St Petersburg occupies a special place in the development of hospice in Russia. The remarkable combination of people, circumstances and events that came together at the end of the 1980s encouraged a change in attitudes towards death and dying that attracted attention throughout the length and breadth of Russia. Much has been achieved: hospice has become an integral part of the cancer care programme; each district has a palliative care service – either inpatient or homecare; new units are being constructed; hospice patients have equity with hospital patients; and basic care is met from public funds.

St Petersburg was the site of the first WHO demonstration project (Lakhta); the first education courses (1990 for nurses, 1991 for physicians); trials of the first imported MST tablets (Lakhta, 1990); and the first extensive research into hospice and palliative care (Zelnitzky, Kolpino hospice). A case study was undertaken in 2001. ³⁷

Russia ’s first hospice at Lakhta was constructed around the beginning of the 20 th Century and originally opened as a social hospital for the elderly poor. It now provides inpatient and home care services for about 373,000 residents in the St Petersburg district of Primorski. The medical director, Dr Galina Moskalenko, has worked at the hospice for 10 years. She leads a core team of four doctors; three others work night shifts. In 2001, 326 inpatients were cared for; 274 (84%) died. The hospice has 4 home care teams, each comprised of a doctor, a nurse and a social worker. In 2001, the teams visited around 700 patients. In the same year, the hospice spent about US$170,000 on all aspects of the service. A feature of the hospice is the care offered to bereaved children by the Sisterhood of St Elizabeth. Led by Elena Kabakova, the sisters have cared for over 100 children since 1996. Six palliateurs and around 30 volunteers raise funds to supply clothes, medicines, counselling and religious education. Summer camps and a programme of activities are designed to provide support and keep the children off the streets.

Kolpino hospice provides inpatient, home care and bereavement services for inhabitants of the districts of Kolpino, Frunzenski and Nevski – although patients may be admitted from the rest of the city. There are 30 inpatient beds. In 2001, 555 patients were admitted to the hospice as inpatients; 283 (51%) died. There are 3 home care teams. In the same year, the home care teams visited a total of 854 patients. In 2001 Kolpino spent more than 3 million roubles (US$96,185) on the service – an increase of 60% on the previous year. The average cost per day is 137 roubles (US$4.39). Staff include: 1 medical director; 4 full-time doctors; 4 part-time doctors (1 chemotherapist, 1 dentist, 1 clinical psychologist, 1 radiographer); 1 head nurse; 8 inpatient nurses; 3 outpatient nurses, 1 nurse specialist (sterilisation); 8 junior nurses; and care assistants, cleaners, cooks and kitchen staff – a total of 50.

St Olga’s Hospice is located in a self-contained ward within the premises of Hospital Number 14. The complement of staff is made up of seven doctors, 19 senior nurses and 12 junior nurses, in addition to hospital staff (such as radiographers) who give assistance when required. St Olga’s provides inpatient and home care services for residents of the district of Kirovski. In 2001, around 346,900 people lived within the district; 6,396 patients had cancer, of whom 652 were at stage 4. Amongst these patients, 64 were prescribed narcotic drugs. In the same year, 445 inpatientswere cared for; 254 (57%) died. There are two home care teams, each team comprised of a doctor and three nurses. Around 525 patients were visited during 2001. In the same year, a sum of about $75,720 was spent to fund the service.

Hospice Number 3 is centrally located within the Viborgski district, in premises which are shared with a stoma clinic. On 27 September, 2001, news broke that the hospice was to be compulsorily re-located. Concerns arose regarding the accessibility of the new premises. Guarantees were not forthcoming about transport: an important factor as the new location was not on a well-serviced bus route. Uncertainty was widespread. The acting medical director is Dr Ludmila Alexandrovna Sokolova; the head sister is Nadezhda Rudkovskaya. Staff include 12 doctors; 56 nurses and a chaplain. In 2001, Hospice Number 3 served a population of around 415,000 people, of whom 2,207 were diagnosed as having cancer; 628 patients had advanced cancer and 117 were prescribed narcotic drugs. During this year, 534 patients were cared for as inpatients; 404 died (76%). Two home care teams cared for 421 patients.

In 2001, the hospice unit at the Geriatric Centre served a population of around 185,000 people in the district of Admiralteiski; 2,207 patients had cancer; 108 of those patients had advanced cancer; 39 were treated with narcotic drugs. In the same year, 167 patients were cared for as inpatients; 72 (43%) died. This shows a reduction from previous years where between 60% and 70% of patients died. The home care service began in 2000 and cared for 151 patients that year, 151patients the following year. The medical director is Dr Nadezhda Nikitina.

The medical director of the hospice unit at Hospital Number 36 is Ludmila Vladimirovna Bratslavskskaya. The most recent data are for 1999, when the hospice served a population of 45,700 people in the district of Admiralteiski. Around 500 patients had cancer. Thirty-four patients had advanced cancer and 32 were treated with narcotic drugs. Eighty-one patients were cared for as inpatients that year; 59 patients (73%) died. The total expenditure was RUB 386,700 (USD 12,398) and the average cost of a bed per day was RUB 129.2 (USD 4.14).

In 2003, a total of 6313 were cared for by the St Petersburg hospices

Table 1 Demographic and service details related to St Petersburg hospices, 2003

Despite the gains, challenges for the future remain many and varied. They include a) the need to increase public awareness of hospice b) to continue to change attitudes related to truth-telling c) to encourage more health professionals to work in hospice care d) to increase the availability of non-injectable drugs e) secure more funding f) increase the level of paediatric care g) gain recognition for palliative medicine as a medical specialty. ²²