A little bit of English isn't enough to get by at the doctor's office.
Sitting side-by-side with immigrants at medical appointments, Baltimore County Department of Health interpreter Martha Lujardo tries to bridge the gap between the doctor and those with limited proficiency in English. She rewords questions as many times as it takes until she's satisfied that the patient understands the diagnosis and directions.
Personal interpreters such as Lujardo are considered the ideal way to make health care more accessible to people who do not understand English. But there aren't enough of them to go around in a county with a rising immigrant population.
"If we had a little more people, especially in these clinics where we need to explain to them exactly how to follow and take the medications," Lujardo said, "then that would be very good."
Agencies that receive federal funding are required to provide language access, according to Title VI of the Civil Rights Act. In health care settings, language barriers can lead to lower quality of care and higher patient safety risks. Misunderstanding simple directions — whether to take a teaspoon or a tablespoon of medicine, for instance — poses serious risks.
In Baltimore County, providing adequate language services has emerged as a crucial need in health and related social services. Nearly 10 percent of county residents are foreign-born — more than 74,500 — and about half that number say they do not speak English well, according to census data released this year.
Many people think that it's enough to be able to speak in someone's native tongue when interpreting for them. But reading and writing skills are equally important, especially when you need to recognize regional vernacular, said Monique Lyle, a county health department spokeswoman.
"Semantics become an issue," she said. "We often have to bring staff together to decide on the best word to use for 'bottle.' "
Interpreters might also function as "cultural brokers" who can help work through some immigrants' distrust of Western medicine, said Cheri C. Wilson, a research associate at the Bloomberg School of Public Health at the Johns Hopkins University.
"It's helpful to have someone who's serving as a cultural broker because that person would understand some of the health beliefs that person is bringing to the table," Wilson said.
Health care providers at times resort to drastic measures to overcome the language barrier.
"They would flip through the Yellow Pages to find a restaurant where a person speaks Mandarin Chinese," Wilson said. "Other times, they've used taxicab drivers, family members, custodians, the secretary, a child."
At the Hannah More Health Center in Reisterstown, Lujardo helped one patient who said she understands some English but feels uncomfortable discussing delicate medical matters. With Lujardo interpreting, the woman encouraged the county to let more people know the service is available.
For the health department, the greatest need is for Spanish-speaking interpreters and translators, Lyle said. It has about a dozen employees who know Spanish and other languages and would benefit from dozens more, Lyle said.
"It takes longer to serve someone who needs an interpreter," Lyle said. "It doubles the time because of the back-and-forth. You can't serve as many people in the same time span."
The department has hired more bilingual and multilingual staff members in recent years. When a person is not available to interpret, the county relies on phone services. But that's no substitute for having an interpreter in the room when discussing sensitive health matters.
"If you're one-on-one, it's different," Lujardo said. "They are more comfortable. They feel it's easier when you're there in front of them rather than listening on the line and answering."
And as patients come in for regular appointments, "we become familiar to them," said Carydad Nussa, another Spanish-language interpreter.
The county plans to work with community organizations to make sure that all departments can handle the needs of people who do not speak English. County Executive Kevin Kamenetz's four community liaisons — one of whom speaks Spanish — are expected to be his "eyes and ears," said Don Mohler, chief of staff to Kamenetz.
"Our major priority is to provide access to county government and make sure that government works for all folks across the spectrum, reflecting a variety of cultures," Mohler said.
Baltimore Sun reporter Erik Maza contributed to this article.