The hospice movement began in Sierra Leone in 1994 as a response to the needs of people living with a terminal illness. Gabriel Madiye, founder of The Shepherd’s Hospice, contacted St Christopher’s Hospice, London, and subsequently made contact with hospices in the US. As the nascent movement developed, Sierra Leone was engulfed by a civil war and during the hostilities, the hospice premises were destroyed twice.¹⁹ The vision survived, however, and as the war came to an end, Gabriel Madiye began again and brought the vision to reality once more. He recalls:

It all started with the recognition of the problem in a very genuine way and it continued with organising community effort; sensitising people around the problem to see how they can rally around. It was essentially a volunteer movement and we started in 1994. By 1995 we were able to write the initial statement, write a strategic plan, and we were able to register with the government of Sierra Leone as a non-governmental organisation with a mandate to deliver a service that was basically palliative care.

My own role in the hospice has been management, planning and research; making sure that services are appropriate to the needs of the local community. And I try to make sure that our programmes are based on sound research. Because of that we have always maintained good donor relations - with donor confidence and donor interest in our work. We initially started from nowhere and today, over the last four years, we have been able to work with 11 international donors, including the World Bank, WHO, Bread for the World, Help the Hospices, and now we are doing some work with Comic Relief.

The project itself is capacity building, which implies that The Shepherd’s Hospice itself is a facilitating institution: we have patients referred to us; we train their family care givers; we train volunteers; the volunteers pay visits to the home once every week, and the family care giver is almost always there in the home. The professional team is multidisciplinary consisting of the social worker, a medical officer, and the nurses; they stay at the hospice and they have a routine schedule to visit those patients. And you can call on the professional team at any time and we are mobile; we can go in.²⁰

As plans for the hospice took shape, Gabriel Madiye contacted Sheila Hurton in the UK to join the Voices for Hospices event of 1997. At that time, she was unaware of developments in Sierra Leone:

The whole Voices for Hospices idea just snowballed; so we went from the first event in 1991 when we had simultaneous concerts in all four countries in the UK - plus a late one in Malta - to 23 countries in 1994, by which time we had decided to make it a triennial event. In the next event in 1997 we had gone up to 35 countries. But by this time Gabriel in Sierra Leone had started an embryonic service in 1994; and he had read somewhere about Hospice Information, because nobody in Sierra Leone knew about palliative care; they didn’t know about hospice. So he registered with Hospice Information, got our leaflet and in 1996 he wrote and said, ‘We could take part’ and so from that point we’ve been in contact.

As in all Voices events we send out information and, as we are a coordinating body, we ask for information back. So he was going to do his event in the national stadium, and had it all planned; then sudden silence. And after each event we always ask “Can you tell us what the event did for you? How much it made, any benefits/spin offs and so on?” Nothing from Sierra Leone came back. And then it was a few months later, into 1998, that we suddenly got a heart breaking - I mean heart breaking - fax from Gabriel explaining that they’d been overtaken by the coup in May 1997; the hospice had been destroyed, and there was no way he could continue with his Voices event. And the incoming military president had found in former President Kabbah’s drawer an invitation to go to the hospice event. ‘Why hadn’t Gabriel invited the new rebel president?’ As a result Gabriel was physically abused, his wife and children were physically abused and so on. Gabriel’s fax was a real cry for help, ‘There’s no money in Sierra Leone, I want to get the hospice service re-started - can you help?’

Similar faxes went to Help the Hospices and Hospice Information. I talked to my own Voices for Hospices trustees, of which I’m one, and according to our Memorandum of Association we could not give money away. So I had permission from my own board members to go it alone on this one because it’s the only way I could do it, and put out a plea and the money started to come in. I was aware, even at that stage that every pound I raised here was worth ten pounds to them: money goes a long, long way in Sierra Leone. So I was sending money out as I received it and then one day I came home and my husband showed me a fax that had just come through that day, and he was in tears; and I was also in tears after I’d read it. The rebels had come again and destroyed what had been left.

Since the first destruction, they had been working under destroyed walls with just plastic sheeting for a roof and every time it rained, it soaked all the papers and everything in the office, a simple building. But the rebels had been again; they’d destroyed what was left, they’d destroyed the files and furniture; they’d stolen the truck - which was absolutely necessary to get about. They had burnt down Gabriel’s house and abducted his wife and two young children, and had also burnt down another 150 buildings in the area. I mean, where do you start?

I went into Princess Alice Hospice the next day and spoke to the voluntary services coordinator, showed her the fax and she said “we’ve got to do something” and we decided that we’d have a [special] Sierra Leone day. Within three weeks we got the hospice volunteers, friends and staff on board, and on the day we sold goods on stalls, ran competitions, had a fashion show, served refreshments and many people were involved. By the end of the day we’d raised £3,000. During the course of the day, someone came from the church just up the road and said they were just about to choose a charity for Lent, and he would like to propose to the church that it make The Shepherd’s Hospice its Lent charity. And at the end of 6 weeks I was given a cheque for £2,600. That’s £26,000 to them., So I sent out the £3,000, and then later £2,600 so rebuilding could start, and I also started a newsletter for the growing number of supporters here. Just the fact that somebody, somewhere else was thinking of them seemed to give a huge morale boost. Gabriel said, ‘You’re thinking of us and the staff are just amazed that people somewhere else are thinking of them’.

And then it came to the point where they were coming up to the rainy season and they urgently needed to put a roof on the first floor. I needed to find almost £4000 and knew I just couldn’t do it in time. So I wrote a letter to David Praill (Help the Hospices) and said ‘I just don’t know where else to turn and this matter is urgent’. And Help the Hospices generously made a one-off £3,500 donation. At that stage, and we’re talking about 1999, Help the Hospices had no international involvement so were brilliant to make an exception and meet a really urgent need. So the money was sent and the roof went on - and the rest is history.²¹