Care on Country
Embracing digital innovation to achieve equityIf you were to draw a hypothetical line from the Tropic of Capricorn across Australia, there is a significant disparity in maternal, fetal and neonatal outcomes in Northern Australia with fewer resources, personnel and perinatal specialists to manage the increased morbidity and mortality.
There are many contributing factors including the environmental diversity, wet seasons restricting travel and access, low population numbers and density, higher proportion of First Nation peoples living remotely, food insecurity along with the significant distances to access health care.
The vast distances that women living in remote Australia have to travel for routine pregnancy care and ultrasound is unfathomable. It can be a minimum of one or two flights on commercial aeroplanes which often have significant delays, or 5 to 8 hours by car with limited options for accommodation along with the financials restraints and transportation challenges once women and their families are in town. Things that we take for granted include getting transport out of hours, to and from the airport and their accommodation and then getting to the health services in time for appointments, the cost of food while women are away, not to mention the fact that many women do not get to bring an escort or have a family member with them during their travel times for routine ultrasound and pregnancy care. For a young 16 year-old woman living on Mornington Island in the Gulf of Carpentaria, in her first pregnancy, these barriers are prohibitive to accessing routine ultrasounds at the correct gestation.
Our story began on Palm Island over 20 years ago, when a sonographer and midwife team, Sue Bloomfield and Alexandra Gosden, established monthly visiting sonography service via Queensland Health to compliment the visiting midwifery services.
In the last 4 years, I became involved as a visiting Obstetrician/Sonologist to Palm Island to facilitate the timely reporting of the ultrasound scans, appropriate management of abnormal ultrasound findings and to provide higher risk models of care to prevent women from travelling back and forth. This evolved into the development of pregnancy screening to prevent obstetric complications and working collaboratively with the local medical service through the Palm Island Community Council. Check Up Australia funded additional visits for both Obstetric care, sonography and Gynaecology visits.
Other remote communities in the Gulf of Carpentaria approached Check up Australia with a request for a similar service, and we were approached. The communities included Mornington island, Normanton, Karumba, Doomadgee and Burketown, of which 96% of women usually deliver at Mount Isa Hospital.
In The News
The aim of the Care on Country program is to:
1) Connect women and their families to their pregnancies through the use of ultrasound
2) Reduce the need to travel for routine pregnancy ultrasound
3) Training local staff in how to use the ultrasound machine for point of care and to perform a basic dating scan in order to facilitate an estimated gestation and due date
4) Primary and secondary prevention of obstetric complications such as pre-eclampsia and preterm birth
We are now 18 months into the Care on Country program, which has evolved to embrace the state of the art digital technology. We use a combination of satellite internet (Starlink), web based practice management software that can be accessed anywhere and the use of cloud based PACS . The ultrasound images are performed on a portable ultrasound made by General Electrics (GE). We have also integrated AI to improve the efficiency of documentation and reporting. Women can get their photos either printed out or directly on their smart phones.
In the first 12 months, from July 2023 until the end of June 2024, we have seen over 308 women in the Gulf of Carpentaria, with 250 being obstetric related visits and 59 women were seen from the gynaecological perspective. The majority of ultrasounds performed in the communities were second and third trimester ultrasounds. We were able to perform 28 combine first trimester screening using Fetal Medicine Foundation algorithm for both aneuploidy and placental dysfunction, early onset pre-eclampsia. We also perform routine cervical screening at the time of morphology in line with the Preterm Birth Alliance recommendations. We work collaboratively with the outreach midwifery group practice service, the O&G teams at the base hospital, the local Aboriginal medical services and the local hospitals.
There are always challenges to overcome with any new program. The unpredictable wet season and the multiple cyclones of last summer in the North, resulted in last minute postponement of our trips. Despite this, we were able to do catch up visits and the community engagement remained high.
One of our biggest challenges was the poor mobile reception leading to unreliable connectivity to internet, impacting our ability to upload images to our cloud base server and perform timely reporting. This has been partially resolved by using satellite technology providing high speed internet anywhere. Our reporting efficiency will be aided by the advent of a web based Viewpoint in the near future.
In 12 months, our program has been estimated to save the healthcare system over $2 million in the transportation of women for routine antenatal care and ultrasound. Further economic analysis is being calculated to assess the social value and cost savings associated with improvement outcomes for both mothers and babies.
There is no doubt the greatest part of the program is seeing the delight and excitement generated when a woman sees her baby on ultrasound in their home community for the first time. To be able to share this moment with their families and their children, has the been the highlight for us.
It is such a privilege and honour to meet these amazing families, local staff, the wonderful midwifes and to provide access to services such as routine Obstetric and Gynaecology ultrasound and pregnancy care on country.
To conclude, the statement from the International Society of Ultrasound in Obstetrics and Gynaecology (ISUOG) summarises our mission to achieve equity in women’s imaging. ‘All women should have access to ultrasound, that all scan providers are competent and that all O&G conditions are effectively diagnosed’.
Connecting women and their families to their unborn baby who live remotely, using the portable ultrasound technology, is truly special. We are one step closer to achieving equity and the future of outreach women’s imaging is so exciting.
Get in touch.
If anyone is interested in the program, we would love to hear from you. Please email us at:
