor on the distal radius and a curettage (D & C) and we unwrapped a skin graft that we did 10 days ago and it looks as if it all took on the lady that we had amputated the arm at the shoulder because it was necrosed in a reaction to a penicillin shot. Part of the skin around the shoulder also was necrosed but had finally granulated in and now the skin graft looks good. He saw our Easter hippo bite of a man’s thigh. So far the man is doing ok but still has some drainage as would be expected.
     He is matched to a surgery residency program in Detroit, Michigan then hopes to go somewhere as a missionary surgeon. He is a deferred mission appointee. Maybe he could come to Bere after his residency who knows. He graduates from LLU May 25. He is very likeable and nice to work with.
     We are doing well other than it is hot about like Okla summer.

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