¡Ayúdeme, por favor!

The words from the scene are classic for movie-goers. Actor Strother Martin, playing the part of the warden in the Paul Newman classic Cool Hand Luke, drawls, "What we got here is a failure to communicate."

Although the line has been parodied many times by comics and others, failure of communication is often a very real situation for Miami Valley hospitals. As the number of non-English-speaking patients continues to rise, medical personnel are forced to seek a number of ways to open lines of communication with their patients.

"(The problem) is growing because obviously the Hispanic population is growing," said Phil Morones, who runs the Golden Acres Salud Health Clinic in southern Miami County. Morones, who is bilingual, runs the clinic, which provides free health services to Hispanics.

"Last year we did over 4,400 face-to-face interpreting," said Paula Burton, supervisor for interpreter services at Miami Valley Hospital. Burton said the total, which did not include phone interpreting, included about 1,000 cases in the emergency room. Burton noted that the hospital had 448 such situations in 2001, and totals have doubled within the last couple of years.

"The number has grown significantly over the last two years," said Barbara Estevez, guest relations manager for Middletown Regional Hospital. She said that Spanish is the No. 1 need, followed by American Sign Language and Chinese. Estevez said that less than 1 percent of all emergency visits require an interpreter.

"We see about four to six non- English-speaking patients a month," said Tracy Rutherford, patient representative for the emergency room at Good Samaritan Hospital. Rutherford agrees that Hispanics make up the largest number, but there is sometimes a variety.

"Last month, we had a patient from Africa, and we had difficulty finding anyone to speak and communicate with the patient," she said. Her department has also seen German, Russian, Chinese and Japanese patients recently.

Sometimes a patient or a family member will profess knowledge of English. "Sometimes they understand a little bit," Morones said. "You ask them a question, and they will nod their head, but that doesn't mean they understand. This seems to be a culture thing."

Culture is another possible pitfall when dealing with non-English speakers.

"If a physician were to ask a patient a question using hand gestures, it may mean one thing to one culture and another thing to another culture," Rutherford said. "We try to educate our staff about different cultures."

Good Samaritan has a contract in place with Miami Valley Interpreters. "We contact them any time we have a patient come in that does not speak English or has difficulty speaking English," Rutherford said.

Middletown has hired a part-time language coordinator who is Spanish-speaking and arranges for interpreters in all other languages. Middletown also uses a telephone service, which has dual handsets and speakerphones.

"It's available for up to nearly 150 languages," Estevez said. "Even if you don't know what language they speak, the interpreters can help assess what the patient's needs are going to be."

She said the service, which is nationwide, is available 24 hours a day, seven days a week and is especially valuable when long delays are encountered as patients wait for test results. Instead of having an onsite interpreter standing by, the staff simply calls the service again.

Middletown also contracts with VocaLink, another Dayton-based language service, Miami Valley Interpreters and Community Services for the Deaf for interpreting needs.

Miami Valley Hospital has interpreters from VocaLink full-time during the day at the hospital.

"We also have a full-time bilingual dispatcher that dispatches all our interpreters," Burton said.

Interpreters work throughout the hospital during the day, but are on immediate call for trauma victims. After hours, emergencies are handled by on-call interpreters who can usually respond within 30 minutes.

Life-threatening incidents are treated immediately at all the hospitals.

"Often, in an emergency, the patient can't speak any language," said Estevez. "They may be unconscious. We are not going to hold up life-saving care because we don't have an interpreter at that second." She added that an interpreter would be called to arrive as soon as possible.

Local schools, private and public, are attempting to address the needs by providing courses, especially in Spanish, specifically for health-care personnel.

Spanish for Health-Care Professionals is a course that has been offered by Sinclair Community College for the past five quarters, according to humanities professor Derek Petry.

"Fifteen percent of my regular Spanish students in the (lower-level classes) were in nursing or allied health or something in that field," Petry said. "So I started to move toward developing a class in that nature."

Petry said the class is well-attended and can be taken for required continuing education credit. No former training in Spanish is required. Petry says the course runs the normal 10-week quarter, but it has run as a seven-week course in the summer.

Germaine Language Institute in Dayton offers Medical Spanish, which is 32 sessions of 90 minutes each that cover most aspects such as medical history, different health problems, pre-surgery, pregnancy and trauma.

Student who take the course are from the total spectrum of the medical field.

"It could be a doctor, it could be a nurse, it could be somebody in the emergency room or other situations," said Gail Horvath, Germaine director.

Wright State University doesn't currently offer a course specifically designed for medical personnel, according to Modern Language Department chair David Garrison.

"We have offered it irregularly and the main reason (for that) is that health-care professionals have such different schedules that it is very hard to schedule," he said.

"We also have had a problem finding people who have both the Spanish and the health-care background. It works better if you have someone who is in health care." Garrison said the course was originally taught by a nurse of Puerto Rican extraction.

Robin Melnick, who runs Shapes Language Training in Yellow Springs has just been granted permission by the Ohio Board of Nursing to give nurses 23-1/2 hours of continuing education credit for her Spanish for Nurses course.

Melnick teaches the course in three consecutive days with six hours of intensive instruction each day. Follow-up materials are provided to the students. Instructions focus on the important issues of health care using simple and clear Spanish. Melnick uses Shapes, a language-instruction/computer program that she created for the instruction.

"My focus is pragmatic," Melnick said. "I am not an ivory tower teacher. I am interested in theory only as it relates to use."

Class size is limited to four students. She says she taught 31 health-care providers last year and is opening a new class set on March 15-17.

Classes can also be custom-scheduled. "I can teach comfortably three three-day courses a month," she said. Courses are offered in French or Spanish and can be done for other subjects in addition to health-care.