A young girl sells fruits and berries along the street in Antananarivo.

Back in Antananarivo or "Tana" as the adventure travel operators like to call it, Project Manager Chris Dunston began touring me through parts of the capital city where CARE has been concentrating its self-help and development projects. The streets were crowded with cars making it difficult to get around at times. There was a plethora of street vendors selling everything from fruits and vegetables to hand-carved toys and embroidered linens. Young women prepared fried casava and sliced bread to sell at mealtime.

Dunston took me to one of the health clinics that CARE has helped to revitalize. The first clinic we visited was pleasant with bright teal walls and new furniture. Despite a shortage of trained medical professionals due to the closure of Madagascar's medical schools from lack of funding, the doctors were concerned with the availability of quality and affordable health care. They welcomed each new patient.

Women wash clothes in one of the community washing areas in the poor urban settlements of Antananarivo.

Our next stop was one of the 30 poor urban settlements -- known as fokontanys -- where CARE is working to improve the community's infrastructure and access to health care. Teenaged boys sometimes greet visitors with calls of "faza," meaning "foreigner," most of the Malagasy people are warm and welcoming. Young children were intrigued with my cameras and blond hair. They followed me around imitating my French and asking for their picture to be taken.

A young man tries to clear a drainage canal on the outskirts of Antananarivo.

On the outskirts of Antananarivo, neighborhoods are built on barren land that in the past was used to cultivate rice. In those areas, old irrigation canals have fallen into disrepair and have become filled with uncollected garbage, sewage waste and water hyacinths. Clogged with filth, the polluted ditches breed disease-carrying insects and rats, and cause outbreaks of perilous illnesses, including Bubonic Plague, the disease of the Middle Ages that still affects the poor in Antananarivo. During our tour of one neighborhood, two young men had volunteered to clean the drainage canals. They waded through filth and stagnate water, clearing the canals of plants and rubbish in the hopes of alleviating the sanitation problem the area experiences and the diseases that result from them.

Continue to Day 5