This article gives a brief account of a short course in palliative care run in Arzamas, near Nizhny Novgorod, in Russia. It finishes with an indication of the developments in the city after the course.  Nizhny Novgorod Region has a population of 3.6 million, of whom 20,000 die each year from advanced cancer. Of these, 17,000 are in pain, 9,000 have breathing problems, and 1,000 suffer gastro-intestinal symptoms during the last year of life. In addition, there are 50,000 patients with non-malignant diseases, of whom 33,000 are in pain in the final year of life. 20,400 suffer from breathing difficulties, and 13,600 have gastro-intestinal problems. There is, therefore, a total of 70,000 people who die in distress every year. It is to assist these patients and their families that the Nizhny Novgorod and Arzamas team hope to develop good palliative care services.  The Victor Zorza Hospice Trust following a request to help in establishment a hospice in Nizhny Novgorod region agreed that the best way to help would be to provide basic education in palliative care for some of the staff who would form the core of a hospice team. Wendy Jones was charged with the responsibility of organising a short course on behalf of the Trust.  The visiting teaching team was able to meet with the press and with senior officials of the City Administration and the Health Administration, as well as many senior staff of the local hospitals. These meetings gave the opportunity to emphasise the significance of palliative care and its potential impact on health delivery within the city and region, as well as giving a public platform for raising awareness within the local community.  No palliative care course can be complete without an attempt to utilise the best teachers we have: the patients. In Arzamas, this was achieved by splitting the participants into smaller groups to attend wards or homes where patients with far-advanced, but not necessarily malignant, disease, were being cared for. Each time this occurred, groups were accompanied either by a doctor-nurse team drawn from the UK visitors, or on one occasion by a doctor-doctor or nurse-nurse team. The participants were thus able to watch multi-disciplinary working to some extent, and to observe the relationships between the medical and nursing professions in the western practice of palliative care. Following all clinical visits we held plenary sessions so that groups were able to share their experiences with those who had not visited.  Putting theory into practice - It was gratifying to learn that, following one of the clinical visits to a particularly ill, distressed patient, the ward medical and nursing staff implemented as much as was possible of the regime that had been suggested. A little later the same week, we heard that the gentleman had died peacefully and free of all distress.   Wendy Jones

2.    Educational visit to Perm: 3-7 October 2005

by Sir Michael Sobell House Team

Initiated by Dr Natalya Pereverzeva from Perm, this educational visit was a collaboration between their Hospice Charity and Sir Michael Sobell House, the WHO Collaborating Centre for Palliative Care. The Victor Zorza Hospice Trust funded two health care professionals from Oxford, a doctor (Richard) and a nurse (Liz), to contribute to the development of hospice and palliative care in the city of Perm and the surrounding area. This was achieved through education, training and discussion with health professionals in Russia.  The five day programme was varied and dictated by the needs identified locally in Perm. The teaching team ran a seminar for 150 medical students at Perm Medical Academy on the first day, then a seminar for 60 doctors at a polyclinic in Kirov District, followed by an interactive problem-solving seminar with 15 professionals from Perm Hospice. They also visited Perm Cancer Information Centre and the Belagorski Monastery where they met patients and volunteers, whom they found fascinating. They were also interviewed on television and radio, taking the opportunity to explain and promote what can be done with hospice care and how this was already developing in Perm. The visit culminated in a large palliative care conference for 170 participants at the Perm Conference Centre, where Richard and Liz spoke on symptom management and the principles of a good death.  Language was anticipated to be a difficulty, so the teaching team had translated their teaching material into Russian. This was well-received and they were also assisted by a local interpreter. Interestingly, the doctors wished to be taught in English, acknowledging that although this was about palliative care, it was also a great opportunity to practice their English! The combination of small and large group teaching appeared to have gone down well, as reflected in the positive evaluations by those who participated.  Were it not for the Victor Zorza Hospice Trust, none of this would have been possible. No single educational visit can change the world but we hope that this visit contributed to the Trust’s aim of nurturing hospice care in Russia. The teaching team also returned to UK with renewed appreciation of how lucky we are in the UK and a deep admiration for the stoicism, perseverance and resourcefulness of our Russian colleagues.  Dr Bee Wee Head of WHO Collaborating Centre for Palliative Care Sir Michael Sobell House, Oxford

3.    TWO SEMINARS ORGANISED FOR PERM HOSPICE CHARITY TRUST, RUSSIA

Facilitators Rosalyn Roulston and Kathy Warburton, both counsellors/trainers/supervisors who have co-ordinated bereavement services for hospices in Britain. The contact arose as a result of Rosalyn’s meeting with hospice staff at the Cancer Information Centre on a town-twinning link between Oxford and Perm. Participants Doctors, psychologists, nurses, teachers, social workers and volunteers from a wide area, many of whom worked in a palliative care setting. Content and organisation The Loss and Bereavement seminar included basic counselling skills, theoretical perspectives on loss and bereavement, risk assessment and working with children; the Training for Trainers included these elements plus personal and professional support. Dr Natalya Pereverseva set up the seminars and the materials were prepared in advance by Rosalyn Roulston. The overheads ,worksheets and handouts were translated beforehand into Russian by Natasha Dubrovina who also interpreted for the seminars. The Russian trainers in training served as group leaders for the six smaller groups. Format 9.30  - 17.00 with a coffee break in the morning, an hour for lunch and tea and cakes at the end before we met with the Russian trainers to appraise the sessions, discuss any problems that arose and plan for the next day. This collaboration allowed us to do more in-depth work and cover more sensitive issues such as suicide, depression and personal/professional issues. The training was experiential - working in pairs and small groups with different materials and in a variety of ways to enable the participants to gain the skills, knowledge and understanding to work with bereaved adults and children. A handout booklet in Russian, which was given to each participant at the end of the seminar, contained relevant back-up material based on the bereavement training at Sobell House Hospice in Oxford. The participants tackled the skills work and other exercises with great enthusiasm, seeming to enjoy working in new ways, particularly those relating to working creatively with children. Funding The Victor Zorza Hospice Trust paid for our travel to and from Perm for both seminars. Perm had to find about £2,000 in all for the second seminar - for our hotel costs, the venue, the lunches etc. Half of this came from fundraising and charitable donations and the other half from Help the Hospices. Evaluations The formal evaluations indicated that the seminars fulfilled a real need especially in the area of basic counselling skills, working with children and training the Russian trainers.

4.  Yaroslavl Hospice