Karefa-Smart was placed in the maximum security section of an old British prison, along with supporters from Steven's own cabinet. He spent the first three weeks in solitary confinement, and the remaining 17 weeks in a tiny cell with a small window near the high ceiling. He could not see out, even by jumping and trying to grab the window bars, and he was not permitted visits, letters, or any pasttimes.

So he just sat, marking the days with a piece of charcoal smuggled from the kitchen by a sympathetic trustee. He suspects now that Stevens hoped he would go insane. If so, Stevens gave up. Karefa-Smart was released, again without ceremony. He only had time to count the number of marks on the wall. There were 141.

As he was freed, Karefa-Smart was warned that while there were no charges against him, he should leave the country, that anything could happen during a state of emergency. At first, he tried to see Stevens to ask why he could not remain in peace. But a minor coup sent Stevens to neighboring Guineau for troops. Karefa-Smart envisioned possible retribution for instigating the spirit of rebellion, and took Stevens' advice. He left again for America.

Karefa-Smart and his family went to New England, where his wife was raised. A friend at the Medical School, Dr. Alonzo Yerby, persuaded him to come back to Harvard to teach public health.

He accepted Harvard's offer of a visiting professorship, and, with a handful of others, has been trying since 1971 to elevate preventive medicine from its marginal importance at the Medical School. But his success has been limited. After a steady diet of Dr. Kildaire and Marcus Welby, Americans are conditioned to curative medicine. "It's natural," says Dr. Dieter Koch Weser, associative dean of the Faculty of Medicine and a close friend of Karefa-Smart. "Someone comes to you with a high fever, you give him antibiotics, and two days later, you have accomplished a minor miracle. It's dramatic. But if you walk into a village, line up 200 children, and shoot them with a vaccine, you're no hero."

Saving a few lives continues to be more attractive to medical students than protecting against losses that can only be measured statistically. Emphasis on curative medicine also decreases the probability that patients in Third World countries will die of an easily curable disease while the physician stands by helpless without modern equipment.

"Sometimes, this will have to happen," Karefa-Smart says. "It will not be easy for the doctor, but you have to think of how many lives can be saved with the money that might buy one kidney dialysis machine. You have to set priorities, think of the community. Sometimes you will appear a villain."

Americans, Karefa-Smart has found, would usually rather be the hero. "The American success story has always been that of the individual," he explains. "Supposedly, an individual can by his own efforts rise from lowly cabin boy to president. So the individual tends to look after himself. True community health and capitalism may well be antagonistic."

While his years in the west have taught him the techniques of modern medicine, the workings of power, and the comfort one man may occasionally achieve, Karefa-Smart has resisted the indivudal-oriented outlook--he says he still thinks like an African.

"My approach to life is still very much the same way," he says, surveying his own development. "I'm still very much community conscious. This is why I have never sought a career outside of Sierra Leone. The values I have are essentially African values."

So Karefa-Smart continues to look toward his homeland, writing to friends there, sure that he must return, determined that he will. But he says he is afraid that should he return people might say, "Ah, Karefa-Smart is back. Perhaps better days are at hand." And the political turmoil will begin again.

What if he finds that he will never be able to return to Sierra Leona? "In that sad case," he says, "I will adopt another African country. I would go there, and do what I could in health and politics. There certainly is much to be done."