Honduran immigrant Carlos Galeano took his 15-month-old son Carlito for a checkup at the Rodgers Health Center in Kansas City.

But Galeano doesn't speak English and the pediatrician, Dr. Colette Fleming, doesn't speak Spanish.

Erika Bredée, a specially trained interpreter in St. Louis, arrived via live Internet video to help them speak the same language.

Bredée watched and listened as the doctor examined the child. The doctor and dad watched

Before translating Fleming's English words to Galeano's Honduran ear, Bredée clarified certain words, phrases and instructions with the doctor. Only when she and the doctor agreed they were clear did she translate instructions to Galeano.

After several exchanges, Carlito was deemed healthy. He protested his vaccinations and got an appointment for the next visit.

The scenario is an expansion of services by the Missouri Telehealth Network. The Network, since 1994, has linked specialists from large, urban medical centers to patients and doctors in rural and remote parts of Missouri.

While monitoring the service about a year and a half ago, the sponsors found that immigrants and refugees increasingly arrived in Missouri unable to speak English well enough to converse with their doctors.

Clinics were recruiting relatives, friends and even children to translate for them.

That's risky, said Rachel Mutrux, director of the Telehealth Network. Untrained interpreters could misunderstand medical words.

Seeking a solution, Telehealth sponsors learned of the Language Access Metro Project in St. Louis. For more than a decade, LAMP has maintained a pool of interpreters that has grown to 120 people who offer 35 languages, said Nikki Lopresti, LAMP director.

LAMP interpreters are trained in medical interpretation, then make house calls to clinics and hospitals in the St. Louis area.

"They don't only interpret verbatim, they watch for cultural signs," Lopresti said. "Someone may say she's being punished by the spirits, for some (sort of misbehavior) and our interpreters are prepared for that.

"They can look at body language, hear cultural differences that the (medical people) might miss."

Catholic Family Services in St. Louis created the program a decade ago to interpret medical information for immigrants and refugees in St. Louis, St. Louis County and parts of St. Charles County, Lopresti said.

So about a year ago, LAMP accepted the invitation to blend with the Telehealth Network to create the Missouri Telehealth Interpretation Project.

A two-year grant from the Missouri Foundation for Health supports the fledgling project.

The grant runs out in October of 2010.

SLOW START

The program has taken off slowly. While LAMP serves about 2,200 appointments a month in the St. Louis area, only 60 people from outside the area have used the service since May.

Dana Hughes, with the University of Missouri Institute of Public Policy, hopes that will accelerate as more equipment is installed and more people know about the program.

About 48 of the state's 114 counties are connected, said Mutrux of Telehealth. That will expand to 58 by the end of the year, she said.

Meanwhile, the system is a hit in Kansas City.

"We're so happy with this," said Fleming of the Rodgers Health Center. "Access to interpreters gives us more time with families, more time with disease and wellness."

Says Bredée, from Mexico and an interpreter for 12 years including a year with LAMP, "I just enjoy helping people."