Name: Steven
Lives in: Toronto, Ontario, Canada
Destination: San Marcos, El Salvador
Trip Date: May 2014

El Salvador is the smallest and most-densely populated country in Central America. Although crime and violence are serious problems in El Salvador, after taking proper precautions, foreigners safely travel to El Salvador each year for study, tourism, business and volunteer work, enjoying the culture and many sights that El Salvador has to offer. Steven recently visited El Salvador and shares his own experience below.

Passport Health: What parts of El Salvador did you visit and what was the purpose of your trip?
Steven: My main destination was San Marcos, El Salvador, but I visited and worked in the following cities: San Salvador, San Miguelito, Soyapango, Comasagua and the Volcano of San Salvador. I traveled as the Director of Evangelium & Apologia Ministries, a Christian para-church organization, and our purpose for the trip was for missions, the propagation of the Christian faith, while strategically, in effect, re-orienting youth’s lives towards peace and progress instead of commonplace violence and crime.

Passport Health: Did you travel alone, with family/friends, or with a group?
Steven: I traveled with my wife, Cindy, and two colleagues, Filipe of Edmonton, Alberta, and Ciby of Atlanta, Georgia.

Passport Health: Do you have any previous experience with travel abroad?
Steven: This was my first time leaving North America.

Passport Health: How did the daily life of the locals differ from the life you live back home?
Steven: The daily life of the locals is very different in comparison to Canada. Where in North America it’s common to have a closed home, in El Salvador it’s a luxury. For example, many parts of the homes are uncovered by roofs, such as the main hall, bathrooms, and corridors. It’s open air which allows wildlife to enter the house on a consistent basis.

Security and safety is another concern, no one is safe in their neighborhoods. Police and military soldiers often patrol the streets with machine guns, shot guns, and grenades. The violence and crime has spilled into every street due to the on-going wars between the national crime gangs (“The Maras” and the “MS-13”), and the federal government. Foreigners are targeted and killed for their money on a regular basis, even locals must mind their own business and seek the safest route in groups. Approximately 10 cars are stolen each day, which has led to increased poverty and debt.

Another difference is the quality of life regarding hygiene, where bathrooms are always un-attached to homes, no water is clean and drinkable unless it’s bottled and from the supermarket, and when the water supply runs out in the homes, showers often then involve buckets of filthy water.

Passport Health: Did you eat any local delicacies or interesting foods during your trip?
Steven: I had the opportunity of eating the national delicacy of Pupusas, soft tortillas filled with chicharon (pork), cheese, beans, and other combinations. Even local fruits such as Nances which are not commonly found to be imported into Canada are extremely sweet exotic fruits.

Passport Health: Was the weather any different than in your hometown, and if so, was it challenging to acclimate?
Steven: There was a difference, where Toronto is often colder during the spring season, but El Salvador nation-wide often hangs around the 35 degree Celsius mark, but drastically drops to 16 degrees overnight. The fast changing climate from day to night is challenging because you don’t know how to dress, whether to bring a sweater or to go sleeveless.

Passport Health: What was the most memorable experience during your trip?
Steven: My most memorable experience was speaking to schools in the cities of San Jacinto and San Miguelito, where over 200 students attended a lecture where I spoke on the temptations of youth to leave the school system and incorporate with the national crime gangs. I encouraged them to continue investing in their futures, to follow their dreams in their pursuit of professions, and to get them connected with a church where they can live virtuous lives building up and improving their communities under biblical teachings and local leaders. Their response was overwhelmingly positive, and having brought 50 New Testament Bibles for distribution, students were desperate for a copy, but our supply could not meet the vast demand.

Passport Health: Did you find any cultural similarities between El Salvador and Toronto?
Steven: I grew up in a Latino background. My mother is Ecuadorian and my father is Portuguese, so culturally everything is the way I was raised. It is for this reason that I did not experience a culture shock.

Passport Health: What was most surprising about your trip?
Steven: The most surprising aspect of my trip was seeing how tense busy streets were, and how scary desolate streets are. No matter where you are, there are always heavily armed men guarding properties and public streets. Even military soldiers patrolling highways with armored vehicles can be intimidating.

Passport Health: What places of interest or activities do you recommend in El Salvador?
Steven: I recommend visiting the beaches of El Salvador. The volcanic sand throughout the beaches makes it a black beach, a very unique scenery. What I would also recommend is visiting the Mayan ruins for educational and touristic purposes. But above all, I would recommend visiting local churches and volunteering to help with meeting the needs of their communities.

Passport Health: How did your trip impact the way you view life abroad?
Steven: It opened my eyes. We take life, security, clean water, and our citizenship for granted. In fact, we worry about acquiring our wants, when there are countless of families worried about whether they can afford their next meal.

Are you planning a trip to El Salvador or another country? Be sure you are healthy and prepared for your adventure by scheduling a visit with a travel health specialist before you go.

So Many Vaccination and Healthcare Options

Many people today take advantage of the myriad options available for obtaining vaccinations and other healthcare services. On-site clinics provided by an employer and the availability of certain vaccines at a local pharmacy or health department are common examples of the decentralized healthcare options available to the modern consumer. Due to circumstance and convenience, consumers increasingly receive vaccines from these alternative options, instead of receiving them from a primary care physician. Indeed, moves to new cities and states are a more common part of modern life than at any time in the past, which makes finding and maintaining a PCP relationship even more challenging. Many adults today do not have a primary care physician in the first place (in fact, according to HealthCentral.com, the average person will see nearly 20 doctors during his or her lifetime!), and, even if a person is one of the few with a PCP, not all healthcare providers offer all potentially needed vaccinations, meaning that multiple sources may be necessary to complete the required and recommended vaccinations for various life events such as starting a new job or school year or a visit to a foreign country. It is no exaggeration to say that having all immunizations administered by one provider is virtually impossible, and having all medical records maintained in one place is just as challenging.

The Importance of Maintaining Your Vaccination History

When your personal vaccination history is unclear, you forfeit the security of knowing your health is protected as it best can be. Additionally, if vaccination records are not properly maintained, you may risk paying unnecessarily for a previously administered vaccination or an antibody titer test, which measure the level of disease antibodies (and hence immunity) in a blood sample. Although convenient and preferable to unnecessary vaccinations, it is not enough to rely on titer tests as a replacement for properly maintained records.

The Advisory Committee on Immunization Practices regularly reviews and updates the recommended vaccination schedules. Many vaccinations require multiple doses with varying dosing schedules, and following this complicated schedule is imperative for maximum protection and immunity. However, the best way to follow this schedule of vaccination best practices is to properly and accurately maintain record of vaccinations already received. Unfortunately, without a central solution for your vaccination records, record maintenance and schedule adherence is incredibly complicated, and you risk your health being compromised as a result.

What is a Vaccine Registry?

Many states and health organizations offer vaccine registries, which are central databases where important vaccination history is stored for ease of access by health professionals. However, even in states that have a system established, guidelines vary, utilization and maintenance of the database is not always required, and taking control of vaccination records often falls back on the patient.

For many, the days of relying on a doctor’s office to maintain all of your medical and vaccination records are a thing of the past, if ever even experienced at all. With the idea of falling back on a single PCP quickly becoming an antiquated and unrealistic option, it is important to seek a trusted solution for your important vaccination records.

Luckily, a trusted solution exists. Passport Health’s proprietary Vaccine Registry not only provides a reliable record keeping solution, but it also facilitates the record sharing process, for both individuals and employers. Records may be added as needed to your medical profile and easily shared with those with a need to know, such as medical professionals or your employer, solely through your expressed consent to release records. Passport Health’s Vaccine Registry provides convenience and peace of mind, is completely free for clients to use, and, crucially, it empowers you to take control of your health through safeguarded and updated records.

Sources
Annals of Internal Medicine: Article on Recommended Immunization Schedule
Health Central: Article on Multiple Providers Seen Per Person
Passport Health: Vaccine Credentialing Management

Great success has been made in combating Polio in Southeast Asia. However, that does not mean global efforts to combat this devastating disease can be relaxed. Indeed, the UN has labelled the current Polio outbreak in the war-torn Middle East the “Greatest Polio Challenge in History.”

What Is the Situation?

Polio is a deadly viral infection that can paralyze or even kill those who are affected by it. In most countries, vaccination against polio begins in infancy, and booster doses are administered throughout childhood. Booster doses can be given to adults who work in laboratory setting or who travel to regions where Polio is endemic. The virus has been eradicated from most Western countries including Canada and the United States, but there is still a long, hard fight ahead for public health officials if they want to achieve a Polio-free world.

While Polio has recently been eliminated in Southeast Asia, outbreaks of the disease have been appearing in the Middle East. This is a source of great concern for public health officials. Cases of Polio have been reported in Iraq, Syria, Somalia, Kenya and Ethiopia. These reports are alarming as it means that instability in the region is preventing health specialists and officials from eradicating the deadly disease. In addition, communities in some of these areas have rebuffed the efforts of vaccination workers, sometimes with violence, due to a mistaken assumption that the Polio vaccine causes sterility, low testosterone and other problems.

Why Does War Facilitate the Spread of Disease?

[Read more…]

Many Primary Care Providers and local physicians’ offices ask this very question every day. A practice may not stock specialty vaccines like Yellow Fever, Japanese Encephalitis, or Typhoid Fever, and staff can be at a loss as to where to refer valued patients who come in for an appointment before an overseas trip looking for travel vaccines and expert travel health advice. Look no farther, however; Passport Health is the travel vaccine referral partner of choice for a growing number of doctors’ offices across North America, and we are actively growing our physician referral network.

Just last week, Passport Health was pleased to attend the Idaho Academy of Physicians Conference in McCall, Idaho, attended by over 60 family practice physicians in the local community. We displayed our services with other leading healthcare vendors like Medimmune and Teva Pharmaceuticals as well as key players in the local community like the Idaho Dairy Council and the Idaho Beef Council. While at the conference, we were struck by how many physicians simply did not know that our services, and our ability to fill a key gap in patient care, existed. Happily, our local travel medicine clinic in Eagle, Idaho, is conveniently located for many of the conference attendees, and we look forward to working more with them, and their patients, in the future.

In short, travel medicine, travel consultations, and travel vaccines are Passport Health’s bread and butter; we are the travel medicine experts, and we are happy to serve as the referral partner for local doctor’s offices across North America. For more information about this service or to set up a referral relationship, please visit this link – https://www.passporthealthusa.com/where-can-i-refer-my-patients-for-travel-vaccines/.

This year, Passport Health will celebrate our 20th anniversary, and what a fabulous journey these past two decades have been. I could not be prouder of Passport Health’s progress over the years. As I reflect, I first and foremost want to thank all of the travelers who have entrusted their health to Passport Health, and our clinical personnel who have provided each and every client with nothing less than first class service and medical advice. Additionally, a huge thank you is owed to all of our clinic owners, managers, and administrative staff as well as our corporate team; you have all given so much to this business, and we would not be where we are today without the contribution each and every one of you has made. Thanks to our suppliers, partner organizations, and even our competitors who have helped inspire us to become the best, leading, and largest travel medicine provider in North America.

It was over 20 years ago that I noticed a gaping hole in the field of travel medicine. I was working as the director of a university health center; more and more of my students were traveling (often to underdeveloped countries), but pre-travel medical services were not readily available and were incomplete and fragmented, at best. Many students fell ill, often seriously, during an international trip, despite having received some immunizations prior to departure. Simply giving shots without proper counseling on travel health and safety was clearly not working; it was like handing a diabetic a vial of insulin with no counseling or dietary training and expecting that person to stay healthy! A comprehensive approach was necessary to keep travelers happy and healthy, and I worked on my plan to implement our holistic solution. I listened to what my students and traveling faculty wanted and needed to stay well overseas and combined these needs with my nursing background to develop a comprehensive program that included counseling, immunizations, specialty travel supplies, medications, evacuation insurance, and a follow-up service for booster shots. In 1994, I felt the program was ready for implementation, and Passport Health opened its first office in Baltimore, Maryland.

The business was immediately successful; we offered travelers convenient, expert, and professional pre-travel medical care. All Passport Health locations had easy parking; were conveniently located close to major roads; were staffed by medical professionals who were trained as experts in travel medicine, immunology, and vaccines; and offered clients a professional, comfortable, prompt, well-environment for their appointments. Passport Health was a one-stop shop for travel medicine: a place to get all vaccines, even specialty and hard-to-find shots like Japanese Encephalitis and Yellow Fever; travel accessories to promote health and safety; insurance; global cell phones; and an itinerary-specific consultation that covered everything from safe foods to eat to how to stay protected against mosquito-borne diseases like malaria and dengue fever. What a change a visit to Passport Health was from the other travel medicine options available – limited services at hospitals, unreturned phone calls on message lines, a fifteen minute visit with a provider sandwiched between other patients, or inexpert advice from providers who had no travel medicine training, nor the time to offer any destination-specific advice!

As I look back on those early years, I am reminded of why I started this business in the first place. One of my first travel clients was also one of my most memorable. A young law student came to my office in tears. She had recently married the love of her life, a young man from Ghana, and they had plans to travel back to his home country to continue the celebration with his family. This would not be her first trip to Ghana, however; she had traveled to Ghana to meet his family before the wedding, but, while overseas, she became severely ill to the point that she had to be hospitalized. Her experience was so horrible that she was terrified to go back to Ghana again, but she was willing (albeit with a healthy dose of trepidation) to do it for love. Upon reviewing her health records, I realized that her illness was actually a severe case of travelers’ diarrhea, the number one ailment to afflict international travelers, and she had simply not received sufficient counseling on how to avoid or treat this disease prior to her first trip to Ghana. I gave her some extra advice, and she was off to Ghana with her husband, equipped with strategies to stay well. Upon her return from Ghana, the young woman came to see me stating that she had followed my advice, and that was the reason she stayed healthy and happy this time. That was when I realized I was on a mission: to protect the health of each and every traveler so that he or she can enjoy and remember trips with only photos and fond memories.

Indeed, I wanted to improve the experiences of all travelers, beyond those I could counsel myself; in order to offer this dearly needed service to all travelers, it became clear that it was necessary to replicate the Passport Health model across the country. Therefore, to facilitate expansion, I sold the first Passport Health franchise in 1997. By 2000, there were 34 Passport Health locations in 15 states, and the business showed no signs of slowing down. Then, the terrible attacks of September 11th, 2001, occurred, and travel nearly ground to a halt, but Passport Health’s innovation did not. The events of 2001 gave Passport Health the opportunity to serve new communities: the US government and our armed forces.

Following the Anthrax attacks of that same tragic year, Passport Health became the only private company to ever respond to an act of bio-terrorism by administering the Anthrax vaccine to postal and tabloid workers up and down the East Coast. We received a call two days before Christmas in 2001 asking if we could send doctors and nurses to multiple sites. Initially, we offered counseling and antibiotics. However, in an effort to help calm the public hysteria that was setting in, the CDC decided to offer the Anthrax vaccine for post-exposure as well, but doing so required training on Investigational New Drug protocols and completion of all the attendant paperwork since the FDA had only approved the vaccine for pre-exposure at that point. For eight weeks, we worked tirelessly to comply with constantly changing protocols, and I am proud to say we saved numerous lives in the process due to a combination of medical expertise with a lot of grit, determination, and hard work.

As we are all aware, the September 11th terrorist attacks prompted a military build-up, but the Department of Defense was not fully prepared to handle all aspects of pre-deployment mass vaccination. However, Passport Health was ready and able to augment their service, and the Department of Defense called on us to vaccinate National Guard and Reserve units across the country to ensure they were protected against disease during their overseas tours of duty. As the build-up continued, Passport Health was able to serve in yet another capacity by operating a 24/7 global vaccine call center to provide vaccine information for the military personnel and the medical community at large. The US Department of Defense called on Passport Health to assist during these troubled times, this time to institute a Smallpox vaccination training program, as a further protective measure for our men and women in uniform. The general medical community was very knowledgable on the robust reactions to this vaccine, but Passport Health was able to provide training to help fill this knowledge gap. I am proud and honored to have played some small role in protecting the health and safety of the brave men and women who serve our country.

While the size and scope of the Passport Health business continued to expand, partially in response to geo-political changes, it was also time to respond to changes in technology as well. By the early 2000’s the Internet was playing an increasingly larger role in business development, and it did not take a crystal ball to know that the Internet, and its impact on healthcare, was here to stay. I began to invest heavily in the development of a proprietary Electronic Medical Record and Vaccine Registry system to provide all clients with standardized, streamlined, and convenient access to their health records. Now, as fewer individuals have a Primary Care Provider and instead receive healthcare services from a range of sources, having a single repository for health records has become a profoundly needed service, and one that continues to differentiate Passport Health from others trying to compete.

As proud as I am of Passport Health’s past, I am even more excited about our future. Over the past few years, we have greatly expanded the corporate team and the divisions these team members manage. We now have over 230 clinics in the United States and Canada, with plans to expand across the US and into additional countries. Our network of clinics now serves over 1,200 corporate clients, including many Fortune 500 companies, in addition to the 95,000 individual travelers and clients we see on a monthly basis. We have expanded our service range to include onsite flu and other vaccination events, specialty physical examinations, and vaccine credentialing services. We continue to proactively fill niche healthcare areas, but always do so with the superior service and attention to detail that have driven the Passport Health business model from day one.

Have I done everything perfectly over the years? No! Would I change a single thing about the Passport Health journey? Absolutely not! If you don’t take a bit of educated risk along the way, you will never move forward. What matters is to stay focused, passionate, and continually look for ways to improve, a credo that I, and every team member, adhere to wholeheartedly here at Passport Health. Our steadfast support of concierge, client-focused care continues to drive us to find ways to streamline processes while keeping superior patient care at the forefront of all operations.

Fran Lessans, RN, MS

Passport Health Founder, President and CEO