Visitors need only follow the stench and the gurgling sound to find a pipe belching human waste into the river outside this Kentucky coal town.

Each time a toilet is flushed in one of about 40 homes in the community of Sunshine, another surge of feces and soggy toilet paper flows into the upper reaches of the Cumberland River.

Four years after Kentucky began a crackdown on straight pipes -- so-called because they carry sewage straight from homes to creeks -- stretches of the Cumberland and many other streams are still so foul that swimming is off-limits.

"We have some of the most beautiful streams in the world," Mayor Danny Howard said. "If only we could clean these sewers up and convince people not to put this stuff in the river."

The crackdown is a collaboration between the state of Kentucky and a government-sponsored environmental group called PRIDE. State inspectors issue citations for code violations, and then PRIDE dispenses federal grant money to help poor homeowners and communities fix the problems, which are so bad that the Environmental Protection Agency says some Kentuckians are living in Third World conditions.

The ultimate goal is to help poverty-stricken Appalachia shed its reputation for hillbilly squalor and use the region's natural beauty to attract tourists.

Over the past three years, PRIDE Executive Director Richard Thomas said, 25,200 homes in the region have been connected to municipal sewer systems or hooked into new septic systems paid for through the organization.

Plans are now being drawn up to replace the Sunshine straight pipe with a connection to the Harlan sewage treatment plant, a $1.9 million project funded largely by PRIDE.

"There is nothing short of a historic transformation taking place in southern and eastern Kentucky," said Rep. Harold Rogers (R-Ky.), co-founder of PRIDE. "Thousands of volunteers and community leaders are turning back decades of pollution and a new generation is learning to avoid the mistakes of the past."

There is still a lot to do. The upper Cumberland, once popular for swimming, is off-limits, with no more rope swings hanging from the trees.

"The children are told to stay away," said Joan Robinett of Harlan, an environmental activist. "Just wading in that water can be a problem if you have any kind of cut or scratch or open wound. It's not healthy."

Lonnie Burkhart, 54, recalled swimming in the Cumberland with other kids on hot summer days when he was a boy. He said the water was cleaner then, because most homes did not have indoor toilets and there was no need for pipes to carry waste away.

Burkhart said he is disappointed that his four children have not been able to enjoy the river the way he did.

"We've got a long way to go," Burkhart said. "It's moving in the right direction now. People are a lot more aware of the health hazards, and they want it cleaned up."

The EPA estimates the cost of eliminating straight pipes in eastern Kentucky at $300 million. Dealing with failing septic systems could bring the cost to $1 billion. So far, the federal government has funneled $106 million into eastern Kentucky through PRIDE to stop the flow of human waste directly into streams.

Thomas said cleaning up the mess is also going to require changing a mind-set in Appalachia that says it is okay to pollute. "We have to break the cycle of pollution," he said. "We're trying to teach the young kids why we shouldn't pollute."

When he speaks to audiences in eastern Kentucky, Thomas said, he tries to make clear the effect of straight pipes on the environment.

"I try to get as graphic as possible without being rude and crude about it," he said. "Imagine flushing your toilet. What runs out the bottom of your commode is what runs out into the stream. Most people get the picture pretty quick."