The Hmong man wheeled into the emergency room had suffered a gunshot wound to the head, and his chance for survival looked slim.
Patient communication is critical in emergencies, but Hmong wasn't one of the 30 languages represented on the staff call list at 294-bed St. Joseph's Medical Center in Stockton, Calif.
"Half his head was gone. His eyeballs were falling out," recalled ER manager Renee Pimentel.
The man seemed unconscious, but a Hmong police officer who had trailed the patient to St. Joseph's started to question him. At the first sound of his native tongue, the man suddenly popped up and started talking.
"It scared us bad," Pimentel said. "The police officer almost passed out on the floor. The nurses ran to the back wall."
In communities as ethnically diverse as Stockton, knowing a second--or even a third--language is sometimes a lifesaving skill employed by doctors, nurses and paramedics. And in nonemergency situations, local hospitals and clinics are finding that new bilingual programs and a diverse staff are improving patient relations.
Last August, Kaiser Permanente in Stockton became the first Kaiser facility in California to open a Spanish-speaking call center. Ten nurses and teleservice representatives field at least 60 phone calls a day from Northern California members--and the facility can be expanded to 50 people handling calls as demand grows.
At 181-bed San Joaquin General Hospital in French Camp, Calif., two Southeast Asian employees are summoned by pager when there is need for an interpreter. "Patients are more responsive when they see someone who understands them," said San Joaquin General spokeswoman Ally Keller.
Ibeta Aguinaga, 29, of Stockton said she was uncomfortable delivering her first two children at San Joaquin General. But the third time around, she was impressed with the maternity ward's new partnership with the Council for the Spanish Speaking.
"It's important a translator is here . . . or I would be with a lot of questions," Aguinaga said through a council interpreter as she snuggled with her newborn in a hospital bed.
Some 60% of maternity-ward mothers at San Joaquin General are Latina, Keller said. Last fall, the hospital boosted the number of Spanish-speaking interpreters, in part because the language barrier slowed preparation of birth certificates.
Aguinaga was frustrated during her two previous deliveries when nurses couldn't explain the medication she was given. She said the delivery room doctor knew only two phrases in Spanish: "Calm down" and "Don't yell."
If an interpreter is unavailable in an emergency, local hospitals turn first to a call sheet that lists employees' second languages. Interpreters include friends, social workers, law enforcement officers and local college contacts. Young children may translate for their parents and paramedics.
San Joaquin General shares a pool of Southeast Asian interpreters with other San Joaquin County health agencies.
Some people in Stockton's close-knit Vietnamese community don't wait for a doctor to page Quy Nguyen at San Joaquin General. They call Nguyen at home to check his work schedule.
"They say, `Tomorrow you work? OK, I'll see you,' " laughed Nguyen, 52, of Stockton. "Very, very busy."
Perhaps a patient's biggest risk is the absence of a medical history that would indicate allergies to antibiotics, for example. Some doctors crudely refer to their guesswork as "veterinary medicine."