Novgorod Region has a
population of 3.6 million, of whom 20,000 die each year from advanced
Of these, 17,000 are in pain, 9,000 have breathing problems, and 1,000
gastro-intestinal symptoms during the last year of life. In addition,
50,000 patients with non-malignant diseases, of whom 33,000 are in pain
final year of life. 20,400 suffer from breathing difficulties, and
gastro-intestinal problems. There is, therefore, a total of 70,000
die in distress every year. It is to assist these patients and their
The Victor Zorza
following a request to help in establishment a hospice in
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.
palliative care course can be
complete without an attempt to utilise the best teachers we have: the
In Arzamas, this was achieved by splitting the participants into
to attend wards or homes where patients with far-advanced, but not
malignant, disease, were being cared for. Each time this occurred,
accompanied either by a doctor-nurse team drawn from the
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.
Initiated by Dr
Natalya Pereverzeva from
Rosalyn Roulston and Kathy Warburton, both
counsellors/trainers/supervisors who have co-ordinated bereavement
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.
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
enable the participants to gain the skills, knowledge and understanding
with bereaved adults and children. A handout booklet in Russian, which
given to each participant at the end of the seminar, contained relevant
material based on the bereavement training at Sobell House Hospice in
The Victor Zorza Hospice
Trust paid for our
travel to and from
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.
The Yaroslavl Hospice, which was established in Yaroslavl Region in 1993 when the small hospice was opened at Kurba, has received grants from several sources including the British and Russian governments. Two large grants from the European Commission allowed it to develop a day care centre and a 21-bed in-patient unit with budget lines for training and publications.
A grant from the Victor Zorza Hospice Trust enabled a hospice service for consultations, home care and bereavement support to be opened under the care of the Yaroslavl Hospice in Rostov Yaroslavskii: three local nurses received palliative care training in Yaroslavl.
Another grant from the Victor Zorza Hospice Trust resulted in 15 very short films devised and made by children. Children from Perspektiva, an arts centre in Yaroslavl, were invited to the hospice in small groups to chat to patients and staff. After a discussion about the philosophy of hospice care and issues of sickness and health, with a bit of help from a media expert, the children, in groups of two or three, decided how to present their thoughts about cancer, care and community on film. After a little editing, some of these films were shown on local TV.
Objectives of the project, an exercise in communication and collaboration which took place in the long summer holidays, included education and skills training for the children plus public education which might result in increased health awareness and openness about cancer, still important issues in Russia, and support for the work of the hospice including fundraising.