FRANKFORT - Juan Lievano left behind his native Mexico five years ago to work in largely rural Shelby County.

        But the former laborer now staggers slowly as he walks, after injuring his back while working two years ago.

        Since then, Mr. Lievano said, he has realized how much Hispanics who don't speak English struggle to find adequate medical care in their own language.

        “At appointments, I can't fully explain what's happening to me or my body,” Mr. Lievano said in Spanish during a meeting of rural health coalitions.

        The coalitions, based in Shelby and Montgomery counties, are assessing their medical care resources as part of a four-year program to improve health care access for Hispanics in rural Kentucky and Tennessee.

        “They'll determine on a local basis what changes need to be made to improve access for Hispanics and try to spur those changes along,” said project facilitator Dr. Robert McKnight of the University of Kentucky College of Medicine and School of Public Health.

        The coalitions, which include medical professionals, social service workers and agricultural extension staff, will focus on providing Spanish and English classes and devise plans to overcome cultural and communication barriers.

        A U.S. Department of Agriculture grant will fund the program at the University of Kentucky, the University of Tennessee and Kentucky State University.

        According to the U.S. Census Bureau, the number of Hispanics increased 60 percent in Kentucky from 1990 to 1999 - from 22,123 to 35,122.

        Montgomery County's coalition will concentrate on creating a Hispanic resource center and providing regular health screening programs, said Jan Chamness, program director at the Montgomery County Health Department.

        Although her agency has only one Spanish-speaking staffer, Ms. Chamness said more Hispanics are seeking preventive health services since the coalition's beginning last year.

        “They're a lot more comfortable coming to the health department,” she said.

        “They're open to treatment because they've established a relationship of trust with us,” she said.

        In Shelby County, coalition member Adam Ruiz has seen an increase in more professionals wanting to learn Spanish.

        Part of the project includes sending four people, most of them health care professionals, from Kentucky to a Spanish immersion course in Mexico.

        Shelby County's coalition has been able to start Alcoholics Anonymous meetings in Spanish with the support of community agencies, said Mr. Ruiz, director of Centro Latino in Shelbyville.

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