WATERLOO - In just two months, Maria Ayard will welcome a fourth child into her family.

When she goes into labor, hopefully sometime around Dec. 29, she will make the expected calls to family and the hospital to let them know she is ready to deliver. But there is one more person on Ayard's phone tree. On that day - or middle of the night - a Covenant Medical Center translator also will get the page regarding Ayard's impending delivery.

The 28-year-old Waterloo woman can only hope that it is Betsy Martinez who answers the phone on that particular day.

"She has been with me since I had my other baby," Ayard said in Spanish through a translator.

For the most part, Ayard has been lucky enough to have Martinez's help through both pregnancies and other medical emergencies. But if she delivers in the middle of the night, there is no guarantee that Martinez will be the translator on call.

Covenant staffs two full-time Spanish interpreters and four full-time Bosnian interpreters who serve Covenant and Sartori Hospital in Cedar Falls, the Kimball Ridge Center and area clinics. Allen Hospital has just one full-time Spanish interpreter, but has another six on call. They also have three on-call Bosnian interpreters.

Both hospitals also contract with a telephone service that provides translations for additional languages.

Josie Douglas is Allen's only full-time Spanish interpreter and spends much of her time working with patients at Allen Women's Health. She is not medically trained but said that hasn't been a problem so far.

"I know the terms, but I don't necessarily have to understand them," she said. Instead, she does exactly what her job title says, translates the doctor's words for the patient and the patient's for the doctor. "The patients rely on me a lot and often they talk directly to me. They ask me the questions and sometimes, the doctor will walk out the door and they will ask me more questions. I have to tell them I can't answer them and go get the doctor again."

Though Douglas has not had any children, she has witnessed countless births.

"That was the hardest thing for me. The first time … I wasn't sure what was going to happen, but once you go through the process, you can better understand it," she said. "You end up being more of a doula than an interpreter."

And because of the shortage of interpreters in the Cedar Valley, Douglas said her husband also has had to be on hand for deliveries when her schedule already was booked.

Potentially uncomfortable moments, like that one, can't be avoided in many cases, said Martinez. For her, the most difficult assignment she's ever encountered was telling a woman her husband had died - over the phone.

"The wife was in another state and I had to tell her. I didn't know what to say," she said. "We had very little information at the time and the doctor told me the best thing to tell her was to begin preparing the funeral."

Martinez said she also has translated for patients she knows outside the hospital walls. When that happens, she said she makes it a point to tell them that anything that happens inside the exam room is confidential.

"Most patients are just happy to have us, even if they do have embarrassing questions," she said.

Though interpreters are available, Shelby Medina, Covenant's interpreter services manager, said patients will sometimes refuse the service and instead ask that a family member be the official go-between. The hospital does heed the family's wishes, but Medina said she worries when that person is a young child who may not be able to correctly interpret the doctor's words.

Douglas said she also has encountered similar situations at the Women's Center, but patients often will gladly accept the service once they realize it is available.

"They don't want to have a family member do it, but they live their life like that," she said. "They run errands that way and make appointments that way. So they come in with their kids, but especially women who come in for pap smears, they would rather not have their 15-year-old son in there."

Contact Emily Christensen at

(319) 291-1570 or

emily.christensen@wcfcourier.com.