Never mind that he knew nothing about ranching, PIH clinician Devin Platt was obsessed with becoming a rancher. After college he saved what feed money he could from seasonal jobs as a raft guide and ski patroller. During long drives around the West, he kept his eyes open for the ideal small town. He enrolled in nursing school, in part because it was a natural extension of his backcountry emergency-medicine skills, and in part because an RN promised the free time to learn something about cows. Mostly he cold-called ranchers, some three-dozen between 2004 and 2014.

“I’m a fairly strapping lad,” he’d say. “I can do whatever you want me to do.” 

Sorry, son, came the replies.

In the winter of 2014, he seemed to have a sightline to the future. He had secured a nursing job in Enterprise, a picturesque hamlet in the mountains and pastureland of northeast Oregon, and an invite to work the steers and heifers on a historic ranch. But then Platt, 34, made a tiny choice that proved a big decision. With the nonchalance of a man amused by frothing whitewater and steep avalanche paths, he tossed off an application to fight the Ebola epidemic in West Africa with Partners In Health. He received an offer to work in Sierra Leone for roughly six weeks starting in February, and accepted it.

Last week, he returned to Sierra Leone with PIH for a second time, with plans to work for at least a year. The cowboying and small-town nursing are on hold indefinitely.

“I’m super pumped,” he says.

What's he thinking? Nothing special, it turns out. Platt is part of an impressive group of former short-term, Ebola-focused employees who have opted to return to West Africa with PIH. They reside everywhere from Alabama to California, Washington to Florida. Some have extensive experience abroad, growing up off the coast of Madagascar, for example, or working in war zones and amid humanitarian crises. Others have stayed closer to home in North America. Some are single, others married with children and Harley Davidsons. They are nurses, doctors, psychologists, logisticians, ranging in age from mid-20s to mid-70s. They say goodbye to remunerative jobs, loving families, amazing cattle. In Liberia or Sierra Leone, they do maternal care and supply chain management and everything between. Unlike their first six-week-long stints with PIH, they go for the duration, up to a year. At last count, some 30 of PIH’s 190 short-term employees had doubled down with PIH in West Africa.

Their reasons for doing so are as varied as their backgrounds.

Emergency medicine doctor Luanne Freer, who emailed from the temporary clinic she is running at Mount Everest basecamp, in Nepal, might have the most personal reason for wanting to return to West Africa with PIH this summer. She wrote:

“I fell in love with a 4-year-old boy who was rendered blind by Ebola. I'm working with a group of Danish nurses and PIH to get him corneal transplant surgery.”

Longtime obstetrician Dr. Michael Grady is in Sierra Leone a third time partly for the opportunity to work with colleagues like Freer.

“The people this work attracts—they’re probably the most interesting collection I’ve ever come across,” he says.

His house in Oxford, Ga., burned down while he was completing his first tour, but he returned to Sierra Leone with PIH just weeks after the embers cooled.

Nurse Jennifer Breiman also returned to Sierra Leone in January, unable to feel settled in Atlanta while the Ebola epidemic continued. These days she is starting fires.

“I’m fortunate enough to be part of the decommissioning of our Ebola Treatment Unit in Port Loko. We have to clean and burn everything,” she says. “I’m walking through rooms where Ebola devastated so many families, and I’m reliving all the experiences I had with the patients. Throwing mattresses into the fire feels like banishing Ebola, like freeing the ghosts."

The reason Dr. Charles Callahan wants to return to West Africa with PIH this summer is a bit more abstract. A professor of pediatrics and a Christian, he sees the work echoing the gospel of Matthew 25:35.

“That gospel became real to me in a way I’d never experienced it,” he says, before quoting a bit. “’For I was hungry and you fed me, I was thirsty and you gave me something to drink….’”

Callahan will have good company. Linda Callahan—a passionate fan of Mountains Beyond Mountains, a book about PIH’s founding, a therapist, and Chuck’s wife—is tired of seeing him off. “I want this to be a part of our future,” she told him.

Cheedy Jaja, a professor of nursing who was born in Sierra Leone, feels a patriotic duty to return with PIH.

“The country has experienced massive brain drain,” he says. “If things are going to change in that country, it has to be helped by the diaspora.”

Diana Garde, a nurse practitioner and midwife, plans to go back to Sierra Leone for a third time partly thanks to the culture of the Sierra Leoneans who haven’t emigrated.

“The patients we have are completely appreciative,” she says. “Even in the saddest of times and after the most devastating of outcomes, you still have people that say, ‘Thank you,’ which is amazing.”

Of course there are other reasons short-term employees go back for the long-term—like the inspiring dedication of Sierra Leonean doctors and nurses and midwives and community outreach coordinators and drivers. Most PIHers re-up for a blend of reasons.

But if the answers have one thing in common, it is the underlying belief that the work in West Africa is far from done. Hospitals and clinics need supplies. Local health workers need training. Ebola survivors need support. Liberia and Sierra Leone’s 10 million people need modern, world-class health care systems. Now is a beginning.

For Platt, nursing in West Africa with PIH is an amazing opportunity. Back in Enterprise last winter, he was happily ensconced in a cabin on the banks of a glacial lake, working with wonderful colleagues at the hospital, and soon helping out on two ranches. But giving that up to work in West Africa isn’t a trade-off, according to him. As a nurse manager at Government Hospital in Port Loko, Sierra Leone, he’ll schedule nursing shifts and care for mothers and babies with ailments such as malaria—a disease that has proven fatal all-too-often in Sierra Leone but can be easily treated by expert, well-equipped clinicians like Platt.

“I’m basically leaving the best job in the world for the best job in the world,” he says.