Wednesday, October 22, 2014

surprise, surprise..., the firestone rubber plantation stopped ebola in its tracks


CDC |  On March 30, 2014, the Ministry of Health and Social Welfare (MOHSW) of Liberia alerted health officials at Firestone Liberia, Inc. (Firestone) of the first known case of Ebola virus disease (Ebola) inside the Firestone rubber tree plantation of Liberia. The patient, who was the wife of a Firestone employee, had cared for a family member with confirmed Ebola in Lofa County, the epicenter of the Ebola outbreak in Liberia during March–April 2014. To prevent a large outbreak among Firestone's 8,500 employees, their dependents, and the surrounding population, the company responded by 1) establishing an incident management system, 2) instituting procedures for the early recognition and isolation of Ebola patients, 3) enforcing adherence to standard Ebola infection control guidelines, and 4) providing differing levels of management for contacts depending on their exposure, including options for voluntary quarantine in the home or in dedicated facilities. In addition, Firestone created multidisciplinary teams to oversee the outbreak response, address case detection, manage cases in a dedicated unit, and reintegrate convalescent patients into the community. The company also created a robust risk communication, prevention, and social mobilization campaign to boost community awareness of Ebola and how to prevent transmission. During August 1–September 23, a period of intense Ebola transmission in the surrounding areas, 71 cases of Ebola were diagnosed among the approximately 80,000 Liberians for whom Firestone provides health care (cumulative incidence = 0.09%). Fifty-seven (80%) of the cases were laboratory confirmed; 39 (68%) of these cases were fatal. Aspects of Firestone's response appear to have minimized the spread of Ebola in the local population and might be successfully implemented elsewhere to limit the spread of Ebola and prevent transmission to health care workers (HCWs). 

Firestone Liberia, Inc. is an affiliate of Firestone Natural Rubber Company, LLC, a division of Bridgestone Americas, Inc., that operates rubber tree plantations in Liberia. The original plantation was established in 1926 by the Firestone Tire & Rubber Company. The company harvests natural rubber and wood from a plantation area of approximately 120,000 acres (185 square miles) in the Firestone District of Margibi County (Figure 1). The populations of Margibi County and Firestone District are 238,000 and 69,000, respectively (Government of Liberia 2014 population estimates). Employees and their dependents reside within 121 communities inside the Firestone plantation. Nearly 16,000 students matriculate at 27 schools operated by Firestone. Although Firestone manages the plantation, the area is accessible to non-company residents from surrounding communities and includes roadways permitting passage of people and commerce.

Firestone operates a referral hospital, two clinics, and seven health posts, with 181 health care providers within the plantation area. The main hospital has an emergency department, labor and delivery department, intensive care unit, and 170-bed routine inpatient capacity with an additional 130-bed surge capacity for both adult and pediatric patients. Health posts are located within housing communities and staffed by non-physician primary care providers who reside in those communities. Firestone also operates a mobile medical unit that follows a daily route through the plantation area and surrounding communities. Firestone's reported health care catchment population of roughly 80,000 includes employees, retirees, dependents, and the residents of the densely populated surrounding communities in Margibi and Montserrado counties. Firestone provides perinatal care (representing 70% of all deliveries at Firestone's main hospital), routine vaccinations, primary care through the mobile medical unit, and emergency care for members of the communities surrounding Firestone's plantation area. The total number of patient visits to Firestone facilities averages nearly 5,500 per month.