Delivering care to youths in need
As a medical student at Tufts University, Randy Christensen learned of a mobile clinic serving the homeless in Greater Boston. Hoping one day to do something similar, he got his chance soon after going to work at Phoenix Children’s Hospital in 1999.
Since then, Christensen has gone into some of the roughest areas of Phoenix with a Winnebago retrofitted into a clinic on wheels to provide thousands of homeless teens with medical care, young people who easily slipped through the gaping holes in America’s legal and social safety nets.
Christensen quickly learned that many of the kids living on the streets had run away from home after being sexually abused by close relatives. Others had fled homes destabilized by alcohol and drug abuse, violence, and mental illness. Some had even been sold into prostitution by their own parents.
Lacking access to safe shelter, these kids slept in abandoned buildings, sewers, and dumpsters. Trying to arrange for some of his patients to receive treatment for chronic conditions, he repeatedly came up against barriers preventing them from enrolling in Arizona’s Medicaid program, without which they could not receive the care they needed. For example, one teen suffering from acute psychosis needed urgent psychiatric evaluation and treatment. Without Medicaid, she would not be able to purchase the medications she so desperately needed. However, Medicaid would not enroll her unless she completed the registration process, which included providing detailed information about herself that she was incapable of doing unless medicated and stabilized.
Christensen embodies the kind of devotion and dedication we all would wish for in any doctor caring for us when we are ill. He also does not hesitate to express his frustration and anger at a dysfunctional system, which repeatedly turns its back on those most at need. These frustrations are keenly felt throughout this book, the title of which comes from a bracelet worn by one of his patients who had run away from home after being repeatedly raped by her father (and whose life turned around, in large part, thanks to Christensen’s efforts on her behalf).
After reading the stories, which, although heartbreaking, still manage somehow to inspire hope and even a cautious optimism, it is impossible not to identify with his dissatisfaction with the system and at how it so utterly failed these children. The questions he raises are especially relevant in this period of budget cuts and reductions in services. There are many who disagree with the notion that access to health care is a fundamental human right, viewing it instead as a commodity to be provided only to those who can afford it. It is difficult, however, to believe that the reality in which Christensen has lived and practiced for over a decade, and describes so vividly, is one that anyone would embrace as a model for our society as a whole. Christensen is to be commended for revealing this mostly hidden side of what lack of access to health care means for some of the tens of millions in this nation who struggle with it on a daily basis.
One of the most interesting aspects of the book was Christensen’s personal evolution during this period. Gradually accepting the limits of what he could and could not do (while never, it seemed, giving up trying to do everything he could), he began to recognize his successes in transforming the lives of certain individuals without being overwhelmed with despair at the thousands of others still in great need. As his wife explains to their daughter, “[your daddy] cares about people and wants to help them. But sometimes it doesn’t work. The hardest part of being a doctor is knowing you can’t help everyone.’’
Dennis Rosen, a pediatric pulmonologist, can be reached at firstname.lastname@example.org .edu.