More than one million children in the U.S.today are homeless. As a result, many of them lack regular health care. Ten years ago, a pediatrician in Phoenix, Arizona became the first to run his hospital’s mobile medical clinic – a doctor’s office on wheels. His goal was to help homeless children get the medical attention they need. Their problems –from sexually transmitted diseases to infections from living outdoors – are often very different than those of other children. The converted Winnebago known as “Big Blue” has now served almost 7,000 children. Health care challenges facing homeless children in America.

Guests

  • Dr. Randy Christensen staff physician at Phoenix Children's Hospital and medical director of Crews'n Healthmobile, a mobile medical clinic that provides health care to homeless children

Author Extra: Randy Christensen Answers Questions

Dr. Christensen stayed after the show to answer a few more questions.####

Q: I haven’t heard anything mentioned about the percentage of kids on the street who identify as Gay Lesbian Bisexual or Transgender. Do you find that this is an issue in Grand Rapids as it is in Cleveland? Haven’t done a recent report on GLBT percentages but off the top of my head I suspect about 20% of the adolescent population on the streets. Do you provide STD testing, HIV testing, and education regarding condom use? Is there anyone on your staff who is versed in working with this population?
- From Katherine via email

A: We do indeed do STI testing, including HIV, and educate on safe sex practices including condoms. All clinical staff is pretty comfortable with the topic and we use a modified HEADSS questionnaire form (this is an adolescent risk assessment).

Q: How do you deal with the inescapable recognition that poverty is at the root of most of the social problems you’re dealing with and poverty appears to be institutionalized in this country?

A: I choose to stand up and tell others the stories. I choose to be an advocate and hopefully I can get others to listen and eventually to act. That’s why I keep doing this job.

Q: I was thinking that the house call might make a come back if medical professionals can turn it around. That is to say that I believe that health care reform should start from the people on the inside, not the bureaucracy. I was hoping there might be a movement in what I now call the “Medical Industry” to go back to a more personal healthcare experience. Thoughts? – From Ian via Facebook

A: I think that in the beginning the term “health care reform” meant that we would push medicine towards an “evidenced based/primary care/holistic/medical home” focused way of caring for patients. Unfortunately this has come to mean so many other things based largely on political beliefs. I hope that in the end we truly spend some time looking at the way we deliver health care and maybe there is something to learn from the old traditions of house calls.

Program Highlights

Dr. Christensen’s Mobile Health Care for the Homeless

For the past ten years, Dr. Randy Christensen has run his “clinic on wheels” that focuses on treating homeless children in Phoenix, Ariz.

Working with underserved populations is an idea that Dr. Christensen says he grew up with. He can remember his parents struggling with finances, but they always found a way to try to share what they had with their neighbors and their community.

“Just from a very young age, I can remember my mom saving up dimes so she could help somebody at the end of the year. And the truth is probably $35 or something like that. But she wanted somebody else to be helped in that way,” he said.

Number of Homeless Families Increasing

According to Dr. Christensen, families are the fastest-growing segment of the homeless population. In Arizona alone, there are an estimated 5,000 – 10,000 homeless children, the majority of whom live in Maricopa County.

Every year, Christensen says, the number of medical visits his mobile clinic conducts increases.

Diane asked the doctor how his mobile clinic finds the youths it treats. “We’re very consistent,” he replied. “We try to build relationships, collaborations with many of the organizations out there, whether it be a faith-based organization or a state organization.” Christensen says that he and his colleagues are trying to become a true comprehensive program that also treats adults when necessary.

Memorable Patients

Dr. Christensen tells the story of one young girl who came to the clinic with a bad, persistent ear ache. Christensen examined her to find a small, dead cockroach in her ear.

“It happens relatively frequently,” Christensen said, because these children are sleeping on floors in run-down or abandoned buildings where cockroaches thrive. The little girl took the basin with the cockroach Christensen had extracted and was going around proudly showing it off to others saying, “Look what he took out!”

“And then, of course, she comes and gives me this big huge hug,” Dr. Christensen said.

Read an Excerpt

Excerpted from Ask Me Why I Hurt: The Kids Nobody Wants and the Doctor Who Heals Them. Copyright @ 2011 by Dr. Randy Christensen. Reprinted by Permission of Broadway Books, an imprint of the Crown Publishing Group, a division of Random House, Inc., New York:

Transcript

  • 11:06:55

    MS. DIANE REHMThanks 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.

  • 11:07:23

    MS. DIANE REHMIn 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.

  • 11:08:07

    DR. RANDY CHRISTENSENGood morning, Diane, it's great to be here.

  • 11:08:09

    REHMTell me about that bracelet that's on the front of the book.

  • 11:08:15

    CHRISTENSENThe "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.

  • 11:08:41

    CHRISTENSENIt 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.

  • 11:09:04

    REHMHow did you first get started on this idea of a mobile medical clinic?

  • 11:09:15

    CHRISTENSENYou 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.

  • 11:09:49

    REHMYou 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?

  • 11:10:03

    CHRISTENSENYeah, 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.

  • 11:10:18

    CHRISTENSENWhen 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.

  • 11:10:55

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

  • 11:11:09

    CHRISTENSENYou 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.

  • 11:11:34

    REHMOh.

  • 11:11:34

    CHRISTENSENAnd 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.

  • 11:11:53

    REHMSo how did you fund yourself along the way?

  • 11:11:57

    CHRISTENSENYou 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.

  • 11:12:18

    REHMAnd who is paying for the kids' health?

  • 11:12:22

    CHRISTENSENIt'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.

  • 11:12:43

    REHMThat's terrific.

  • 11:12:44

    CHRISTENSENYeah.

  • 11:12:45

    REHMSeven thousand kids in ten years, that's a lot of children...

  • 11:12:51

    CHRISTENSENYeah, yeah.

  • 11:12:52

    REHM...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.

  • 11:13:04

    CHRISTENSENYeah, 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.

  • 11:13:36

    CHRISTENSENIn 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.

  • 11:13:53

    REHMWow, how do you find these kids? Surely it's not like an ice cream truck rolling by when...

  • 11:14:02

    CHRISTENSENGreat question.

  • 11:14:02

    REHM...kids come out to see you.

  • 11:14:06

    CHRISTENSENWe'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.

  • 11:14:39

    REHMSo if you go to a place called UMOM, presumably moms are there, too, but you're only treating the children?

  • 11:14:52

    CHRISTENSENWe'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.

  • 11:15:05

    REHMI see.

  • 11:15:06

    CHRISTENSENBut 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.

  • 11:15:17

    REHMReading through the book, some of the ailments you're dealing with are rather unusual.

  • 11:15:26

    CHRISTENSENYeah, 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.

  • 11:15:56

    REHMSure it's dangerous on the streets. Are any of them or are many of them involved with drugs?

  • 11:16:05

    CHRISTENSENCertainly 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.

  • 11:16:33

    REHMYou said you had a first-day eye-opener when you were parked at your first stop in Tempe. What happened?

  • 11:16:44

    CHRISTENSENSo -- 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.

  • 11:17:07

    CHRISTENSENWe 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.

  • 11:17:55

    REHMWho was with you?

  • 11:17:56

    CHRISTENSENThe 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.

  • 11:18:26

    REHMCertainly, it sounds as though it was on-the-job learning.

  • 11:18:31

    CHRISTENSENExactly.

  • 11:18:31

    REHMDr. 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."

  • 11:20:03

    REHMAnd 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.

  • 11:21:05

    CHRISTENSENYou 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.

  • 11:21:36

    REHMI would think so. Mistrustful.

  • 11:21:39

    CHRISTENSENYeah, 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.

  • 11:22:11

    CHRISTENSENAnd 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.

  • 11:22:33

    CHRISTENSENIt'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.

  • 11:22:50

    REHMAnd Mary was actually the child who had the bracelet around her wrist. You saw where she lived.

  • 11:23:03

    CHRISTENSENYeah, 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.

  • 11:23:47

    REHMI know you change names to protect people's identities, but why did Mary leave home?

  • 11:23:57

    CHRISTENSENMary, 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.

  • 11:24:39

    CHRISTENSENAnd 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.

  • 11:24:53

    REHMIt'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."

  • 11:25:17

    CHRISTENSENYou 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.

  • 11:26:01

    REHMWhat were some of your earliest mistakes?

  • 11:26:05

    CHRISTENSEN(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.

  • 11:26:50

    CHRISTENSENI 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.

  • 11:27:06

    REHMAnd of course you have a marriage yourself, you have a family. How did you manage to balance both of those?

  • 11:27:17

    CHRISTENSENYeah, not well at first, I think.

  • 11:27:19

    REHMNot well.

  • 11:27:20

    CHRISTENSENI -- 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.

  • 11:28:00

    REHMSo what you were doing was dealing with the stress internally.

  • 11:28:07

    CHRISTENSENYeah, 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.

  • 11:28:54

    REHMAnd 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?

  • 11:29:43

    CHRISTENSENGreat 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.

  • 11:30:31

    CHRISTENSENThere 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.

  • 11:30:51

    REHMCan you draw me a mental picture of that van?

  • 11:30:57

    CHRISTENSENOh, 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...

  • 11:31:15

    REHMThey can see it coming.

  • 11:31:16

    CHRISTENSENThey can see it...

  • 11:31:17

    REHMYeah.

  • 11:31:17

    CHRISTENSEN...coming from everywhere...

  • 11:31:18

    REHMYeah.

  • 11:31:18

    CHRISTENSEN...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.

  • 11:31:49

    CHRISTENSENThen 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.

  • 11:32:18

    REHMGosh, you've gotta be efficient.

  • 11:32:20

    CHRISTENSENYeah.

  • 11:32:21

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

  • 11:32:33

    CHRISTENSENExactly. 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...

  • 11:32:41

    REHMYeah.

  • 11:32:42

    CHRISTENSEN...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.

  • 11:32:49

    REHMWhen you think about what you've accomplished, how much more is there for you to do?

  • 11:32:58

    CHRISTENSENWell, 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.

  • 11:33:28

    REHMRandy 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.

  • 11:34:02

    RICHHi. 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?

  • 11:34:29

    CHRISTENSENGreat 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.

  • 11:35:14

    CHRISTENSENUnfortunately, 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.

  • 11:35:55

    REHMWas the child adopted?

  • 11:35:59

    CHRISTENSENThe child was adopted out, yeah.

  • 11:36:01

    REHMOkay. Thanks for calling, Rich. To San Antonio, Texas. Jose, you're on the air.

  • 11:36:10

    JOSEHi. 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?

  • 11:36:28

    CHRISTENSENGreat 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.

  • 11:36:50

    REHMBeen rejected by family.

  • 11:36:53

    CHRISTENSENExactly, 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.

  • 11:37:29

    REHMDr. 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.

  • 11:40:03

    REHMAnd a number of our listeners are asking, Dr. Christensen, how you deal with children with special needs, with mental health problems, for example.

  • 11:40:19

    CHRISTENSENIt'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.

  • 11:40:51

    CHRISTENSENWe'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.

  • 11:41:31

    REHMIt'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?"

  • 11:41:46

    CHRISTENSENYeah, 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.

  • 11:42:33

    CHRISTENSENIf 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.

  • 11:42:50

    REHMHave you had face-to-face time with members of Congress or is it mostly their aids?

  • 11:42:59

    CHRISTENSENNo, 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.

  • 11:43:36

    REHMHere'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."

  • 11:44:00

    CHRISTENSENYou 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.

  • 11:44:52

    REHMTo Salt Lake City, Utah, good morning, Scott.

  • 11:44:58

    SCOTTGood morning, thanks for taking my call.

  • 11:44:59

    REHMSure.

  • 11:45:00

    SCOTTI'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.

  • 11:45:31

    CHRISTENSENYou'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.

  • 11:46:16

    CHRISTENSENEverybody 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.

  • 11:46:23

    REHMScott, you said you had done this for about 15 years. Have you given up?

  • 11:46:32

    SCOTTWell, 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.

  • 11:46:53

    REHMWow.

  • 11:46:54

    CHRISTENSENYeah.

  • 11:46:54

    SCOTTOften, there's different case managers. You think there's a way we could do this...

  • 11:46:59

    CHRISTENSENYou know, one of the...

  • 11:46:59

    SCOTT...that would be more effective and...

  • 11:47:00

    REHMMore simply.

  • 11:47:00

    CHRISTENSENYeah. 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.

  • 11:47:35

    REHMScott, 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."

  • 11:47:58

    CHRISTENSENYou 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...

  • 11:48:18

    REHMIt's my understanding that only three percent of their funds go to abortion.

  • 11:48:26

    CHRISTENSENYeah, 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.

  • 11:49:06

    CHRISTENSENI 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.

  • 11:49:23

    REHMI 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?

  • 11:49:46

    CHRISTENSENSo 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.

  • 11:50:27

    CHRISTENSENOur 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.

  • 11:50:48

    REHMI 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.

  • 11:51:20

    CHRISTENSENYeah, 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.

  • 11:51:59

    CHRISTENSENAnd 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.

  • 11:52:33

    CHRISTENSENAnd 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.

  • 11:53:14

    REHMOh.

  • 11:53:14

    CHRISTENSENAnd she gives me a big hug.

  • 11:53:16

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

  • 11:53:30

    SHANEHello. 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.

  • 11:54:26

    SHANEAnd 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.

  • 11:55:12

    SHANEAnd 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.

  • 11:55:22

    REHMWow.

  • 11:55:22

    SHANEBut anyway, I turned her on to your show, Diane, and let her know that that was an excellent resource.

  • 11:55:27

    REHMOh, I'm so glad.

  • 11:55:27

    SHANEBut you have -- I'll take my answer off the air, but thank you.

  • 11:55:32

    REHMThank you, Shane.

  • 11:55:34

    CHRISTENSENWell, 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.

  • 11:55:49

    REHMBut he really wants to know what drives you.

  • 11:55:53

    CHRISTENSENYeah, 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.

  • 11:56:28

    CHRISTENSENAnd 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.

  • 11:57:01

    REHMAnd 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.

  • 11:57:37

    CHRISTENSENWell, thank you so very much for inviting me.

  • 11:57:39

    REHMMy pleasure. Thanks for listening all, I'm Diane Rehm.

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