Dr. Randy Christensen: "Ask Me Why I Hurt"

MS. DIANE REHM

11:06:55
Thanks for joining us. I'm Diane Rehm. Mother Teresa once said that the poverty of being unwanted, unloved and uncared for is the greatest poverty. For the past decade, one pediatrician has tried to lessen that pain for homeless children living in Phoenix, Ariz.

MS. DIANE REHM

11:07:23
In a new book Dr. Randy Christensen describes his clinic on wheels. It's helped thousands of often abused, unloved children who live on the streets get regular healthcare. The book is titled, "Ask Me Why I Hurt," and Dr. Christensen joins me in the studio. Of course, we welcome your calls, questions, comments. You can join us by phone, send us an e-mail. Join us on Facebook or Twitter. Good morning to you, sir, it's good to have you here.

DR. RANDY CHRISTENSEN

11:08:07
Good morning, Diane, it's great to be here.

REHM

11:08:09
Tell me about that bracelet that's on the front of the book.

CHRISTENSEN

11:08:15
The "Ask Me Why I Hurt" bracelet. So I was actually sitting outside and I was kind of trying to get a couple of minutes rest and there was a young girl sitting outside and she had this bracelet on. And we were making small talk and I looked over and I noticed the bracelet and I started to read it. And I took a second glance at it and it said, ask me why I hurt.

CHRISTENSEN

11:08:41
It seemed kind of an unusual bracelet to be wearing and I almost was tempted to ask her right there what it meant. Later on and throughout the book, you sort of realize that I do come to ask her what it means. But I think that's a symbol to me to ask everybody why it hurts and how you can help.

REHM

11:09:04
How did you first get started on this idea of a mobile medical clinic?

CHRISTENSEN

11:09:15
You know, it's one of those things. I loved working with underserved populations. It's just something that I sort of grew up with. I saw the first mobile medical unit that I was aware of in Boston when I was at medical school in Tufts. And I just thought it was a neat idea where you were really taking care right out to the patients. It reminds me of doctors of old when they'd make house calls and so now I'm making house calls, even though there's no house to go to.

REHM

11:09:49
You know it's interesting that you talk about Tufts. Do they treat not only people on the streets, but literally go to people's homes?

CHRISTENSEN

11:10:03
Yeah, the program in Boston, I think, was called, "The Bridge Over Troubled Waters." And I remember going down to some of the squares, Harvard Square and such, and seeing a bunch of homeless kids. And I just was trying to imagine where they were getting their care.

CHRISTENSEN

11:10:18
When I ultimately ended up in Phoenix, I started a clinic when I was a resident at school that was then the Thomas J. Pappas School. It's now called, Children First Academy. And I walked in and all the kids there were homeless or at real high risk of being homeless and I just felt, you know, that this is where I wanted to be. I remember looking at the attending, the doctor in charge, and I said, this is where I'm going to be. And I'm sure she looked at me and said, you know, who is this young kid and what does he think he's doing just walking in here and saying that. The truth is, is that I've never left.

REHM

11:10:55
But you, I see you have the bracelet on yourself, But even when you first suggested this, what kind of feedback did you get?

CHRISTENSEN

11:11:09
You know a lot of people ask what kind of crazy scheme I was trying to come up with. The program got started by a local non-profit in Arizona, HomeBase Youth Services. And together with Phoenix Children's Hospital, they wrote a grant and the grant was funded. And everybody was excited and then they realized that there was no money for a medical director.

REHM

11:11:34
Oh.

CHRISTENSEN

11:11:34
And they asked me if I wanted to be it and of course, you know, it had no money so I jumped at the chance to go and do it. I can still remember walking into my boss' office saying, you know, I really want to do this. And he says, well, how much is the carve out? How much are they going to pay you to take this time off? And I said, well, there's no money actually right now, so it was tough to convince.

REHM

11:11:53
So how did you fund yourself along the way?

CHRISTENSEN

11:11:57
You know, that was one of the great things. Right in those early years, a lot of organizations were getting together. So one great organization, the National Network Children's Health Fund, they came in and they said, we're going to help fund your salary. And pretty soon, you had three partnerships being formed and it just took off after that.

REHM

11:12:18
And who is paying for the kids' health?

CHRISTENSEN

11:12:22
It's pretty expensive so the program itself is about $1.2 million a year. Phoenix Children's takes the lion share of that burden so my salary now and several of the nurses' salaries. But we have funding from all different kinds of sources. We have private funding. We have federal funds. American Idol even gets involved in it as well.

REHM

11:12:43
That's terrific.

CHRISTENSEN

11:12:44
Yeah.

REHM

11:12:45
Seven thousand kids in ten years, that's a lot of children...

CHRISTENSEN

11:12:51
Yeah, yeah.

REHM

11:12:52
...who are homeless in that area. That doesn't strike me as an area that I would think of as having lots of homeless kids.

CHRISTENSEN

11:13:04
Yeah, that's the unfortunate thing is that I think most of the big cities and even some of the small ones have a lot of homeless kids and families out there. The families are the fastest growing segment of the homeless population. In Arizona alone, they estimate there's somewhere between 5,000 and 10,000 homeless kids. Unfortunately, the majority of them live in Maricopa County, the county where Phoenix is, and Pima County, the county where Tucson sits.

CHRISTENSEN

11:13:36
In 2008, we saw about 3,000 medical visits. In 2010, we saw close to 4,000. By the end of 2011, we think we're going to see 5,000 visits.

REHM

11:13:53
Wow, how do you find these kids? Surely it's not like an ice cream truck rolling by when...

CHRISTENSEN

11:14:02
Great question.

REHM

11:14:02
...kids come out to see you.

CHRISTENSEN

11:14:06
We're very consistent. We go to the same places. We try to build relationships, collaborations with many of the organizations out there, whether it be a faith-based organization or a state organization. We have sites at the YMCA. We have sites at some schools. We have -- the biggest site that we have is at a family shelter, UMOM and they are actually the largest family shelter in the State of Arizona. So there are about 400 kids in our age just right there in that shelter.

REHM

11:14:39
So if you go to a place called UMOM, presumably moms are there, too, but you're only treating the children?

CHRISTENSEN

11:14:52
We're pretty good at creating enough collaborations so that we can have adults. Our funding -- because of some of the funding that comes in, we're taking care of aged zero all the way up to 24, so the young adults.

REHM

11:15:05
I see.

CHRISTENSEN

11:15:06
But the moms come in. They get help. And they're getting a lot of counseling and mentorship. We're trying to become a true comprehensive program.

REHM

11:15:17
Reading through the book, some of the ailments you're dealing with are rather unusual.

CHRISTENSEN

11:15:26
Yeah, I get the question, you know, what do they come in for? And they come in for the regular typical things. They come because they have a cold and they can't get ibuprofen or Tylenol or whatnot. They might have a little asthma or diabetes and then you sort of dig a little deeper and you find out that they've been raped, they've been abused, they've been beat up the night before. Pretty unbelievable things happen to the kids out there. It's dangerous on the streets.

REHM

11:15:56
Sure it's dangerous on the streets. Are any of them or are many of them involved with drugs?

CHRISTENSEN

11:16:05
Certainly there's a lot. People ask, why are they on the streets and what are the causes for that? And you know, I tell them it's usually some sort of history of mental health problems. It's education problems, learning disabilities and abuse, either physical or sexual abuse. And it happens either in them or their parents and that all gets together and pretty soon you're on the streets.

REHM

11:16:33
You said you had a first-day eye-opener when you were parked at your first stop in Tempe. What happened?

CHRISTENSEN

11:16:44
So -- and truly it was probably a first-year eye-opener. In fact, I think I still have my eyes opened every day I go to work. But, you know, going out there those first times, I was young. I thought that, you know, we were going to provide just, you know, standard medical care and they would get their asthma treated and then they'd get off the streets. And the truth was that we were very unprepared.

CHRISTENSEN

11:17:07
We had difficulty sort of getting the kids in. We had difficulty sort of having a streamlined process. We had difficulty, you know, doing proper screening and giving them their meds and how we did all this. A lot of details were left out. Of course, the van was an older van and we were trying to get that thing up and running and it took a lot of money. And even then, the things would break down so hydraulics would break down sometimes. The steering was -- I can remember trying to drive and you'd turn and you'd turn and turn and turn and turn and then the van would start to turn. And you're like, oh, we've got to get this steering fixed. And the mirrors would fold up so you couldn't see behind you. It was just all kinds of craziness.

REHM

11:17:55
Who was with you?

CHRISTENSEN

11:17:56
The first years, or the early years, my nurse practitioner, Jan Putnam. She is an unbelievable woman and came through with all those details. She worked out ways to hand out meds and ways to keep track of them and to make labels for the kids. She worked on ways to screen the kids properly so we could get an idea of why they were there and to catch all those undertones that they were coming in for as well.

REHM

11:18:26
Certainly, it sounds as though it was on-the-job learning.

CHRISTENSEN

11:18:31
Exactly.

REHM

11:18:31
Dr. Randy Christensen, he's a physician at Phoenix Children's Hospital. He's also a medical director of the mobile medical clinic that serves homeless children in and near Phoenix, Ariz. His new book is titled, "Ask Me Why I Hurt."

REHM

11:20:03
And if you'd like to join us, Randy Christensen is with me. He's a doctor who operates a mobile medical clinic that serves homeless children in and near Phoenix, Ariz. He's written a book about his experiences. It's called "Ask Me Why I Hurt: The Kids Nobody Wants and the Doctor Who Heals Them." Join us, 800-433-8850. We do have links to UMOM, The Crews Mobile and the Children's Health Fund on our website. And you can go to drshow.org. Tell us about some of the kids you've seen, Dr. Christensen.

CHRISTENSEN

11:21:05
You know, I think about them all the time. I think about some of the successes we've had and of course I think some of the tragedies. And sometimes it overwhelms you. I think about the kids that come to us. They're innocent, they've been abused, they've been hurt in some way or another and they're afraid of going into places. They're afraid.

REHM

11:21:36
I would think so. Mistrustful.

CHRISTENSEN

11:21:39
Yeah, they have a good deal to be afraid of sometimes. Sometimes they've been hurt by the very people that you think should be the ones that trust you the most. I remember talking about writing the story of Mary. And we had the collaborator, Rene Denfield (sp?) , one of the great people I've met through this book. And she came in to interview some of the kids that we met.

CHRISTENSEN

11:22:11
And we sat around talking with the team and there were five women that we were taking care of that month that had been raped and abused by the father or stepfather. And it was just amazing. You'd think that some of these stories are so rare and not typical. The truth is is that many of the kids that we see have gone through so much.

CHRISTENSEN

11:22:33
It's funny that people sort of look at them when they see them on the streets and they think they're lazy and they're good for nothing. And they're survivors. They've amazing that they get up every morning and put their shoes on. None of us, I think, would be able to survive some of those tragedies.

REHM

11:22:50
And Mary was actually the child who had the bracelet around her wrist. You saw where she lived.

CHRISTENSEN

11:23:03
Yeah, yeah. She lived in a hole and there's no other better way to describe that than just a true hole where she sort of had to go down. The opening width, it's very big. And of course, it didn't smell very good there and there was, you know, trash all around. And, you know, she would crawl down in there. But the truth, again, is that many of the kids are living in the same holes. I was literally out to a place not far from where we park the van just a couple days ago. And there's a whole new set of clothes out there and all these holes and these culverts and under trees and boxes and whatnot. It's like a little village.

REHM

11:23:47
I know you change names to protect people's identities, but why did Mary leave home?

CHRISTENSEN

11:23:57
Mary, like many of the girls left home, because they felt it was safer on the streets than it was at home. And she had been, you know, sexually abused and so she needed to get out of that. She had been sort of forced into things that are so dark and so scary that we don't like to think about it that it actually happens. It's the truth that there's a lot of Mary's out there. We think that most of the girls that are out in the streets, kind of the averages, they're out in the streets for about three days and then they're forced into something. We call it survival sex because they're trying to stay alive. They're trying to get food or shelter, get out of the heat or get out of the cold, depending on where you live.

CHRISTENSEN

11:24:39
And probably true as well of the boys as well. They just won't admit it. And a lot of them have been forced into things that they never even dreamed. And it's not after weeks and months of being on the streets, it's after a few days.

REHM

11:24:53
It's interesting. We've had a couple of calls and e-mails. Here's something from Aaron who says, "I was curious about the kind of advice Dr. Christensen has to give students who would like to be involved in this type of work."

CHRISTENSEN

11:25:17
You know, that's the most amazing thing about the book. Literally, people get done and sometimes they cry and sometimes they're happy and sometimes they're mad. But they all ask, how can I help? I didn't think that everybody was going to go out and take care of homeless kids. But I think that we can, you know, follow our passions and go and help our neighbors and our communities. I put a lot of things in there about what I did wrong, some of my faults and some of my idiosyncrasies and what not, because I want everybody to understand that you don't need to be a super hero to be out there. You just gotta care. And going out and asking how can I help is the first step.

REHM

11:26:01
What were some of your earliest mistakes?

CHRISTENSEN

11:26:05
(laugh) I made a lot of them so I think, you know, underestimating the homeless problems. I mean, really, I thought that that was going to be something I could undertake. I now realize that to truly end the homeless cycle, you really have to come at it from all angles. It's like a wheel with a number of different spokes. And certainly medical care is on there, but mental health and dental health and mentorship and education and all those other pieces fit in it, and that's the only way you're going to get that wheel to roll.

CHRISTENSEN

11:26:50
I also learned a lot about myself and relationships and I learned you can't do it alone. And we've increased the team and you need to tell others when you are having difficulties.

REHM

11:27:06
And of course you have a marriage yourself, you have a family. How did you manage to balance both of those?

CHRISTENSEN

11:27:17
Yeah, not well at first, I think.

REHM

11:27:19
Not well.

CHRISTENSEN

11:27:20
I -- you know, I probably didn't talk to as many people as I needed to. And certainly I didn't talk to my wife and tell her that, you know, I loved her and I needed the help. And I think that, you know, non-communication is never good in any kind of relationship. And when you have something that is as stressful that I'm going under, or her as well -- I have friends who've read the book and they love it. They come up and they say, you know, it's fantastic, you know. But I'd really like to, you know, snap you upside the head so you can understand that you've got to talk to your wife and tell her what's going on. And I said, you know, I'm learning, I'm learning.

REHM

11:28:00
So what you were doing was dealing with the stress internally.

CHRISTENSEN

11:28:07
Yeah, yeah. I -- you know, it's one of those things where you go home and you're so tired and you're so exhausted and there's so many things going on. And I just sort of kept it all in and I didn't talk to anybody about it, specifically Amy. And, you know, it took its toll. It took its toll. But, as I said, I'm learning and I think, you know, we have -- writing the book was almost like marriage counseling. You know, it was fantastic because we learned so much about each other throughout the book. And I think my team as well and, you know my relationship with Jan and with the rest of the team. They're such a fantastic group of people. We really learned how we approach things and I think it's better.

REHM

11:28:54
And I'm sure there are lots of people who can identify with that whole issue of stress and how it makes you withdraw as opposed to reaching out and seeking help. Here's an e-mail from Meg who identifies herself as a pediatrician in Grand Rapids, Mich. She said she'd love to do something like what you're doing there in Grand Rapids. Where do you get your medications such as antibiotics, asthma meds, etcetera? Do the pharmaceutical companies donate samples? Do you carry all of these on the van?

CHRISTENSEN

11:29:43
Great question. So as I sort of said at the beginning, the van is an expensive program. Mobile medical care is probably three times more expensive than fix site care because you're driving around, you're not as efficient, you have to take everything. Everything's got to be put in a little spot. Our meds can cost, you know, 20, $30,000 a year. We put all that in the grants that we write, and some of the funding. We do try to carry all the meds. We don't carry any narcotics and we don't carry any benzodiazepines, the medicines like valium and such, just because I think that creates -- that can create a problem. But almost every other medication that you can think of, some medications for asthma and diabetes and all that, we'll take those with us.

CHRISTENSEN

11:30:31
There are some pharmaceutical companies that have been helpful and give us samples, but only a small percentage. And the reason why is there's a lot of paperwork, there's a lot of process to go through to get those kind of medications. And so we end up making sure that those meds are well within our budget so we know what we have for each year.

REHM

11:30:51
Can you draw me a mental picture of that van?

CHRISTENSEN

11:30:57
Oh, it's great. So it's the one thing that -- and I get in trouble for calling it a van because it's really not a van. It's an RV so it's the same size as a Winnebago. It's 38' long and it's big and it's blue. All the children...

REHM

11:31:15
They can see it coming.

CHRISTENSEN

11:31:16
They can see it...

REHM

11:31:17
Yeah.

CHRISTENSEN

11:31:17
...coming from everywhere...

REHM

11:31:18
Yeah.

CHRISTENSEN

11:31:18
...around the city. And when you walk into it, it looks like a mini doctor's office. So you walk in and you'll see a little tiny waiting area and you'll see the captain's chairs turned around and we'll have our case manager sitting there and they'll be at their computers. And then you walk down and you'll have, you know, bathroom and then you have all this counter space that has, you know, things to draw blood. Then you come to this next room and that's where a nurse will be checking in somebody. And there's a vital sign pole and the blood pressure cuffs and that.

CHRISTENSEN

11:31:49
Then you move a little bit further down and you get kind of our second big room. And it's tiny. You walk into it and you don't have much place to sit. And then at the very far end of it there is a room like a doctor's office. It's a good sized room, still a little bit tiny but we can do a well-woman exam there. We can have a mom in there with a couple of kids. And everything has its place, so lots of little nooks and crannies.

REHM

11:32:18
Gosh, you've gotta be efficient.

CHRISTENSEN

11:32:20
Yeah.

REHM

11:32:21
You really, really do in that kind of space. I mean, there's not much room for sort of putting something in the wrong place.

CHRISTENSEN

11:32:33
Exactly. And trying to find it, too. So the nurses are pretty good because I never seem to be able to find anything. I'm like, okay, where is...

REHM

11:32:41
Yeah.

CHRISTENSEN

11:32:42
...you know, our suture sets? And then we'll have to go and I'll open up the drawer. They'll finally have to show me where they've put them.

REHM

11:32:49
When you think about what you've accomplished, how much more is there for you to do?

CHRISTENSEN

11:32:58
Well, I guess, first it's -- you know, it's always been part of the team. So it's not just me. There's just so many people standing behind me and they're so fantastic. What I would really like, I'd like to not have a job. I'd like there to be no children living on the streets and in holes. I don't think that time is just around the corner so I'm going to keep plugging at it. And I'm going to try to spread the message and I'm going to tell the stories. And hopefully by telling the stories people will want to act.

REHM

11:33:28
Randy Christensen. He is a physician, a pediatrician who operates a mobile medical clinic in Phoenix, Ariz. and Tempe. And you're listening to "The Diane Rehm Show." We're going to open the phones now, 800-433-8850. First to Indianapolis. Good morning, Rich, you're on the air.

RICH

11:34:02
Hi. I'm a social worker and I work in foster care and child welfare. My question to the doctor is often times in this field we come across various stories of abuse and neglect, which you've already gone into. But how do you work reporting that and do you have to report it? And if so, how does that affect your working relationship with those kids?

CHRISTENSEN

11:34:29
Great question. And first, thanks for all that you do out there. We are obliged to report to the State of Arizona for sexual abuse. And we tell the kids straight off, hey, thanks for coming. Everything you say is confidential. If you say something that the law requires us to tell or you're in trouble of hurting yourself or you're going to hurt somebody else, we're going to tell. And they pretty much look at us and say, oh, yeah, well, we sort of understand that. There are sometimes that, you know, they're old enough, they're over 18 and they don't want to tell anybody else and they don't want to talk about other things. And we try to accommodate them if we can.

CHRISTENSEN

11:35:14
Unfortunately, there are sometimes when we have to tell and sometimes that's tough on the relationship. But most of the kids that we've actually, you know, reported CPS to -- so we had a young mom once who had a baby who wasn't doing well on the streets. And we ultimately reported that mom to CPS and -- the mom had been seeing us. We were -- the mom was our patient -- and the CPS took the baby away and the baby ultimately did fine and the mom continued to see us. She was -- I think she was finally relieved. She was young and she was on the streets and she didn't have any way to take care of this little baby. And I think ultimately she thanked us for that.

REHM

11:35:55
Was the child adopted?

CHRISTENSEN

11:35:59
The child was adopted out, yeah.

REHM

11:36:01
Okay. Thanks for calling, Rich. To San Antonio, Texas. Jose, you're on the air.

JOSE

11:36:10
Hi. I've known from research that lesbian, gay, bisexual and transgendered young people are disproportionately represented in the homeless youth population. I'm just curious what the specific experience is in that direction, and also if that factors in when partnering with organizations in various places, especially faith-based organizations?

CHRISTENSEN

11:36:28
Great question and you're right. You do see a disproportionate amount of adolescents that are on the streets and, you know, they're dealing with sexual identity issues. And they feel safer again on the streets or they've run away or, you know, some of the kids we've known have just been told, just get out of the house, I don't want you in the house.

REHM

11:36:50
Been rejected by family.

CHRISTENSEN

11:36:53
Exactly, exactly. We call those kids throwaways. And we -- as I said before, we create relationships with a lot of different organizations. When it comes down to it I'm their doctor and what they tell me is confidential except for the fore mentioned sort of process if they're in trouble. So none of the other organizations can sort of say, you know, you can't see or what kind of advice we give. Most of the organizations that we work with and we collaborate with are fantastic organizations and they're fully supportive of the patients that we see.

REHM

11:37:29
Dr. Randy Christensen is a physician at Phoenix Children's Hospital. He's also medical director of a mobile medical clinic that serves homeless children in and near Phoenix, Ariz.

REHM

11:40:03
And a number of our listeners are asking, Dr. Christensen, how you deal with children with special needs, with mental health problems, for example.

CHRISTENSEN

11:40:19
It's a great question. And, unfortunately, I think, that's sort of the weakest part of the whole program. The mental health and the dental health those kinds of issues are difficult to come by. Most of the time we work towards getting them on our state insurance or some sort of program which will allow them mental health services. As I said before, that's one of the big causes of kids being on the street is troubles with mental health.

CHRISTENSEN

11:40:51
We've looked at some snapshots and sometimes 40 to 50 percent of our kids are actively, you know, contemplating suicide. So we think that mental health issues are probably three to four times the amount that's in the general population. And I've come to the conclusion that the best way that we're going to be able to deal with it, for our patients, is really to find grants that will be able to support our own psychiatrists on the van. So we will actually try to get a program in which we will take mental health services out to the streets, as well.

REHM

11:41:31
It's interesting. Yvette in Bowie, Md., says, "Why are lawmakers proposing to cut Medicaid to the bone in light of what you're telling us?"

CHRISTENSEN

11:41:46
Yeah, you know, I realize that healthcare issues are complex and I realize that funding is very limited and people have to make cuts. But it's my job to tell you what the priorities are and kind of tell you what's happening out there. And the truth is is that when you take away some of these services, you're going to pay for it more in the end. And so when I go to the Hill and I'm trying to advocate for the homeless population, I can tell them that it's the right thing to do. I can tell them that it's important to take care of these children, but really the argument that I use is it's also fiscally responsible to take care of these kids.

CHRISTENSEN

11:42:33
If you don't, they're going to show up to the emergency rooms. They're going to get sick. They're going to end up in the hospital and those kind of bills that you're going to pay, that we, as a society, are going to pay, are going to be much, much more expensive than if you just take care of them right at the beginning and do some preventive care there.

REHM

11:42:50
Have you had face-to-face time with members of Congress or is it mostly their aids?

CHRISTENSEN

11:42:59
No, actually, it's been great. As part of, sort of, the network of Children's Health Fund, we go to D.C. every year and we, sort of, pound the pavement and we try to be advocates for the children. With CHF they have 25 different programs across the country. So we have a lot of co-colleagues and a lot of people there talking about what's important. And with that kind of mass we can get some things done sometimes.

REHM

11:43:36
Here's an e-mail from Sheila who says, "The plight of the homeless is not something for the weak-hearted. I work as a mentor with two mothers. It's the toughest job I've ever had. God speed to you and all who do this work."

CHRISTENSEN

11:44:00
You know, again, thanks to that last e-mailer. That's fantastic. I appreciate that you're out there. I sort of thought about one of my nurses. She is a little firecracker and she's just unbelievable. She has now over 20 homeless moms in some sort of nursing school going through. So these are moms that would have never had a chance. They were told that they were worthless. And, you know, she's organized a club and so they're studying together. And they're getting into nursing school. One of my favorite moms, she's got a little girl that we saw since she was just a little, tiny infant. And now this mom has a full ride to a nursing school there in Arizona. She's living in her own apartment. She's going to have a great job because somebody believed in her.

REHM

11:44:52
To Salt Lake City, Utah, good morning, Scott.

SCOTT

11:44:58
Good morning, thanks for taking my call.

REHM

11:44:59
Sure.

SCOTT

11:45:00
I'm a pediatrician, as well, and I did similar kind of work with at-risk kids for about 15 years and one of the things that just kept coming up was how complicated it is for these families to get all of the different services that are available through state and federal agencies. And I just want to congratulate you, Randy, on what you're doing. But I'm just curious about what your view of how we could make all these services easier for people to get to, rather than -- it's almost a full-time job just to get the services.

CHRISTENSEN

11:45:31
You're so right. And, again, thanks for what you do. I think one of the important things that I learned at the very beginning is not to try to reinvent the wheel. So I'm not a dentist. I'm not a psychiatrist. But if I can create a collaboration, if I can get a number of people to sit down at the table -- and that's what it's all about; it's about the partnerships. So that's why when I talk about, sort of, all the people that are involved we have, you know, the state people, we have federal people, we have faith-based organizations, we have non-profits and we put them all together. The parole officers, you know, all these people in the same room, we all see we have the same goal and we can move around.

CHRISTENSEN

11:46:16
Everybody can continue on with their agenda, their mission. But together, we can put our missions together and, I think, that's when you start to see the success.

REHM

11:46:23
Scott, you said you had done this for about 15 years. Have you given up?

SCOTT

11:46:32
Well, I've -- my career moved on and I worked in public health for about 12 years and now I'm working with hospitals. But what I was trying to get at, Randy, was just that there's about 15 different federal agencies that have some piece of children's health and they -- it's a different eligibility process, it's a different budget process, it's a different set of services.

REHM

11:46:53
Wow.

CHRISTENSEN

11:46:54
Yeah.

SCOTT

11:46:54
Often, there's different case managers. You think there's a way we could do this...

CHRISTENSEN

11:46:59
You know, one of the...

SCOTT

11:46:59
...that would be more effective and...

REHM

11:47:00
More simply.

CHRISTENSEN

11:47:00
Yeah. One of the things that we've always been, sort of, proposing to our members is to have a White House office on youth. We do that with a lot of other, sort of, special interest groups or such. And it would be important to have somebody who really can figure out where all the funding is and who's in charge of it and really put that together. That would be on sort of a federal level, but, obviously, having, you know, your local elected officials, you know, having them address some of these issues in a broader scope, as well.

REHM

11:47:35
Scott, thanks for calling. Here's an e-mail. "Please ask your guest to comment on the increased pressure to de-fund Planned Parenthood, which provides important medical service to poor women, men and teens around the U.S."

CHRISTENSEN

11:47:58
You bet. There are so many great organizations. Planned Parenthood is one of those that, certainly, takes care of people that don't have access to healthcare. They don't have access to the things that they need to get by. And...

REHM

11:48:18
It's my understanding that only three percent of their funds go to abortion.

CHRISTENSEN

11:48:26
Yeah, and, you know, from what we've seen on the streets, we've not seen a lot of kids that even ask for that sort of option. And, you know, I think a lot of people sort of wonder why. And I think that's sort of the unconditional love that they're looking for. They'll all have pets. They may not be able to get food for themselves, but they'll have pets. And when they find out they're pregnant, they sort of are a little overwhelmed. But, at the same time, they really just want to, you know, kind of, move on with their lives. And I think having a baby, for them, just sort of brings them that unconventional love that they've missed out in their lives.

CHRISTENSEN

11:49:06
I don't know if that's the right thing or the wrong thing for them. I suppose there's lots of different cases and in some cases, for us, it's worked out well. And in some cases, as we talked about earlier, they need to give the kid up for adoption. It just is.

REHM

11:49:23
I know that you talked about the kids and, in some instances, their wish to remain anonymous. What happens with your desire to keep electronic medical records?

CHRISTENSEN

11:49:46
So we're very good. And the book, I think, as well, we tried hard to make sure that none of the identities of the kids would ever be able to leak out. Most of the kids, especially the ones that had success and are kind of moving forward with their life, they don't want to sort of be involved in the old life. So we're very, very careful, even those that have consented in the past to interviews and newspaper articles and whatnot, some of them have been persecuted on the streets. And when you're on the streets you don't really have a whole lot of options out there.

CHRISTENSEN

11:50:27
Our medical records, the same way. We keep all of our medical records on a server through an electronic medical record, very password protected and under the same scrutiny that major hospitals would have, as well. So we think that, you know, our data is pretty well secured and very encrypted.

REHM

11:50:48
I was stunned by some of the stories you told about the health problems you found in some of these kids. Matthew, sort of a quiet, good natured boy who had a super infection on his feet, but one child who had something so extraordinary in the ear.

CHRISTENSEN

11:51:20
Yeah, yeah. Those are just some of the stories that, you know, that you just -- for me, it's one of those things that happens relatively frequently. Not too long ago, I had a similar child. She had been living with her parents. They'd lost their job, they lost their house, they lost their car and they were in a shelter. And she'd had a pain for a couple weeks and they were living at this shelter and they'd just gotten there. And we pulled up in the van and they came out and the little girl comes up and says that her ear's been hurting for so long.

CHRISTENSEN

11:51:59
And the parents said, you know, we haven't been able -- we finally got some, you know, some small jobs and we didn't want to lose the job and try to take her and, you know, we didn't have insurance anyway. And so, you know, I'm looking in the ear and I'm pretty sure that I know what's going on. And, of course, I look in there and it's not rocket science. She had a little dead cockroach that had crawled in her ear. It happens, you know, as I said, relatively frequently. It's a warm place and moist. You know, these little baby cockroaches are, you know, on the floors in these, you know, abandoned buildings or hotels or whatnot.

CHRISTENSEN

11:52:33
And so it doesn't take much and I can get the, you know, the little cockroach out and squirt it out with some saline and stuff like that. The little girl, literally, got the little basin and has the stuff in there. She's showing everybody in the shelter, look what he took out. Look what he took out. And then, of course, then she comes and gives me this big huge hug. And it was right after the People Magazine article came out and so one of the employees of the shelter gave her the picture of me. And so she, literally, has this picture by her bed. And this is, you know, this is a couple years now. I saw her recently and she walks up and she goes, I know you. You're Dr. C.

REHM

11:53:14
Oh.

CHRISTENSEN

11:53:14
And she gives me a big hug.

REHM

11:53:16
That's lovely. It's worth it all. And you're listening to "The Diane Rehm Show." And to Angola, Ind., hi, there Shane.

SHANE

11:53:30
Hello. I've got a question for Randy. I would like to know what drives you and what's your driving force and do you feel that there is something internally that pushed you to do what you do? And I'd just like to say that the work you do is very honorable. It's something that is, you know, something that we all need to aspire to do is to teach our children that there are others that are less fortunate than we are. And my wife and I do that with our son, he's only seven, and we teach him, you know, that we need to help out those that need help. And so we work on that with our son, but I just wanted to know, because I feel that internally that I need to do that, that we need to help these kids and these people that need help.

SHANE

11:54:26
And the other thing is is that I wanted to comment earlier on in the show you hesitated to ask the girl about her bracelet. And I make a conscious effort to -- when I see people and they have something, like I always try to ask. And I did one time and it turned out really well. There was a woman -- a girl working behind a desk in a hotel and I thought she had a pink ribbon. And, of course, when I seen it, I thought of, you know, a breast cancer survivor or somebody that she knew. So I asked her and she said, no, people think it's pink, but it's actually orange. And she said, it's for self injury. And it was right after Diane had her show on self injury.

SHANE

11:55:12
And so I was able to relate to maybe some of the things that she was going through or some of the things that maybe a friend went through because the reason why she had the tattoo.

REHM

11:55:22
Wow.

SHANE

11:55:22
But anyway, I turned her on to your show, Diane, and let her know that that was an excellent resource.

REHM

11:55:27
Oh, I'm so glad.

SHANE

11:55:27
But you have -- I'll take my answer off the air, but thank you.

REHM

11:55:32
Thank you, Shane.

CHRISTENSEN

11:55:34
Well, great for asking. I think that was one of the things that I learned and, you know, that's why I titled the book, "Ask Me Why I Hurt." So it's a constant reminder for people to ask, to really figure out what's going on and not just a hello, how are you, kind of thing.

REHM

11:55:49
But he really wants to know what drives you.

CHRISTENSEN

11:55:53
Yeah, yeah. And that's the important -- that's the important part of the question, I'm sure. And, you know, I look back and my mom and dad, they were raised -- they were poor farm kids. My mom was 16 before she even had a real floor. They had had dirt floor before that. We always had a roof over our heads, but we, you know, I can remember my parents struggling. But no matter how much we struggled, it was always, you know, sort of instilled in my sister and I that we were responsible for our neighbors and our community.

CHRISTENSEN

11:56:28
And I think that, you know, just from a very young age, I can remember, you know, my mom saving up dimes so she could help, you know, somebody at the end of the year. And the truth is probably $35 or something like that. But, you know, she wanted somebody else to, you know, be helped in some way. And we sort of felt the same way. My wife and I just, you know, we really wanted to go out there and take care of our community. And that's what our kids are doing now.

REHM

11:57:01
And we should say that a generous portion of the proceeds of this book are going into the work that Dr. Christensen is doing. The book is titled, "Ask Me Why I Hurt: The Kids Nobody Wants and the Doctor Who Heals Them." Dr. Christensen, thank you for being here. Thank you for the work you do. I hope you continue in that line.

CHRISTENSEN

11:57:37
Well, thank you so very much for inviting me.

REHM

11:57:39
My pleasure. Thanks for listening all, I'm Diane Rehm.
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