24.03.2020 Breast abscess and Case #13

So one of my c-section patients is back.  Wound has healed well but this time it’s a lactation problem or stall in the pipeline I should say.  Despite conservative approach for the last week it has turned into an abscess despite best efforts.  Since it is of small diameter and there is a good chance to avoid an operation, I opted for puncture and drainage under antibiotic cover.  My medical student, Gyde, assisted me during the procedure with the ultrasound while I proceeded to puncture.  Success!  Lots of pus and some blood.  Normally a culture would be taken but well I guess you probably know by now that many things I normally would like to do are just not available.  Will be seeing her the next couple of days for repeat puncture.

Sonographically guided abscess puncture

The afternoon brought about our first new challenge in light of the new Corona virus.  Early onset of contractions for our planned re-c-section patient Eugenie who had a longitudinal laparotomy.  That wasn’t the only challenge.  She had high fever, a cough and was overall very suspicious for Covid 19.  We called the government health ministry to report and get her tested and transferred to the hospital managing those cases.  That hospital, however, does not have a labor and delivery ward. These further planning procedures were put on hold as the onset of contractions increased and imminent delivery necessary. We went in with minimum staff and extra precautions (just what I was looking forward to with a potential complicate case).  Luckily the only defect was in the fascia near the midline so that took a little more time to adapt.  The only challenge it turns out really was the large skin scar that required excision in order to have enough normal skin tissue to enable adaption.  Thankfully mother and baby were well.  We kept them in the midwife mobile outside the hospital in quarantine to protect our staff.  The ministry got back to us and informed us she was Corona free – reason given that she had no contact to white people.  I ask myself, did they just really not want to test her?  Potentially increase our official count of 19 to 20? 

Case #13 (104) with reduced staff (me, Anna and Dr. Joselitto) and extra masks

Midwife Lova with Eugenie's baby born at 37+0 weeks.  So happy this little one was fit despite wanting to come a little bit early.