By Jeannie Harrell, DNLCC Board of Advocates member

     Children who have been abused by adults need the best possible medical care in order to recover, heal, and thrive.   The Dee Norton Lowcountry Children's Center (DNLCC) is fortunate to have on staff two of the first physicians in the state to receive extensive training in child abuse pediatrics, Dr. Anne Abel and Dr. Michelle Amaya.  Both work with MUSC Children’s Hospital, and also have offices at DNLCC. 
     Dr. Abel, Dr. Amaya, and their nurses saw one thousand six hundred and twenty-nine children in 2009; one thousand and four at DNLCC alone.  “That’s many more patients that we were able to see each year at the child abuse center I worked at in Alabama,” comments Dr. Amaya.  “I think it’s partly because we’re available around the clock.” 
     Some of their patients are babies and toddlers, too young to be able to express in words what has happened to them.  Some are preschoolers, who can describe the abuse, but who are often vague in their understanding of time; they may use the word “yesterday” to describe the day before today, a day last week, or sometime in the past.  Some small bodies have too many scars to count, while other children tell clear and reliable stories of harm done to them, but the abuser has been careful to avoid leaving physical evidence.   These children have been physically, emotionally or medically neglected, sometimes by caregivers struggling with addictions or mental illness themselves. 
     Responding to the complex issues these young patients present, and the large body of research that has been published in recent years, the American Academy of Pediatrics has established a subspecialty in child abuse pediatrics.  Pediatricians can now choose to pursue a full time three-year fellowship to deepen their knowledge of the best treatment of victimized children.  Doctors who qualify must meet rigorous requirements, including spending at least half their professional time since their pediatric residencies caring for abused children.   The first certification exams were offered in 2009.
     During the fellowship, pediatricians become experts in many important disciplines essential to treating suspected victims; they develop, for example, an extensive knowledge of sexually transmitted diseases, abuse-related injuries, and conditions or injuries that can mimic child abuse.  They gain detailed understanding of the interpretation of imaging results, which can often provide the proof necessary to ensure the child’s safety in the future.   They also receive training in making court appearances, so that they will be able to help a judge or jury understand their findings.  
     After the fellowship, they take written board exams, which they must pass in order to be qualified.  “And they’re very challenging!” comments Dr. Abel.  Dr. Abel did her fellowship training at Brown University; Dr. Amaya did hers at the University of Alabama.  By passing the exams, Dr. Abel and Dr. Amaya became two of fewer than two hundred certified child abuse pediatricians in the country. 
     Often called to consult by emergency room physicians, the child abuse specialists have training in asking the difficult questions that primary care doctors may be reluctant to ask.  They then listen carefully to parents’ responses, which often reveal much about the child’s home life.  “Sometimes we’re able to rule out abuse, based on our findings,” explains Dr. Abel.  “That’s always a tremendous relief for everyone involved.”
     The fellowship training prepares child abuse specialists to become leaders in the field, and one of their goals is to train other professionals to help keep children safe.  “One of the many impressive aspects of DNLCC is its unique emphasis on training, which is one of Libby Ralston’s many remarkable contributions, “Dr. Abel notes.   Dr. Abel recently organized the Second Annual Sara Schuh Child Abuse Conference, attended by attorneys, social workers, therapists, nurses, police officers, and guardian ad litems.  Dr. Abel and Dr. Amaya also train general pediatric residents, medical students, and physicians’ assistants to recognize and respond to child abuse.  “It’s the heart and soul of pediatrics,” said Dr. David Habib, Interim Chair of MUSC’s Department of Pediatrics, at the recent conference. “The safety and well-being of children.”
     The partnership between MUSC Children’s Hospital and DNLCC has been a godsend to the community.   Dr. Abel, Dr. Amaya and their team are all MUSC employees, and Dr. Abel credits Dr. Habib and Hospital Administrator John Sanders for their strong support of DNLCC.  “John has always been able to find us the funds we need,” she comments.  “And David has provided unceasing support for our work.”   Furthermore, DNLCC provides an ideal setting for the treatment and healing of abused children.  “It’s one of the best child advocacy centers we’ve ever seen,” note Dr. Abel and Dr. Amaya.   “The community support is outstanding, and so broad.  It runs all the way from the Mayor Riley’s office down to the grassroots. “ 
     “I have hope,” smiles Dr. Abel, “that all of the efforts over the past twenty years are resulting in abused children being treated earlier.  We are getting much better at identifying cases that doctors might have missed before.  Our experience and knowledge helps, as do our more sophisticated testing and imaging techniques.  We can even now see fine details on MRI’s that we could never have spotted ten years ago. “These improvements result in far better outcomes for the children, notes Libby Ralston.  “These doctors are an essential part of our community effort to identify and heal the harm kids have experienced, and to keep them safe in the future,” she explains.  “We are very fortunate to have them.”