PIKEVILLE, Ky. — The scene is etched into Dr. Baretta Casey's memory — a screaming baby boy with golf-ball size blisters on his buttocks and legs.

        Dr. Casey was a third-year University of Kentucky medical student working clinical rotations when the 6-month-old was brought into the emergency room for treatment of burns caused by being placed in scalding water by an abusive father.

        She could see the pain in the baby's face and hear it in his cries.

        “It's something you can never forget,” she said. “I said then that I would never be afraid to be a child's advocate any time I felt that something was wrong.”

        The Pikeville family practitioner is one of only nine physicians in Kentucky's Appalachian region who routinely examine children for signs of sexual abuse, according the Children's Advocacy Center of the Bluegrass. Most other doctors in the region of more than 1.1 million people opt to refer children elsewhere.

        The most common reason doctors give for not doing the exams is that they're too busy to take on the time-consuming cases that often come with the added burden of testifying in court, said Dr. Deborah Stanley of Lexington.

        Dr. Stanley, medical director of the Children's Advocacy Center of the Bluegrass, has taken most of the referrals from the region over the past 10 years. Now, she is trying to recruit physicians in eastern Kentucky to share the work load.

        “I don't find fault with any physician who chooses not to do the exams,” Dr. Stanley said. “It's very emotionally wearing. You have to be a certain personality to be able to do this kind of work.”

        However, the reluctance may mean that some cases of child sexual abuse go undetected. The Children's Advocacy Center, in an application for federal funding, said the number of sexual abuse screenings done in eastern Kentucky increased from 83 to 300 in the past two years with Dr. Casey, Dr. Stanley and the other seven physicians redoubling their efforts.

        Melissa Quillen, executive director of Kentucky River Children's Advocacy Center in Hazard, said some children now have to wait three to four weeks to see the lone physician who does child abuse exams for the eight counties she serves.

        “Our goal was to have several physicians rotating the duty, instead of just one,” Ms. Quillen said. “We've not been able to get anyone else.”

        Deborah Burton, a UK Medical Center technology consultant who has helped Dr. Stanley develop a recruitment and training program, said too many doctors shy away from what could be considered the most important kind of work — protecting innocent children.

        “Child sexual abuse has a special taboo with it that people don't like to talk about,” Ms. Burton said. “It is very much an issue in our society, and it has to be recognized as such because the cases we have identified are only a drop in the bucket compared to those not identified, reported or acknowledged.”

        The Appalachian Regional Commission is funding the initiative to get additional physicians in the region to do the exams. Over the past two years, the commission has contributed $467,000, and has just awarded another grant of $307,000.

        The grants cover the cost of training and equipping doctors to do the exams, plus computers that allow them to consult with Dr. Stanley and other experts on difficult cases.

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