Dr. C. John Ritter and his wife, Marcia Southard-Ritter, arrived in Liberia in July with plans to work as volunteers-in-mission at a rural hospital until the end of December.

But a flare-up of the west African nation's continuing political unrest forced the Ritters to flee before the end of September.

And the unlucky mosquito bite that gave Ritter malaria didn't help make the trip any more pleasant.

"I still have nightmares, but they're going away," the doctor said.

The Cape Girardeau couple left Liberia on Sept. 24, fleeing to the neighboring Ivory Coast and then home.

It wasn't all bad, Southard-Ritter said.

"We did some good work. We made some very good friends and met some fine people," she said.

The Ritters worked at a rural hospital in Ganta, about 280 kilometers north of Monrovia, Liberia's capital, as volunteers-in-mission for the Methodist church.

Ritter, a physician who retired from private practice in 1997, took care of patients at the 60-bed hospital.

Southard-Ritter, a registered nurse who retired as vice president of patient care at St. Francis Medical Center in March, worked with private agencies to bring much-needed food, medical supplies and money to the hospital.

Liberia was colonized by freed slaves from the United States. It was established in 1822 by the American Colonization Society and became an independent nation in 1847.

Once one of the most stable nations in Africa, Liberia has been wracked by a civil war that began in 1989 when rebel leaders -- and political rivals themselves -- Charles Taylor and Roosevelt Johnson led uprisings against then-president Samuel Doe.

Doe was assassinated in 1990, and the bloody struggle for control between various factions destroyed much of Liberia's infrastructure and economy. An estimated 150,000 Liberians died in the fighting.

In April 1996, Taylor and his allies went on the rampage against opposing factions. The violence waned later in the year, and Nigerian peace-keeping troops now occupy much of the nation.

Taylor was elected president in 1997, but rivalries rooted in political and tribal divisions continue. It was those rivalries that forced the Ritters out of Liberia.

The hospital at Ganta "is really in pretty bad shape," Ritter said. The building was stripped of most of its equipment and fixtures during the civil war.

"There was very little light," Ritter said. "You could hardly see in the wards on a cloudy day."

Southard-Ritter said it was in better shape than most of the other hospitals in Liberia. It had once served as Taylor's headquarters, "so it was still there," she said.

Ganta, in a rain-forest region, is fairly isolated, Southard-Ritter said. Twice-daily radio checks with the Methodist mission in Monrovia were the only contact with the outside world.

Day-to-day patient care kept the Ritters busy.

"We were doing some good there," Ritter said. "The children were malnourished. Malaria was rampant. We had quite a few kids die there from cerebral malaria. The other problem we had was bloody diarrhea."

Drugs and medical supplies were limited, and the Ritters usually had to drive into Monrovia to get them.

On one trip for X-ray film, they could only get one box. And other basic supplies, like tubing for intravenous and blood transfusions, were hard to come by.

"You'd go in to order 100 or 200 tubings and you'd come home with 25," Southard-Ritter said.

It wasn't uncommon to see newborns infected with tetanus, she said. Women were hospitalized for childbirth only if they needed C-sections. Otherwise, midwives were used.

"They would use rusty razor blades to cut the umbilical cord, and that's how the babies got tetanus," she said. "It was something that would be so preventable in a developed country."

Ritter learned about malaria the hard way when he was infected himself, despite faithfully taking his anti-malaria medication.

"Malaria is a horrible disease," he said. "I didn't realize how bad it was. There's the fever and the chills and the aches and pains. You are just as sick as can be."

He was seriously ill for four or five days.

Liberia is a very poor country. The hospital at Ganta wouldn't treat patients unless they paid cash. Several families asked the Ritters to adopt their children.

The Ritters went to Monrovia to see friends and pick up supplies one weekend when violence broke out again.

They were getting ready for dinner with friends, Ritter said, when they heard "popcorning popping": automatic weapons fire.

"It was AK-47s and grenade launchers and the whole business," he said.

Taylor's forces began sparring with Johnson's forces, who fled to the U.S. embassy.

That Sunday, the Ritters returned to the hospital in Ganta.

The road from Monrovia to Ganta includes some 17 security checkpoints, Ritter said. "Usually they just waved us through," he said. But that Sunday they were stopped at every checkpoint.

The next day the Ritters and their fellow volunteers were told not to worry and to remain in Ganta.

"Tuesday they called and said get back as soon as you can," Ritter said. The Ritters returned to Monrovia that day with about five other volunteers from the hospital.

Again they were stopped at every checkpoint. In some places civilians manning the checkpoints demanded bribes. In others, they worried their luggage and equipment -- including a computer and satellite phone -- would be stolen and sold.

"They were shouting anti-American slogans at us," Southard-Ritter said. "That was my first experience with that sort of thing."

The airport at Monrovia "was a mob scene," Ritter said. They were able to get a flight into the Ivory Coast Thursday, and then they were on their way home.

"We were very sad we had to leave," Ritter said.

Southard-Ritter said she would return to Liberia if she could be sure she and her husband would be safe.

Ritter is less sanguine, pointing out that they might not even be asked to return since they had to leave so quickly.

Last year the Ritters worked at a rural hospital in Mozambique, also in west Africa.

In February they will be returning to Barbuda, a small island in the Caribbean, to work at small hospital.