Friday, 31 January 2025
Ultrasound in the Outback: The challenges and rewards of rural sonography
Working as a sonographer in rural Western Australia requires adaptability and resilience. Driven by a passion for improving healthcare access, Isla Lucas, sonographer/radiographer at Integrated Ultrasound Education, provides vital diagnostic services to remote communities, even scanning patients in ambulances. In this interview, she shares her experiences and the strong connections she's built with patients and colleagues.
What motivated you to work in rural Australia?
I was born and raised in regional WA. I liked the more laid-back lifestyle, and the community feel to country towns, people are just so much more friendly! I’ve also seen firsthand the big difference in healthcare services available for regional and rural residents compared to city dwellers, often long wait times and a lot of services are just not available in country areas.
In WA, many people must travel long distances to Perth for some specialist healthcare that is readily available to metro residents. I was fairly determined to give back to the country towns and communities as I believe they deserve access to good healthcare services, like the people in the metro area.
Plus, I like a short commute to work and no traffic.
"You learn to think on your feet in rural areas. Resources are limited, but that’s where adaptability and versatility kick in."
Did you have any expectations before starting?
Yes, from an ultrasound point of view, I guess I expected to see a mixed bag of cases. You see everything in a rural clinic, a very broad range of cases and pathologies. I also expected to be a little more involved with patient care. You are part of a small multidisciplinary team in the clinic, so you are on a first name basis with everyone, which I was really looking forward to!
What were the main challenges you encountered? If so, how did it affect patient care?
There are many! Long wait times being the main one. No matter how many patients I squeeze into a day, the waitlist doesn’t seem to get any shorter. Regional and remote sites are often understaffed, some have no staff at all. This directly affects patient care as patients wait longer for investigative scans and reports, then follow appointments with clinicians are also difficult to get due to long waitlists and then treatment is often delayed.
You are often working alone. No radiology colleagues and no radiologists on site to bounce off so sometimes that’s tough if you’ve encountered a new pathology or there’s a tricky patient management issue. Luckily, I’ve built up a network of colleagues over the years that I can text or call anytime for advice which is very helpful. Never be afraid to phone a friend!
"Sometimes I’ve run an extension cord outside to scan a patient in the back of an ambulance. You go above and beyond for these communities."
Also, communication regarding appointments and visiting clinics can be challenging. Versatility and adaptability are key! Particularly in very remote outback settings, patients are still travelling hundreds of kilometres to see you for their scan. If they are an hour or more late, so be it. Phone signal and postal services can be non-existent. Patients often move between communities, so you may come across them in a different clinic on a different day. You make it work. Often the clinics don’t have ultrasound specific equipment, so you improvise. I have scanned patients in chairs whilst sitting on the ground as my trolley has not gone low enough and doesn’t sit up at all. I’ve even run an extension cord outside to a portable ultrasound machine to scan a patient in the back of an ambulance! You go above and beyond, often small changes, and the patients are very grateful, and it can make a world of difference for their care.
Did you discover any unique aspects to the community or patient care that surprised you?
Yes, I was pleasantly surprised to be so involved in the patient care within a multidisciplinary team. In small remote clinics, you work closely with GPs, visiting specialists, diabetic educators and nurses, podiatrists. You all share information and discuss patient management and care. You’re in constant communication with so many different health professionals and learning all the time. I’m always learning new things from colleagues, and I was surprised that my opinion mattered.
Saying that, I have been surprised how much I need to know! Ultrasound covers a very broad range of scans and it's hard to be an expert in all fields, especially in rural and remote settings where you often don’t have anyone to teach you. I have often done scans with textbooks open or had to phone an expert for advice. Webinars and other online learning are also helpful.
Did you have a different experience or connection with the patients compared to urban settings?
Absolutely. The connection to rural and remote people is great. They are usually very friendly and extremely happy you are there to do their scan in their town rather than them having to travel long distances for their scans. These patients can be your neighbours, local workers, even the local hockey team coach! People you see out of work every day in the community. You feel more of a rapport with them, and you want to help them best you can. Sometimes you see these patients for all their scans. I feel more directly involved with their care rather than amongst a production line!
"The work-life balance is amazing—no traffic, more free time, and you live surrounded by breathtaking countryside."
Would you recommend other sonographers to take up rural work, and why?
Yes, always yes. The experience you get from both working and living in rural and remote Australia is invaluable. You learn to think on your feet. You often don’t have the resources you’d have in the city, so you have to adapt. You learn to be resourceful and versatile.
The work – life balance is excellent. No long commutes, no traffic. You’ve got more free time and often normal day shifts so you can participate in many community activities or sports. The countryside is beautiful, we live amongst some spectacular scenery!
From your experience, what could be improved to support sonographers in remote areas?
Funding and incentives to support sonographers embarking on a rural job. At the moment, there is very little incentive for sonographers to leave the metro areas and go country. Housing is expensive and in short supply and wages do not reflect the daily challenges rural sonographers face. Subsidised or housing and wage loading incentives, especially in remote locations, would go a long way to entice more sonographers to take a leap of faith and head out bush!
Working relationships with receiving tertiary hospital ultrasound departments or radiologists could also be improved. Rural sonographers often work alone and have no colleagues to bounce off. I feel if they had that support and working relationship with ultrasound departments or radiologists in large tertiary hospitals in the cities, that would surely benefit both patients and rural sonographers. Get on the phone and call a friend!
Isla Lucas, sonographer/radiographer at Integrated Ultrasound Education.
Do you have a sonography story to share? Please contact us at communications@sonographers.org