They are two of Bermuda's hardest working charities, involved in fighting the scourge of cancer, but the functions of the Bermuda TB, Cancer and Health Association and PALS are distinctly different.

TB, Cancer and Health, which launched its Health and Breast Cancer Awareness Month last week with a charity walk and denim day, concentrate on awareness, prevention and early detection while PALS' work begins once a diagnosis has been made.

In this the month of cancer awareness, PALS (Patients Assistance League and Service) president Ann Smith Gordon tackles some of the misconceptions surrounding the 20-year-old charity. One of them is that PALS is associated with death.

"Even some doctors don't fully understand,'' said Mrs. Smith Gordon. "We still hear doctors say to a patient `you're not ready for PALS yet'. But what does the `yet' mean? I hate that word `yet' to be associated with death.

"We talk about living with cancer, not dying with it and when they say `you're not ready for PALS yet' it means `just wait and within a few months or weeks you're going to be sicker and you're going to need PALS' help'.'' Added Mrs. Smith Gordon: "There are patients out there today who have refused help from PALS because I think they, too, misunderstand it (PALS). They associate it with death but it's not true.

"The truth is PALS will assist any cancer patient at any stage of his or her disease, from the moment of diagnosis. Suppose you went out of the blue to your doctor and he said `let's do a blood test' and then tells you you have prostate cancer.

"Your world falls apart in moments. I don't care how much of a man you are, it's a terrible illness and it's on the rise throughout the world.'' PALS was founded in 1980 by Hilary Soares in an effort to provide hospice care for cancer patients in their own homes. At that time the word cancer was spoken only in a whisper and there was little support in the community.

Back then PALS had a few patients who were visited by a handful of volunteers, but nowadays, at any one time they could have more than 100 patients being cared for by five full-time oncology nurses, Shirley Higgs, Josie Wright, JoAnne Armstrong, Anne Brown and Lindsey Manderson.

The charity's expenses this year are at its highest -- $600,000 -- and Mrs.

Smith Gordon admits that without a grant from Government and donations from the private sector "we don't exist''.

"We've got to find about $500,000 a year on top of what Government gives us,'' she disclosed. "Some of our most touching donations have come from people who don't own $50, let alone $100.'' One fundraising effort that left the charity speechless came from cyclist Jim Butterfield who cycled 3,300 miles across the United States raising $166,000 for the charity. He was joined in Topeka, Kansas by fellow Bermudian Steven Petty for the month-long ride in May.

"We have never had anybody raise that amount of money before,'' Mrs. Smith Gordon says with deep appreciation.

She also tells a story about a seven or eight year old boy who raised $2.67 through collecting recyclable cans and donated it to the charity with a note scribbled on a piece of paper.

It read: "You helped my grandpa so much I hopes this helps you.'' "That donation is from the heart,'' she says.

In 1999, 63 per cent of expenses were made up of direct patient care which included free visits by paid nurses. Also provided free of charge are medical equipment such as electrical beds, wheelchairs and walkers as well as the visits by the nurses which total more than 6,000 annually. The food supplements are only paid for by the patients if they can afford the cost price.

"We are standing by 24 hours a day with help for any cancer patient, but they do have to have the diagnosis of cancer,'' explained the president.

"If an AIDS patient has cancer, which can happen, we will then be there to help, but we have felt that we have not had the resources to care for all the diseases and illnesses in Bermuda.

"I think it is better to concentrate on what we are doing and doing it well rather than trying to spread ourselves thin and trying to cope.'' Agape House is an excellent alternative if the patient's family cannot cope at home, according to Mrs. Smith Gordon.

"If the family cannot cope at home or if we cannot get some home help then that is a very attractive alternative for them,'' she noted.

"Sometimes the care-giver (family member) of a cancer patient might need a little respite and they might go into Agape House for a week or two while that care-giver gets a break. We have to be very aware and mindful that care of the care-giver is very important, also.'' Patients often prefer to be at home with their families and in familiar surroundings. Mrs. Smith Gordon says the illness has been known to bring together feuding family members.

"Homecare is the way of the future,'' she believes.

"We want to keep patients at home with their loved ones and their pets, their own photographs, books and music. I would rather be in my own home where I can play my music and be with my books and not restricted by visiting rules.'' She added: "Agape have some wonderfully caring nurses there and they are very good. Yes, people do go there and they do die, but not all die. Neither do all PALS patients die.

"We are constantly discharging patients from our service. You may find it difficult to understand when I say that a lot of them don't want to be discharged. "They will try anything to stay on our books, because they have made wonderful relationships with the nurses and volunteers and they don't want to lose that.

"The courage of our patients is incredible, absolutely amazing. The ones able to face the illness and accept it do seem to do better.'' Mrs. Smith Gordon is vice chairman of the World Home Care and Hospice Organisation (WHHO).

That special friend in the community This summer in Vienna, Austria, she gave the welcoming address to the hundreds in attendance for the second World Congress. Her speech was translated into three languages.

She also wrote the Bermuda chapter of the book entitled `Hospice Care on the International Scene' which contained submission from 19 other countries.

Two PALS nurses go away each year for special cancer care courses in the United States, Canada and the UK, which the charity funds. It's all designed to better improve the service they provide.

"The nurses always come back feeling good about PALS and about the way we do things here,'' said the president.

"We have an extremely cooperative relationship with the physicians. "I know the nurses away might take a day of two days to get hold of a doctor to change or alter a medication where in Bermuda that can be done almost on the hour, which is a big advantage.'' Incidents of cancer continue to rise and Bermuda is no exception. In August there were 124 cancer patients on PALS books, while recently there were 18 new persons diagnosed in one month. The youngest is just three years old! "We've had 128 new patients referred from November 1, 1999 to the last day in August 2000,'' explained Mrs. Smith Gordon. "And we've still got September and October left in our fiscal year!'' Another shocking statistic is the one quoted by the American Cancer Society that states that "80 per cent of all cancer is caused by the way we lead our lives''.

"To me that's a terrifying statement,'' said Mrs. Smith Gordon. She has been involved with the charity for almost 18 years, including running it as a volunteer for 14 years. They started out in the same building as the TB, Cancer and Health Association but have been at their present location on Point Finger Road for two years, sharing space with St. John's Ambulance.

"We need the public to understand why we need our own building,'' said the president, who places a cost of $1.5 million on the project which includes land the charity already owns. The charity will hold their annual fair on Saturday, November 4 at St. Paul's Christian Education Centre.

PALS' present home is also used to store beds, mattresses, wheelchairs, walkers and other items which help them serve the patients and they have already run out of space with even their bathroom used to store items.

"People need to recognise we have different needs,'' Mrs. Smith Gordon stressed.

"We feel it's time for PALS to `grow up' and have our own custom built accommodation.

"People in the community really do not fully understand what PALS does and the extent of the help and support we can give until they are personally involved through their own illness or a love one's illness.'' The Governor's wife, Mrs. Jennifer Masefield , is the Patron of PALS and five times a year she visits patients in their homes.

"She has been so supportive and so has his Excellency, the Governor,'' said Mrs. Smith Gordon.

"She loves going into the homes and meeting the patients. Sometimes they feel a little intimidated and nervous but she is so kind, so down to earth and it is an experience they talk about for a very long time.''