After Rashawn was treated for numerous broken bones when he was just a few months old, Ebbini Harris, 16, had to convince the Durham County Department of Social Services she and the baby's father were not hurting the child. They were cleared when their son was diagnosed with osteo-genesis imperfecta, a brittle bone condition.

But that wasn't the family's only trouble. By the time Rashawn, now a babbling 11-month-old, got to the Duke Clinic on Roxboro Road to see Chancey, a pediatric resident, both he and his mother were living in foster care. Harris said her mother kicked them out of her home when the teen could not pay the rent.

And Harris had yet to figure out a daycare situation that would enable her to start her freshman year of high school again because her son's condition prevented him from being safely left with others.

Patients like Rashawn Williams are why pediatric residents at Duke now complete a special rotation called "Docs for Tots." The four-week rotation helps young doctors become patient advocates by exposing them to the social, environmental and cultural factors lower-income patients contend with that contribute to health issues.

"A lot of our patients, especially like patients like Rashawn, come in with medical concerns but we can't address the concerns unless we address the social issues as well," Chancey said.

Chancey's experience with Rashawn will help her down the road when she completes the rotation in January. Numerous public agencies are working together to help Rashawn, including Healthy Families, part of Welcome Baby, and the Department of Social Services. The rotation will teach Chancey about how those programs work, as well as broaden the context in which she sees patients.

"Duke is the pilot site for North Carolina," said Julia Wacker, the Docs for Tots North Carolina program coordinator. "Our hope is that we'll expand it in other medical centers in the state."

Docs for Tots was brought to Duke when Durham's Partnership for Children learned about the national initiative and wanted to make it local, said Marsha Basloe, executive director of the partnership. Basloe contacted program founder Dr. George Askew in 2005. Her staff then got in touch with Duke's pediatric residency program.

The program targets second-year residents, and involves more intimate exposure to patients by way of home visits, as well as experience working with legislators. The residents visit schools and community events like this weekend's CenterFest downtown.

"It catches the doctors at a pretty critical time in their training," Wacker said. "They don't realize the power that they have."

Dr. John Carter recently visited Durham's Central Park School for Children where he talked to a third-grade class about body parts, healthy living, and everything in between.

While trying to explain how the digestion system works (poop was of great curiosity) as well as what happens during an asthma attack, Carter was bombarded with personal anecdotes from the children such as, "I once had a bug fly in my ear" and "I learned that stomach acid tastes disgusting."

Carter said this rotation has attuned him to problems facing lower-income families. Most doctors do not come from low-income neighborhoods, soit might not occur to a doctor brought up in a middle-class family to consider lead poisoning, even though that may be something that is making poor children sick.

Wacker, the program coordinator, said Docs for Tots has three focuses: to help residents understand how poverty affects patients, recognize they have both the power and a responsibility to help, and see concrete ways to make a difference.

Proponents hope to see funding grow for children's health initiatives, and hope other hospitals adopt similar programs - the failing economy has made children's health an even bigger issue with job losses and budget cuts to welfare programs.

"Now this is almost more pertinent than ever," Wacker said.