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.
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