22 Dec. 2013

Only two more shopping days until Christmas!  Ha!   Not much to shop around here but one saves money that way.   One has to plan months in advance for such things such as when you are home or before someone else is coming so they can bring something.  Most people here are more interested in how to survive or where the next meal is coming from.  Most live in mud walled grass thatched roof houses and depend on what they can raise during rainy season mainly rice, millet, and peanuts and beans with a few other things such as tomatoes or cucumbers occasionally.  

Friday we had a volvulus or torsion of the sigmoid colon that was very distended and almost dead but did pink up after we untwisted its pedicle and I think he is going to be all right.  Also had a c-section for too large baby for pelvis.  We have had lots of hernias and hydroceles and prostatectomies.  We had another boy with infected clavicle fracture so we took out part of the clavicle as one does not have to have a clavicle and so far he is doing well.  

Sabbath we went to the Bendele church instead of Bere and had the lesson while Dirk had the sermon.   It is a little challenging to adapt concepts to their level of understanding even about the plan of salvation and the origin of sin and the great controversy between God and Satan and especially emphasize the love of God that He is not some vengeful tyrant that has to be appeased.   In the afternoon we went out in the bush to see a lady with some neurological problem and movement disorder.  We think she has some problem with the basal ganglia but not sure what.   It began when she was age 20 about 7 yrs ago.  She has never had any children and began about the time her husband left her because she was not having children.  Her history is not consistent.   Don’t know if she had any kind of trauma or not although no history of such is given.  On the way through the bush we saw some parakeets and some red billed hornbills.  

THINK!!   What can I do for someone this Christmas that they would not have or have done otherwise?

Matt 1:21; 2:2  Have you thought who were the wise men from the East that knew the prophecies so well and knew to look for a king or Saviour and followed the star?  Probably descendents of Abraham also through Ishmael.

Love,   Rollin and Dolores

27 Dec. 2013

We have had two volunteer doctors the past two weeks that were very helpful.   Dirk the neurosurgeon from Germany did a lot of organizing that needed done and helped with some of the surgeries and did some sorting of instruments and other things.  Vadym the surgeon from Ukraine that had not had much hands on experience got lots of exposure and hands on with various things the past two weeks, much more than he would get at home in a long time.   He is interested in becoming a long term missionary but will need a sponsor.   He is still unmarried and has not found a woman that would share this experience with him.   He is an only child and has parents and grandparents back in the Ukraine.  They have a family business of an orchard of apples and pears.  

Christmas day we had breakfast together having pancakes and various toppings and kids opening presents then in the afternoon we all got together in the open pavilion even though it was about 100F but about the same everywhere else.   Also in the morning some of them drove out in the town and gave away small trinkets and soap bars just throwing things out from the back of the pickup other wise might have a stampede trying to get things.  We had plenty to eat at lunch time.  We did have a strangulated hernia to do that morning.  It was fun watching the grandkids open their gifts.  The Parkers had a surprise for their Christmas.  Their children are here for the Christmas vacation and especially Tammy had no idea that they were coming courtesy donation from someone.    

Tues we had a fractured patella that turned out to be difficult because there was also a fracture of the lateral femoral condyle (part of the knee joint) that was displaced and the knee was partially dislocated so had to reduce the displaced fracture segment and put in a screw to hole it then could repair the comminuted fracture of the patella (knee cap).  This is all done without any x-ray but he looks good so far and hopefully eventually get an x-ray to confirm.  We also did endoprosthesis of the head of femur part of the hip joint on a lady that had fractured the neck of femur about 2 years ago but her son was insisting that it could be fixed.  We had been trying to get some surgical tools to be able to do it for many months and finally get some from Germany with Dr. Dirk Wonderlich.  (He also brought out a lot of other surgical instruments in his suitcase as he came to visit) I was surely thankful for that.  I hope that it works ok.  The son is one of our employees.  There was also another vacuum extraction on Christmas eve but the baby does not look healthy seems to have some kind of neurological problem, ”floppy baby.”  

Dolores made five insulated holders for water bottles that would hold ice all day and gave them to  the student missionaries and two other volunteers.  I got an i-phone for Christmas.  I had in mind to order one through Kermit (Olen’s dad) but I guess Dolores had already done that through Danae or Olen and brought out with the Parker children.  I’m sure Cathi was in on it also to send the check.  I’ve got to learn how to use it.  These smart phones are maybe smarter than me.   IT is really nice.   Hopefully it will help with emails or text messages.  The little Nokia cell phone had almost quit entirely.  Danae made some Christmas stockings for the student missionaries and Tammy and family made a bunch of “snow” (cut out paper snowflakes) during the night of Christmas eve and scattered them in front of Danae’s house so that we all could come through the snow as we went to breakfast. 

Thur  we had two hernias and a ruptured appendix that was very retrocecal.  We have a lady that has the most fluid in her abdomen that any of us has ever seen.  Drained off about 3 or 4 gallons and can hardly tell the difference in her appearance.   Not sure the cause yet.   She has no edema. We have a man with a intertrochanteric fracture of his hip that we hope to do an internal fixation tomorrow (Friday).  Also a little girl that fell out of a mango tree and suffered a multi fracture of skull with some brain matter came out and has a fracture femur.  She is awake and eating and looks like she might survive so will need traction on her leg or a plate on the femur try to keep it simple until we know she is going to survive.  

Have a happy and prosperous new year and keep your priorities straight ie keep the Lord as first priority.

Love, Rollin and Dolores

Dec. 12, 2013

We have been busy and I did not realize it had been so long since I have written anything. Since the beginning of the month the surgeries have suddenly increased markedly now up to 6-8 per day. We have done two brachial cleft cysts this week and saw yet another one to be done when they pay something for it. These were all very large
cysts in the neck under the mandible but involving the whole left side of neck. They were all three left sided.

This past Sunday I did a fracture tibia SIGN nail that had been fractured 6 months before
and very scarred and also a fracture femur that was in three pieces with two pieces stuck together that involved about 4 cm below the greater trochanter and the 2nd break about 10 cm below that. It was quite difficult but I think we got good results with the SIGN nail
system and no x-ray, but of course it was an open reduction. The man’s other fracture femur (just a short distance above the knee) we had done the previous Sunday in Moundou. Also did a 12 yr boy fracture of femur through the growth plate and almost through the skin the previous Sunday. I had to plate it then immobilize it.

Most of our volume of surgeries involves hernias and hydroceles but a few ovarian cysts, hysterectomies, and prostatectomies. I just assist Danae on the GYN cases. We work well together. She has been doing some of the surgery rounds while I do surgery on the days when we have so many to do. OPEN FOR SUGGESTIONS.

The little baby that had severe burns of hands and chest that lost his fingers of one hand is doing well otherwise. We did a pilonidal cyst today.

We have all three been busy lately with the hospital stuff and now we have visitors which makes it more interesting. We have a couple from France here for a month. She is a “midwife” and homeopathy and he is a mountain rescue and ski person. He is helping Jamie some with construction.

We have Mason McDowell here now with two of his anesthesia students.  Mason will be moving here long term next May or June to be teaching anesthesia to students out here so that more Africans can have good anesthesia care. His wife and two children ages 8 and 10 have not been here yet. They are very nice and a joy to have around. The
brachial cleft cysts went much better with their help for anesthesia. His students that came with him from the USA are learning some things about anesthesia in not so ideal conditions.

It is not supposed to rain in December but the past two weekends we have had some showers around in fact Dec 1 it rained hard in Moundou while I was there. It is about 70 at night and about 90 in day so pretty nice.

Last Sunday Dec 8 it was dark on the way back from Moundou and the road from Moundou to Kelo (about 60 miles) is paved good road but lots of pedestrians, goats, cows, ox carts, stalled vehicles, dogs, etc on the roadway so it is very stressfull driving after dark. Especially one time a woman and child ran across the road and we just missed them
by inches as we swerved the car and the guardian angel helped I am sure so that we missed.

Dirk Wunderlich a neurosurgeon is here from Hamburg, Germany for 10 days. He was here last Dec also. He brought some surgical instruments with him especially orthopedic.

Our emails are drbland@sbcglobal.net and dfbland01@gmail.com
Our phones are 235-90627822 and 235-62674586
Rom. 8:28 and Phil 4:13
Love Rollin and Dolores

Nov. 30, 2013

We hear of the snow and ice back in the USA and we shiver in the “cold” here.   It gets down to 75 F in the mornings. It is pretty nice here with dry air and ground and highs only in the 90’s.  Hope each of you have had a happy Thanksgiving and “black Friday” holiday. On Thurs all of the expats got together and we ate very largely of all the good food that various ones had made.  No TV or football or other things like that. Of course it is not a holiday here like there. In fact we did two surgeries in the morning.  

Today Dolores and I went out in the bush for church and took a patient with us returning to her home there about 45 or 60 minutes (only about 16 miles) from here if you did not stop. The “road” through the brush is sort of hard on side mirrors on the vehicle but overall smoother than the “main road." A one day church had been built there about a month ago and they now have 40-50 adults and about that many children that come to hear Bible stories.  The church is not finished on the floor and besides it is cooler under the mango trees now in dry season.  They have no medical care or clinic in that village.   We may start an occasional clinic there to try to help them.  Gary Roberts is marking out an air strip there and they are favorable towards that and hopefully any government officials are ok with it then it would be only a few minutes away even in rainy season whereas could not drive there in rainy season.  

Have repaired two meningoceles in the past week.  Yesterday (Friday) was one meningocele, a strangulated hernia, vesico-vaginal fistula, mastectomy, hydrocelectomy,  prostatectomy, and an ordinary inguinal hernia. This past week we drained a liver abcess with about 2 liters of pus.  Last Tuesday I did a SIGN nail (intramedullary rod) on an open fracture of a lower leg but also the knee was totally messed up and laying open for 3 days with lots of gravel and dirt in the wounds.  The lateral tibia plate was partly absent and little small pieces and fracture patella and the ligaments all torn apart. Hopefully it is repaired somewhat and hope for a good stiff leg without too much infection.  Putting in the nail was the easy part. Tomorrow I have a bilateral femoral fracture to repair but the accident was one year ago.  One side is loose and the other has healed together but much shorter so have to take it apart and will put in SIGN nails in both.  Both SIGN cases are in Moundou as I am covering for James Appel for those while he is in the US for a month. Tonight we had a man with fracture of tibia and fib about 2 or 3 inches above the ankle but was refusing treatment at first but finally let us cast it I think in fair position and it had no skin breaks.  We had one other vesico vaginal fistula this past week.  Both cases were redo that had not quite held with the previous surgery.  No one wants to pay for those fistula repairs as the woman is sort of an outcast with leaking urine and can’t have sex etc and chronic urine smell.  If the repairs work it gives the woman a new lease on life.  We need a large fund to cover the cost of those repairs.  

I think it is official now that Dr. Scott Gardner (Olen’s uncle) will be coming to Moundou.  He previously was going to be in Koza, Cameroon.  Dr. James Appel is going to Abeche, Chad to get some work going there that has been minimal thus far and Dr. Roger (Congolese doctor) is moving from Moundou to Bature in southern Cameroon. 

We love to hear from any of you.   

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

Nov. 18, 2013

Well I just got another year younger or older.  Anyway Dolores had the expats over for cake and home made ice cream Wed evening for my birthday.  Thank you to each one of you that sent birthday greetings via email.   I am not that old although next year will be my 50 year college class reunion at Union College in Lincoln, Nebraska.  We are planning to be there for that.

The birthday was just another day at the hospital.  We did a bilateral orchiectomy and amputation of scrotum for necrosis and necrotizing fasciitis of the perineum.  Hopefully he will live but it is looking doubtful as his necrotizing fasciitis or whatever has extended up through his cord and now today appears to be into his abdomen in spite of every antibiotic we could give him.  The relatives are wanting to take him home to die there as I think he is dying anyway.  Also did a partial amputation of clavicle for severe osteomylelitis from a previous fracture.  He  also had an old healed fracture of his femur that was shorter.  Another little boy has osteo of his clavicle and osteo of his femur and of one metatarsal and they claim there was no trauma.  Tues I had to redo the girl with the fistula but appears to be holding this time.  We also did another skin graft on a leg.  Sun we had a strangulated hernia and another one today.  We had another lady with kerototic 1 or 2 mm nodules only in the folds of her palmar skin.  I am told that these are benign and there is nothing to do for them.  

We have Hector, Kathy, and Michelle Figoroa from Florida here for two weeks.  Michelle was a student missionary here a few years ago.  Hector is an anesthetist.  

I don’t know what you hear in the media but BBC reported about a priest that was abducted in Koza, Cameroon and has not been heard from since.  The following is an email from Bekki and Scott Gardner (Olen’s uncle) who had been planning to go to Koza as a surgeon there.  They are presently in France studying French for another month then??    

“I don’t know what all you hear in the media but  I guess the first requirement to be a missionary is 'flexibility.' It is still very disappointing. We don't know what the GC will tell us or what will happen with the governments and the Boko Haram. The priest definitely needs our prayers. I read on the BBC website that he had emailed or texted the french embassy 4 hrs before he was kidnapped and must have been in the process of evacuating when they came. His empty suitcase was found on the side of the road the next day. The BH has been pretty active the last 6 mos. They went into a mosque and killed a bunch of people, pulled kids out of a school and set them on fire, attacked and massacred students in their dormitory at a government agriculture school and then set the buildings on fire, they dressed up in Nigerian military uniforms and set up a checkpoint (from the description in the news I think it was on the road between Koza and Ndjemena) anyway they stopped cars, pulled the people out and started shooting and hatcheting the people until they got a call on their cell phones that the real military was on the way, then they took off on their motos. It doesn't appear that they stole anything or that they even wanted the cars. They are a very strange group. They don't seem to have much of an agenda except to kill, destroy, control and terrorize. They do want money for weapons but they don't really seem to be stealing much. I suppose they don't bother with petty theft when all they have to do is kidnap a few westerners a year to collect millions so they can go back to terrorizing and killing.

The couple from Jengre had to leave early this yr. They actually didn't tell anyone they were leaving. They had a moving truck show up. Literally threw their things in and left with out saying good bye or anything. They had spent the better part of the last 20 yrs there and felt that was a horrible ending but felt for their own safety that was the way it had to be.

Thank you for keeping us in your prayers.

Bekki "

The Boko Haram has been officially declared a terrorist organization similar to Al Queda by the US state department.  They are the ones that were making trouble in Mali and Niger and northeast Nigeria and now Cameroon.  There was a French couple abducted a few months ago in Cameroon also.  They have especially been active in northeast Nigeria and in Mali.  Jengre, Nigeria is where we were 40+ years ago and we had once thought of visiting there but that looks unlikely now.  

So far here in Chad it is quiet and no evidence of their activity here that we know about.   I have not heard of any problems here other than frequent military check points when traveling on a main road and if one travels anymore it is helpful to have a letter of explanation from your organization such as hospital of why you are going to wherever so that they let you through faster.    We are way out in the bush and in no danger.  

Continue to pray for all missionaries of all kinds.    The devil is active trying to keep people from learning about the Saviour.

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

Love,   Rollin and Dolores

Nov. 12, 2013

    We have about finished moving all our stuff out of the apartment and
to our “new house." There are some other volunteers coming that will
need to stay in the apartment in a few days. It seems we have
accumulated more stuff in the last two years. Of course we have put
some stuff that we are not using right now back into the container.
   Friday we had a strangulated inguinal hernia but the intestine was
still viable so no problem.
   Sabbath was busy as I taught English Sabbath School class then
preached a sermon that was translated into French and Ngere. In the
evening we had two maternity cases with one that was dead baby before
she arrived that delivered and then had to have a manual removal of
the placenta and the other was a very difficult forceps delivery with
baby that had a heart beat but never responded otherwise to
resusitation. Then about midnight a man presented with a
strangulated inguinal hernia but when we operated he had about 10 feet
of dead small intestine from a strangulated volvulus which we removed
and reanastamosed to about 6 inches of terminal ileum . The
strangulated hernia had also necrosed his cord and testicle on that
side so had to remove that but that made his hernia repair easier
His hernia incision had to be extended cephalad quite a way to get
enough exposure to figure out the problem. 

   Sun we had what appeared to be a perforated ulcer but turned out to 

be acuteappendicitis. Also saw lady that had burns on her face and arms 

from boiling oil thrown on her by her husband then he would not let her
come in for treatment for two days but she finally got away and he is
in jail. Often times when a husband abuses his wife nothing will
happen to him. Also saw a girl with edema, ascites, shortness of
breath, pulsating neck veins, and a severe systolic heart murmur heard
over most of chest but more in left mid axillary line. Also on
Sunday put in a chest tube for empyema. We had another cancer of
cervix and uterus (not sure which was primary) that we debulked but
not cured.
   As we think of this holiday season time of year we turn to
thankfulness. We are thankful for the plan of salvation that Jesus
has provided for us with his perfect life and sacrifice. We are are
thankful for the friends and relatives that think of us and continue
to pray for us. We are thankful for the emails and notes that some
send us. We are thankful for the donations that have been provided
so that various projects can continue. We are thankful for the
Adventist Service Industries, Maranatha, and Adventist Health
International that have provided many new building shells but now we
need to finish them up on the inside with interior walls and plumbing
and electric wiring, etc. We are thankful for the large and small
donations that have been made to help provide equipment and interior
necessities such as sinks and stoves. More are needed. We are
thankful for the volunteers that have come and that will come to work
to make this place a better place with their various talents. We are
thankful for the Parkers that have done so much to direct the
construction and help with the school. We are thankful to be able
to work with Olen and Danae in the mission hospital work and of course
to be with the grandkids here (now three). Much more is needed to
make everything useable. We are thankful that Bere Adventist
Hospital is one of the better hospitals in the country (but still has
lots of room for improvement). We do more surgical procedures than
any other hospital in the country (will be over 1200 this year). We
are thankful for your prayers for each patient and employee. We are
thankful for the buildings that have the shells for the volunteers
that will come. They need to be finished with walls, plumbing, sinks,
toilets, stoves for cooking meals, etc. For instance a cook stove
for each place is over $300 plus $150 for gas tanks, gas and hook ups
need about 12. We need interior walls for the private wards,
maternity and OR areas. We need fans for each of the volunteer
buildings, as well as the private wards and other places. The new
buildings are designed with lots of ventilation so that air
conditioning is not really an option except hopefully in the OR.
Besides air conditioning takes lots of electricity which we have only
so much generation capacity. There is not and will not be any
public power available in the forseeable future. I am amazed at how
much is done with so little to work with. I am thankful for how
much the Lord has blessed the work here in Bere, Chad.
   Be sure to read the blogs on www.missionarydoctors.blogspot.com
Keep looking up "for our redemption draweth nigh" but there are still
many people in the world that do not know the love of Jesus. God
is waiting for all of us to let them know Do your neighbors and
friends know Him?

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

November 7, 2013

We are going batty. Dolores found a bat in her skirt when she put it
on after she had brought it in and layed it with the clothes. She
had taken it off the clothes line the day before.

Past Wed we had a very large ovarian tumor that came out easily but
there were inguinal and periaortic nodes so I’m not sure if cancer or
just lots of inflammation. Then I did a myomectomy of a 12 cm
fibroid from the apex of an uterus (she wanted more children) and
amazingly the uterus looked nearly normal when we got done with it
also normal tubes and ovaries. Then had a hematouterus with lots of
old blood in the enlarged uterine cavity but no products of conception
but appeared to be old retained menses. Her internal os of cervix was
stenosed closed so opened it and did a curettage and found nothing
else. In the past week we have had two sets of twins and one set of
triplets then another set of twins two weeks before which was from a
lady with ecclampsia so she was delivered by c-section and did ok but
the others were all vaginal deliveries. We now have 3 that have the
abdominal wounds packed open. One was a previous c-section that had
gotten severely infected and another was a typhoid perforation that
had multiple perforations repaired but developed another or else we
missed one so repeat surgery closing the fistula and packed her open.
The third one was a previous that was infected and now is almost
closed.

We are moved into our “new house” although nothing is organized yet.
We don’t have hardly any shelves up yet so we can put stuff away.
We are able to sleep in the bed there and it is much quieter than
where we were in the apartment for the past two years. We now don’t
have the roosters crowing under our window or the dogs barking at the
door or someone sweeping the yard by the door all of which usually
began about 5:00 am. I still wake up with daylight anyway. We
have spare beds in the other bedrooms so come visit us. Although the
bed rooms may have to act as storage places for awhile. Of course we
still have the shipping container that we are using for storage of
some things. It seems that the bugs moved in with us so I now have
sprayed pyrethrin around the outside and inside where the metal walls
are sitting on the cement and around the windows and will see if that
helps. We have our kerosene refrigerator going and it keeps stuff
real cold and we have our large freezer running that is supposed to
use no more power than a 100 watt bulb or max of 140 watts. We are
also using our new stove from America that was in our container that
even has electronic ignition and a large oven. Dolores really likes
it as compared to the one burner stove and small oven that we have
been using the past two years. Dolores is trying to get some
curtains made for the windows for looks as the windows are semi-opaque
anyway. She is even making some ice cream and some smoothies (all
vegan). They really taste good esp on hot evenings.

Zane and Lyol already have malaria with fever and are taking quinine.
There has also been some GI bug maybe Giardia or some virus going
around. So far Dolores and I are healthy. Two of the student
missionaries have malaria again.

We enjoy emails even if we might be slow answering sometimes. Our
internet service is only part time and very slow and costs as much as
back home would be for good service.

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