“Technology in our pocket”: How point-of-care ultrasound is helping reshape patient care in Samoa

Point-of-care ultrasound (POCUS) is changing the way doctors diagnose and care for patients, especially where access to radiology services may be a challenge. POCUS lets doctors see inside the body in real-time, right at the patient's bedside, using a portable and easily accessible device. This helps them make timely diagnoses, perform procedures more safely, and make decisions with greater confidence wherever it's needed, whether in an emergency room, dialysis centre, or a rural clinic.

In Samoa, where rural and district health facilities face challenges accessing formal imaging, a recent Point-of-Care Ultrasound in Emergency and Acute Care in Resource-Limited Settings (PEARLS) training led by the Ministry of Health, with support from volunteer doctors from Australia and New Zealand, the World Health Organization (WHO) and other partners, is helping build local capacity to use this portable, life-saving technology.

"Ultrasound is really the most useful tool for any doctor to make a diagnosis, and also to do critical treatments," said Dr Michael Schick, emergency consultant and course director for the PEARLS training programme, who is part of the group of doctors who volunteered to assist in facilitating the training in Samoa. "A lot of times, the technology is there, but the education is not. So we're bringing education to places that need it for this critical diagnostic tool."

"Most people would be familiar with ultrasound as something that might happen during pregnancy," Dr Schick explained. "It's often done on a very large machine, like the size of a refrigerator. The technology has improved. So we have ultrasound devices that are the size of a phone. We can literally have this technology in our pocket."

^{Dr Michael Schick facilitates the Point-of-Care Ultrasound in Emergency and Acute Care in Resource-Limited Settings (PEARLS) training in Apia, Samoa. Photo: WHO / Faizza Tanggol}

Growing interest in point-of-care ultrasound

"Our radiology department faced a lot of difficulties and challenges trying to get radiologists. And also, we only have two sonographers on the island working, so I think POCUS is the way forward to help address this challenge," explained Dr Sebastian Paulo, junior registrar in the emergency department at Tupua Tamasese Meaole (TTM) Hospital and the lead organiser for this training.

The PEARLS training brought together over 30 doctors from across Samoa, including general practitioners, emergency physicians, paediatricians, and other doctors from the main hospital and rural health facilities.

"A lot of people were interested in this training," Dr Paulo said. Dr Paulo participated in the first PEARLS training held last year by the Ministry of Health with support from a team of Australia and New Zealand-based doctors, the Australasian College for Emergency Medicine and the Australasian Society for Ultrasound in Medicine. He is now organizing and helping facilitate this second session with more Samoan doctors involved. The PEARLS training programme is designed to be sustainable, with the aim of building momentum to involve more people until it becomes a fully Samoan-run training programme.

"Our goal is to strengthen service delivery through diagnostics and innovative technology, ultimately improving the standards of patient care and safety," Dr Paulo said. "We want to build a group of passionate people who can help deliver the PEARLS course and grow the network, but at the heart of it, it's about making sure patients receive reliable and high-quality care."

^{Dr Sebastian Paulo (back) helps facilitate the point-of-care ultrasound training with fellow Samoan doctors. Photo: WHO / Faizza Tanggol}

Applying ultrasound skills in rural and specialized care

For Dr Nola Gidlow, a general practitioner in Savaii who also works at the National Kidney Foundation, the training has already provided her with ideas on how to apply her learnings in her practice.

"Many of our rural hospitals and smaller places don't have specialist services available, such as sonographers and images. To be able to have this skill means that we can do more investigations out in these rural places," she said. "Sonography is a skill that's going to help with our nurses at the National Kidney Foundation, because we have a lot of trouble with access to fistulas, which is a skill they teach here in this training, on how to cannulate difficult vessels under imaging. And right away, I know this is something I can transfer on to our specialized nurses up there."

^{Dr Nola Gidlow uses a portable ultrasound device during hands-on training. Photo: WHO / Faizza Tanggol}

In places like Samoa, where access to advanced scans such as computed tomography (CT) or magnetic resonance imaging (MRI) can be difficult, POCUS is a cost-effective solution that helps doctors treat patients earlier and potentially reduce hospital stays. It also enhances capacity by enabling frontline clinicians like Dr Gidlow to deliver quality care in rural health facilities.

The initiative also aligns with this year's World Patient Safety Day theme, which focuses on maternal and newborn care. "One of the talks yesterday was regarding maternal emergencies," said Dr Paulo. "For example, a ruptured ectopic pregnancy, you can help identify those cases early and refer them early to hospitals and OB-GYN colleagues."

POCUS lets doctors quickly see what's going on inside the body, such as finding bleeding or fluid. This helps them make timely decisions, identify the causes of symptoms, and enhance patient safety during procedures such as intravenous insertions. It also prevents unnecessary tests for patients.

"Many of us do actually have a scan in or close by our hospitals, but none of us had the skills to use it, so definitely, I see the potential for us going away and right away being able to deliver a safer service, especially to our antenatal mothers who come in," explained Dr Gidlow. "Many times, when we question a diagnosis or worry about pain, we need to send patients quite far for basic investigations like scans. For example, they might have to travel by boat to reach a pier, which can take two to four hours. Being able to do this at the bedside and very quickly identify whether someone is safe and everything is progressing well, or if there is an impending emergency, actually changes our practice enormously."

Leveraging innovations and partnerships

Technology has played a vital role in making this possible. The use of this innovative pocket-sized, cloud-connected ultrasound device enables clinicians to scan patients in remote settings and interpret the results. They can also upload the images once they have internet access and receive expert feedback if needed.

Providing frontline doctors with better diagnostic tools results in safer and prompt care for patients in urgent situations. It's a real step forward in preventing harm and ensuring individuals receive the right treatment, especially where getting scans has long been a challenge.

"We've been blessed to have the Australasian College for Emergency Medicine donate four portable ultrasound devices last year," Dr Paulo shared. "With those four, we've been able to train more than 30 doctors, but to maintain and sustain, we're going to need more."

Dr Paulo thanked the group of volunteer doctors from Australia and New Zealand who helped facilitate the training, as well as partners like WHO and nongovernment organizations for supporting the training. "It's a great feeling getting people behind this initiative and getting their support," he added. "This is the future of medicine."

Looking ahead, the Ministry of Health and its partners aim to expand access to POCUS across Samoa, ensuring that more clinicians are equipped with the skills and tools to deliver safer and more effective care. With continued support, this initiative has the potential to transform diagnostic services and strengthen patient safety nationwide.

^{Doctors conduct bedside scanning with patients at TTM Hospital as part of their week-long training. Photo: WHO / Faizza Tanggol}