So the first practical application of Kelly's humanitarian imperative came into being when he and Barrie created an NGO, a nongovernmental organization that would implement the mission of the foundation he'd started back home.

Kelly left Freetown for Kono District in the east - the region with the diamond mines, where the war had done its worst.

Was he ever concerned for his safety or his health?

"Nobody has pulled a pistol on me yet," says Kelly, who goes solo ice-camping in Patagonia to relax.

"He has no fear," says his mother. "He has no frontal lobes."

Reminded that he has contracted both malaria and typhoid, Kelly dismisses it: "I took the medications and it went away. No big deal."

Sarah Bones watched him hold meetings and teach workshops while ill last spring. "It only slowed him down to what most people would consider normal speed," she says.

They had met at a lecture in Villanova about health care in the developing world. A year later, Kelly sent an e-mail inviting the Philadelphia-area photographer to see his work in Sierra Leone. It was not an easy decision.

"I went because I believed he could make a difference," she says. "Or he would die trying."

Through much of 2007, Kelly and Barrie treated hundreds of Kono amputees in their houses, turning them into "mobile" clinics for two or three days at a time, while they sought a permanent location. Eventually, an important donor was won over.

"Chief Komanda said, 'This crazy white man has come a million miles and done what Leoneans have not done,' " says Barrie. " 'We would be crazy if we did not give him the land.' "

Kelly designed the simple cinderblock structure with a sketch program he found on the Web. There is no electricity and no staff quarters. Water is hauled in five-gallon jugs from a half-mile away.

Last Monday, people began lining up at 6:30 a.m. for the 9 o'clock official opening of the Kono clinic for war amputees and their families: people with typhoid fever, malaria, parasites, diarrhea, vomiting, pneumonia, and asthma brought on by dust from the mines.

All treatment is free. The clinic needs a water well, a generator, solar panels, and all the equipment for a lab.

"Mostly we need enough money to make sure we have a constant drug supply - that's our biggest concern. We still don't have the facilities to help women do labor and deliver children," Kelly says. "And we want to build a therapeutic feeding center here. There are a lot of severely malnourished children."

Working with a United Nations grant, Kelly also launched a program for severely malnourished children in the Port Loko District on the coast.

Both initiatives have full-time staffs and are organized to run without Kelly there. Mohamed Barrie - having resigned his hospital position outside Freetown and now working full time for the NGO - has become a partner in his long-term plans.

"The issue is not only health, it involves other sectors," Kelly explains. "We are a health-focus organization, 'using health to eradicate extreme poverty,' but you have to realize that micro-agriculture is a natural extension of health into economic development and real sustainability for this amputee project."

He plans to fly to London today to begin setting up a British office of the Global Action Foundation and to give fund-raising talks. He will return to the United States in May to graduate from medical school.