A Caribbean placement: supporting ultrasound services with RAD-AID
Sonographer Alex Koulouris shares her experience of two weeks in Grenada with the non-profit outreach organisation
Alex Koulouris, obstetrics and gynaecology sonographer
Alex Koulouris, obstetrics and gynaecology sonographer
Grenada is known as the Spice Isle, where nutmeg, ginger, turmeric, cinnamon and cocoa grow in abundance thanks to the tropical climate and nutrient-rich, burnt orange volcanic soil. In February, I spent two weeks volunteering with RAD-AID International in Grenada. I was part of a team of three, providing training on obstetrics point-of-care ultrasound to 11 midwives. We started with a two-day workshop using Philips Lumify portable ultrasound and phantoms before visiting nine rural health centres, where I worked one on one with midwives in the community.
Grenada is an upper-middle-income country; the healthcare system is financed by government funds (5.7 per cent of GDP)1, international donors and out-of-pocket (OOP) expenditure. The proportion of total health spending accounted for by OOP payments is high at 52 per cent, the third highest in the region2. With a population of 117,000 spread across three islands and 63 per cent of that population living rurally3, rural health centres are located throughout Grenada, Carriacou and Petite Martinique. These provide daily clinics and are supported by nurses, midwives and doctors. Radiology services are only available at private clinics and at Grenada General Hospital in St George’s parish. Accessing the main hospital can be challenging for those living rurally and could mean multiple hour-long bus rides through the winding, mountainous single-track roads.
Antenatal care is free in Grenada, but the percentage of women attending at least four antenatal visits during pregnancy is less than 70 per cent – one of the lowest across Latin America and the Caribbean2. Patients pay OOP for an antenatal ultrasound scan (around £36) and, while the majority of women we interacted with had received more than one scan, between 5 and 10 per cent had not received a scan at all during their pregnancy. Access to healthcare depends on whether people can afford it and, therefore, depends on household income.
RAD-AID has partnered with Grenada’s Ministry of Health to address growing radiology needs and has secured funding through the Philips Foundation to support obstetrics training and equipment provision.
Sharing expertise
We visited the main hospital to deliver a workshop on obstetrics point-of-care ultrasound using Philips Lumify and phantoms. Perched on the water’s edge, Grenada General Hospital is adorned with bunting and balloons and the nation’s colours are splashed everywhere, brightening any day spent at the hospital.
The two-day workshop primarily focused on probe orientation, fetal presentation, amniotic fluid assessment, fetal heart rate and placental location. We adopted a lecture-scan-lecture-scan structure and used both first and second trimester phantoms. The phantoms were great for teaching as they allowed the midwives to practise what had just been covered, which revolutionised the process. We could also flip and rotate them to give a different fetal presentation and placental location. We ended the workshop with an individual assessment; 11 midwives participated, and everyone passed.
Workshop on use of Philips ultrasound technology in Grenada
Workshop on use of Philips ultrasound technology in Grenada
Workshop on use of Philips ultrasound technology in Grenada
Workshop on use of Philips ultrasound technology in Grenada
Ultrasound in rural communities
We began our visit to the rural health centres by heading to a smaller island north of Grenada, Carriacou, accessible via a two-hour ferry ride. The journey to Carriacou is one that’ll be forever etched in my memory, partly because the ferry passes directly over an active submarine volcano (which creates a bumpy ride, to say the least), but mostly because, as the sun sets, the sky comes alive. It felt like we were true explorers, navigating via a celestial map with Orion’s Belt overhead.
An ambulance outpost in the rural communities
An ambulance outpost in the rural communities
We arrived at the port and were greeted with the hustle and bustle of an island preparing for their annual carnival. Celebrations had started early, and soca music was pumping out of every car. We found our driver and arrived at the apartment to find our accommodation was already occupied by an American couple, and carnival meant everywhere was fully booked so we were sharing… cosy. I spent the night with a lizard in my room and almost grabbed it while opening the window. As the lizard scurried away, I too was happy to get going. As we drove around the island, the destruction caused by 2024’s Hurricane Beryl was visible. The island is still recovering, with some homes still roofless.
I met midwives Carol Alexander and Maria John at Hillsborough Health Centre and worked with another midwife, Christine Bartholomew, in the afternoon at L’Esterre medical station, a new facility built after the hurricane. We had nine patients in total, and I provided support during the ultrasound scan. Each midwife scanned and confirmed viability and assessed fetal presentation, amniotic fluid and the placenta. They explained that there are no surgical facilities on the island; if there’s an obstetric emergency, they have to stabilise the patient and travel via ferry to Grenada.
Me (far left) with Maria John, Carol Alexander and Joshni (RAD-AID volunteer) at Hillsborough Health Centre, Carriacou.
Me (far left) with Maria John, Carol Alexander and Joshni (RAD-AID volunteer) at Hillsborough Health Centre, Carriacou.
Introducing ultrasound into this rural community and teaching them to check fetal presentation and placental location (both vital for a low-risk delivery) felt extremely fulfilling. The impact of this health system strengthening project is empowering communities and elevating antenatal care, which will no doubt improve maternal and newborn health outcomes.
Island health centre map
Island health centre map
Inside the radiology department
Inside the radiology department
Challenges and reflections
We had a busy two-week itinerary, meaning the logistics were the greatest challenge of the project. We achieved nine health centre visits in eight days, including the two-day trip to Carriacou. This would not have been possible without everyone working together; the team of midwives, drivers and the Ministry of Health all contributed to the organisational efforts, and together we created a meticulous timetable. Coordinated schedules, 6am starts, multiple drop-offs and a dozen WhatsApp groups resulted in us being able to spend at least one day with each midwife in the community.
It’s been an honour to work with and learn from the midwives in Grenada. It highlighted how important international knowledge exchange is and, as a result, we were able to tailor the teaching to fit what was most needed in practice. Through discussions with the midwives, we were able to gain insight into when they may choose to use ultrasound in their clinics. They all agreed that in their setting the Lumify would be tremendously beneficial.
Overall, my time in Grenada was a truly fantastic experience. Being a part of this project and seeing the impact RAD-AID’s work has on a community has been a career highlight. Anyone considering volunteering with RAD-AID International should absolutely go for it!
The midwives I worked alongside during my travels
The midwives I worked alongside during my travels
About the author
Alex Koulouris is an obstetrics and gynaecology sonographer working in Edinburgh and has recently completed an MSc in global health at Karolinska Institute in Stockholm, passing with distinction.
References
1. World Health Organization. Grenada Health data overview for Grenada [Internet]. 2023 [cited 2026 Mar 7]. Grenada, Health data overview for Grenada. Available from: https://data.who.int/countries/308
2. The World Bank, OECD. Health at a Glance: Latin America and the Caribbean 2020 [Internet]. Paris: OECD Publishing; 2020. Available from: https://www.oecd.org/en/publications/health-at-a-glance-latin-america-and-the-caribbean-2020_6089164f-en/full-report/component-5.html#section-d1e1196 doi:10.1787/6089164f-en
3. Our World in Data. Our World in Data [Internet]. 2024 [cited 2026 Mar 6]. Number of people living in urban and rural areas, Grenada 2024. Available from: https://ourworldindata.org/grapher/urban-and-rural-population
(From left to right) Lauren Kulinski, CFO of RAD-AID, the SoR's Charlotte Beardmore, SoR president Katie Thompson, Daniel Mollura, CEO of RAD-AID
(From left to right) Lauren Kulinski, CFO of RAD-AID, the SoR's Charlotte Beardmore, SoR president Katie Thompson, Daniel Mollura, CEO of RAD-AID
More about RAD-AID
RAD-AID International is a US-based nonprofit organisation that aims to improve and share radiology and radiotherapy services in low-resource countries.
The SoR works with RAD-AID to organise placements for radiographers. SoR members who are interested in this type of work can register with RAD-AID and can receive funding support from the College of Radiographers.
Therapeutic Radiographers can now also register, as RAD-AID is supporting radiotherapy projects as well as diagnostic imaging.
Find out more about RAD-AID here.
The College of Radiographers offers support for SoR members to take part in radiography development projects in low and middle-income countries. Details are available on the CoR website.
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