Sept 22, 2013

It definitely is raining less now than it was and things are beginning to dry up a bit. It is possible that the bus service to Bere  may start again in perhaps 2 weeks if the road continues to dry up somewhat. We have not been anywhere but that is what we are told.  

People are getting out into the fields more or the snakes are beginning to move around more as we seem to have someone with snake bite in the hospital most of the time now.  I lanced a big toe this am to drain off some fluid that was tight. The toe had been biten a few days ago.  

I did a c-section for a baby that I knew was dead but was unable to get it out with a vacuum or with forceps even though it was her 7^th pregnancy.  She had been referred from another clinic than I finally got the information that she had been given IM oxytocin.  The light finally clicked on my mind so I knew what the problem was.  It was as suspected a ruptured uterus with lots of blood in the abdomen.   I’m glad I was not successful with vacuum or forceps.  I think she will survive but we did a tubal ligation on her.  We considered doing a hysterectomy but was able to repair the uterus ok. That makes the 5^th ruptured uterus I have had since December.  I did have two others that were beginning to rupture when we did the c-section but I did not count them.  I often wonder how many babies and perhaps mothers that have died because of being given IM oxytocin before the baby is born.  Oxytocin is a uterine stimulant to make it contract more. 

Sometimes you think what if I had done whatever or maybe I should have. I had a girl that had swallowed a candy stick and was having severe laryngeal stridor. I could not find any foreign body with the laryngoscope.  She was getting better on IV steroids in fact she went home then they apparently took her to Moundou a day or two later and got an x-ray and went to a clinic there then developed worse stridor and died there. They did not do anything for her there they say.  I wonder if I had done a tracheostomy here maybe that would have been  prevented. Hindsight is always better.

I sometimes wonder what kids have been told or what they are thinking about the “nasara” (white people).  When I was coming to the Ped ward to make rounds this am one 5 year girl went screaming to the other end to her mother when she saw me in the doorway.  Maybe she thought I was a ghost or that the “nasara” would get her.  Almost everyone on the ward was laughing at the incident but she kept with her mom and would not look up.  

Dolores has canned a few tomatoes and continues to paint trim etc. There are 4 banana trees that are blooming and putting on bananas in Danae’s yard now.    

Donations for the project here can be given to the Jay Seventh Day Adventist church and marked for the  “Bere Chad Project”      The address is 13717 East 390 Road, Jay, OK 7436.

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

Love,  Rollin and Dolores

15 Sept. 2013

Nothing too exciting the past week except that we have been ill.  Dolores had chills and fever and aching Friday so began her Malarone and took her Fansidar today.  She is feeling better today and back to sanding and painting.   Neither of us felt like going to church Sabbath also we were the only “nasaras” (white people) on the compound.  Jamie and Tammy are in N’Djamena to meet some new people that are coming, three public health workers and three student missionaries.  Hopefully they can get through the road.  It takes about 1 ½ to 2 hours to go the 25 miles to Kelo.  It has very deep holes and water  over parts of the road.  Last year it was totally impassable for some months so it is not as bad as last year.

I had some kind of “cold” with cough and sinus drainage the past 3 weeks then a week ago had fever to 101.4 so began Malarone but did not improve so began quinine.  I also began some Augmentin for the sinusitis about that time.  Someone thought I had typhoid even though I have had the typhoid vaccination.  The typhoid test was positive but it should be with the vaccination.  But vaccinations are not 100% so I began the Cipro along with the quinine.  The respiratory and sinus thing has cleared. I think I have had several of the side effects of quinine such as palpatations, tinnitus, partial deafness, stomach upset, crazy dreams, not able to sleep well, bitter taste in mouth, no appetite, etc. but today I’m beginning to feel better as now I am off the quinine.  I ate well at noon and supper or at least better.  Maybe the “cold” was actually malaria coming on or something and should have begun the medicines sooner.  I did not see patients for 3 days but did do rounds today and probably will do some surgeries tomorrow if I feel like it. I still have weakness but hopefully will get a good night’s rest tonight and be stronger tomorrow. This is the first time that malaria if that was what it was has bothered me much.   Maybe it was the combination of that with the respiratory infection as I had a productive cough which has now cleared.  Fortunately the hospital census is low now.  Maybe the malaria epidemic has subsided. 

All four children and their families got together this weekend in Oklahoma.  The two oldest grandchildren were off to college, Rachel at Southern Adventist University and Robby at Southwestern Adventist University. They did email some pictures of the grandkids to us.  Of course they are all beautiful and handsome and very intelligent.  Little Addison is so cute and chubby.  We are looking forward to seeing her next month along with the rest of her family. 

Continue to pray for us and the hospital project.   

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

Love, Rollin and Dolores

Sept 5, 2013

My shoulder is much better now although still a twinge of pain if in wrong position ie. extend it back too far.   I’m not taking any more ibuprofen for pain now.  Have been able to do surgeries ok.  Have you ever tried to play volleyball with only your left hand when you are right handed?   Not trying to do much of that although I have learned to serve a fair left-handed serve.  

The hospital work seems to be ho-hum or same things recurrent.  Oh yes we had a 3 inch bladder stone the other day, several prostatectomies and urethral stricture dilations.   A c-section every so often for various indications including two the past week that the uterus was beginning to rupture.  One had a live baby and the other baby had been dead for awhile.   One patient was quite different.  A lady had an apparent mass in the abdomen that turned out to be a greatly enlarged hypertrophied stomach and almost no visible intestines; very atrophic.  I was not sure what to do so I did a pyloroplasty opening up the outlet of the stomach (the duodenum was visible).   Amazingly she is recovering and eating and the abdomen appears more nearly normal now so we let her go home today.  We had a ruptured appendix a few days ago doing well and went home today.  The malaria and typhoid seems to be letting up a little bit although we are still getting rain almost daily.   

Today was a different kind of day. We got a call about 0800 wondering if there was some way we could help the MCD (district medical officer, the guy that has given so much problems to the hospital in the past).  He had taken the 4-wheel drive high clearance ambulance with its driver out to a remote village and got stuck in the mud.  He spent the night out in the bush with the mosquitoes etc.  Several people had tried to get it out of the mud but it was pretty thoroughly buried when we got to it.  Jamie took the hospital pickup and I took our Toyota 4 runner (which has a winch) out to where they were at.   If one got off the “road” at all it was like quicksand very soft mud.  We had to go through water was almost to the top of the wheels especially the last kilometer.  We fastened the back of my car with chain to a nearby tree and hooked the winch to the ambulance and we were able to pull him out with some difficulty.  Jamie had to be pulled out also as he had gotten out of the “road” slightly.  Then we had to back up through the deep water to a place where we could turn around.  After that I got in a soft spot and had to winch ourselves out.  We had just gotten back to Bere when there was a call that Augustine with his car and a pickup bringing a bunch of pipe to the hospital were stuck near Kelo so we took off again.  It turned out that the pickup had worked out of the mud when we got there but Augustine had run out of gasoline.  His gauge does not work.  I had my gas can with me so we went back to a spot that had some gasoline and bought some and took it back to Augustine.  The trip back to Bere was uneventful other than the deep belly dragging holes and water over the road in places.  The MCD now says that I am his best friend and was very profuse in his thanks.

Dolores has been busy painting the walls and rough cement floors of Danae and Olen’s house. It involved a lot of stuff moving so could do all the floors.  She painted the shelves under the kitchen counter tops in our new house one day this week.

We are in good health other than minor aches and pains sometimes. 

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

Love,  Rollin and Dolores

26 Aug. 2013

It seems as though there is nothing new but as we listen about various ones back home having heart attacks and having stents put in and having cancer surgery and some dying from their heart problems maybe it is safer here than there.  We just have to be concerned about malaria and parasites mainly.   Oh yes there are people here with cancer also usually too advanced to do much about.  Although I recently saw one that I had done a mastectomy and axillary node dissection a year ago and she still looks good with no sign of recurrence yet.  No chemo or radiation available here.  

Today we had the 4^th little boy with a calculus lodged in his penis in the past two weeks.   Also had one 3 days ago.   Last week we had a c-section for prolapsed cord and the baby lived amazingly.   Also had a c-section for footling breech (foot waving at us ) but she had twins the second baby was transverse and they both lived and went home ok.   Also a c-section for an arm waving at us and only 4 cm dilation cervix.  They did well also.  The Pediatric census has decreased the past few days.  It seems the malaria and typhoid tends to come in waves.  

Sabbath evening we had some unusual cloud formations.  The sun was getting low in the west and there were some very large thunderheads but above them were these bright clouds coming over them like over a mountain top and they had various colors of the rainbow in them.  They also had like waves in them.  We did get pictures of them.  They were very beautiful.  There was even some lightning to the side but did not get any pictures of that.  Then during the night it rained very hard all night

Dr. James Appel was here this weekend with two senior students from the Union College Physician Assistant program.  I did not know I was supposed to speak for church until just as we were ready to go up front.  I thought they wanted me to have prayer or something until I was asked what my text was for the  message.  Fortunately I had some notes in my Bible.  I preached on “The Bride of Christ” and Dr. Appel translated Into French.  I guess it went ok.  With translators you have a little time to think between each sentence.  

My right shoulder has been almost immobile the past week since apparently injuring it playing volleyball last weekend.  I still can not abduct it but minimally but it is a lot less painful than it was.   I’m not sure if it is a pulled muscle or stirred up arthritis or possibly a partial torn rotator cuff.  Maybe I will get a MRI next April when we come homeon annual leave as there is none available in this country and it is getting better so maybe by then I won’t need anything hopefully.  We are in good health otherwise.

Progress report:  we have electricity in our new house although not all finished yet.  Jamie plans to have the electric and plumbing done in it by next week.  Dolores has been busy painting in Danae’s house also cooking meals for a German boy here the past month but he left today.  

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

Love, Rollin and  Dolores

August 17, 2013

The big news is that we have a new granddaughter, Addison Noel Netteburg, born Aug. 13 and weighed 7 lbs 15.5 oz to Danae and Olen.   She joins her two brothers Lyol and Zane as “missionary kids."   She was born in Bay State Hospital, Springfield, Ma where they had done their residencies before coming to Chad.   The bad part is that everyone else will see and hold her before we get a chance to do so but they will all be coming back to Chad in Oct so then it will be daily.   For a good description of the birthing go to  www.missionarydoctors.blogspot.com

I have done 3 skin grafts in the past week although one was a repeat.   I caught this nurse diligently changing the dressing and scrubbing where the graft had been put or I might not have known what happened to the graft.   I did not kill the nurse but . . .some just aren’t very smart and did not read the orders that said “pas change dressing.”  He was one not usually on the surgery ward.   I have since given a short talk about skin grafts to all the nurses at the staff meeting.  Two of the grafts were on legs that  had had a severe infection with necrosis of some of the skin and tissue that was debrided and now granulated in so hopefully the grafts will take and cover the areas involved.   The hippo bite mangled leg that we put in a intramedullary SIGN nail in the tibia so far is doing well and amazing don’t see any purulence draining anywhere yet.   A c-section for arm presentation that was waving at us even though the dilation was only 4 cm, is doing well both mother and baby.   It seems we are averaging about one vacuum extraction per week also and occasionally a forceps delivery.   This afternoon we had another strangulated hernia that was barely in time so did not have to remove some bowel.   Also this afternoon we had a urethral stone that had to be cut out of the base of the penis.   It was our second in a week.  Both boys had stones about the size of two garden peas and the stones just would not come on through.  

It is raining two or three times per day lately.  They all say that is good for the rice so they don’t complain even though the “roads” are big deep water holes.   So far we are not having the flooding like they had last year.   Of course the humidity stays high and things get moldy if not used including the interior of our car.   The temperature has been very nice in the 70 and 80’s.

We have the poles set and the net up and the court marked off so that we can play some volleyball when we have time or it is dry enough.   They are getting the interior metal paneling and insulation done on the housing.  Jamie has been working on the electric on our house to be and plans to get the plumbing and water hook up to it within a week or so.    Dolores has been painting interior of Danae and Olen’s house.  

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

Love,   Rollin and Dolores

August 8

When one thinks of acute pain in abdomen you usually think of
appendicitis, cholecystitis, perforated gastric ulcer, aortic aneurysm
and things like that but here it is more likely to be perforation of
distal intestine secondary to typhoid.  Yesterday we had an acute
abdomen secondary to bleeding in the tissue all through the abdomen.
He had a history of snake bite on the foot 5 days previous but no
swelling  or reaction of the foot.  We opened the abdomen and closed
it after we saw what it was.  We gave antivenem and fresh blood even
though the antivenem probably is of no value after 5 days.  His
prognosis is not good.  We do occasionally have perforated gastric
ulcer and appendicitis and ruptured ectopic pregnancy and tubal
infections with abcesses.
Every bed in the hospital was full yesterday including the extra beds
in the building that is supposed to be eventually lab and pharmacy.
Surgery, Peds and medicine beds were full.  Perhaps a few empty beds
on maternity.  We have a neonatal tetanus that is finally looking
like he might live.  He has been fed with NG tube but yesterday he
was sucking a little from breast.  The little boy that we grafted
skin on his leg after previously taking some extruded bone off is now
getting stronger and trying to walk and his family is very happy on
how good he looks.  The graft looks good so far.  He had not walked
since his fracture leg 2 yrs ago.  We also released some of his
contracture but he still has somewhat deformed leg but useable.  We
have several in the hospital that are somewhat long term with various
abcesses.  We had a 5 yr old boy a few days ago with a lodged stone
in his urethra at the base of his penis.  I could not get it to move
so had to excise it from there and repair his urethra.  Apparrently
he had a bladder stone that tried to pass but could not.  He is doing
ok now.
Aug 9 next day.  The man with hemorrhagic abdomen after a snake bite
died last night.  Not suprising!  We did another laparotomy for acute
abdomen today that was full of blood but he was oozing blood from
cancer all over his upper abdomen.  His liver was full of tumor so he
won’t live long.  Two more people with huge abcesses and necrotic
areas on their leg are looking better now.  We debrided them and they
are beginning to granulate somewhat.  Maybe they will be ready for
skin graft end of next week.    We had another C-section this am for
severe small pelvis and baby was having some meconium(we found when we
opened).  Mother and baby are doing well so far.  WE also did an
orchiectomy and hernia repair on a man with a large hernia but also a
large tumor of his testicle.
This afternoon I gave a basic talk on pulse and blood pressure (how to
do)  to some people from some other villages that wanted to be able to
help their people some.    Then we went to a “fet” given by our night
watchman for us.  He is a Moslem but a very nice man and more honest
than a lot of other people.  Yesterday was end of Ramadan (the Moslem
fast for a month and don’t eat during the day but can at night).
Mohammet, our night watchman, has a new young wife so was giving the
“fet” for us.  He fed us some Chadian food that was very delicious.
His new wife is age 14 and Arabic and petite.
A lot of people have gone home the past 2 days esp from Peds.  The
Peds census is down in the 20’s.  The surgery ward is still pretty
full.
Go to www.parkers4bere.blogspot.com for an interesting story about a
chained man.
We are still “hurriedly waiting” for the Netteberg baby that is due
almost any time now.  Still no progress on that from Massachusetts.
I am always glad for Fridays and Sabbath for more time for reading and
getting together for “potluck” and theoretically less work in the
hospital.  Although often it makes up for it on Sat night.
Our emails are  drbland@sbcglobal.net  and  dfbland01@gmail.com
Our phones are    Rollin      235  62674586        Dolores    235 68824768
Hopital Adventiste de Bere,  52 Boite Postale,  Kelo, Chad,  Afrique

Some have asked about how to get donations to our project.    One
option is to send to :
    Jay Seventh Day Adventist Church
    13717 E. 390 Road,  Jay, Ok.  74346

Earmark for the “Bere, Chad Project”
Thanks for all your prayers.
Love,  Rollin and Dolores

Sometimes I wonder

We read the commands of Jesus that we are to go into all the world and
preach repentance, teach, baptize, and make disciples everywhere.
Matt 28:19, 20; Mark 16:15; Luke 24:47; John 20:21; Acts 1:8.
Sometimes I wonder if I am really doing mission work for the right
reasons.  Is it because we have been commanded to do so?  Is it
because it is my “duty”?  Is it some sort of penance to go where life is
dangerous and uncomfortable and to do surgery and other hospital work
or other types of mission work?  Am I doing it just because of all
the different and interesting pathology that one can see out where
there is little medical care?  Do I endure loneliness and maybe lack
of appreciation just because I want to “earn” some kind of merit?
Would I give my life for someone who does not appreciate what I am
doing?  Sometimes it seems there is no one who is honest, and
everyone wants to get all they can from the “nasara” or white person.
Taking things or not returning things that have been “borrowed” is a
way of life for some but I see some of that back home too.  What are
we really here for?  Is God expected to make things easy just because
I claim to be one of His children?    On the other hand Jesus has told
us that His followers will have hardship and even persecution so does
that mean if things are going well and easy that maybe I am not
following Jesus as closely as I should?  Or conversely if there are
problems does that mean that I am a follower of Jesus or just reaping
the results of my bad choices?  Most of the world’s major religions
such as Islam, Budhism, Hinduism, Catholicism, etc teach about doing
various things to earn merit for the after life.  Some times I wonder
if maybe we get into the same mental attitude.  I am thankful that we
serve a God that is full of forgiveness and grace and has promised
eternal life with Him if we repent, believe, and accept His
forgiveness and then serve Him because we love Him so much for what He
has done for us.  Jesus gave His life for a bunch of nonappreciative
people even some that claim to be His followers but do not do His
commands.  I am thankful that He has given us the privilege of
communication with Him and with each other.  Continue to pray for us.
Our emails are  drbland@sbcglobal.net and  dfbland01@gmail.com
Love,  Rollin and Dolores