Second only to the chief, 42-year-old Daouda Mbengue is the most-respected man in his village. Although he speaks three languages and completed his medical degree in Sénégal’s capital city of Dakar, those are not what set him apart. His two wives and their sons are considered a symbol of status in his Muslim community, but that’s not why he is admired, either. What distinguishes Daouda is that he came home.

Much of Sénégal, in Western Africa, lies in the dry Sahel Desert, but the southern Casamance region has a lush and tropical climate. The capital, Dakar, lies on the Cap Vert peninsula, the westernmost point in Africa. This is the land of the Lébou, Daouda Mbengue’s people. Numbering about 300,000, the Lébou, traditionally fishermen, live along the coastal regions of Sénégal, in Mauritania, Gambia and Guinea-Bissau.

Daouda’s father and grandfathers made their livelihoods from the ocean, but commercial fishing boats slowly emptied the waters. Now, the only way for a Lébou man to make a good living is to leave the villages for the cities, just as Daouda did. His family pooled their money for him, the oldest son, to go the university in Dakar.

Daouda Mbengue is the director of the clinic in the village of Sindou in Senegal, West Africa.

After earning his degree, Daouda was offered a prestigious job with the Sénégalese military. He worked in the children’s hospital of a large city and specialized in tuberculosis — a very different world than he knew growing up in the small fishing village of Sindou.

One day he received news that this village had built a clinic, but the country’s shortage of medical workers meant that there was no one to run it. Unless he returned to his village, the clinic would sit empty.

“Assalaamaalekum [Peace be upon you],” I said, greeting the man wearing a lab coat, as I took off my plastic sandals and entered the clinic. I had only been in Sénégal a few months, but already my cultural eyes had adjusted. I could see that this small, cement-block building with no water or power was a symbol of progress for the people of Sindou.

Unlike their neighbors, they now had a clinic. When malaria made its annual trek through the country, they would have a place to go for medicine. When their children fell on the jagged rocks, they could be stitched up. They had someone they could trust, one of their own who had come home to help them.

They also had me, a young American health worker who stumbled through their melodic Wolof language and didn’t know the first thing about treating malaria. But Daouda understood my greeting, and he reached out to shake my hand. “Maalekum salaam [and on you be peace],” he said, heartily.

Daouda introduced me to the clinic staff, which included Aida, the assistant, Pape, the pharmacist, and Mbaye Siny, the receptionist. Mbaye’s painful-looking twisted leg was the result of a poorly aimed immunization needle that damaged his sciatic nerve as an infant, a fact that did not escape me the day Daouda taught me to give injections and run an I.V.

I had prayed that my first patients would not be children, fat tears on their pudgy cheeks. In fact, the experience could not have been any farther from what I’d imagined.

Daouda and I walked on sand through dry baobob trees to the nearby village of Pintiure, where a woman was very sick, but her family did not have the money to have her hospitalized. We found the woman on a thin foam mat in her hut surrounded by her sisters, who were chanting and praying to Allah. (More than 90 percent of the population is Muslim.)

The woman’s name was Fatou. She was severely dehydrated, and not responding. Daouda’s resourcefulness impressed me as he strung an I.V. up to the straw roof. As I helped him, he said, in what I hoped was a joking tone, “Tomorrow you can do this by yourself. I’ll just watch.”

True to his word, the next day Daouda watched me preparing Fatou’s intravenous cocktail and then administering it during a five-hour process. My prayers had been answered: The first veins I worked on belonged to an adult who could not respond with tears or cries. Ironically, now I prayed that she would.

As we drank rounds of hot mint tea and waited, Daouda asked if I could come back tomorrow and do the same thing alone. We had been joking all day — like when I asked what to do with the used needles, and he told me to eat them to be sure the kids didn’t play with them — yet I decided not to respond sarcastically to his request for me to return solo, in case he was serious. He was.