“Siete, ocho,” says the patient, wincing and holding her shoulder. “Seven, eight,” the interpreter repeats to the nurse, answering a question about how much pain the patient feels, on a scale from one to 10.

The nurse asks the patient whether she has any allergies or if she is taking any medications. The conversation moves quickly, English to Spanish, Spanish to English.

Medical translator Claudia De Almeida serves as the go-between for a Portuguese-speaking patient and an emergency-room nurse at MetroWest Medical Center's Framingham campus.

A similar scene is repeated dozens of times a day in the emergency room at MetroWest Medical Center's Framingham Union campus, with the languages including Arabic, Chinese, and Russian

"I could really see the difference," said the interpreter, Raquel Santander-Nelson, remembering when she arrived at the hospital more than a decade ago. "When I started working here, there was a really small interpreter services."

As more immigrants to Greater Boston have created a higher demand for medical interpreters, the profession is racing to catch up.

Just 15 or 20 years ago, area hospitals would routinely pull in someone from the housecleaning staff to help the medical staff communicate with a patient, according to Beth Donnelly, spokeswoman for MetroWest Medical Center. It is a potentially dangerous practice when someone's health is on the line, she said.

In 2002, it became a state law to use only professionals in emergency rooms and mental health departments. Now a Boston-based group, the International Medical Interpreters Association, is pushing for a national certification program.

The idea is to standardize the profession in medicine, which is the fastest-growing of all interpreter fields, according to Izabel Arocha, president of the association.

"There seems to be a really good consensus now nationally that the field would benefit from having a national certification of medical interpreters," she said. "Otherwise, what happens is we end up with bilingual employees who are being used to interpret that aren't qualified."

Access to healthcare is a major issue nationwide, and language can be a huge barrier to getting quality care, Arocha said, even when it appears there is help available. An unqualified interpreter can do just as much damage as no interpreter, she said, adding: "An interpreter can make a life-or-death difference."

Demand for medical interpreters is greater than supply, she said, but it's important that people who are bilingual receive the specialized training they need to deal with medical situations.

To address the issue, her 1,500-member nonprofit organization is developing a written and oral test. A Spanish version has undergone trials and is being translated into nine other languages, she said, and the hope is that once such a test is accepted by interpreters, it could be incorporated formally into law. Arocha said she would like to see her organization become a certifying body.

Arocha said it is only natural for the effort to come out of Boston, which she described as the "birthplace of the medical interpreting field worldwide." The old Boston City Hospital was the first to provide medical interpreters, she said.

Demand appears to be rising, but record keeping varied from hospital to hospital until recently, when figures started being reported to the state.

Most hospitals in the state use Spanish and Portuguese interpreters more frequently than other languages, according to data from the state Department of Public Health, but a variety of languages pops up in smaller numbers.

Boston Medical Center logged the highest volume of calls for interpreter services in the country, at 194,000, last year. This year, the South End successor to Boston City Hospital will probably break 200,000, according to Oscar Arocha, its director of interpreter and guest support services, who is married to Izabel.

A decade ago, Boston Medical Center saw just 35,000 requests a year, he said.

"The more available you make your services - the greater access there is to interpreter services - the more the system gets utilized," Oscar Arocha said.

Massachusetts is at the forefront of medical interpreting for political reasons too, he said. There is more of an emphasis on social services in this state, he said, and an understanding that it actually saves healthcare dollars if a doctor, with the help of an interpreter, can understand what's going on during a patient's first visit.

Local colleges are noticing the demand. Boston University, for example, has been expanding course offerings at its Center for Professional Education and now offers programs for translating between English and Chinese, Portuguese, Spanish, or Vietnamese.

Santander-Nelson, who is from Chile, said she supports the move toward a national certification, and noted that it's not just words, but ideas and perceptions that must be translated.

Once, a doctor was upset when a patient was found to be taking medicine obtained from a friend, a common practice in some countries. The patient didn't understand the doctor's reaction. It was Santander-Nelson's job to bridge the cultures.

"It's a very rewarding profession," she said. "There isn't a day that goes by where you don't say, 'I helped someone.' "

Globe Staff / June 8, 2008

Lisa Kocian can be reached at 508-820-4231 or lkocian@globe.com

(Patricia McDonnell for the Boston Globe)