The sorry state of the country's roads has limited development. In the capital, cars and SUVs inch along narrow roads swarming with pedestrians. There are no traffic lights.
Even traveling to Freetown from its international airport is daunting. The distance is only 10 miles, but by land it takes at least four hours. A ferry is quicker, but often out of service. Water taxis make the journey, but frequently capsize. Most travelers use a private helicopter service, which charges $70 each way. Vintage Russian-made choppers, carrying 18 passengers each, complete the journey in a tense, thundering seven minutes.
There are a few signs of economic life. Wealthy businessmen and government officials keep two nightclubs, Old Skool and the Office, thumping until dawn, with Playboy videos on flat-screens, top-drawer Scotch on the shelves and Lexus SUVs in the parking lots. Large mansions are going up on the outskirts of the capital.
Michael Kargbo, a Sierra Leonean who ran a construction company in New Jersey before returning five years ago, says he has $1 million in construction projects underway, and his crews are building homes for government officials and the business elite.
"Most of the guys in power today are guys I either went to school with or knew in the States," he said, pausing at the site of a two-story hillside home under construction. As he spoke, Koroma's motorcade, escorted by soldiers with sirens and flashing lights, sped by. From his Mercedes, the president waved to Kargbo, who smiled and returned the greeting. As the motorcade disappeared, Kargbo said, "Business is good and getting better."
For some, perhaps. But the country remains a political tinderbox. Tens of thousands of former child soldiers, who were forced into militias that killed, raped and hacked off the limbs of victims, have melted back into society. Some, like Lamin Bangura, who became a rebel fighter at age 12, now drive motorcycle taxis, known as okadas, in the capital.
"We used to steal, but now we can make a living," said Bangura, 27. A dangerous living. Okada drivers are harassed by policemen seeking bribes and taxi drivers who resent the competition.
But large numbers of those former rebels are unemployed, and their anger, combined with their military training, poses a threat to political stability.
"We have been stigmatized by society and the government turns a blind eye," said Kabba Williams, 24, a college student who leads a group of onetime child soldiers lobbying the government to create jobs. "If there is a war, and someone is looking for mercenaries, they can find them right here, unfortunately."
The precariousness of Koroma's position was clear early this year when he left the country for unspecified medical treatment in India. His rivals attacked the headquarters of the president's party in a downtown melee involving 5,000 youths.
The government feared a coup was in the making and prepared to respond with force. But Michael von der Schulenburg, the U.N. secretary-general's representative in Sierra Leone, drove to the scene and brokered a resolution. Later, the president and his opponents signed an accord pledging support for democracy.
"If we can prove that here, in the poorest country in the world, there is a possibility to go from conflict to democracy and stability, it would be an example for other countries," Schulenburg said. "We have to keep it stable at any price, because Sierra Leone could easily become another Somalia."
'So many problems'
The most immediate crisis, though, is healthcare. The country has only two pediatricians, and Thorlie is one of four obstetricians. All work at Princess Christian.
Doctors Without Borders set up clinics in Bo, the second-largest city, during the civil war. Now it's time to begin pulling out and move to other countries in crisis, but Jan van't Land, the local director, says he's worried.
"We're in a difficult situation," he said. "If we leave, who would take over? It might create another crisis."
When Koroma took office in 2007, his wife, Sia, launched a global effort to draw attention to the public health crisis. An oil industry chemist before the war, she started a career in nursing during the couple's years in London. Her evangelical work has brought some help, but she acknowledges that progress has been slow.
"We are faced with so many problems -- illiteracy, poverty, youth unemployment and the need for gender empowerment," she said. "I'm trying to be an advocate for women and children, because they are the most vulnerable."