Karefa-Smart went right to work at the missionary hospital in Rotifunk with the American missionary who had originally inspired him to go on to college. And when she returned to America on furlough, he continued alone. Twelve to fourteen hours a day, he treated the Africans who came to him with every tropical disease imaginable.

"It occurred to me what I was really making no progress at all," he says. "The same type of people from the same village communities along the river would come with diarrhea, with infections, with malaria--the whole range.

"Then it occurred to me that perhaps the right approach was preventive, since I didn't have the missionary attitude to this. I had the interests of my people at heart, and wanted to do something about community health."

By "missionary attitude," Karefa-Smart means the spirit of self-serving forays into the jungle by westerners in the footsteps of Livingston and Schweitzer. Their attempts at curative medicine had little impact on total community health; they were better at healing their own spiritual woes.

"They are always coming back to report to their country," Karefa-Smart says. "They tell how the people are suffering; they speak of the great need. In this way, they get support, but there is no real progress for the Africans. It is only a career to the missionary: getting support and treating a few people. I want to see my people's health improved."

So Karefa-Smart came to Harvard in 1947 to study public health, and, after a year, returned to his village to apply community health measures he was sure would cut down the number of patients needing treatment for contagious diseases. But, before he could begin, the University of Ibadan, Nigeria, asked him to train other Africans in preventive medicine. He lectured there until 1951.

Karefa-Smart's political awakening came shortly after that, during a tour of East Africa. He was stunned by the exploitation of Africans in the mining industry throughout the copper belt, and, looking around, saw far more rigid repression than relatively liberal Sierra Leone had known.

He was surprised to find one young man who was already fighting this discrimination, and they became friends. That early organizer was Kenneth Kaunda, now the president of Zambia. Kaunda's courage forced Karefa-Smart to re-evaluate his own career and the fruits of all his education.

"I said to myself, look: Here you are, you have a university education, a professional education, and you are not doing as much for the political situation of your people as this person here," he recalls.

Karefa-Smith returned to Sierra Leone and resigned all of his other posts to go into political life. With Sir Albert Margai, he organized the Sierra Leone People's Party, which eventually won Sierra Leone's independence from Britain in 1961. Over the next three years, he served in a variety of key positions: Foreign Minister, Minister of Defense, and Acting Prime Minister during Margai's frequent illnesses.

When Margai finally died in 1964, his brother, Sir Michael, took over the government by military force to avoid an election with Karefa-Smart. This placed Karefa-Smart in a delicate position. "When this brother pulled this fast one on us, I found I could not stay under those conditions," he says. "So I left the country. I remained a member of Parliment, but took a post at Columbia University because it would be safer."

Karefa-Smart commuted from New York to sessions of Parliament four times a year until 1965, when new coups forced him to cut off all political contact with Sierra Leone. For the next five years, he served in Geneva as assistant director general of the World Health Organization, but continued to watch the political situation in Sierra Leone. In 1970, with power in the hands of an old political ally, Dr. Siaka Stevens, he reasoned that the time was right for him to return to Sierra Leone for good. Karefa-Smart smiles at his own innocence now when he says," I thought I was getting to the age when you could retire."

There was no peace waiting for him in Sierra Leone. Stevens saw his return as a political threat--the people might sweep this old but not aging hero, who had negotiated Sierra Leone's independence, back into office. He declared a state of emergency, and, in October, 1970, ordered his former friend's arrest.

"It was all quite unceremonious," Karega-Smart recalls. His house was surrounded by soldiers, and one interrupted his family's dinner, and said, "Dr. Karefa-Smart, I have orders to take you."

Karefa-Smart began to protest, but another soldier put a hand on his soldier, and said, "Please don't argue, Doctor. We have orders to shoot you if you do." He went quietly.