The polytunnel in my garden is warm and humid. When the rain is hopping off its roof, if I close my eyes and breathe in the moist fragrance of earth and greenery, I am taken back to Sierra Leone.

“You’re going to Sierra Leone?” asked Johnny. “Where’s that?”

"It's in Africa. It's a small country, an ex-colony, very green and beautiful, and very poor. And it's always raining at this time of year."

"I see," he said. "A kind of African Ireland then."

I had never been outside Europe before. It was the 1980s and Paul Simon's Graceland had put African music in the charts. Medical students like me raised money to go to work in hospitals in Africa for the summer. It was generally conceded, by those going to more glamorous East African countries, that I had drawn the short straw.

An earnest academic berated me in the college bar after an Amnesty International conference.

“I don’t agree with it,” he said. “What good can you do against the enormity of the suffering in Africa? You should do what you can in your own community.”

A calm woman with an international reputation in human rights
disagreed. "When you come home, you will see your own world with different eyes. Then you will know how to change things."

Confusion and chaos
I had not really thought it out. As the plane flew for hours over the Sahara desert, it felt like a great adventure. When I landed in Freetown, it was terrifying. Armed soldiers were everywhere. The buildings were huge, decaying, postcolonial relics. There was no infrastructure, no electricity, just teeming thousands of African people getting by as best they could in the hard, heavy rain.

If you went to a state hospital, you had to buy your own medicines. If you went to prison, they did not feed you; you had to rely on family.

At the bush-hospital in Serabu where I stayed for the whole long summer, I was haunted by the words: “What good could I do?” Every morning dozens of patients of all ages in bright robes waited by the clinic door. They had a bewildering variety of tropical diseases: Lhasa fever; bilharzia; TB; and malaria. Everywhere.

Their hospital wards were huge and full of patients, their families, their chickens and the occasional snake. Yet there was a wonderful atmosphere of life and good humour among all the suffering and illness.

I got to know the quiet Sisters of Mercy nuns who ran the compound. There was not much proselytising that I could see. Most of the doctors had no religion at all and did not seem to suffer from the lack of it.

Talking to the nurses and sitting with the men of the village, I got a sense of the rhythm of the country. Most families lived on subsistence farming without money to invest in tools or seed crops. The large American and Dutch mining firms had great compounds, enforcing miserly pay, dreadful conditions and strict apartheid behind the wire fences. As the European bosses drove to and from the airport in their air-conditioned four-wheel drives, children sat dying at their gates, their bellies swollen with malnutrition.

The profits from gold, diamonds and titanium were diverted from the people. The straight lines on the map of Africa meant little to the tribes composed of millions of people.

I developed great respect for the Europeans who had chosen the hard task of living in the tropics among the poor. The real task lay in education, treatment for gastroenteritis, avoiding malaria and basic hygiene.

Improving global healthcare
I still think this is the way to improve global healthcare. Develop local centres of care, employ local nurses and doctors, and pay them well enough so that they can stay there. Get the fundamentals right and let the country evolve from there.

Shortly after I left, the gentle Mende people were thrust into a horrifying war. It is now over and Sierra Leone is getting on its feet for the first time.There are no more blood diamonds and the beautiful beaches are attracting tourists.

When I came home, thin, brown and cold, I saw the western world and our greedy overconsumption of just about everything through different eyes. Having so much did not seem to make anybody happier than the Africans who had so little. I can't wait to go back.

Dr Pat Harrold is a GP in Co Tipperary