Translation errors are a growing concern throughout the medical community, where the changing of a word can lead to even more health problems.

In the Central Valley, the problem is compounded by the huge number of non-English-speaking patients and range of languages.

Health care providers in Stanislaus and Merced counties said they have worked for years to bridge language barriers.

Merced County Public Health Director John Volanti said: "There's no question it has a bearing on the kind of care one gets. It's an important factor, it makes it hard to make a diagnosis."

In a Boston study, Dr. Glenn Flores uncovered dozens of problems when he taped exams of 70 Spanish-speaking children in emergency rooms and clinics.

In one case, a nurse ordered an oral antibiotic to clear up a 7-year-old's ear infection. The child's mother spoke no English, so medical personnel pulled in a bystander to translate. The translator told the mother to pour the drug into the girl's ears.

While the situation is going to get easier for patients, it will become more difficult for medical facilities.

"In the coming years, we're going to be required to certify translators," Volanti said, "And that's going to be a whole other problem and hurdle to jump."

Stacey Hendrickson, spokeswoman for Mercy Medical Center Merced, said the certification requirement is part of the Civil Rights Act. It requires some form of translation service for all patients whose care is at least partially funded by the federal government.

Mercy Medical Center uses Healthy House of Merced, a translation service that provides certified Hmong and Spanish translators.

The hospital also relies on bilingual staff members, some of whom have undergone specialized interpreter training. And Mercy has contracts with AT&T Language Line, a phone-based interpretation service, and the Deaf and Hard of Hearing Service Center.

The Merced County Public Health Department has staff members who speak Spanish, Hmong and Mien, the three most common foreign languages in Merced. His department uses the Language Line for other translation services.

In the past, Volanti said, medical personnel used patients' family members to translate. But that created additional problems when dealing with sensitive health topics.

"With translators, we can maintain confidentiality and achieve competency," he said. "Ideally, you would have someone who speaks the first language as the provider, but that's difficult."

It is an issue that keeps health care providers on their toes because the cultural makeup of the valley is always changing.

"With medical terminology, you want to be certain you are translating correctly for the individual," said Anita Talkington, spokeswoman for Memorial Medical Center in Modesto. "The need for interpreters has grown as the population has become more diverse."

The hospital has an extensive list of employees who are fluent in Spanish, Arabic, Armenian, Assyrian, Cambodian, Chinese, Fijian, French, Hungarian, German, Italian, Japanese, Korean and sign language.

Increasingly, Memorial sees patients who speak only Hindi, and the hospital has more than 30 employees who can serve as interpreters in those situations, Talkington said.

In a pinch, the hospital can use the AT&T service, she said. The number is posted in Memorial's various departments.

The Stanislaus County Health Services Agency, which operates public health clinics, pays stipends to employees who are certified as bilingual, agency spokesman David Jones said.

About 30 percent of the agency's employees speak second languages, with about 25 different languages represented.

County clinics also have access to the AT&T service, but have rarely, if ever, needed to use it, Jones said.

"I have not heard of (any problems) in communicating with patients," he said. "We recruit staff so we can communicate in an effective way."

Doctors Medical Center in Modesto formerly paid a differential to staff members who speak second languages and serve as interpreters. Some nurses were upset when the extra pay was taken away early this year.

Turlock's Emanuel Medical Center, with 1,100 employees, also relies on bilingual staff.

"When you have a place with a large number of employees, then the makeup of your staff tends to mirror your community," said Pennie Rorex, spokeswoman for Emanuel.

About 21 million people in the United States speak limited or no English -- 50 percent more than a decade ago -- and health workers are struggling to care for them.

Hospitals "are reeling from the major change in the number and diversity of languages they're encountering," said Ellen Pryga of the American Hospital Association.

Unable to hire an interpreter for every language, medical facilities are trying creative methods: volunteer translator clubs, teaching foreign phrases to doctors, and hiring bilingual nurses, clerks and even janitors who can translate in a pinch.

Still, just having bilingual staff is not going to work in every situation.

Special training is crucial because general fluency in a language seldom guarantees knowledge of complex medical terms, said Yolanda Partida of Hablamos Juntos, a program started by the Robert Wood Johnson Foundation to improve medical communication for Spanish-speaking people.

Hablamos Juntos is funding 10 experiments around the country to find innovative solutions, especially in hard-hit rural areas such as central Nebraska.

Six counties where the Hispanic population more than tripled in the 1990s are preparing to test a videoconferencing system that would let emergency rooms and maternity wards share 24-hour access to Spanish-speaking interpreters -- and train addi-tional translators long-distance.

Ultimately, said Flores, of the Medical College of Wisconsin, going without trained interpreters "is costing the system more." He cited research showing that translation service can keep medical costs down, by preventing illnesses.

Generally, doctors confronting language barriers cannot turn away patients. And, under civil rights law, medical facilities must make provisions for non-English speakers, if the facilities accept federal money.

Just how many languages must be covered in different facilities, and by what methods, the law does not make clear. The government recently proposed an updated set of guidelines to help sort that out.

Reprinted by permission of Modesto Bee.