24 February 2014

Addison is eating more different things as they are introduced to her. She does not seem to be a picky eater. All of us are healthy presently.

We had an interesting surgery Friday. A lady with diffusely mildly tender abdomen that we finally opened had what looked like typhoid perforation with lots of yellowish material in the abdomen but could not find a perforation in the usual place so we looked around more and found a ruptured liver abcess which we cleaned out and debrided and stuck a drain into. We had two other typhoid perforations of terminal ilium this past week. One had been operated on elsewhere then referred here as the person was not improving and had a large amount of stool like drainage from the drains that they had wisely put in. Apparrently the repair was not sufficient and the bowel totally came apart so we had to take out a small segment of intestine and put it back together. He seems to be doing ok now although he seems to have an infected incision as might be expected. So far our three vesicovaginal fistula ladies that were repaired last week are doing well. We have two men with osteomyelitis of the temporal mandibular joint and are unable to open their mouth or jaw. They can eat between their teeth. Unable to pry open their jaw. What do you do for them besides antibiotics and drain purulence. Unable to get to the infected tooth that needs extracted.

Last Sunday I went down to Moundou to help Scott Gardner on a couple of bone cases. One was a proximal tibia and tibia plateau fracture comminuted so it was quite difficult to get the pieces to go in place and put screws in and a plate with long screws. The other was a fracture neck of femur. Was able to put in a steel piece something like a Jewett nail. The hardware for both cases had just been brought here from Germany by the German doctors visiting from there. They brought a good supply of orthopedic hardware and two good hyfercator monopolar and bipolar so good for stopping little bleeders. They also brought a perfusion pump that would be good for being more precise regulating fluids such as oxytocin drips. We did not have any before.

We have had a few sets of twins lately. One recent was C-section because of transverse lie and did well. Also a recent c-section for abruptio placenta and the baby lived. We have had 4 maternal mortalities so far this year with malaria and ecclampsia etc. The treatment for malaria, quinine, causes hypoglycemia especially in pregnant ones. We had a c-section Sat for ecclampsia with dead baby and no labor and minimal dilation then another ecclampsia Sun but delivered with forceps and a living baby. One recently was reported as being dead but was given dextrose and she came to life however she died two days later. We don’t have good nursing with close observation and vital signs being taken regularly unless you call vitals once daily as regular. Sometimes can get them two times per day. We need a nursing director that can teach them what real nursing is but they know they can go work in a government hospital where they don’t have to be very responsible.

Dolores has been drying some mangoes on a big screen mesh in our living room with the fan going and the very dry air. They dry very rapidly maybe one day. The humidity is less than 20 percent all the time. She is trying to get some done before we go on annual leave in April and May.

Our emails are: drbland@sbcglobal.net and dfbland01@gmail.com
phone: 235 91453226

Love, Rollin and Dolores

Feb. 15, 2014

Valentine's Day has passed.  Dolores gave me a nice Chadian outfit
to wear for Valentine's day.  We had a special supper and vespers
about love. It was very nice.

Addison has passed her six months mark and is now starting on solid
foods.  She chowed down quite well her first solids as we watched.
She has two teeth now also.

Todays sermon in church (by a local Chadian pastor) was about fighting
the good fight of faith with the fruits of the spirit comparing that
to members of a football (soccer) team which was quite good.

We had a recent unusual case of a 9-year-old girl that came in with right
lower quadrant pain, but she also a very large mass in her upper abdomen.
She had been told almost a year ago that she had a mass, possibly
ovarian that needed removed, but did not.  Now at surgery she had a
torsion of a right ovarian mass that apparently was this same mass
that was seen a year ago.  Surgery was quick and simple.    

Another little boy hardly a year-old came in with severe shortness of breath
and stridor.  We could hardly feel a soft mass in his neck slightly
to right of midline.  We aspirated some purulence which seemed to
help some, but next day he was worse so had to do something more
drastic.  We stuck a knife in his neck hoping to not hit any major
blood vessels.  At first got nothing so stuck it deeper yet and got a
large amount of purulence out.  After a few days he is breathing
normally now and has minimal drainage but apparently it was pressing
on his airway.  

Another little girl about age 1-yr had an epigastric hernia we thought,
but when we operated there was no hernia but still a mass so 
opened still farther and found pus between her fascia and
peritoneum.  So we cleaned that out and packed it open, possibly closing
later after the infection is gone.  It sometimes seems surgery rounds
is abcess rounds.  We are still doing lots of hernias and hydroceles.
We have  logged about 85 procedures so far this month but there are
a lot waiting to be done.

We should be starting  home in about six weeks.  We plan to be in
Oklahoma by April 2 and plan to drive up to Union College April 3 for
the Alumni weekend than begins that night.  We have a room reserved
for April 3, 4, 5 in Rees Hall thanks to Gary Gray (another 50-yr
Unionite that plans to be there).  We plan to be in Jay, Ok the 2nd
weekend for a baptism at the Adventist church there.  We probably
will be in Texas the 3rd weekend to visit Edwin and family and Harold
Wallar and go see the Texas bluebonnets in the hill country then
meander west to Ariz and Calif to see Gloria (Dolores ' sister) and
others; enjoying the desert along the way, perhaps even up into Utah.
On the way back to Chad we leave about June 1 and plan to tour Turkey
a little with Olen parents (Kermit and Ronnalee Netteberg) seeing
the 7 churches area etc.

Looking forward to see some of you along the way.
Our emails are  drbland@sbcglobal.net  and  dfbland01@gmail.com
Love,    Rollin and Dolores

8 Feb. 2014

It seems that I have been too busy or else not inspired to write but 

some of you may be wondering if we are well and we are well. We have
had a gastrointestinal bug of some sort going around but have
recovered. It is warming up somewhat as it is in the 90's and over
100 a few days only 99 today but it cools down in the 70's at nights.

It seems we have accidents coming in almost every evening lately.
The road through town has been graded so people are going much faster
in their vehicles including their motorcycles and there are always
lots of pedestrians and cows and oxcarts etc on the road so it is
dangerous to go very fast especially after dark. When the "road" was
very bad then there were not so many accidents but we are also having
more that fall out of mango trees now that the mangoes are beginning
to get ripe in some places. Many are just now blooming.

Today we went out in our 4-Runner to try to find this one Fulani
village way out in the bush through some trails that had not seen a
car maybe never before. But we did not find the village; maybe we did not go
far enough but did see some beautiful birds including carmine bee
eater and Abysinian roller, some parrots (not sure what kind), some
swifts (not sure what kind ). The birds were around a grass fire
catching insects as they came up away from the fire. There are some
beautiful yellow flowers coming up in some burned over areas.

Olen has been very busy with administrative issues lately including
replacing the administrator. Olen's parents were here and recently
went back home to DC area.

We now have two doctors visiting for 3 wks here from Germany, a Ob-Gyn
and a hand and foot specialist. They also brought some nice equipment
and instruments with them for us including a fetal monitor and a
electrocautery machine.

During Dec and Jan we logged in about 350 procedures including 202 for
Jan. Did lots of hernias and hydroceles and prostates and incision
and drainage of huge abcesses; also some hysterectomies, ovarian
masses, ectopic pregnancies. We had another ruptured uterus recently
(pt lived but of course baby died). Recently a ruptured spleen but
fortunately we did not have to remove the spleen and patient is doing
well post op. Recently had an HIV positive patient with a rectal fistula
and a hemoglobin of 6, but relatives refused to give blood for him and
in fact just took him home when surgery and blood donation were
suggested. We recently had a not so good result with avesico-vaginal
fistula that involved also the uterus. We had what appeared to be a
great repair then she had a cardiac arrest and we were unable to resuscitate her.
She expired probably an anesthetic death as the blood loss was not much.
That was the second one in 3 yrs. Will be glad when our full time anesthestist
gets here in May or June. We have quite a few cases waiting to be done
as I was not the usual full of energy this past week.

I am going to Moundou to help Scott Gardner do a couple of SIGN cases
on old femur fractures tomorrow. Scott is new in Chad and presently in Moundou.
James Appel is moving to another place (Abeche, Chad) to start some work
there. Every year the surgeries here in Bere have increased considerably
over the previous year. However there is a limit how much can be done in one OR.
It will probably be another year or so before the new buildings will be usable;
then we will have 2 OR's and a few more beds although we will still be short of bed space.

Looking forward to seeing some of you in April and May when we will be
home on annual leave.

Our emails are drbland@sbcglobal.net and dfbland02@gmail.com
The iphone 235 91453226
Love, Rollin and Dolores Philippians 4:13

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