Before handing Josue Suarez a car, the speech and language pathologist asks him to repeat in English and Spanish the phrases she had just uttered.

The boy, who suffers language delays, doesn't suspect a thing. He repeats the words in a soft, yet strained, voice. As Plazola hands him the toys and praises his efforts, he bounces around the office at the Yakima Hearing and Speech Center.

Plazola is one of the few bilingual therapists opening doors for Spanish speakers seeking treatment for hearing or speech problems in Yakima. Most medical clinics and therapeutic centers must rely on interpreters.

To correctly diagnose and resolve medical problems, doctors and mental health and speech therapists need to understand what their clients are saying and build a trusting relationship in order to have them open up.

Bilingual therapists help make that happen. But they are few and far between, said JoAnne Hanses, a speech and language pathologist at the center.

Josue's mother, Gabe Haro, agrees.

Plazola's sensitivity and understanding for Josue has drawn them back since therapy started in June, she said.

"She communicates with us better," said Haro, who speaks both English and Spanish. "She understands me better -- (it shows) in the way she pays attention to my kids."

She wanted a bilingual provider because Josue finds some words more comfortable in Spanish and others in English. And Plazola can easily shift from one language to another, as is done at Josue's home.

"We should have that (information) in our language," Haro, 26, said. "We should support people like her."

Experts say a national shortage of bilingual and bicultural medical providers makes it difficult for many non-English speakers to get adequate health care.

Getting emergency medical care can be a problem, but it's especially difficult for those who need long-term treatment, including mental health and speech therapy.

According to Dr. Jane Delgado, with the Washington, D.C.-based National Alliance for Hispanic Health, Hispanics nationally represent less than 5 percent of physicians and less than 2 percent of nurses.

"We don't have enough Hispanics graduating from high school to go to college," she said. "If you want to be in the health field, you have to be very committed."

But even if all Hispanic providers spoke Spanish, which they don't, it wouldn't be enough to serve the Spanish-speaking population, said Delgado, a clinical psychologist.

It's also hard to tell if providers who claim to be bilingual, in fact, are really bilingual, she said. Some people may be conversational, but not speak at the level needed to deal with patients.

The state Department of Health doesn't track the non-English language proficiency of physicians, spokeswoman Allison Cook said.

"It's just not really something that is as important to track as education and training," she said.

Although Delgado doesn't know the exact number, she believes the percentage of bilingual speech and language pathologists is much lower than physicians and nurses. Plus, there's an overall shortage of all speech and language pathologists.

"It's like any other profession -- there's just not enough to go around," Hanses explained.

Plazola, a Mexican-American who grew up in Moxee, said 26 of her 38 cases need therapy in Spanish.

Before Plazola was hired, Hanses said the center relied on medical interpreters to serve about 20 clients and their monolingual Spanish-speaking parents each week. If families don't have government assistance for an interpreter, the center must carry the expenses. Interpreters can earn $40 to $45 an hour, depending on the demand.

But interpreting services for medical providers and their patients doesn't work well for a number of reasons. A speech therapist, for example, must focus on nuances in a client's pronunciation, Hanses said.

Simultaneous interpreting also distracts from the therapy. And pathologists risk making a wrong diagnosis when interpreters fill in the language gaps, she explained. For example, she said, a child can say "car go" in Spanish, but it may be interpreted as "the car goes."

"It's hard for me to judge (speech problems)," she said. "(Interpreting is) not as effective as having a bilingual therapist. Unfortunately, that's what's available."

Mary O'Brien, clinical services manager at Yakima Valley Farm Workers Clinic's Behavioral Health Services, said her facility prefers staff and providers learn another language, particularly Spanish. She said most of them want to learn the language to better serve the community. She estimates more than half the clinic's 1,200 patients speak primarily Spanish.

Although several of her support staff are bilingual, 12 of her 38 mental health therapists speak Spanish, she said.

O'Brien said many clients seek help with anxiety, attention deficit disorder, major depression and post traumatic stress. Having an interpreter in the room makes it difficult for therapists to build healthy communication and trust with the patient, O'Brien added.

"It can happen," she said. "It's a longer time and more work."

Knowing a patient's native language, O'Brien says, helps providers connect with them quicker and obtain more detailed medical information.

"There's a sense of being heard," she said. "You're more likely to feel confident and comfortable."

Gabe Haro, Josue's mother, who frequently switches between English and Spanish during conversation, smiled as she told Plazola that Josue has learned more words since therapy began. Haro sits in the corner, gleaming as her son mimics the numbers Plazola calls out from an educational puzzle.

"Ayuda (help)," the infant said to Plazola as he shuffles the cardboard pieces.

 For more information on Hispanic health care, call the National Alliance for Hispanic Health hotline at 866-783-2645.