The Christian Science Monitor

America was home for Ernest Darkoh. He had a nice apartment in the New York borough of Brooklyn, he was making good money, his social life was thriving, and his first nephew had just been born.

But something was gnawing at him.

ERNEST DARKOH: • Operations manager, Botswana National Antiretroviral Program • Educated at Harvard and Oxford universities ANDY NELSON - STAFF

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"I could see my life stretching ahead of me in the States," says the 33-year-old American-born son of Ghanaian parents. "I would be ... just another professional."

It's the end of a long day at work in his stuffy office in Gabarone, Botswana's tiny capital city, and he sways slightly on a swivel chair. "What I wanted to do was follow my heart," he says. "Go somewhere where my input was really needed."

More than 15 million people have died of AIDS in sub-Saharan Africa, and to date, 11 million have been orphaned. In Botswana, 38 percent of adults are HIV-positive and life expectancy has plummeted to below 40 from over 65. By 2010, it could sink to 29, predicts the United Nations Program on HIV/AIDS - a level not seen in developed nations since the Middle Ages.

Outside input here is needed, and Darkoh - with a medical degree and a master's in public health from Harvard, an MBA from Oxford, and a several years' experience working at McKinsey Company in New York - wanted to give it.

One of his projects at the consulting firm was a study, the first of its kind, of the feasibility of launching HIV/AIDS antiretroviral therapy in Botswana. Soon after, he was recruited by Botswana's government to head its AIDS-drug rollout efforts. It is a groundbreaking project into which private US companies and foundations have poured millions.

The program distributes the drugs free of charge to anyone who needs them. It is generally regarded as the developing world's most comprehensive assault on AIDS and a model for fighting the epidemic elsewhere.

Even so, Darkoh hesitated before accepting. "I had certain criteria in my head that needed to be fulfilled," he says. "I wanted to make sure I knew what I was heading into."

He wanted to make sure he could be effective and had a clear mandate, he says, and he wanted to have independence within the public sector. "Because you can really get bogged down by a system and get nothing done," he explains. "Especially in this part of the world."

He's up early every day and spends most of his time in the office. He complains, only half kiddingly, that he would prefer to be more hands-on with patients, but that someone has to do the administrative stuff. Still, he travels in pretty rarefied circles: He met with President Bush during his trip to Africa this summer, as well as Microsoft founder Bill Gates, who has poured some $50 million into the project Darkoh is spearheading.

Darkoh initially had to overcome the perception that he was too young for the job. "I knew that the key to gaining trust was to show that I was sensitive to the politics and that I could deliver results," he says. "I had to work almost 20 hours a day for the first year of the program."

Getting qualified Africans who study abroad to come back to a place where they will make less money, face more frustration, and often not be able to put into practice some of the advanced techniques they learn in Western schools, can be a challenge, say many here.

"Parents pay a lot of money for their children to get the sort of training I did," says Ibou Thior of Senegal, another Harvard graduate who today is director of the Botswana Harvard AIDS Institute. "And the expectation is that not only will you make a difference - you will also make a living." A person returning from study overseas, argues Mr. Thior, needs to be rewarded, not frustrated.

"The government needs to provide good working conditions and opportunities so one can apply what has been learned.... Otherwise, you might not want, or be able, to return."

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COMING HOME: Africa's emerging power players
KENYATTA Possibly Kenya's next president		MAKATIANI Launched Africa's biggest Internet company		KAYOMBA Founded an independant newspaper in Rwanda		DARKOH Leads Botswana's free AIDS-drug program
BRUKTAWAIT Started Ethiopia's largest private bank TSELE General Secretary of the South African Council of Churches
• Regional map
• Q&A: The higher education equation in Africa's development