When actress and producer Salma Hayek arrived in Sierra Leone in September, she was not whisked off to a movie set.
She was there not as a celebrity, but as a humanitarian, to see firsthand a leading cause of death in the developing world: tetanus.
"Nightline" co-anchor Cynthia McFadden went along to document the journey.
To most people in the United States, tetanus brings to mind rusty nails and a quick trip to the doctor's office for a shot. But in developing countries like Sierra Leone, maternal and neonatal tetanus (MNT) is a top cause of death among mothers and their babies.
Hayek said that she didn't know what to expect from the trip.
"I was just open to this experience and it's been quite an amazing one," she said.
Hayek's 'Exciting' Work
Sierra Leone has the highest infant and child death rate in the world. One in five children die before reaching their fifth birthday and tetanus is a big contributor -- 21 percent of all infant deaths are related to tetanus.
Tetanus deaths are preventable with routine vaccinations. UNICEF has launched an initiative to eradicate the disease worldwide by 2012. In Sierra Leone the cost of immunizing one person is about 74 cents.
Once a woman is immunized, her children will be protected from the disease at birth, before needing immunizations of their own.
In 2008, Hayek became a spokeswoman for the Pampers "One Pack = One Vaccine" campaign to support UNICEF's efforts to eliminate tetanus. For each pack of specially marked Pampers diapers sold, parent company Proctor and Gamble donates the cost of one tetanus vaccine to UNICEF. The North American campaign has generated funding for more than 45 million vaccines since the beginning of 2008.
"What really excited me about this was the concept of mothers from around the world working together to protect children," said Hayek, who is the mother of a 16-month-old daughter named Valentina.
"The thought of somebody in Los Angeles, where I come from, purchasing the one pack of Pampers ... by doing this that they were going to do anyway, they could ... provide one vaccine for another mother somewhere else in the world, someone they don't know ... these anonymous women around the world coming together to protect women and to protect children was really exciting."
Infants Face Dire Situation
As soon as she landed in Sierra Leone, Hayek was taken to a hospital in the country's capital of Freetown where she saw the painful reality of tetanus. A 7-day-old baby girl named Fatima lay dying. There were no medications to give her but the serum given to horses with the disease.
"I was talking to this little girl and I was touching her and there was the slightest reaction, like she took a couple of breaths," Hayek said. "And then I felt guilty to be in that room because I felt we were taking away oxygen. And as I walked out, I knew it. I felt it, the baby passed away. "
"Her mother was so young and to lose a baby within one week at the age of 19, I cannot think of a worse thing to happen to someone than to lose a baby," she said.
In countries like Sierra Leone, still recovering from an 11-year civil war that ended in 2002, high death rates are due to a combination of deficient health services and education.
Most women have not been vaccinated because of insufficient resources or a lack of information about the preventive measure.
These factors -- together with a lack of transportation in rural areas to bring pregnant women to health clinics -- cause most women in Sierra Leone to give birth at home, in unsanitary conditions that are the breeding grounds for the bacteria that cause tetanus.
The bacteria are spread when dirt enters the body through a cut or wound. Mothers are often infected by contaminated instruments during childbirth. It similarly spreads to their infants when traditional birth attendants cut the umbilical cord with an unsanitary knife, or, as is often the case, the umbilical cord is dressed by the traditional method of packing it with dirt, clay or cow manure.
Once tetanus has been contracted, the most notable symptom is stiffness of the jaw, which leads to stiffness in the throat and difficulty in swallowing.
In babies, that makes feeding impossible because the infant loses the ability to suck. Soon after, the other muscles become stiff and the infant experiences muscle painful spasms and contractions. Death is virtually certain.
Hayek: Bringing 'a Little Bit of Hope'
"It's heartbreaking," Hayek said of the situation. "As sad as it is, it makes it extra sad that there is so much that can be done and it's not done. At the same time there is a little bit of hope in knowing there is a lot you can do."
Hayek hopes her trip will show those who have participated in the campaign by purchasing Pampers that they are making a real difference on the ground in countries like Sierra Leone.
"I want all the people that bought the Pampers and were hoping that their contribution got to the right place and to the right people and wondered if this actually happened to know that I can testify that it did. And that I unfortunately was able to testify [to] what happens when it doesn't get here in time."
An estimated 386 million vaccines are needed to wipe out tetanus in the remaining 26 countries yet to eliminate the disease. Pampers expects to donate at least $10.8 million during the next three years and that will fund more than 200 million more tetanus vaccines, but the work has just begun.
"I think the needs are well identified by the government and by UNICEF ... definitely more facilities. ... There is a huge need for more doctors," Hayek said. "And then you have to understand there's no electricity. So these medications have to be put in cool places; you need to refrigerate them. So if you just get the medication, there might not be a place to store them. And if you get the refrigerator, there might not be electricity for them."
Hayek on Motherhood
Hayek's daughter, Valentina, turned 1 before the trip and the actress spoke about the importance of breast-feeding, especially in underdeveloped countries such as Sierra Leone. In fact doctors there say that because malnutrition is so rampant they would like to see women in Sierra Leone breast-feed for two years. But such behavior is rare. The reason? Men urge their wives to quickly stop breast-feeding because of cultural mores that forbid sexual intercourse with breast-feeding women.
"It is the best thing you can do for your child, not only the bonding, that's how you build the immune system, so in a country like Africa imagine how important it is for the mothers do that," she said. "But here, there is the belief that if you are breast-feeding you cannot have a sexual life so the husbands, of course, of these women are really encouraging them to stop and this is just a taboo."
Despite all the challenges in Sierra Leone, Hayek is hopeful.
"It's a very complicated but very doable, very doable project," she said, one that she hopes to share with her own daughter one day.
"When she grows up I'm going to make sure ... when I continue to do this work that she comes with me and that she is in touch with all of these beautiful people and all of the different kids of people around the world and that she continues to be a generous and caring person," Hayek said. "I think that's the best thing I can give her as a mother."
For more information on the "1 Pack = 1 Vaccine" campaign and UNICEF's efforts to eradicate tetanus worldwide, visit www.unicefusa.org or call 1-800-4-UNICEF.