The FOHG Ultrasound (US) Program in Nagekeo, June 2025

In June 2025 a FOHG team specializing in obstetric ultrasound were able to provide a skills transfer program over a week for health professionals from health center’s (Puskesmas) in the District of Nagekeo. Nagekeo is situated in the central and northern areas of the coast of Flores, but still under supervision of the Province which is in situated in Kupang and is the center of health administration. It was only designated as a District in 2007 and generates only a small revenue to support the people.

Map of Nusa Tenggara Timur (NTT) showing distance from Kupang.

This was the 4th FOHG ultrasound training trip to Nagekeo, and the first since 2019. The teaching was aimed at doctors (GP’s and Junior Medical Officers) and midwives based in rural Puskesmas. Most Puskesmas have been donated ultrasound machines, but few doctors and no midwives have had any training in their use. Use of ultrasound in the obstetric setting has the potential to decrease maternal and perinatal morbidity and mortality.

Program structure

On this trip the number of participants in the programme was minimized so that all could obtain maximum skills transfer while being mentored by Team FOHG. All but one of 14 participants were doctors. There was one midwife. The course content was designed around skills participants had reported needing on previous visits. Feedback revealed that fetal weight, length and other estimations were the skills participants most wanted to acquire. The team provided skills transfer to estimate fetal heart rate, presentation of the baby, estimation of amniotic fluid, and placental location. They also provided input on dating and early pregnancy, miscarriage and recognition of ectopic pregnancy. Lectures on each aspect of US were kept simple with an emphasis on live scanning. As well as improving the knowledge of the participants, the aim was also to provide this group the ability to provide understanding for the use of ultra-sound at a basic level to their colleagues. Presentations were in Indonesian with Pak Nus (interpreter) providing any English translation from questions for the team. However, there was quite a wide spectrum of English understanding amongst the participants.

Each participant was able to have ‘hands on’ US skills practice with women who had volunteered for scanning. During the programme a total of 54 women voluntered for 6 scanning sessions over 4 days, all organized by Pak Pria from the Polytekes in Nagekeo. Participants scanning the women were mentored by FOHG specialists and women were followed up if anything out of the ordinary was observed. In these photos, Dr Kris Barnden, Dr Annie Rose and sonographer Nia Hardy all from
Tasmania are providing support for the participants.

Course Evaluation and Future Programmes.

Pre- and post-course questionnaires on self-perceived confidence in a variety of domains were conducted. The post-course questionnaire indicated a considerable improvement in confidence. All were presented with participation certificates by Dr Barnden.

The participants were very happy with the program and are looking forward to Team FOHG revisiting in 2026. Dr Barnden is planning to revisit Nagekao in early 2026 to further evaluate if their confidence has turned into improved skill sets. This time, on the participants home turf, their puskesmas.

Reflections.

Since the US teams last visit to Nagekeo a district hospital has been completed and two specialists, an obstetrician and gynecologist have been recruited. They are now performing routine scans for dating and growth at a high standard for most women. Subsequent US programs will be preceded by a new needs assessment, consulting with the local O&G’s. Doctors who are identified as having good basic skills which they use on a regular basis may be invited to help facilitate future workshops.

The program was topped off on the trip home by an invitation to Puskesmas Nongororo, from one of our participants, Head of the Puskesmas, Dr Mensi’s Ndoi. We were delighted to look over the puskesmas and enjoy lunch with her family on the beach.

 

Team FOHG (from left). Dr Annie Rose (advanced O&G trainee), Yohanes Sebastianus [Nus] (interpreter), Nia

Harvey (sonographer), Dr Kristine Barnden (obstetrician),
Dr Helen Bradley (Coordinator).
Dr Helen Bradley with input taken from Reflections of the US Program by Dr Kristen Barnden.
10/10/2025