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Harvard Public Health Review/Summer 2002


Sierra Leone's Optimist

If I become a pessimist, I might as well lie down and die," declared John Karefa-Smart, MPH'48, who at the age of 86 ran for president of war-torn Sierra Leone in its last elections, held on May 14, 2002. To an outsider, for whom Sierra Leone is a distant place known for its ten-year civil war, diamond-bred atrocities, and intense poverty, Karefa-Smart's undying optimism may seem surprising. But perhaps a country described by James Traub in a June 2000 New York Review of Books article as "The Worst Place on Earth"--for its last-place ranking on the UN Human Development Report, low life expectancy, high infant mortality, and high illiteracy--needs all the optimism it can get.

The recent elections came at the end of more than a decade of conflict that began in 1991. The Revolutionary United Front, led by Corporal Foday Sankoh, the rebel leader currently on trial for murder, waged a war against the acting government, resulting in persistent violence that would kill tens of thousands of people and displace more than two million others. Although the rebels' stated aim was the toppling of a corrupt government, at stake was control of the country's diamond-rich mines, with no concern for the poverty-stricken population. Civilians suffered great atrocities at the hands of rebels--rape, murder, amputation of body parts--as well as the burning of their homes and farms. This fall, the United Nations will begin a war crime tribunal in Sierra Leone, with hopes of bringing this tragic chapter in the country's history to a close.

Karefa-Smart shares that hope. Back in April, with characteristic understatement, he laughed when asked to respond to the description in Traub's article and replied simply: "All the things that he said made it the worst place on earth we hope to change." What does Karefa-Smart want to tell the international community about Sierra Leone to counteract the images they have of his country? "They should just wait and see what happens once we have a chance through the electoral process to make a new way of life," he answered.

Like his optimism, Karefa-Smart's supreme confidence in the electoral process comes as somewhat of a surprise. In 1996, during Sierra Leone's last presidential election, he ran against Ahmad Tejan Kabbah, leader of the Sierra Leone People's Party (SLPP). Kabbah eventually won the presidency in a run-off poll, amid substantiated claims of voting irregularities. Waiving his constitutional right to contest the elections lest a period of litigation prolong the rebel war, Karefa-Smart, whose United National Peoples Party (UNPP) earned the second highest number of votes, took his seat in parliament as the "Leader of the Loyal Opposition." In May 1997, when the new government was ousted in a bloody coup d'etat, the president and his cabinet fled the country; Karefa-Smart remained, trying to negotiate a peaceful return to constitutional rule. Only later, his life threatened, did he exile himself to the United States. Karefa-Smart had hoped that this next electoral go-around would be different--that with impartial, intensive monitoring of the voting process by organizations like the British Commonwealth and the European Union, his claim to the presidency would be vindicated.*

Still, he admitted that running for election in a country as devastated as Sierra Leone would have its own emotional and administrative challenges. "To campaign in a situation where people have lost their homes is not as easy as it would have been in the United States," he said sadly.

By his own admission, Karefa-Smart has a led a long and productive life. Despite his youthful, fit appearance, his age has led to jibes that the sole purpose of his campaign was to procure himself a state funeral. Unfazed and young at heart, he recently told journalists, "I will probably live until I'm 110." His desire to help his kinsmen, however, began from day one. "I was born with a sense of responsibility for the well-being of our people," he said in a pre-election phone call from Sierra Leone's capital, Freetown.

The privileged grandchild of two "paramount chiefs"--Sierra Leone's traditional rulers--Karefa-Smart received bachelor degrees from Fourah Bay College in Freetown and Otterbein College in Westerville, Ohio, and earned his MD from McGill University in Montreal in 1944. As a citizen of the British Commonwealth, he served as a captain in the Royal Canadian Army Medical Corps in the Bahamas during World War II. Upon returning to Sierra Leone, he said, "I saw nothing being done in preventive health." His veteran's benefits paid for him to study for an MPH at the School. "I owe a lot to the Harvard School of Public Health," he said. "That's where I first got a vision of bringing comprehensive health care to Sierra Leone."

Karefa-Smart spent the next 50 years on a dual path of politics and public health, in service to Sierra Leone, Africa, and the rest of the world. He became Sierra Leone's first foreign minister after helping the country achieve independence from Great Britain in 1961, and he led the delegation that negotiated its admittance as the 100th member of the UN. During the 1950s and '60s, he rose through the ranks at the World Health Organization, eventually serving as an assistant director-general from 1965 through 1970-- the first black and first African to hold that position.

Karefa-Smart's long and distinguished public health career has been characterized by a creative and innovative approach to expanding the mandate of health care programs in order to set in place accessible and comprehensive, community-based prevention and treatment services worldwide. Working for organizations as local as a comprehensive community health center in Boston to those as broad-based as the Pan American Health Organization, USAID, and the World Bank has taken him virtually everywhere. "I was counting the other day," he said. "I've been to 120 countries." He added, "The only place I'm dying to go to, and I hope to go there before I die, is Australia and New Zealand."

Of his involvement in Sierra Leone politics, he said, "It has been very exciting. I've seen the development of getting free from the colonial administration to setting up a government. But I have to say the story has not always been pleasant." According to a communiqué signed by Karefa-Smart and the leaders of the two other political parties in February, the May elections meant a chance to leave behind the Kabbah government and the SLPP, which, "for six years has failed to demonstrate any political will to improve the quality of the lives of Sierra Leoneans."

Improving the quality of life in Sierra Leone will be a big job for any president. Civil strife and poverty there have intensified the public health problems shared by other African nations: infant and maternal mortality, infectious diseases like malaria and dysentery, contaminated water supplies. "If you put all of those together and compound them by nutritional deficiency, you can see it's a heavy health problem," said Karefa-Smart, adding, "I've not mentioned AIDS, about which we know little in this country." Because of the war, Sierra Leone has few statistics on the spread of AIDS, which has devastated many other sub-Saharan nations, but preliminary indicators from the World Bank show it to be on the rise.

Beyond delineating the problems at hand, Karefa-Smart said it is too soon to recommend specific solutions, but he asserted, referring to the riches of his land and the capacity of its people, "We have enough resources. If we marshal our resources, we shouldn't be a poor country at all."

What Sierra Leone has lacked, Karefa-Smart said, is vision. He does not wish to dwell on the world's view of Sierra Leone as a place of evil done by humans to humans, a country of amputees and a conflict-promoting diamond trade. "Those are things that happened because there was no vision among the people in power for the last 30 years," he said. "That is irrelevant to our purpose. All of that will change."
Asked about the nature of his presidential candidacy, Karefa-Smart acknowledged that his party is not unique in wanting to rid the country of illiteracy, unemployment, and corruption. What makes his United National People's Party different, he said, is that it stands for change--"change in everything you could possibly think." Karefa-Smart believed that he and his colleagues could begin to undo the damage of decades of mismanagement of their country's resources. "We will learn to conserve, develop, and share our resources," he declared, "so that the people and not individuals benefit. When we begin to do that, respect for human rights and for the law of the land will follow."

Karefa-Smart's optimism is infectious. After speaking to him one really believes that Sierra Leone can break out of the cycles of poverty and war, and that its people can enjoy a better life someday. What-ever the future holds for Sierra Leone, one thing is certain: Karefa-Smart will struggle for change as long as he can. "To me it's a moral obligation--I have to be involved until the day I say goodbye."

*In May, incumbent President Ahmad Tejan Kabbah swept Sierra Leone’s elections, receiving about 70 percent of the vote, as reported by the country’s National Electoral Commission. At the time, Karefa-Smart congratulated Kabbah on his victory, adding that he remained committed to eliminating Sierra Leone’s myriad problems, which “if left unsolved, will deny our people and our country their rightful place as models in our region, continent, and world.” In a July telephone call, Karefa-Smart said he will reside in the Washington, D.C., area for “an indefinite time,” with hopes of tackling Sierra Leone’s health, social, and economic problems through “non-political” means. He plans to found a non-profit organization to raise funds for this effort. “The problems are huge,” he said. “The best anyone can hope to is make a little contribution.”

Eman Quotah

Karefa-Smart: A Life of Public Health and Politics

Born in Rotifunk, Sierra Leone.

Receives MD degree from Canada’s McGill University.

Co-founds a precursor of the Sierra Leone Peoples Party, which wins his country’s independence from Britain.

Earns MPH degree from the Harvard School of Public Health.

Uses Fulbright scholarship to study parasitic diseases.

Member of Sierra Leone’s parliament.

Assistant Director-General of the World Health Organization

Spends 6 months as a political prisoner in Pademba Road Prison in Sierra Leone.

Visiting Professor at Harvard’s School of Public Health and Medical School.

Medical Director at Roxbury Comprehensive Community Health Center in Boston.

Professor at Howard University Medical School.

Presidential Candidate of the United National People’s Party in Sierra Leone.

Presidential Candidate of the United National People’s Party in Sierra Leone.

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