Effective communication between doctors and patients is essential to improving medical care, says Eric Candle, the New York state representative for the International Medical Interpreters Association.

While Candle is an advocate for programs to train and certify medical interpreters who can assist those with limited English ability, he says the problem of failed communication extends well beyond immigrants.

Perhaps as many as half of all American adults are not "medically literate" and "cannot successfully navigate the medical care system," he says.

Candle, of Fairport, owns ECdata, Inc. a Brighton computer services company. Having immigrated years earlier and settled in Rochester, Candle brought his parents from Russia in 1993. Candle speaks German and Russian - which he says allows him to communicate with Ukrainians and others from former Soviet republics.

In 1988, as immigrants from Eastern Europe and Russia began to arrive in larger numbers, word of his language skill spread and "people started asking me for help," he says.

Immigrants with little or no English proficiency delay seeking medical care as long as possible and then opt for more expensive emergency room care, he says.

Citing research by The Joint Commission, an Illinois-based medical research and accreditation organization, Candle says the annual cost of "misdirected, misunderstood medical care is $73 billion. The price tag includes everything from the cost of illness prolonged by patients' inability to follow care instructions to the cost of redundant testing and procedures performed because of insufficient record-keeping or patients' inability to explain their medical care or history."

Language and cultural barriers present real problems, says Kathy Miraglia, director of interpreter services for the University of Rochester's Strong Memorial Hospital. Miraglia, an American Sign Language interpreter, says the hospital has sign language and Spanish interpreters on staff 24/7 and can call in other translators as needed, or use a telephone translation service with access to interpreters in any of more than 170 languages.

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There is a need for trained interpreters, and a program to train and certify interpreters through one or more area colleges would be welcome, she says.

Representing the IMIA, Candle has been reaching out to Rochester area colleges in hopes of beginning such a program.

It's not easy. Finding start-up funds is the first hurdle, he says. And, says Miraglia, there needs to be a source of money to pay interpreters once they are trained.

A certification program, backed by national standards, would guarantee providers access to interpreters whose abilities are proven. And face-to-face contact is far superior to telephone or video services as a way to build trust and detect subtle evidence of confusion or doubt.

In Monroe County alone, he says, there are 120,000 people who speak little or no English. The need is great. Hospitals have many pressing needs, he says, "but it's important that they see this not as an investment, but as a way to curbs expenses and provide better care."

This and many other communities are again being remade by new waves of immigrants - from China, Vietnam, Burma, Africa and Eastern Europe.

Their health, and potential contributions to our community, depend on their access to quality care, and on their ability to understand and participate in their own treatment.