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"Put it this way," Dr. Mike Marks said to the group of 22 Americans who stood before him. "Nearly 300,000 people died in the [2004] tsunami, right? Well, that's the same number as die monthly in Africa. Not many people know that. Did you?"

No, I said, shaking my head. I could tell by the surprised murmurs of my companions that they didn't know that either.

"If only Africa had the same outpouring of aid," Marks said. "Who knows what we could accomplish?" He stared at us for a moment, then held up the findings of the Commission on Africa. "This report claims that, unless we intervene in a big way, by the year 2010, every third child in Zambia will be an orphan."

Marks spoke like a seasoned orator, punctuating his statements with Shakespearean idioms, which didn't seem out of place, even against the backdrop of this impoverished African town. Two years ago, he left a lucrative private practice in England to become the sub-Saharan Africa advisor for Direct Relief International, a Santa Barbara-based secular nonprofit that annually donates and delivers $210 million worth of medicines, supplies and medical equipment to countries suffering from extreme poverty, war or disaster. Now Marks spends most of his days among Africa's poorest and sickest, fighting poverty and disease.

We had met him here in Mansa, a remote town in northwestern Zambia, a part of this savagely poor but beautiful country that rarely sees tourists. We had come here to raise money for Direct Relief.

The idea for our trip came from Sherry Villanueva, of Montecito, a friend who is a volunteer member of the Direct Relief board. She's the sort of person who is dead set on bettering the planet and thinks you should be too. "It's our responsibility," she told me.

So, following a growing trend in philanthropic reality travel, Sherry proposed an annual trip to raise money and create awareness of Direct Relief's work. She chose Zambia for the first trip and asked her friends to bring their families. Her goal was to raise $100,000.

We were a group of 11 adults, most in our 40s, and 11 children, ages 10 to 20. The trip costs $5,500, and each family had to raise or donate $15,000 to be part of the group.

The plan was to spend three days visiting clinics supported by Direct Relief in northern Zambia. Afterward, we would head southeast to Luangwa National Park to spend 10 days on safari.

Of the 52 nations in which Direct Relief operates, Zambia was selected for its political stability and stunning scenery. Despite its nascent tourism industry, AIDS, malaria, tuberculosis and malnutrition have ravaged the country's population. Average life expectancy is 33 years. Nearly 1 million Zambians are HIV positive or have AIDS. On average, there is only one doctor per 15,000 people, and the disparity is greater in rural areas.

Although my children were too young to travel on this trip — the minimum age was 10 — I could not pass it up. I wanted to see how American children would respond in a place of such privation.

From the air, the land around Mansa looked plundered and drained, as if Earth itself had given in to apathy. The sky was sepia-stained with smoke, because Zambians burn nearly everything. They burn their fields, they burn garbage, they burn to cook, to flush out animals, to warm themselves. The result is pervasive pollution that stings the eyes and irritates the lungs.

Mansa, a town of about 200,000, looked crafted from whatever was at hand. The streets were cut from dirt, and dust coated all things. Although we saw no other foreigners in Mansa, signs of Western culture were everywhere: "Malcolm X Haircutters," "Michael Jackson Quick Serve" and, bizarrely, a hardware shack called "God Knows Investments."

Women wore the traditional brightly colored fabric wrap skirts, paired with T-shirts sporting brand names. Men sported well-worn Western-style shirts and slacks. Mansa was like thousands of other African towns, a place where people make do and get by.

Early on our first morning here, we split into three groups. Each group would travel hundreds of miles into different parts of northern Zambia. Some took Jeeps; some flew in an African Medical and Research Foundation plane. Our group took a bus to the Mambilima Hospital, close to the river that divides Zambia from the troubled Democratic Republic of Congo, and returned by plane.

Three doctors accompanied us: Jerome Sulubani, born in the Congo, trained in Italy and one of only two pediatricians serving almost 12 million people in Zambia; Bill Morton-Smith, chief medical officer for Direct Relief; and Marks.

"It's frustrating," Sulubani said. "We have so much to do and little to do it with. At Mansa General, we have 403 beds intended to serve the hundreds of thousands of people in the province that might need surgery. In the West, I believe you would call that ridiculous."

Direct Relief, he said, was the only reason he stayed.

We arrived at Mambilima Hospital, where a man in a white coat introduced himself in English as Tentani Mwaba. I called him "doctor," but he shook his head.

"I am not a doctor," he said. "There are no doctors in this part of the province. I am the administrator. We have only one clinical officer and two registered nurses here."

Following him, we entered a room where a woman sat dolefully in a chipped iron bed.

"This is Makemba," he said. "She walked here from the Congo, and she has just lost her third child. She has AIDS, and she knew that here in Zambia there was a clinic with free medicine that could help the baby be born virus-free," he said. "She has already lost two children to AIDS, and her husband had told her this one must live."

She arrived in time for the birth, but the clinic had no nevirapine, which decreases the risk of mother-to-child transmission of HIV/AIDS.

If a mother gets a single dose of the drug during labor and her infant gets a dose within its first 72 hours, the child has an 85% chance of not contracting the virus.

Makemba's baby boy lived for 11 hours. But it wasn't HIV that killed him.

Malnutrition, Mwaba said, shaking his head.

It was as simple as one good meal a day. If Makemba had made that journey across the river months earlier, he told me, she could have been given the vitamins, been told to eat more protein. The baby might have lived.

"This is what you do," he said, as though I were personally responsible for the stockroom of Direct Relief-provided prenatal vitamins and protein powder. "You save babies."

He then ushered me into an empty, fluorescent-lighted, cinder-block room. "This is our new operating theater," he said proudly. "Direct Relief has pledged to equip it."

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