Washington ? The nurse ordered an oral antibiotic to clear up the 7-year-old’s ear infection. But the mother spoke no English — and a bystander pulled in to translate told her to pour the drug into the girl’s ears.

It was one of dozens of dangerous translation errors Dr. Glenn Flores uncovered when he taped exams of 70 Spanish-speaking children in some Boston emergency rooms and clinics. And that’s just examining the nation’s most common foreign language — imagine the difficulty when a hospital encounters its first patient speaking, say, Hmong.

About 21 million people in the United States speak limited or no English — 50 percent more than a decade ago — and health workers are struggling to care for them.

Hospitals “are reeling from the major change in the number and diversity of languages they’re encountering,” says Ellen Pryga of the American Hospital Assn. “The reality is … if someone shows up who needs services and doesn’t speak English, you have to figure out how to communicate with them. It doesn’t matter if they’re the only one you’ve ever encountered who speaks Swahili.”

Unable to hire an interpreter for every language, they’re trying creative methods: volunteer translator clubs, telephone interpreters, teaching foreign phrases to doctors, and hiring bilingual nurses and clerks who can translate in a pinch.

But the question is what works. Special training is probably crucial because general fluency in a language seldom guarantees knowledge of complex medical terms, says Yolanda Partida of Hablamos Juntos, a program started by the Robert Wood Johnson Foundation to improve Spanish health communication.

Hablamos Juntos is funding 10 experiments around the country to find innovative solutions, especially in hard-hit rural areas like central Nebraska. Six counties where the Hispanic population more than tripled in the 1990s are preparing to test a videoconferencing system that would let emergency rooms and maternity wards share 24-hour access to Spanish-speaking interpreters — and train additional translators long-distance.

Doctors generally can’t turn away sick patients because of language barriers. Civil rights law requires health facilities that accept any federal funding to make provisions for non-English speakers.

Just how many languages different facilities must be able to tackle, and using what methods, the law doesn’t make clear. The government this month proposed an updated set of guidelines to help sort that out.