year and has grown from small beginnings to become the leading community support service for people suffering from cancer and their families. Last month, the organisation moved to new premises at Dunrossil House on Point Finger Road in Paget. Here, Ann Smith Gordon, the president and chief executive officer of P.A.L.S., tells the story of the organisation.

Hospice and Palliative Care, Symptom and Pain Control, as we understand it today, was a relatively unknown subject in Bermuda until 1979.

In that year a physician from the Royal Victoria Palliative Care Unit in Montreal, Canada, come to Bermuda to speak to local physicians on the subject of pain control using morphine in palliative care.

Also in 1979, Hilary Soares RN, was appointed Oncology Services Coordinator, a newly-created post at King Edward VII Memorial Hospital.

At that time she was the person directly involved with cancer care at the Hospital and acted as the tumour Registrar, Secretary to the weekly Tumour Conference, Administrator of Chemotherapy and Counsellor to the Patients and Nurses.

In 1980, Mrs. Soares travelled to England to observe and gain knowledge in Palliative Care, visiting three locations including St. Joseph's Hospice and the Royal Marsden Hospital in London.

Upon her return to Bermuda, Mrs. Soares was dismayed to realise that with very few exceptions, no-one was interested in hearing about care of the dying. She was accordingly instructed not to discuss death with the patients.

Only one or two physicians permitted Mrs. Soares to visit their hospitalised cancer patients. In speaking to Ward Nurses, she learned there were between 20 and 30 such dying patients who were spending long periods of time in the hospital, many abandoned or neglected by their families.

They were in the hospital because there was no community support system in existence, and it was too expensive to keep patients at home. There was considerable fear of death in general and families were simply unable or unwilling to care for their loved ones in the home setting.

In those days, cancer was a word hardly spoken aloud in the community.

Patients were isolated for fear of contamination and families were even afraid to use the same utensils. Patients were denied the affection they desperately needed from loved ones who, in their ignorance, feared that a kiss or any physical contact would result in their contracting the dreaded disease.

After a few months and much prayer, a giant step forward was taken when Mrs.

Soares was finally given permission to visit hospitalised cancer patients with a view to doing all she could to help them.

The Beginning of P.A.L.S.

To comfort those patients unable to return home, nursing friends were approached who, hopefully, would volunteer their time to sit and talk to patients, perhaps feed them, read to them, and generally keep them company.

One of those first volunteers offered to sit with a lady whose life was rapidly drawing to a close. It was not until too late to make another arrangement, that Mrs. Soares realised with horror that the volunteer happened to be the wife of a funeral director whose visit could easily been misinterpreted! However, the next morning the patient was very much alive, had a big smile on her face and announced "what a wonderful conversation'' she had with the volunteer who, as it turned out, did help complete her funeral arrangements -- a worry that had weighed heavily on the patient's mind. The volunteer had allowed her to express this worry, to make her own decisions without persuasion and it proved to be a valuable and meaningful visit.

The difficulty was that to the physician, historically, death was interpreted as a personal failure and a failure of the system and they were not comfortable confronting the difficult questions put to them by the patients.

These questions were more often answered with silence, and details of diagnosis and prognosis were not discussed. The guidance that each patient needs and deserves was not forthcoming. As elsewhere in the world the biggest stumbling block to effective medical use of narcotics for pain relief was fear of addiction.

Patients were treated for their serious pain but often did not respond to the insufficient doses of morphine prescribed, and many died suffering in the belief that nothing more could be done to help them. This is one huge problem that is mercifully being recognised and dealt with by many physicians today.

It is to be hoped that all future medical students will graduate with a far deeper understanding and appropriate attitude toward pain and symptom control, a subject rarely mentioned in medical books until recently.

Later on during 1980, some cancer patients were able to return home with a few volunteers checking on them. Assistance for those patients in the community was a priority, but the government-employed District Nurses were not comfortable caring for cancer patients, were untrained in this special field of nursing and there were no funds available to employ a special nurse.

The Chief Medical Officer was persuaded to give permission to Audra Mitchell, a nurse employed by the Bermuda TB, Cancer and Health Association, to visit cancer patients in the community in addition to her duties of visiting TB patients and checking hotel food handlers, but he limited her cancer patient visits to three hours weekly. As anticipated, within a few weeks Mrs. Mitchell was spending far more then the permitted time with cancer patients. When this was realised, the Chief Medical Officer refused to allow her to continue, and it was not until further intense persuasion that she was reinstated.

Realising that private funds were urgently required by the now budding organisation to hire a community cancer nurse, another step forward was taken when wealthy Hollywood film producer and then-Bermuda resident Robert Stigwood was contacted. In response to the plea, he kindly provided wages for two years to employ one part-time nurse. Anita Furbert began her duties in February, 1983. Also realising that additional funds would be required for supplies and equipment, funeral directors were approached.

It was suggested that the funeral directors might persuade families of those deceased cancer patients who had received nursing help gratis, to request memorial donations to the organisation in lieu of flowers traditionally sent and often at considerable expense.

This idea was accepted by many families and friends and today accounts for a large portion of P.A.L.S. income.

During this time it was also realised that formal organisation of the volunteer programme already underway was badly needed, and inquiries were made of other organisations as how to proceed. Margaret Vaucrosson dreamed up the perfect name, P.A.L.S., an acronym for Patients Assistance League and Service.

But today P.A.L.S. is legally and formally known only as P.A.L.S.

Hilary Soares became chairman and June Stephens acted as the first Volunteer Coordinator. The first formal minutes of P.A.L.S. were recorded in August, 1980. By the end of 1980, 730 hours had been given by volunteers visiting patients in there homes and in the hospital.

Development of P.A.L.S.

(Volunteers) Volunteer training sessions were begun and continue today for each prospective volunteer. After an initial interview, each volunteer is required to complete an application form, sign a form of confidentiality, and attend the training session before being allowed direct patient contact.

The training seminar covers various aspects of P.A.L.S., the definition of cancer, it's treatment and the devastating effects it can have on the patient and his/her family. Other topics include listening skills, the importance of confidentiality, and the vital role of the volunteer.

Once the seminar is completed, the "PAL'' is considered ready for direct patient contact, The volunteers are called upon to do a considerable amount of driving for those patients requiring physician visits, blood work, or chemotherapy at the hospital. If a volunteer is assigned to a particular patient as a "PAL'', great effort in made to match their personalities as well as ensuring they have common interests.

The "PAL'' is initially introduced to the patient, usually by the nurse and then visits the patient regularly offering friendship and moral support. Often deep personal and meaningful relationships are formed.

The history of P.A.L.S.

Each month a volunteers meeting is held offering interesting and educational topics associated with some aspect of cancer. Today PALS has approximately 70 trained and caring volunteers who contribute enormously to the organisation.

There is difficulty in keeping accurate volunteer statistics but it is estimated that the volunteers put in more than 5,000 hours annually.

Being a small community, volunteers are often recruited through personal friendships, or are people who know and admire our work and wish to be involved to make their own contribution in some way.

It is stressed that a commitment to P.A.L.S. must be given by each volunteer who is required to give a minimum of 50 hours annually to the organisation.

Fortunately, very few applicants are considered unsuitable. The volunteers are supervised by the Volunteer Coordinator and Chief Executive Officer.

If a very ill patient requires several volunteers daily, a roster is drawn up to ensure the needed hours of companionship are covered. This is deeply appreciated by the loved ones who are then able to continue with their jobs and attend to other details outside the home. Our volunteers are very aware of patient rights and the fact that we are guests in their homes.

Some volunteers are less comfortable with direct patient contact but are invaluable in assisting with P.A.L.S. regular annual fundraising events and helping in the office. In fact, P.A.L.S. did not have an office at all until 1984, when the already crowded Bermuda TB, Cancer and Health Association came to the rescue by kindly providing a tiny cramped room only large enough for one typewriter and our mercifully petite volunteer secretary.

We eventually managed to squeeze a telephone in also! In 1986, after extensive renovations to the building, The Bermuda TB, Cancer & Health Association provided us with much larger space including offices and a badly needed storage area. At last we had a proper home.

By 1990, it had become impossible to keep up with the daily routine and we employed a part-time office administrator who is invaluable in the day to day operation. Today in order to cope, we employ two office administrators.

Our happy arrangement with the Bermuda TB, Cancer & Health Association lasted until February, 1998 when both organisations were desperate for additional space. On Friday the 13th of March, after searching for several years for suitable premises, we finally moved to Dunrossil House -- the headquarters of the St. John Ambulance Brigade -- on Point Finger Road in Paget.

NEW HOME FOR P.A.L.S. -- Jennifer Masefield (second right), wife of Govenor Thorold Masefield and Patron of P.A.L.S., cuts the ribbon of the charity's new offices at `Dunrossil House' last Friday. Looking on from left are Colin Curtis, chairman of the St. John Ambulance Brigade management committee, Mr.

Masefield and Ann Smith Gordon, president and CEO of P.A.L.S.

FIRST VISITOR -- Audra Mitchell, the first nurse to visit cancer patients.

MOVING TIME -- P.A.L.S. moved to Dunrossil House at 22 Point Finger Road, Paget DV04 last month. The organisation -- which searched for years for suitable premises -- will share the building with St. John Ambulance Bridge.

Their new telephone number is 236-PALS (7257) and their fax number is 236-7250.

FOUNDER -- Hilary Soares, who later helped to start the hospice for the terminally ill at King Edward VII Memorial Hospital and has been a leader in developing palliative care in Bermuda, was the first chairman of P.A.L.S.