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SEVENTH ANNUAL

Global Health Symposium March 18-20 and 25, 2019

Sponsored by

Office of Faculty Affairs

Office of Global Health

Office of Student Life and Engagement,

Division of Student Affairs

Events at a Glance

Daily events will be held from noon-1 p.m. Lunch will be provided.

Monday, March 18 Armour Academic Center Room 539

Tuesday, March 19Armour Academic Center Room 539

Wednesday, March 20Armour Academic Center Room 540

Monday, March 25Armour Academic Center Room 971/975

Monday, March 25Armour Academic Center Room 994A/B3-5 p.m.

Assuring Lifelong Access to High-Quality Care and Treatment Services for Persons Living With HIV in Low- and Middle-Income Countries: a Human Rights Challenge for the Global Response to HIV/AIDSBradley S. Hersh, MD, MPH, FACP Global Health Consultant

From Generosity to Justice: Ethics and the Practice of Global Health DeliveryPhuoc V. Le, MD, MPH, DTM&H Associate Professor of Medicine and Pediatrics, University of California, San Francisco; and Assistant Professor of Public Health, University of California, Berkeley

Caring for Survivors of Torture and War Trauma – Direct Action for Complex TraumaBraden Hexom, MD Associate Professor and Residency Program Director, Department of Emergency Medicine, Rush Medical College

Socioeconomic and Racial Disparities in the Prevention, Detection and Outcomes of Sports-Related Concussions: a Review*Shyam Desai, BA, Third-Year Student, Rush Medical College*Jennifer Denike, BA, Third-Year Student, Rush Medical College

Witnessing the Rabies Epidemic in India*Allison Rzepczynski, MD, Resident, Department Internal Medicine, Rush Medical College

Introducing Microscopy to Study Prevalence of Vaginitis in Women from Jerusalem, Haiti*Xixi Zhao, MD, Resident, Department of Internal Medicine and Pediatrics, Rush Medical College*Angela Li, MD, Resident, Department of Internal Medicine and Pediatrics, Rush Medical College

Lessons Learned From Introducing Dilation and Evacuation in Low-Resource Settings: Experience From Tigray Region in Northern Ethiopia *Laura Laursen, MD, MS, Assistant Professor, Department of Obstetrics and Gynecology, Rush Medical College

Poster Session and Award Reception

*The presenting member is listed here. For a complete list of project members, please see poster abstract.

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SEVENTH ANNUAL


Dear Students, Faculty and Staff:

On behalf of the Office of Global Health at Rush, I thank each of you for participating in the

seventh annual Global Health Symposium. As health care providers, we dedicate ourselves to

the mandate of “primum non nocere”, meaning “first, do no harm.” Often it is easy to identify

when harm is likely to occur, but sometimes the dangers are much more subtle.

The arena of global health is fraught with such dangers. Consider the negative consequences

of unintentionally undermining existing health care systems, creating dependency, providing

culturally inappropriate care — all under the belief that we are doing good. We will explore some

of these themes and hope you leave with enhanced knowledge and sharper tools to do good

and minimize harm.

Thank you to everyone sharing your global and local health equity experiences. We are looking

forward to learning from, and inspiring, each other.

Gratefully,

Stephanie Crane, MD

Director, Office of Global Health, Rush University

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Dear Students, Faculty and Staff:

I am excited to welcome you to the seventh annual Global Health Symposium. We are pleased

to welcome accomplished speakers to share their views and experiences.

One of the goals of the Office of Global Health is to expose the Rush community to global

experiences and facilitate scholarly work on initiatives that benefit international communities.

Many of our faculty, students, residents and staff devote their time and efforts to make an

impact worldwide. The symposium provides a platform to share the results of their work.

I thank you for supporting the Offices of Faculty Affairs and Global Health, and our co-sponsors,

the Office of Student Life and Engagement and Division of Student Affairs.

We look forward to your continued involvement.

Sincerely,

Susan Chubinskaya, PhD

Vice Provost, Faculty Affairs, Rush University

SEVENTH ANNUAL


SEVENTH ANNUAL


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Assuring Lifelong Access to High-Quality Care and Treatment Services for Persons Living With HIV in Low- and Middle-Income Countries: a Human Rights Challenge for the Global Response to HIV/AIDSBradley S. Hersh, MD, MPH, FACPGlobal Health Consultant

Biography

From 1987 to 2017, Bradley Hersh, MD, MPH, FACP, participated in global health initiatives with the U.S. Centers for Disease

Control and Prevention, the World Health Organization and the Joint United Nations Programme on HIV/AIDS, with assignments

in Atlanta; Burundi; Washington, D.C.; Switzerland and Cambodia. Most of his work focused on supporting low- and middle-income

countries in reducing morbidity and mortality from vaccine-preventable diseases — especially polio eradication and measles

mortality reduction — and scaling up HIV prevention and treatment programs.

Since retiring in 2017, Hersh has served as an independent consultant in global health, dividing his time between Switzerland and

Chicago. Hersh, a native of Chicago, studied bacteriology at the University of Wisconsin-Madison, and received his medical degree

from the Chicago Medical School at Rosalind Franklin University and a master’s in public health from the University of Illinois at

Chicago. He completed his residency in internal medicine at John H. Stroger, Jr. Hospital of Cook County. He is board certified in

internal medicine and preventive medicine, and is a fellow of the American College of Physicians.

Synopsis

Remarkable progress has been made in the global response to HIV/AIDS. When HIV was first identified in 1983, the overwhelming

majority of people infected with the virus died. In 1996, with the discovery of Highly Active Anti-Retroviral Therapy, or HAART,

hope was restored. HIV infection became a potentially treatable condition.

However, since the cost of HAART was about $20,000 per year and more than 90 percent of people infected with HIV were living

in low- and middle-income countries, most life-saving HIV treatments were reserved for those living in high-income countries. HIV

incidence and mortality rates continued to increase unabated in the rest of the world.

Since 2002, with the establishment of the U.S.’s President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS,

Tuberculosis and Malaria, unprecedented international funding and novel partnerships became available for supporting HIV

prevention treatment and care activities in low- and middle-income countries. At the end of 2017, of the 36.9 million people

globally estimated to be living with HIV, 21.7 million (59 percent) were accessing anti-retroviral therapy. In the same year, however,

there were 1.8 million new HIV infections and 940,000 AIDS-related deaths, resulting in a continued expansion of the epidemic.

Innovative strategies and technologies are needed to reduce HIV transmission and create a world without AIDS.

Global Health Symposium

Monday, March 18, 2019 Noon-1 p.m., Armour Academic Center, Room 539

From Generosity to Justice: Ethics and the Practice of Global Health DeliveryPhuoc V. Le, MD, MPH, DTM&HAssociate Professor of Medicine and Pediatrics, University of California, San Francisco;

and Assistant Professor of Public Health, University of California, Berkeley

Biography

Phuoc V. Le, MD, MPH, DTM&H, is an associate professor of medicine and pediatrics at the University of California, San Francisco,

and an assistant professor of public health at the University of California, Berkeley. Le completed a combined residency in internal

medicine, pediatrics and global health equity at Brigham and Women’s Hospital and Massachusetts General Hospital, teaching

affiliates of Harvard Medical School.

During residency, he worked with Partners in Health to provide equitable health care in Rwanda, Lesotho, Malawi and post-

earthquake Haiti. Le co-founded the HEAL Initiative global health fellowship at UCSF in the Department of Medicine.

Synopsis

Much of today’s global health landscape — including implementation work, financing and the education of undergraduate medical

education/graduate medical education trainees — involves the framing of global health delivery from a generosity perspective.

Too often this leads to a relative lack of accountability for Global North (high-income countries) trainees and implementers, which

can result in preventable harm to Global South (low-income countries) communities. Le argues that a concerted re-orientation of

global health from generosity to justice is crucial to the global solidarity movement for health equity.

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Tuesday, March 19, 2019 Noon-1 p.m., Armour Academic Center, Room 539

Caring for Survivors of Torture and War Trauma – Direct Action for Complex TraumaBraden Hexom, MDAssociate Professor and Residency Program Director, Department of Emergency Medicine,

Rush Medical College

Biography

Braden Hexom, MD, is an emergency medicine physician and associate professor at Rush Medical College. He is currently the

residency program director for Rush’s emergency medicine residency program, which had its inaugural class begin in July 2017.

Hexom is a graduate of the University of Wisconsin-Madison and earned his medical degree from the Medical College of

Wisconsin in Milwaukee. During residency training at the Mount Sinai School of Medicine in New York, he developed an interest

in global health through clinical work in Guatemala, Honduras, Liberia and Haiti. He worked with Mount Sinai’s Global Health

Training Center and other collaborating institutions to provide emergency care and infrastructure development support at

JFK Medical Center in Monrovia, Liberia.

He was a faculty mentor for Mount Sinai’s Global Health Student Program and has advised students working in Jamkhed, India,

and Queens, New York. He was a founding director of the Libertas Center for Human Rights, a comprehensive medical clinic at

Elmhurst Hospital in New York for survivors of torture. His research interests include identifying the health care seeking behaviors

of trauma survivors and improving access to care. He has served as a reviewer and editor of the Global Emergency Literature

Review since 2011.

Synopsis

Many more of our patients who are immigrants have survived more traumatic disruption of their lives, countries and families than

we realize. Patients who have been tortured exhibit an especially complex constellation of symptoms, which manifest as both

psychiatric and medical problems.

We will discuss how to identify patients who have potentially been tortured, as well as how to advocate for the comprehensive

and individualized services needed to support survivors of torture in their recovery. The initial step is simply to acknowledge an

individual’s often traumatic and frightening journey. Developing a rapport and safe environment is essential to facilitate history

taking. Acknowledging trauma and allowing patients to share their experiences can help determine where further care is most

needed. Having a network of likeminded specialists who understand complex trauma fosters comprehensive care and establishes

a medical home.

We will also discuss cases in which patients continue to experience retraumatization due to the process of seeking asylum, and

how we can guide patients through the process. Using examples of especially difficult cases, we will explore the cultural and

communication barriers to achieving health stability.

Finally, we will discuss how physicians can affect larger policy change to improve access of care for survivors. Volunteering to

evaluate, document and testify in immigration proceedings is a highly effective practice that can mean significant improvement in

the medical and psychiatric health of asylum seekers.

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Wednesday, March 20, 2019 Noon-1 p.m. Armour Academic Center, Room 540

1. Socioeconomic and Racial Disparities in the Prevention, Detection and Outcomes of Sports-Related Concussions: a Review1Desai S.A., BA; 1Denike J.R., BA; 2Dugan S.A., MD, PT 1Rush Medical College, Chicago; 2Department of Physical Medicine and Rehabilitation, Rush University Medical Center

The subject of concussions has been brought to the forefront of news in recent years, largely discussed in the context of high-

profile professional athletes. However, nearly two-thirds of the estimated 300,000 sports-related mild traumatic brain injuries, or

mTBI, that occur annually are in those younger than 19 years old. As more attention and research is devoted to the study of the

pathophysiology, prevention and outcomes of mTBI, socioeconomic and racial disparities are also being explored. While increasing

research on this subject is available, a comprehensive review of that data has not yet been published.

The goal was to perform a comprehensive review of studies on socioeconomic and racial disparities surrounding prevention,

detection and outcomes of sports-related concussions.

A comprehensive PubMed search was performed using the following search criteria: “concussion and (disparities or health

disparities or socioeconomic status or racial disparities).” In addition, the search was sorted by using the “Best Match” option,

and only human studies until Dec. 31, 2018 were reviewed.

Through a thorough examination of the literature, we found evidence that children in lower-income communities may be less likely

to have access to concussion prevention, such as flag football leagues and coaches trained in football safety. Recognition, and

thereby diagnosis and subsequent treatment, may also be poorer in low-income communities and communities with majority black

or Hispanic populations. It has been shown that coaches in these communities received less training in concussion recognition and

that black and Hispanic youth were less likely to have knowledge of concussions than white students.

Additionally, these discrepancies may extend to long-term consequences, as it has been observed that black students are

significantly more likely to experience clinically significant cognitive decline post-concussion than white students.

This review demonstrates the existence of racial and socioeconomic inequalities in the prevention, detection and long-term

outcomes of concussions. It supports the need for further research and interventions, some of which are explored in this project, to

address these discrepancies and ensure they continued to be explored as the conversation surrounding concussion continues.

Funding: None

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Monday, March 25, 2019 Noon-12:50 p.m. Armour Academic Center, Room 971/975

2. Witnessing the Rabies Epidemic in India1Rzepczynski, A., MD; 1Bampoe, A., MD; 1Towbin, J., MD 1Rush University, Chicago

Rabies is one of the oldest known diseases affecting humans. Though rabies is fully preventable, it is still prevalent in developing

countries. In India, there are about 15 million animal bites annually, with most bites (91.5 percent in 2009) from dogs. There are

about 18,000-20,000 cases of rabies a year in India, which accounts for 36 percent of the world’s deaths from the disease. We

describe a case of rabies and why prevention is still lacking in India.

A 45-year-old man presented with acute encephalopathy to the Sir Ronald Ross Institute of Tropical and Communicable Diseases,

also known as Fever Hospital, in Nallakunta, India. About two months prior, a stray dog bit his toe, but he did not seek prophylactic

therapy, as he thought he was unlikely to contract rabies from a puppy. He developed progressive paresthesias in the weeks

following the bite and sought treatment from a local “black witch doctor.” He then developed acute encephalopathy, prompting

admission to the Fever Hospital.

He was acting erratically and aggressively, pulling out his IV catheter, throwing his IV pole against a wall, and yelling and spitting

at providers and family. He refused any palliative medications, including benzodiazepines and analgesics, to control his symptoms,

and he was not a candidate for aggressive therapy with antivirals due to his late presentation and absence of post-exposure

prophylaxis. He died within 24 hours of admission.

This case, like many others, centers around a lack of awareness and access to health care resources for prevention. This man, like

a reported 60 percent of those suffering from animal bites in India, chose to receive care from an indigenous healer rather than

receive standard prophylactic therapy. It is unclear what is to blame: lack of education on the dangers of animal bites, as suggested

by one survey that indicated 30 percent of participants had never heard of rabies, or a lack of access to appropriate medical care

and vaccinations. Additionally, India is home to about 25 million dogs, and the vast majority of them are strays. Efforts to vaccinate

and control the stray populations are ongoing but are still lacking, especially in rural communities.

Funding: None

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3. Introducing Microscopy to Study Prevalence of Vaginitis in Women From Jerusalem, Haiti1Zhao X., MD; 1Li A., MD; 1Ozaki B., MD; 1Rajakumar P., MD; 1Crane S., MD; 1Towbin J., MD1Rush University Medical Center, Chicago

Vaginal discharge is a common presenting complaint among women living in Jerusalem, Haiti. Our current practice is to empirically

treat based on presenting symptoms. However, since there is significant overlap in symptoms among the etiologies of vaginitis,

none of the findings from our general evaluation allow for a definitive diagnosis.

The study aims to introduce microscopy into the diagnostic toolbox to determine the prevalence of bacterial vaginosis, or BV,

trichomoniasis and vulvovaginal candidiasis, and to practice improved antibiotic stewardship.

The sample group consists of female patients over the age of 18 who complain of vaginal discharge. They were evaluated by

providers from Rush University Medical Center during a weeklong trip in April 2018 at a stand-alone clinic in Jerusalem, Haiti.

Consented participants first received a questionnaire to collect demographic data, and that was followed by a pelvic exam using

a speculum.

The collected vaginal specimen is sent to a local laboratory to be evaluated for BV, trichomonas and yeast by using the Nugent

criteria. Chi-squared tests were used to find any associations between reported symptoms and physical exam findings with

particular diagnoses. A value of p <0.05 was considered statistically significant.

Fifty-five women participated in our study; they had a mean age of 35.4 + 12.3 (range 19-77). A total of 74 diagnoses were made.

Six (8.1 percent) women received a diagnosis of BV, 12 (16.2 percent) trichomonas, 11 (14.9 percent) yeast, 41 (55.4 percent)

indeterminate for BV and four (5.4 percent) physiologic. The only reported symptom that was significantly associated with a

diagnosis was dysuria with trichomonas (P<0.05). Eleven of 12 women who were diagnosed with trichomonas reported dysuria.

The majority of women had a diagnosis of being indeterminate for BV, followed by trichomonas, yeast, BV and physiologic vaginal

discharge. Since we were unable to test for gonorrhea or chlamydia, it is unclear whether these infections, if present, can interfere

with the microscopic evaluation. Moreover, the typical risk factors, such as douching or having an increased number of sex

partners, did not significantly associate with BV, although this could relate to sample size. Future studies should include a larger

sample size and test for gonorrhea and chlamydia to further elucidate these patterns of prevalence.

Funding: Rush Office of Global Health

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4. Lessons Learned From Introducing Dilation and Evacuation in Low-Resource Settings: Experience From the Tigray Region in Northern Ethiopia1Laursen L., MD, MS; 2Yeman A., MD; 2Desta A., MS; 3Goba G., MD, MPH; 2Berhe Y., MD 1Rush University Medical Center, Chicago; 2Ayder Specialized Referral Hospital Mekelle, Ethiopia; 3University of Illinois at Chicago

Access to safe abortions has improved in Ethiopia since it legalized abortions in 2005 for indications other than saving the life of

the mother. Gaps remain, however, especially in second trimester abortion provision. In facilities where second trimester services

are available, medical abortion is the standard, and no large-scale clinical trainings on dilation and evacuation, or D&E, have been

provided.

The goal of the work was to perform a needs assessment and implement D&E services at Ayder Hospital in Ethiopia.

The group conducted a D&E needs assessment, which included the identification of key stakeholders and gathering provider

perspectives on how they choose method of termination. Trainings were then conducted over a two-week period with 18 residents

and six OB-GYN faculty. Didactics covered indications, counseling, cervical preparation, pain management, procedure steps and

complications. A skills training followed on a low-cost model along with hemorrhage simulation.

At Ayder Hospital in 2016, 68.6 percent of the 605 abortions performed were in the second trimester. Key stakeholders were

enthusiastic about starting D&E services but were concerned that patients would generally prefer induction. They believed that

D&E would be especially important for patients with comorbidities, fetal anomalies or prior failed induction.

No equipment was accessible, specifically for D&E; as such, two sets of supplies were donated along with laminara. Next, the D&E

procedures were performed under supervision with spinal anesthesia. One provider completed 15 of the total 18 D&Es. He was able

to competently perform the procedure by the completion of the intervention. The largest concern was lack of consistent supply of

laminara, and these were reserved for procedures over 20 weeks.

Misoprostol and mifepristone was used for cervical preparation whenever possible. One procedure was converted to induction

at 19 weeks due to difficulty visualizing her cervix. All other procedures were done without complications. Since completing the

intervention, 13 additional D&Es have been performed. There have been no complications.

D&E was performed successfully and safely with good patient acceptance. To maintain the continuity of D&E procedure, next

steps should focus on sustainable and consistent provider training. Resources should be mobilized to ensure a stable supply of

laminara.

Funding: The Fellowship in Family Planning

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5. Leprosy in the 21st Century: Spotted in India1Bampoe A., MD; 1Rzepcynski A., MD; 1Towbin J., MD 1Rush University, Chicago

Though leprosy is not prevalent in the modern world, it is still a chronic affliction that ravages the developing nation of India. As of

March 2018, there were 3,427 reported cases of leprosy in the Andhra Pradesh region of India (a 0.64 prevalence rate per 1,000).

Hyderabad, the capital city of Andhra Pradesh, has an estimated 9 million residents and a multitude of leprosy rehabilitation

centers. One center, the Sivananda Rehabilitation Home, or SRH, has about 500 residents and many more walk-in patients that

receive leprosy care.

Leprosy patients fall into two categories: lepromatous and tuberculoid leprosy. Lepromatous leprosy results due to a lack of

cell-mediated immunity, leading to widespread systemic disease. In tuberculoid forms, there is a strong immunologic response,

resulting in a less severe, more localized presentation.

One patient at SRH presented with lesions consistent with lepromatous leprosy. He reported lesions that initially presented on his

arms and then progressed to his chest, back and face. Typical of lepromatous form, the lesions were of different types. Macular

lesions were diffuse across his upper body and bilateral arms. His face had the more widely recognized nodular lesions. At the time

of presentation, the patient endorsed peripheral neuropathy. He also had developed an ulnar claw due to his neuropathy. He was

immediately initiated on multi-drug therapy, which consists of dapsone, rifampin and clofazimine once a month for one year.

The goal of treatment is to cure the patient and decrease the risk of transmission. In addition to medical treatment, SRH also

provides physical therapy, surgery and psychotherapy for their patients. This patient underwent daily physical therapy to help

adapt to his hand deformity. They provided splints and daily exercises to help with the patient’s progress.

Leprosy eradication has been a global public health effort since 1981. As of 2016, the World Health Organization initiated the next

public health wave focused on “accelerating toward a leprosy-free world.” This joint government and health care effort is ever

present in centers like the SRH, which serve as a crux for treatment and disseminating information.

Funding: None

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Monday, March 25, 2019 3-5 p.m. Armour Academic Center, Room 994A/B


6. Hearing Health Care Accessibility in Guatemala1Benson A., BS; 1Casper, K., BA; 1Cote, J., BA; 1McNamee, M., BA; 1Sheeran, K., BA; 1Silwal, K., BS; 1Turek, K., BS; 1McCarthy, P., PhD1Rush University, Chicago

Access to hearing health care is lacking throughout Central America. In Guatemala, there are only two audiologists in the entire

country to provide hearing health care to both children and adults. The need for increased hearing identification and rehabilitation

is staggering. Furthermore, there is a lack of infrastructure in Guatemala for college-level education opportunities to train future

audiologists. Audiology training must be obtained outside of Guatemala. The first audiologist in Guatemala, Patricia Castellanos de

Muñoz, AuD, received her doctoral training in the United States.

Currently, the two audiologists in Guatemala practice in the center of the country, Guatemala City. Castellanos established the

Centro de Audición, an audiology clinic dedicated to the prevention, diagnosis and intervention of hearing loss. However, access

to hearing health care for those in remote areas of Guatemala is non-existent, requiring significant travel time to Guatemala

City for those who need services. To better meet the needs of those in rural Guatemala, Castellanos established the Fundación

Sonrisas que Escuchan (Smiles That Listen Foundation). This nonprofit organization conducts hearing screenings and hearing aid

intervention across the country.

For the past five years, Rush University Student Academy of Audiology members have travelled to Guatemala to assist Castellanos

in a large hearing health outreach project. The weeklong trip is sponsored by the Fundación Sonrisas que Escuchan, and includes

hearing screenings and other audiologic services. Screenings are conducted at schools in Guatemala City and during trips to

remote areas of Guatemala to provide services to those in need.

During the most recent trip, in fall 2018, 800 adults and children received hearing screenings, with an overall 31 percent refer rate

suggesting the large need for extensive follow-up. In this poster session, we describe the organization, fundraising and planning

needed for this trip.

Discussion expands on mitigating factors contributing to hearing loss, including noise exposure without hearing protection, lack of

newborn hearing screening and the lack of availability of hearing health care in general. Finally, the foundation’s efforts address the

lack of hearing health care accessibility, and the creation of prevention initiatives is presented.

Funding: None

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7. Availability of Resources to Identify and Treat Pediatric Sepsis in Ghana1Boakye-Donkor A., BS; 2Wilkerson M., MD, FAAP; 3Ansong D. MD; 4Zhang Y., MS 1Rush Medical College, Chicago; 2Rush University Medical Center, Chicago; 3Kwame Nkrumah University of Science and

Technology, Ghana; 4Rush University, Chicago

The 2016 Surviving Sepsis Campaign, or SSC, guidelines emphasize early goal-directed therapy in the management of sepsis.

Several studies have found that the implementation of these guidelines improve morbidity and mortality related to sepsis in the

Western world. However, in low- and middle-income countries, or LMICs, which bear the weight of sepsis mortality, the availability

of resources to implement the SSC guidelines and the improvement in morbidity and mortality is questionable. In addition, there is

a paucity of data regarding the execution of the SSC guidelines in the pediatric population of LMICs.

The objective of the survey was to assess if hospitals in Ghana, an LMIC, have the resources required to execute the SSC

guidelines.

This study was a self-reported, anonymous questionnaire-based survey among pediatric health care providers of three hospitals

in Ghana: Komfo-Anokye, or KATH, Suntreso and Nkawie. The health care providers included in this study were physicians, nurses

and physician extenders who care for children ages 0-14 years. The 83-item questionnaire evaluated the availability of equipment,

medications and disposable materials needed to implement the 2016 SSC guidelines. Group comparisons were performed with

Fisher’s Exact tests.

Eighty-eight questionnaires were administered to the hospitals. Eighty-seven surveys were analyzed: KATH, n = 71; Suntreso,

n = 9; Nkawie n = 7. The following is the response rates among providers in all hospitals: physicians, 26.1 percent; house officers,

28.4 percent; nurses, 31.8 percent; rotational nurses, 12.5 percent; and other, 1.1 percent. KATH had the resources to implement

2.8 percent of the SSC guidelines overall, 2.2 percent of the strong recommendations and 4.2 percent of the weak

recommendations. Nkawie and Suntreso did not have the resources to implement the SSC guidelines in their entirety.

The results highlight that the 2016 SSC recommendations have restricted application in a teaching hospital and, due to a lack of

resources, cannot be implemented, at any level, in regional and district hospitals in Ghana. However, the availability of resources

is only a piece of the puzzle needed to answer why the SSC guidelines are minimally effective in the treatment of pediatric sepsis

in LMIC.

Funding: None

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8. Emergency Department Visit Differences Between Urban and Rural Cohorts in Illinois1Dahleh A., 2Monica N., 1,2Kelley K., 2Flores Y., 2Arana B., 1,2Garibay-Pulido D., 1Cendejas-Zaragoza L., 1Maschino M., 1,2Rossi M. 1Rush University Medical Center, Chicago; 2Epilepsy Foundation of North Central Illinois, Rockford, Illinois

The team has identified a reference cohort of individuals with spells/seizures composed of 542 individuals (patients within the

electronic health record database) from McHenry county, a rural setting, and has also identified a matched reference cohort

composed of 315 at Rush University Medical Center, an urban setting, through retrospective data analysis.

They hypothesize that they will be able to identify significant differences and patterns in emergency department, or ED, visits

between the two cohorts, which can be used to determine essential frontline population health-related services that can improve

health care.

Retrospective data analysis was used to track patient ED admissions to the Rush Epilepsy Monitoring Unit from both the

Population Health Management referral center and Rush-based referrals, along with admissions to Centegra major health system

from Dec. 15, 2014 to June 30, 2017. Differences in ED visits were used to determine differences in health patterns within the

rural mHealth-PHM hub (mobile health-population health management hub) compared with those seen in an urban-based setting

at Rush.

Of the 120 rural patients that presented to the Centegra major health system, 42 (35 percent) were documented to have had one

ED visit, 21 (17.5 percent) were documented to have had two ED visits, seven (~5.8 percent) were documented to have three ED

visits, nine (7.5 percent) were documented to have four ED visits, and 41 (~34 percent) were documented to have had five or more

Ed visits within that particular time frame. Of the 120 urban patients who presented to urban-based hospitals, 54 (45 percent)

were documented to have had one ED visit, 27 (22.5 percent) were documented to have had two ED visits, 15 (12.5 percent) were

documented to have had three ED visits, 11 (9 percent) were documented to have had four ED visits and 13 (11 percent) were

documented to have had five or more ED visits.

Patients within the rural cohort were more likely to experience five or more ED visits than patients within the urban cohort.

Therefore, a portion of this rural cohort will serve as the intervention cohort for frontline rural population health-related services

to observe a decrease in community ED visits. Such PHM strategies will include implementing novel communication connectivity

strategies, ambulatory biosensor monitoring (mobile health) and a rich, virtual education platform.

Funding: None

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9. The Prevalence of Depression in Peralta, Dominican Republic, and Associated Risk Factors1Ballout F., MD; 1Mesfin N., MD; 1Kalra S., MD; 1Grant M., MD; 1Towbin J., MD 1Rush University, Chicago

Depression is a major global health problem that has previously been identified as the fourth-leading cause of overall disease

burden worldwide. Limited data exists regarding the prevalence of mental health disorders, especially depression, in developing

nations. The paucity of health care resources, stigma surrounding mental health, and social and cultural barriers make it

challenging to detect mental health disorders in these communities.

This study aims to investigate the prevalence and associated risk factors of depression within the community of Peralta in the

Azua provicine of the Dominican Republic.

The community health workers in Peralta, previously associated with the Rush Global Health program clinic, went door-to-door to

visit previously seen clinic patients. The PHQ-2 was administered as a screening tool in Spanish. Patients with positive results were

further screened using the full PHQ-9 and the Somatic Symptom Scale survey. Additional information was obtained, including age,

sex, weight, height, body mass index, comorbidities, education level, occupation, status of primary income earner, total household

income, number of people in household, number of people in household < 18, and prior personal or family history of mental health

issues. The data was analyzed using a t-test for continuous variables, two-proportion z-test for ratios and Pearson’s

chi-squared test for categorical variables.

There were 32 patients in the Peralta community screened using the PHQ-2 survey. The mean age was 44 years (standard

deviation +/- 13) and 78 percent of respondents were female. The rate of hypertension was 25 percent (n = 10) and diabetes

mellitus was 6.25 percent (n = 3). The prevalence of positive screen for depression was 12 percent (n = 4). Among the surveyed

population, income insecurity (defined as variable monthly income or lack of knowledge about income), crowded household

(defined as greater than four people in the home), family history of mental health or lack of formal education did not confer

increased risk of depression.

The preliminary results of this study suggest education level, income instability, psychiatric family history and crowded household

are not correlated with depression incidence. The small sample size of this study limits our ability to draw significant conclusion at

this time.

Funding: None

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10. Efficacy of Tuberculosis Prophylaxis Therapy in Patients Living With HIV in a Rural Community in Southern India1Kothadia S., MD, MPH; 1Scharping J., MD; 1Gandhi S., MD; 1Kollipara R., MD 1Rush University, Chicago

Tuberculosis, or TB, is the most common opportunistic infection in people living with HIV. Though adequate antiretroviral therapy,

or ART, reduces the risk of TB, people with HIV are 30 times more likely to develop active TB infection than those who do not have

HIV, and 75 percent of mortality in patients with TB occurs in those who have concurrent HIV infection.

In India, an estimated 11,000 people with HIV died in 2017 due to TB infection. There is a high prevalence of TB in India, where

50 percent of people have latent infection. Studies consistently show that isoniazid preventive therapy, or IPT, is an effective

method to prevent activation of latent TB, as well as the development of new TB infection even though it does not provide a

significant effect on overall mortality. The duration of benefit conferred by IPT is still unclear.

Share India is a nonprofit organization founded in Telangana, India, with the purpose of promoting health equity by providing

health care to rural populations and conducting research. In the first study of its kind in India, Share India set out to analyze the

incidence of active TB infection among people with HIV on ART and IPT.

In this longitudinal cohort study, adults and children living with HIV receiving care at ART centers in Telangana were screened

for active TB by inquiring about current cough, fever, weight loss or night sweats. If screening was positive for any symptom, the

patient was sent to further evaluate for active TB infection and, if tested positive, was excluded from the study. If the patient’s

symptom screen was negative and the patient did not have any contraindications, IPT was administered daily for six months.

The study included a cohort of 1,169 patients with HIV on ART treated with IPT. These participants were then monitored for

development of active TB infection for one year after completing IPT.

The results from this study are pending but are expected to be available shortly.

This study will evaluate the efficacy of six months of IPT in preventing new cases of active TB among people with HIV in India. If

IPT is shown to reduce incidence of TB in this population, this study will also provide further information about duration of benefit

conferred by IPT. Results have the potential to influence current World Health Organization guidelines, which currently recommend

IPT for 36 months for people living with HIV in TB endemic areas.

Funding: Share USA, U.S. Department of Health and Human Services, Texas A&M Health Science Center, University of Pittsburgh,

Sanofi Pasteur SA, Centre for Chronic Disease Control

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11. From the Classroom to the Community: Analyzing Needs Assessment Results at an Urban Homeless Shelter to Improve Student-Run Clinic1Gore D., BA; 2Marqui P., BS1Rush Medical College, Chicago; 2Rush University College of Nursing, Chicago

The Rush Clinic at Franciscan House of Mary and Joseph is a student-led initiative that provides acute care to homeless

populations on Tuesdays at the Franciscan House of Mary and Joseph on Chicago’s Near West Side. The health clinic offers limited

medications and non-invasive physical exams, but it does not provide prescription medications or laboratory tests. Despite the

clinic’s limited service provision, many Franciscan residents rely on the clinic as their primary health care source. Considering the

multiple comorbidities and health barriers affecting homeless populations, it is clear Franciscan residents do not have their medical

and social needs met by the the clinic.

The goal was to identify the unmet medical needs of Franciscan residents and adjust clinic services to better address those needs.

Volunteers conducted anonymous, biobehavioral surveys among consenting Franciscan residents, including half of the female

residents and one-third of male residents in August 2018. Residents were recruited through random sampling procedures and

informed consent was collected. Survey components asked about previous diagnoses, current health care usage and access,

and medical service preferences. Blood pressure and body mass index metrics were collected prior to survey administration.

Institutional Review Board approval was provided by Rush University.

Of the 170 recruited residents, 104 (61.2 percent) completed the survey (22 women, 82 men). In completed surveys, 66 (63.5

percent) identified as black/African-American, 28 (26.9 percent) white, three (2.9 percent) Asian, four (3.8 percent) Native

American/Alaskan Native, seven (6.7 percent) other. Eighteen (17.3 percent) had a history of asthma, 14 (13.5 percent) of chronic

lung conditions, 26 (25.0 percent) of chronic pain disorders, 36 (34.6 percent) of mood disorders, 19 (18.3 percent) of anxiety

disorder and 15 (14.4 percent) of diabetes. Seventy-three (70.2 percent) used the emergency room at least once in the past

12 months. Fifty-three (51 percent) had no primary care provider outside of Franciscan. Seventy-nine (76.0 percent) said they

“definitely would use” free socks if offered, 71 (68.3 percent) said the same for dental care, 69 (66.3 percent) for eye care,

67 (64.4 percent) for foot care and 63 (60.6 percent) for general health checkups.

Multiple services must be expanded at Franciscan to accommodate patient needs. The clinic must increase its selection of

asthma drugs, analgesics and diabetes drugs. Franciscan must improve linkage to mental health services, primary care providers,

podiatrists, dentists and optometrists.

Funding: None

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12. Height, Weight and Blood Pressure Measurements of Children in a Haitian Orphanage1Pidgeon, H., BS; 2Maravelias J., BS; Butnariu M., MSN, RN; 2Raj R., BS; Vuong P., MSN, RN; Bauer K., DNP; Kovac L., MS-HSM;

Schlaker C., MS-HSM; Slevin B., MSN, RN; 2Steward S., BSN, RN 1Rush Medical College, Chicago; 2Rush University College of Nursing, Chicago

In the United States, it is recommended that children see a pediatrician 12 times in the first 36 months after birth and then annually

until age 21. These visits are meant to monitor appropriate growth and development, promote healthy living and manage any

illnesses that may occur. The preventative health care system for children in Haiti is significantly less structured; some children will

interact with a health care provider less than two times in their lives before age 21. We sought to provide children at an orphanage

in Jerusalem, Haiti, with a health record to be used as a baseline for future health care interactions.

The goal was to characterize some growth characteristics of the children at the orphanage.

Over two consecutive days, the team took measurements of height, weight and blood pressure of children at an orphanage,

and plotted height and weight on gender-appropriate growth charts. For children under 1 year old, head circumferences and

percentages were recorded. Children younger than 5 years old had developmental milestones recorded as reported by the children

themselves or by older children also living at the orphanage.

There were 53 children, 55 percent of whom were male, aged 10 months to 18 years, with an average age of 8 1/2 years and a

median age of 8. The average height was 123 centimeters, and the average weight was 27 kilograms. Seventeen percent were

below the third percentile for height and 11 percent were below the third percentile for weight. There were two children at or above

the 90th percentile for height and one child at the 90th percentile for weight. Blood pressure was measured for 50 children, and

one child had measurements above the 95th percentile.

Most children at this orphanage had height, weight, blood pressure measurements within normal limits. The team had no prior

measurements to track progress over time, so they could not draw conclusions from one abnormal measurement. Dates of birth

were not known for some children, which could have given falsely low detection of children at low percentiles. The hope is that

these health charts will serve as a baseline for future health care providers.

Funding: None

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13. A Community’s Strength: a Qualitative Analysis of Combating Social Determinants of Health Affecting Children at a Haitian Orphanage 1Pidgeon, H., BS; 2Maravelias J., BS; Butnariu M., MSN, RN; 2Raj R., BS; Vuong P., MSN, RN; Bauer K., DNP; Kovac L., MS-HSM;

Schlaker C., MS-HSM; Slevin B., MSN, RN; 2Steward S., BSN, RN 1Rush Medical College, Chicago; 2Rush University College of Nursing, Chicago

The World Health Organization defines social determinants of health as “the conditions in which people are born, grow, live, work

and age,” which are “mostly responsible for health inequities — the unfair and avoidable differences in health status seen within

and between countries.” In Haiti, a lack of access to resources perpetuates health disparities. Nonetheless, local communities are

working to actively combat these inequities.

The team’s goal was to characterize social determinants of health of children at an orphanage in Haiti and to identify community

efforts to combat barriers to health.

During the team’s stay, it observed daily life of Haitians living in the resettlement region Jerusalem. Team members spent each

day at an orphanage interacting with the orphanage workers, teachers and laborers who lead the construction of a playground.

Information was gathered through direct observation and conversations. Each member of the team wrote a reflection on the social

determinants of health upon returning.

Education is prioritized, and all children are required to attend school between the ages of 3 and 18; local teachers provide primary

and secondary school education on-site. Hygiene practices and sexual education are emphasized; children bathe regularly and

attend school in clean uniforms. Only clean, purified water is used for drinking and food preparation; the water source comes from

an onsite well, and potable water is stored in a tank. Meals occur two to three times per day, and the children are kept well-fed to

ensure adequate intake. Garbage and refuse is collected regularly.

Despite limitation of resources, the community of Jerusalem has identified barriers and implemented creative solutions to

improve the health and well-being of children at the orphanage. Establishing a structured environment to improve early childhood

development and provide access to education helps promote improved long-term health outcomes.

The data and observations documented during this trip will be used to inform the contributions of future Rush Interdisciplinary

Service-Learning Experience groups. Specifically, educational interventions will be implemented to further enhance the efforts

already established by the community of Jerusalem.

Funding: None

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14. International, Off-Site, Subspecialty Radiology Service — A Collaboration Between the Department of Radiology at Rush University Medical Center and Mbingo Hospital in Cameroon1Baqui Z., MD; 1Praver M., MD; 1L’Heureux D., MD 1Rush University Medical Center, Chicago

Since October 2017, the Department of Radiology at Rush University Medical Center has collaborated with Mbingo Hospital in

Cameroon to provide subspecialty image interpretation of the hospital’s CT imaging. Mbingo Hospital is a rural referral hospital

in the northwest region of Cameroon.

The goal of the work was to provide expert, subspecialty CT image interpretation for Mbingo Hospital.

Cross-sectional CT images were interpreted from Mbingo Hospital via RadConnect, a web-based medical image management

tool that integrates with a picture-archiving and communication system PACS to enable intuitive, quick and secure retrieval and

sharing of Digital Imaging and Communications in Medicine images.

CT scans were interpreted and dictated by radiology residents, and subsequently reviewed and approved by attending

radiologists. Numeric data was gathered from October 2017 to January 2019 and stratified by radiologic subspecialty and

type of CT. Interesting cases from each subspecialty were selected and pictorially presented.

During that span, 2,304 cases were interpreted from Mbingo Hospital, including 1,732 neuroradiology cases, 373 body cases,

106 pediatric cases, 93 thoracic and 13 musculoskeletal. The group summarized an interesting case: a 3-year-old girl who

presented with a one-month history of abdominal distention, pain, fever and weight loss. The patient was found to have an

8.8-by-8.4-by-13-centimeter cystic and solid retroperitoneal mass encasing the abdominal aorta. There was additional loculated

abdominal ascites with mass effect on the bowel. A 2-millimeter pulmonary nodule was seen. This was felt to represent necrotic

neuroblastoma.

The Department of Radiology at Rush has provided CT interpretation for Mbingo Hospital since 2017. The relationship provides

Mbingo Hospital with expert radiology interpretation; the hospital has no long-term radiologists on staff. For residents and

attending physicians at Rush, the type and severity of pathology referred by the Mbingo Hospital presents an opportunity to

evaluate disease that is not frequently encountered among the patient population at Rush.

Funding: None

15. Pediatric Dental Needs Assessment in Haiti1Rispens J., MD; 1Roehler D., PhD, MPH; 1Scotellaro M., MD 1Rush University Children’s Hospital, Chicago

Childhood dental decay is a major health problem resulting in pain, infection and poor growth. Parental dental decay is a known

risk factor for early childhood caries due to the transmission of oral flora. Little research exists regarding dental disease in

Haitian children.

The goal was to collect data on the dental health of children in Haiti and the association to parental oral health to determine

potential areas for intervention.

A Rush Global Health team set up community clinics around Pignon, Haiti, in October 2017. Pediatric patients were evaluated by an

attending pediatrician or senior pediatric resident. After the medical visit, the provider administered an oral survey using Haitian

interpreters regarding both the child and caregiver’s oral health. Fluoride varnish was offered to each pediatric patient regardless

of survey participation. Rush Institutional Review Board approval was obtained.

Participants included 81 children from 3 months to 18 years old. Median age was 6.1 years (SD = 3.3). Ninety percent had

never received dental care. Thirty percent reported a history of dental problems while 33 percent showed decay on oral exam.

Ninety-six percent of children reported brushing teeth daily, and every caregiver reported daily brushing. There were significant

age differences, with older children having higher incidence of decay (p < .05), history of dental care (p < .05) and brushing

daily (p < .01). Caregivers of children with a history of dental problems or visible decay were more likely to have received dental

care (p ≤ .001).

High rates of dental decay, lack of preventative care and need for preventative dental education exist in Haitian children. Fluoride

varnish application was found to be feasible and well-received by families, and will likely benefit this population and similar groups

that do not have access to other preventative dental care services. The correlation that we observed between parental history of

receiving dental disease and dental decay in their children could inform future, focused, preventative interventions for the children

of people with dental pathology.

Funding: None

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16. Children With Communication Disabilities in Jerusalem, Haiti: a Needs Assessment1Rotert E., MS, CCC-SLP, ATP; 2Towbin J., MD; 2LaGorio L., PhD, SLP 1Proviso Area for Exceptional Children District 803, Maywood, Illinois; 2Rush University, Chicago

Limited information exists regarding children with communication disabilities in many places around the world, including

Jerusalem, Haiti, which emerged as a resettlement community following the 2010 earthquake.

During a medical service trip in July 2017, a Rush University Global Health-affiliated speech-language pathologist, or SLP,

conducted a needs assessment to learn how the community perceives children with communication disabilities; determine what,

if any, supports are available; and gain the community’s input on providing support.

Thirty participants — including mothers, community health care workers, local physicians, interpreters and teachers —

volunteered to participate. Participants were interviewed via focus group, semistructured interview, or one-on-one consultation

with interpretation as needed. All interactions were guided by a structured script. These interactions were transcribed, and an

inductive approach to thematic analysis was used to code the data and define themes.

Five themes emerged: 1 — Families struggle to meet the basic needs of all children and are often unable to provide food and

clean water; 2 — Children with disabilities are frequently bullied, teased and mistreated; 3 — Limited awareness about disabilities,

including possible causes and treatment options, prevails; 4 — No resources exist in the community of Jerusalem, and limited

resources are available in the country. Some individuals were aware that a center in Port-au-Prince existed, but they believed this

center was expensive and too far away; 5 — People in Jerusalem are eager to learn about children with disabilities and possible

treatment options.

Three conclusions were drawn based on the themes: basic needs, such as potable water, should be addressed; a cultural pattern

of bullying and teasing individuals with disabilities exists, possibly caused by lack of awareness; and, despite limited resources,

local professionals are interested in learning more about children with communication disabilities and how to help them. Moving

forward, Rush University Global Health-affiliated SLPs will support children with communication disabilities by developing a

“teach the teachers” curriculum to educate and train key members of the Jerusalem community.

The goal is to give community members the tools to provide beginning intervention to children. Ongoing and regularly scheduled

support from Rush SLPs will ensure the interventions’ effectiveness in meeting the community’s needs.

Funding: None

17. Development of a Novel Emergency Medicine Physician Training to Improve Care for Survivors of Sexual Assault: a Preliminary Survey1Prusky M.; 1Solomon C., MS; 1Tracy K.; 2Rodriguez J., BSN, BS, RN, SANE-A; 3Balata, M.; 3Mangiaracina M.; 4York S., MD, MPH; 5Tirone V., PhD; 6Rumoro D., DO, MPH 1Rush Medical College, Chicago; 2Office of the Illinois Attorney General; 3Resilience; 4Department of Obstetrics and Gynecology,

Rush Medical College; 5Road Home Program; 6Department of Emergency Medicine, Rush Medical College

One in three women worldwide experience sexual violence in their lifetime. One in seven survivors are younger than 6 years old.

While emergency medicine, or EM, nurses and social workers undergo continuing education in caring for survivors of sexual

assault, physicians typically do not. Training for EM physicians is imperative to achieve physician competence and confidence of

care for survivors.

The objective in this work is to understand from the perspective of EM physicians what topics should be included in a training to

improve competency and sensitivity of care for survivors of sexual assault. This will provide insight into points-of-care that are

lacking for sexual assault survivors when presenting to the emergency room.

In collaboration with the chairperson of Rush University Medical Center’s Emergency Department and the nonprofit organization

Rape Victim Advocates, or RVA, an anonymous checkbox-style survey was administered to 40 Rush EM physicians asking what

topics they would like to learn more about in a training. Four categories were included in the survey: communication, roles and

responsibilities, medical care and legal considerations.

Twenty-seven EM attendings completed the survey. Of the respondents, 96 percent requested education on communication,

70 percent on roles and responsibilities of various health care providers and law enforcement, 93 percent on follow-up medical

needs and 96 percent on legal considerations specifically for survivors under 18 years old.

Sexual assault is a significant public health problem that requires EM physicians receive specialized training in areas including

trauma-informed health care. The goal of this research is to assess physician understanding of, and confidence in, providing health

care to survivors of sexual violence. Survey results will be considered alongside expertise provided by RVA and sexual assault

nurse examiners to develop a training program to improve quality of health care and health outcomes.

Funding: Rush University Medical Center Department of Emergency Medicine

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18. Rural Otolaryngology Care Disparities: the State of Illinois1Urban M.J., MD; 2Wojcik C.; 1Jagasia A.J., MD 1Rush University Medical Center, Chicago; 2Chicago College of Osteopathic Medicine

During the past two decades, data on health disparities have become increasingly published across all medical specialties.

In otolaryngology, studies have largely focused on disparities between patients of variable socioeconomic status and ethnic

backgrounds. More recently, rurality has been evaluated as another social determinant of health. However, within the ear nose

and throat specialty, or ENT, there is a significant lack of data evaluating and addressing rural-urban disparities.

The goal is to highlight rural-urban disparities in otolaryngology and quantify the disparity in access to care across Illinois.

Counties in Illinois were classified based on urbanization level on a scale from one (most urban) to six (least urban) using

the National Center for Health Statistics, or NCHS, urban-rural classification scheme published in 2013. The six urbanization

levels include four metropolitan (I-IV) and two non-metropolitan levels (V and VI). Name and practice location of all registered

otolaryngologists in Illinois were collected using the American Academy of Otolaryngology website at entnet.org. Population data

were recorded from the most recent U.S. census (2010).

Two hundred seventy-eight academy-registered otolaryngologists were identified in Illinois. One hundred fifty-two of these

providers were located in a single county categorized as level one by the NCHS scheme. There are over 600,000 people living in

NCHS level-six counties in Illinois and no registered otolaryngologists. There was a statistically significant difference in the number

of registered otolaryngologists per 100,000 people practicing in the six NCHS classifications, as determined by one-way ANOVA

(p<.001). Metropolitan levels (I-IV) averaged 2.4 ENTs per 100,000 while non-metropolitan levels (V and VI) averaged 0.7 ENTs per

100,000 people (p < .001).

To the knowledge of the group conducting research, this is the first study to quantify the disparity in access to specialist care in

otolaryngology for patients who live in a rural setting in the United States. Clinical vignettes will help illustrate gaps in quality of

care for rural patients with otolaryngology-related problems. Further research is indicated to investigate strategies to bridge these

inequalities.

Funding: None

19. Extracorporeal Photopheresis Kit Packaging: a Unique, Single Academic Medical Center Use of Recyclables1Uzelac D., RN, BSN, CCRC; 1Heitschmidt M., RN, PhD, APN, CCRN-K; 2Bautista M.1Rush University, Chicago, 2University of Illinois Urbana-Champaign

Thousands of photopheresis kits are delivered to health care facilities across the world. Each shipment contains multiple layers

of packaging.

The purpose of the study is to describe the amount of waste created at a single institution from these shipments, as well as an

innovative usage of these materials.

Kit usage data for 2016 was collected from Rush University Medical Center. The number of cardboard dividers provided for safe

packaging and transport of kits was reviewed. Reusing or recycling the packaging was then researched.

In 2016, 386 photopheresis treatments were completed at Rush. Each kit was packaged with one cardboard divider. The total area

required for these cardboard dividers alone is 577 square feet. The area of one football field could be covered by the cardboard

dividers sent to Rush in 2016. Connecting with a community school allowed the packaging to be innovatively recycled. All

discarded reusable kit cardboard materials were distributed to local schools for arts and crafts projects.

Large volumes of waste are created by photopheresis kits annually. There are alternatives to sending kits to waste sites or landfills.

If health care facilities are able to find and implement more effective recycling methods, thousands of square feet of cardboard can

avoid entering landfills and waste sites. One such method was identified at Rush with positive outcomes to the medical center and

local school children.

Funding: None

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20. Community Needs Assessment of a Hyper-Local Farmers Market in Little Village, Chicago1Wornhoff R.; 2Benitez A., MPH; 1Brown M., DO; 3Saucedo B.; 3,4Garcia J.; 3Garcia K.; 3,5Mora S.1Rush University, Chicago; 2Enlace Chicago; 3Little Village Gardeners Coalition, Chicago; 4Malcolm X College, Chicago; 5Harold Washington College, Chicago

Prior community research suggests that the development of chronic disease, specifically diabetes, could be addressed by

improved access to fresh produce. Little Village, a predominantly Mexican-American community on Chicago’s West Side, is one

of the only neighborhoods in the city without a farmers market where community members can buy and sell local produce.

The Little Village Gardeners Coalition, a grassroots community organization, commissioned a needs assessment with at least

400 participants to determine community interest in developing a farmers market.

With youth from a local summer program, anonymous 10-question surveys were conducted throughout the community from

July to August 2018 on Android tablets with Rush Institutinal Review Board approval. People were asked if they would support

a farmers market in the community and when, where and what types of products they would like to see in a market.

Of the 424 people approached in the community, 70 percent were women, 75 percent were residents of Little Village and

64 percent chose to answer the survey in Spanish. Of the respondents, 57 percent were very likely to attend a market if one

was held in the neighborhood. Another 36 percent were somewhat likely to attend. There was an especially strong interest among

residents of Little Village (59 percent of them very likely to attend), women (59 percent very likely to attend) and adults over

age 50 (61 percent very likely to attend).

The results indicated an overall interest for a market in the community and provided other guidelines to the coalition regarding

times, locations and products desired. While the survey is subject to selection bias as a volunteer convenience sample with an

over-representation of women, the Little Village Gardeners Coalition is using these results to apply for grants and explore a

proposed market in a manner compatible with the community’s wishes as expressed in the survey.

Funding: Little Village Gardeners Coalition and Enlace Chicago

Rush University Office of Global Health

Our Mission

Rush University promotes involvement in voluntary global health initiatives

that allow our students, residents, fellows, faculty and staff to bring their

skills to populations in need and grow as health care professionals.

Office of Global HealthArmour Academic Center

600 S. Paulina St., Suite 1044Chicago, IL 60612 (312) 563-0369

[email protected]

rushu.rush.edu/global-health

Susan Chubinskaya, PhDVice Provost

Faculty [email protected]

Jacqueline Lagman, RN, MSN, CNLProgram Manager, Global [email protected]

Stephanie Crane, MDDirector, Global Health

[email protected]

Dina Rubakha, MEdAcademic Program Manager

Faculty [email protected]

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