At 58, Dr. John Karefa-Smart wonders where he will be a year from now. The tall, trim visiting professor of International Health may still be at the Medical School, lecturing on preventive medicine and world health. Or he might be back in West Africa, helping fellow Africans survive the unending five-year drought. But, if he had his way, he would be home in what he calls "my little country," in Sierra Leone, where re-arrest and imprisonment may await him now.

"I would go back tomorrow if I could," he says with a wistful smile. "I never will adjust myself to living out of Africa. Every time I have left it has been a temporary sojourn." But then he laughs, and nods toward the large, base-relief map of Africa above his desk, and adds, "In some ways, I never really leave."

If Sierra Leone were to suspend tomorrow the four-year-old state of emergency--declared the last time Karefa-Smart came home--and the government withdrew its warning to him to stay out of the country, he could probably be packed in time for an afternoon flight. His office at 641 Huntington Ave. is clearly a temporary measure, dominated not by a massive oaken desk, but by a few filing cabinets and bulletin boards. There is another map of Africa, perforated by colored push-pins, and an exhortation, carefully written in magic marker on lined yellow paper, to remember that "I" is the least important word and "we" is the most. His inspirational message is obscured when the office door is open. Karefa-Smart maintains a more substantial address out in Weston with his wife, but, from all appearances, he is only hanging his hat here for a while.

A sudden departure would not be too traumatic. By now, Karefa-Smart must be used to drastic changes in his life--once, he was taken from his dinner table in Sierra Leone, imprisoned, and released just as unexpectedly 141 days later. Having witnessed the confusion and coups of Sierra Leone's birth and growing pains, he realizes that he cannot enjoy a peaceful retirement after a long, lucrative practice like that of most of his McGill classmates. His open-end appointment at Harvard is as secure a job as he has had.

Despite the instability that has characterized his career, he bounces from continent to continent, confident that he will always be wanted, that he will always be useful. "There is so much to do," he says frequently when discussing the world's health, and he seems uncomfortable with suggestions that much of it cannot be done.

Karefa-Smart traces his determined optimism and sense of community to his childhood among the indigenous tribes of Sierra Leone. His grandfather was Paramount Chief of the area, and concern for all of the Chief's subjects naturally flowed to others in the ruling family.

Karefa-Smart was a third son, and not in line for his grandfather's post. "So I had to look for other fields," he says. An American missionary encouraged him to attend the American Missionary Society's local grade school and the high school at the capitol, Freetown.

The westernized schools gave him a piously western education: "We learned about all the capitol cities of Europe, the rivers of Europe and America, the mountains of those places, and very little about our own," he recalls. "Even the songs we learned in school--we sang about ice and snow. At that time, I never dreamed I would ever really know what ice and snow were."

Karefa-Smart's understanding of his own people was based on his parallel education that began when his grandfather decided that, at the age of six, he was ready for initiation into the secret Poro Society. Seventy-five years ago, that society gaimed fame for its resistance of British domination. But by the 1920s, it was actually an indigenous community school, and becoming a member was like making a social debut.

"It was secret just in that there were passwords that only members knew," Karefa-Smart explains, stripping away the mystery. "We learned tribal history, tribal customs, tribal traditions. At the end, we had a big ceremony in which we were introduced to the tribe as new members.

"All the stories you hear of Tarzan in the jungle and so on just aren't true. What is true is that we have our own system of life, our own culture."

Intent on helping the missionaries at the local hospital, Karefa-Smart decided to become a doctor--an almost unreachable goal for an African then. He was the first member of his community to go to college, and only the second from an indigenous tribe in the entire country to go to professional school. The first was Sir Albert Margai, Sierra Leone's first Prime Minister; Karefa-Smart became Margai's top aid and the country's first Foreign Minister.

At 23, a mature Karefa-Smart left Africa for the first time to study premed courses at Otterbein in Ohio. American medical schools were practically closed to all blacks, so he enrolled at McGill. As a British subject, he was drafted by the Canadian government during World War II, served his time in the Bahamas, and immediately after V-J Day, returned to his home village of Rotifunk.

He saw his community in a new light. "I was shocked to find what the real health status of my people was," he recalls. "When I went away, I knew nothing about nutritional diseases; I regarded it as normal that everyone should have worms. Every year at the beginning of the rainy season, we all took the indigenous medicine for expelling the worms, but for us it was natural.

"I remembered children often having high fevers, and sometimes, dying. But when I came back after being trained as a doctor, I couldn't believe what I saw."