Neurosurgeon Samuel Macomson looked at Andres Merlin Tapia and asked, "Any headaches?
"Yes, headaches," Mr. Merlin Tapia said.
"The headaches, where are they?"
"This area right here," Mr. Merlin Tapia said, touching the spot on the left side of his head where Dr. Macomson removed part of his skull to accommodate brain swelling after the Aiken man was beaten with a bat.
Dr. Macomson nodded.
Inside the exam room at Medical College of Georgia Hospital and Clinics, the only person who either man can understand is Vivian Rice, whose melodious voice deftly converts Dr. Macomson's words into Spanish and Mr. Merlin Tapia's replies into English.
"As a medical interpreter, our role is to facilitate the communication between the health care provider and that patient," Ms. Rice said. "Meaning I am that doctor at that moment. At the same time, I am that patient."
And the need for interpreters is growing.
Augusta hospitals report an increasing need to use medical translation services to communicate with patients with limited or no English.
While Spanish is the most requested language, there also is a growing need in Augusta for Chinese languages, Portuguese and Haitian Creole, according to medical translation company CyraCom.
The need for translation in Augusta rose 187 percent between 2002 and 2006, according to the company, which provides translators by telephone to Augusta hospitals. And the need locally and nationally is constantly shifting, CyraCom CEO Michael Greenbaum said by telephone.
"Every year is unique once you get past the most commonly requested language, which is Spanish," he said. "And this reflects the immigration patterns that an area has."
When immigrants came to the U.S. 100 years ago, "most of the immigrant population was settled in the towns along the seacoast," Mr. Greenbaum said. Now, they are moving into the interior and rural areas as industries locate there.
Mr. Merlin Tapia came to Aiken four years ago from Vera Cruz, Mexico, to do construction and yard work. It is that way with most immigrants, said Ms. Rice, the manager of Culturally and Linguistically Appropriate Services at MCG.
"We look at the United States as a nation of freedom, we look at the United States as a nation of opportunity," said Ms. Rice, a native of Puerto Rico. "If you're looking for growth and improvement, I believe that is one reason the diverse population is also increasing."
Part of the reason diversity is increasing in Augusta is because of MCG, she said.
"As we grow, as part of being a world-class academic medical center, we do exchanges with students from China, South America," Ms. Rice said. "Those students come here to the states to continue their education, they bring their families, they bring their children, so obviously their population will increase."
It is not just language that can be a barrier. Helping the deaf and hearing-impaired also might require translators, which can be tough to find.
"That's probably our most difficult," said Rosanne Grubbs, the manager of speech and hearing at University Hospital, which has two American Sign Language interpreters on contract. "They're on call for us 24/7, but that doesn't mean they are always available."
MCG clinical services is "lucky" to have found two sign language interpreters and is trying to train others, Ms. Rice said. When that's not possible, the hospital is planning to use an interactive video service that displays an interpreter who can sign back and forth to the patient through cameras.
Having some way to get through to the patient is crucial, Ms. Grubbs said.
"If a patient's there and doesn't speak English and doesn't have any means of communicating with the health care professional, that's very, very frightening," she said. "To have someone translate the information is a miracle for these people."
As a nurse case manager, Kim Cooper uses the phone translator at Doctors Hospital. She looks across at the patient listening to her native language and "you can see their heads begin to nod or just kind of tell by the expression on their face that they begin to understand," she said. "Suddenly we're having good dialogue with them, coming up with questions."
Hospitals discourage using a family member to interpret, Mr. Greenbaum said.
"When you use an interpreter that's not connected to you, you don't shield stuff," he said. "And therefore the quality of the communication between the patient and the physician goes up because it's not like your kid is helping you and you don't want to tell him intimate information or you don't want to worry him."
It also means not just knowing the lingo, but also knowing the people, Ms. Rice said. In China, for instance, the pronunciation of the number "four" sounds similar to the word for "death," and many consider the number bad luck.
"If you have a patient coming in to be admitted, you're for sure not going to try and put him into the room No. 4," she said.
More than anything else, though, it is about the patient's well-being, Mr. Greenbaum said.
"This is not just to make the people feel better, but we get better results in our national health care system because people can say what they're feeling or what hurts," he said.
In Mr. Merlin Tapia's case, it is his "cabeza," or head. He was attacked with a bat in Aiken last November, and Dr. Macomson removed two skull pieces to allow the brain to swell and then heal. The pieces have been stored and now, through Ms. Rice, Dr. Macomson and Mr. Merlin Tapia are talking about putting them back.
"It's not something that you have to have done, but I think that it would be better because without having the bone to protect your head here, then you're going to be at risk of having an injury to your brain, if something were to hit you in the head," Dr. Macomson said.
Without pause, Ms. Rice unspools an 11-second burst of Spanish, leaving Mr. Merlin Tapia and his girlfriend, Patricia Zaragoza, knowingly nodding. The bottom line is the same for all - to let the Aiken man get back to the reason he came here.
"Like this, I cannot go back to work," he said.
Reach Tom Corwin at (706) 823-3213 or firstname.lastname@example.org.
The need for medical translation services changes from year to year and reflects the immigration pattern of the area. According to the medical translation company CyraCom, the most requested languages in Augusta were: