1 of 5

Buy Photo

Henry A. Barrios / The Californian

Thirteen-year-old Devin Vallejo checks his blood sugar level for the second time recently one morning. Reading more than 200, he will inject himself with insulin to bring the sugar level down. He also will have his breakfast of eggs and spam, cream of wheat, a banana and milk to get him through his classes, which includes P.E., until lunch

2 of 5

Buy Photo

Henry A. Barrios / The Californian

Devin Vallejo injects himself with insulin before having breakfast and starting his school day. Because he has juvenile diabetes, he has to inject himself four times a day. He still lives the active life of a 8th-grade boy, running the mile several times a week in P.E. and showing pride in running a 1/4-mile lap in 55 seconds.

3 of 5

Buy Photo

Henry A. Barrios / The Californian

Devin Vallejo keeps a log of his blood sugar level readings. His grandmother encourages him to take his own blood sugar readings and keep his own log to help make him responsible for controlling his diabetes.

4 of 5

Buy Photo

Henry A. Barrios / The Californian

Devin Vallejo starts his walk to school recently. He has to carefully monitor his blood sugar level to control his juvenile diabetes but also is enjoying the life of a 13-year-old boy.

5 of 5

Buy Photo

Henry A. Barrios / The Californian

Pamela Mayfield helps her grandson, Devin Vallejo, control his juvenile diabetes by helping him make good choices for his after school snacks.

For 13-year-old Devin Vallejo of Oildale, visiting a specialist for his juvenile diabetes means a two-hour drive each way to the children's hospital in Madera.

For Pamela and Mike Mayfield, his grandparents and legal guardians, each trip also means spending scarce money to rent a car.

Devin is covered by Medi-Cal, a publicly funded health program for low-income and disabled residents. But he also joins a group of children with serious medical conditions -- including hemophilia and cerebral palsy -- who receive some medical care through a different public program called California Children's Services (CCS).

Devin was referred to a pediatric endocrinologist at Children's Hospital Central California in Madera because the family was told that was the closest specialist who accepts Devin's complicated mix of insurance, said Pamela, 52.

"We have no diabetes doctor for children like Devin in Bakersfield. Unless you have good insurance, then you can go to any doctor here," she said. "If there's an emergency, it's not like I can jump in the car and go to Madera."

Devin, an eighth grader at Standard Middle School, takes insulin shots four times a day. A sometimes brooding teen, he doesn't always admit to his grandmother when he has eaten a donut or other sweet treat that sends both his blood sugar -- and her blood pressure -- soaring.

When asked how he feels about traveling to Madera at least four times a year for appointments, Devin uses a few choice words such as "lame" and "sucks" at first, then elaborates.

"There should be no such thing as Medi-Cal. It should be equal," he said. "Why can't it be close? Why does it have to be far?"

Like Devin, about 70 percent of CCS-eligible kids also are eligible for Medi-Cal. The Medi-Cal program reimburses their care.

Finding a Medi-Cal doctor can be challenging enough. But kids on CCS have to go one step further and find specialists in the CCS network, according to the state Department of Health Care Services.

Those doctors have the most specialized training and skills to treat CCS-covered diseases, said Anthony Cava, department spokesman.

"It may not be in Kern County, but it's the best care the child is going to receive," he said.

The Mayfields have a truck, but it needs work and can't be trusted for the drive to Madera. Fixing it is beyond the reach for the one-income family, Pamela said.

"We've missed appointments quite a few times because of transportation," she said.

Devin's last appointment in Madera was in November. His next is in February. Pamela plans to rent a car "unless by the grace of god we come up with god knows how much money to fix our car," she said.

The trips also take a physical -- and emotional -- toll on the family.

"I have to get up at 4 or 5 a.m. sometimes," Devin said. "One time we went to Madera and we were just in and out in, like, 15 minutes. It was like no point in even going."

"I would rather see a doctor here," he added.