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Long before anyone suspected Ebola would cause the raging epidemic that’s killing thousands of people every month in West Africa, a woman got sick on a huge rubber tree plantation in Liberia.
What Firestone Liberia Inc. did in response to that March case is a textbook example of how to fight the virus, public health experts say.
It included quick isolation of the patient and a quarantine of her family. When one child got sick, the father was given personal protective gear so he could care for him until lab tests came back negative.
“Aspects of Firestone's response to the current Ebola epidemic appear to have limited its growth among the local population and might be successfully implemented elsewhere,” Dr. Erik Reaves of the Centers for Disease Control and Prevention and colleagues wrote in a report released Tuesday.
“The experience of Firestone in Liberia also might provide successful strategies for interrupting Ebola transmission to health care workers.”
Ebola, which before had caused only limited outbreaks affecting no more than a few hundred people, has infected more than 9,000 people in West Africa and killed more than half of them, according to the World Health Organization. But WHO and other experts say this is a large underestimate, and WHO says the death rate is closer to 70 percent.
"We were in the situation of figuring it out on our own.”
The woman who got sick in March was married to an employee, says Don Darden, a spokesman for Firestone’s parent company, Bridgestone. “She had been upcountry taking care of a relative who had died of Ebola,” Darden said.
“We contacted the government, the Ministry of Health, and basically at the time there was nowhere to take her,” he said. “We were in the situation of figuring it out on our own.”
Employees hit the Internet, Googling Ebola and finding out quickly that they had better isolate the patient and quarantine her family. They didn’t have the right personal protective equipment for health care staffers, so they improvised. “We had suits that could be used in a chemical spill. Those were the first things we reached for,” Darden said.
“It turned out they were as good as or better than anything you could have used.”
Firestone has a huge amount of control over its 185-square-mile rubber and wood plantation east of Monrovia, Liberia's capital. It runs schools, hospitals and, yes, a company store. There’s a hydroelectric plant, and the company can ship in the supplies it needs. “We were able to do some things pretty quick because we do have that organization,” Darden said.
The woman died, but no one in her family was infected and no one else got sick until August, when Ebola was raging across Liberia. The company closed four of its schools and turned them into quarantine centers, luring in employees by feeding and caring for them.
“If they started showing any signs or symptoms, we’d move them up to the next level of care,” Darden said. The CDC set up a lab nearby to do lab tests, so Ebola cases were quickly diagnosed. When the government closed schools, the company sent its 450 staff teachers into nearby communities to educate people about Ebola and encourage them to seek treatment quickly.
"Now people are seeing survivors so they are more willing to come forward and get the treatment that they need."
“As of yesterday at Firestone Liberia, we’ve had 78 total Ebola cases and 55 deaths,” Darden said. Two patients are being treated.
The company has 8,500 employees but provides health care to 80,000 Liberians, including people in surrounding communities. One key move was setting up an incident management system — something governments were slow to do in Liberia, Sierra Leone and Guinea, the three worst-hit nations.
Quick isolation of suspected cases and thorough training of health care workers has helped Firestone manage the outbreaks, the CDC team said.
And the company is taking care of survivors too, in a very public way, providing “graduation” ceremonies for patients cleared of virus and supplying them with food, mattresses and other furniture that were destroyed when they learned they were infected.
“There is such a stigma with this when it first began and now people are seeing survivors so they are more willing to come forward and get the treatment that they need,” Darden said.
Firestone is a private company and could move quickly, and governments cannot always be so nimble, the CDC said. The three countries being affected also do not have the same resources as Firestone.
But countries and aid organizations can try to replicate other elements of the company’s successful response, including education, social mobilization and reintegration programs.