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Ultrasound in the life of a Broome-based midwife

With 13 years and counting in the Broome Aboriginal Medical Service (BRAMS), Tamsen Prunster, a second-generation registered nurse and midwife is the trusted go-to for a wide community of expectant and new mums. In a practice that usually has 50-60 pregnant women on its books, Prunster says ultrasound is an indispensable tool for checking in on babies in utero. When invited to extend her ultrasound knowledge and apply for the 2018 Zedu-GE Rural and Remote Ultrasound Scholarship, Prunster didn’t hesitate and wrote the winning application.

The annual scholarship, now in its second year, and previously won by Emma Pickstone, a doctor working in the Torres Strait Islands, is valued at more than $15,000. It includes a three-day course in Emergency Ultrasound for Rural and Remote Medicine, at Zedu (formerly known as Ultrasound Training Solutions) in Melbourne; and the use of a GE Healthcare portable ultrasound system for a year.

“It’s important that companies like GE recognise and support the work of dedicated professionals like Tamsen and Emma,” says, Matt Tucker, CEO of GE Healthcare in Australia and New Zealand. “We want to help provide people throughout Australia with access to life-enhancing health services, and we’re perfectly partnered with Zedu to offer nurses and doctors working in remote settings opportunities to develop their imaging and diagnostic skills.”

In remote-area healthcare, portable ultrasound devices such as the GE Healthcare Vscan enable in-home scanning at the patient’s bedside, or at periodic or travelling rural clinics. For women who can’t always visit BRAMS for antenatal screening, or who are reluctant to leave their homes, it can provide a first assessment that forms the basis of ongoing care. Wrote Prunster in her application:

“The advantage in providing a bedside scan at the first visit is being able to have an estimated due date if needed by the hospital or other health care facilities when the woman presents there. The early scan can also look for anomalies such as ectopic pregnancy and multiple gestations.”

In the BRAMS clinic, which this year celebrated its 40th anniversary of caring for women and babies in the Kimberley community, ultrasound again quickly provides a context for ongoing care. “Some women come in at 30 weeks without knowing the date of their last period,” says Prunster, “and ultrasound lets you judge how far along they are. You can also check on breech presentations and on foetal growth and well being. It’s reassuring for mothers to see their baby’s heartbeat, and that the baby is forming properly, especially if they’ve had some bleeding.”

Working at the top end of Australia, Dr Pickstone made an almost constant companion of her portable Vscan Extend, using it in a range of medical situations, including in the back of a helicopter and during CPR.

She said, “Despite its small size – smaller than my current phone – the screen is excellent and easy to get a good ultrasound image in a variety of situations. The lung protocol with pre-labelled images is probably my favourite tool so far. It guides the user through with ease.”

This year’s scholarship recipient, Prunster says that attending the UTS course, and the subsequent mentoring by Zedu experts, have boosted her ultrasound practice. She has embedded a couple of new, helpful steps — “scanning through to check the iliac veins that supply the pelvic region, and locating the ovaries” — into her ultrasound routine, and is now able to carry out emergency abdominal scanning if required.

Exposure to a wide range of ultrasound equipment during the course also gave Prunster a new love interest — after test driving a number of systems, she says, “I fell in love with the GE Healthcare Venue.” The in-clinic companion to handheld roving ultrasound systems, “It’s fantastic,” says Prunster, “because it’s touchscreen and has very fast response and the screen is so big that you get a lovely picture…”

Showing pregnant mums an ultrasound image of their developing baby helps them establish a connection and motivates them to make healthy living decisions as they prepare for birth, says Prunster. She has great empathy with Indigenous women who commonly lead peripatetic lifestyles, travelling around the region to attend cultural events, which are sadly often funerals, and who may also frequently move homes to avoid overcrowded living conditions.

“One of the great things about my work,” says Prunster, “is that I’ve been able to stay for so long and get to know all the ladies. I’ve had the privilege of providing care to multiple sisters from the same family and occasionally seeing women antenatally and post-partum sequentially through their first to their fourth pregnancy. It’s always very interesting and enjoyable work. Every one of these ladies could write a book — they have incredible stories.”

Prunster well understands the power of storytelling, having followed in her mother Dasee’s footsteps on the basis of her stories as a nurse and midwife with the Royal Flying Doctor Service (RFDS) in the 1960s, and realising how much difference advances in healthcare can make if they can be delivered in Indigenous communities.

A Queenslander by birth, Dasee started nursing at 16 years old, and trained in Roma and Dalby before arriving in the West as a young relief nurse for the Emergency Service of the RFDS. Within a year she was married to Michael Gugeri, a young man with his own trucking business, and made her home in Derby.

Prunster is proud of her long connection to the region. “There’s trust here, and rapport and continuity,” she says. “People get to know you, so they come in and say hello when they think they’re pregnant, or come in to talk if they want to get pregnant.”

Now at the end of her scholarship, Prunster plans to, “work on my skills with a determined passion to supply the best possible antenatal care to the most vulnerable.”

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