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In April 2003 a new 24 bed hospice opened in Prokopjvesk a large mining town in the Kuzbass region of Siberia, FSU. The town was a prime location for such a care development, having been identified by the regional cancer figures for several years previously as having the highest incidence of the disease in the population.

The new hospice was in the planning stages for six years, having been the vision of one Nadya Adamova, Chief Nurse at one of the city’s nursing homes for the marginalized. She had attended lectures on Palliative Care given by Maureen Gill and a visiting Palliative care team to Kemerovo Regional Hospice in 1998. With the help of the Chief of the local health Administration in Propkopyvesk, Dr.Nikolay Zinevsky, and in corroboration with Maureen Gill, the vision of a hospice for the city became a reality.

At the hospice opening ceremony, Dr Zinevsky apprehensive about the lack of training in the speciality for hospice staff approached Maureen Gill.
This group had simply been allocated jobs at the unit following the conversion of their old place of work (a gynaecological hospital) into the hospice building. Education in the philosophy and practice of Palliative Care was therefore paramount! Personal support in this area of work was also essential for staff!

Our main aim was to provide staff with a basis of knowledge in Palliative Care by offering stimulating and high quality lectures. This information needed to be based on frameworks that could be adapted to the Russian culture and take into account the lack of many medicines and services. Lectures were delivered in the hospice itself. Whilst the room was adequate for the numbers attending on any given day, there was a lack of any aids to teaching. The lack of equipment meant long periods for students to listen to only translated material and could not have helped to hold their interest. Staff present varied in number depending on their manager being able to release them from the workplace at any given time but generally varied from 15-50. As well as the staff from the hospice, hospitals and nursing homes were represented. The meetings were multi- disciplinary and this is a step forward in Russia where it has been previously difficult to reach doctors and nurses in the same group.

We were particularly pleased that as time passed, students felt confident enough to be more and more interactive and the more formal lectures began to take on a more relaxed atmosphere. Many had only previously experienced a more didactic method of teaching and time is needed to change this and to allow individuals to realise they are not being judged or tested by tutors, and that their opinions are valued.

Some began to stay behind after lectures for more informal discussions on all aspects of Palliative Care.

We had prepared a full programme for students, but because of the time taken to interpret as well as other matters, time was the curtailing factor.
We were given the opportunity to visit the patients in the hospice and talk with them. As we had only one interpreter it was not possible to take students with us on this occasion, which, for the learners, could have been a valuable learning curve. To have been invited to talk with patients and observe the day to day working of the hospice was however another stride forward as far as foreign visitors are concerned and marked a new feeling of openness and sharing with our Russian nursing and medical colleagues.

Valuable discussions with Dr Nikolay Zinevsky and the Chief Dr. of the hospice Dr. Vladimir Zhebenkov took place often at mealtimes and at the end of the working day. Our hosts were extremely generous and most hospitable. We hope these deliberations will prove fruitful in the future development of the hospice as well as more broadly the furthering of Palliative Care in the region under the leadership of Dr Zinvesky, a man of great insight.

We took the opportunity to visit the city of Kemerovo during our stay at the kind invitation of Dr. Olga Berezikova, the Director. Although Maureen Gill had previously played a part in teaching at this hospice, it had changed its location and had been under the responsibility of a different Director. It was decided to accept this invitation in order to re-establish good working relationships with this unit. Fortunately we were also given several opportunities to teach and exchange ideas with staff and again Dr. Berezikova was most hospitable and hopes for future collaboration in teaching of Palliative care for her staff and other interested parties. She arranged a meeting for us with the Deputy Chief of her Health Administration, who voiced his hope that we may consider a new partnership for future cooperation.

Whilst in Kemerovo we were also invited to visit the City Hospice and have discussions with staff working there. Many doors were opened for us and this was most encouraging.

Evaluation of the Project

Maureen Gill had prepared a simple evaluation form for the students. It became evident; however, that staff had not previously used this methodology. Some did attempt to complete the evaluation forms. Themes emerged from both these documents and the verbal opinions of the participants. These are:

Topics were of real interest and relevance to day-to-day work at the hospice.
Communication skills were especially mentioned on more than one occasion.
Psychological support lectures were mentioned as extremely helpful.
A friendly atmosphere was deemed significant and its part in learning.
Many group members mentioned, "Putting the new information/skills into practice"
One evaluation asked for more to have been given on "medicinal care"
No other suggestions were made for other topics to have been covered.

Verbal feedback was positive and there was a real feeling of hunger for knowledge, genuine interest in all that was being discussed. We felt that students were impressed that we valued their contributions and we tried to support and praise them for the impressive work they are doing at the cutting edge of Palliative Care in their country.

The Way Forward.

The way forward should be carefully considered at this time. Maureen Gill has been involved with developments in Palliative Care in this region for seven years now and it would seem an ideal time to plan the best way to consolidate this work.

One suggestion has been that a new formal partnership should be set up. The purpose of this would be to identify and train Russian teachers of palliative care. This is an interesting prospect and one that deserves serious consideration. It is not possible to perpetuate teaching trips of this nature. Monies are becoming more and more difficult to obtain and with ever rising costs, more and more expensive to fund. Time and travel over such a great distance, geo-physical barriers and huge cultural differences add to the problems. There is now enough knowledge and interest in Palliative Care for individuals regionally to recognise if it is the area of work in which they would like to specialise as teachers.

Another way to move the service forward would be to do a "shadowing" trip with a physician and a Nurse Specialist actually spending mornings working at the bedside with Siberian colleagues and discussing patient care and decision making in the afternoons.

Our Russian colleagues are asking us for more help and support in their work in any way possible and these two methods would give positive outcomes. We should also be continuing in some areas to continue to train and update.

Conditions and support for the dying and those facing life-threatening illnesses has considerably improved over the years and help for those in the field of Palliative Care and must be continued as a real humanitarian cause.

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Hospice in Kemerovo	Dr Wootton and Nurse Maureen Gill with Dr. Olga Berezikova, Director of the Kemerovo Region Hospice and the Director of Nursing Academy
With patients and visitors at Kemerovo Region Hospice	Dr Nikolay Zinevsky, Head of Health Administration in Siberia, receiving the IAHPC Certificate of support for hospice and palliative care with staff members of the Hospice in Propkopyvesk
Dr. Olga Berezikova introduces Dr Wootton and Ms Gill to the staff members in Hospice in Kemerovo	With staff members attending the workshops at the Hospice in Propkopyvesk