BALTIMORE -- There is an odd silence in the office. Donna Walters, a registered nurse, and Debra Powell, a patient, are talking. Yet not a word is audible.

Powell is deaf. Gesticulating with hands and fingers, she talks with Walters, a skilled sign language interpreter who supervises deaf services at the Albert Witzke Medical Center in east Baltimore.

It is the only comprehensive medical program for the deaf in the Baltimore-Washington area and one of less than a handful for the estimated 2 million deaf people in the United States.

It is a place where patients ranging from the profoundly deaf to the hearing impaired may go for their ordinary aches and pains, but without the additional hassles they often experience at conventional clinics or hospitals where they and staff workers don't speak the same language.

"Deaf people often face frustration at a regular medical center and can't be understood," said Walters. Their gestures are confusing, their speech garbled. "It is a life problem of a deaf person," she said.

The result is that emergencies are often overlooked or misdiagnosed by physicians for some deaf people. Others, wary of clinics and fearful of being misunderstood or rebuked by impatient staff workers, avoid medical attention, "sometimes until it's too late," Walters said.

At the Witzke center, in the gritty Highlandtown section of east Baltimore, the atmosphere is relaxed. Patients and staffers wave cheerfully to each other. The three-member deaf services team, all fluent in sign language, works with a steady stream of patients every day, processing appointments, interpreting for doctors, instructing patients in health care. The barriers to communication are gone.

"It was good to come here and get an interpreter," said Robert Haines, 68, a high-blood-pressure patient, who, like many other patients, has been coming to the center for years. Through a sign language interpreter, Haines said in an interview he didn't learn that he should get regular checkups for his blood pressure "until I started coming here."

Muriel Strassler, spokeswoman for the National Association of the Deaf, said such continuing care is essential. "At the {Witzke} center," she said, "patients feel at home. They're participants."

Most patients come from Baltimore and its five surrounding counties, according to Baltimore Medical System Inc., the nonprofit organization that operates the center. Many are poor and poorly educated. Forty percent are unemployed. More than 60 percent receive government medical assistance. Sixteen percent have no insurance.

Walters attributes the high unemployment to the fact that "employment options are extremely limited due to their hearing impairment." Also, she said, the affluent deaf "tend not to come here. They have more ways to manage on their own."

All told, more than 530 patients -- 10 percent of the deaf population in the Baltimore area -- are registered with the center's deaf services. They are integrated into the much larger flow of hearing patients who also come to the center each day for medical attention ranging from internal medicine and gynecology to dentistry, optometry and psychological counseling. Laboratory, pharmacy and X-ray services are also available.

Walters and her two assistants, Ann Covington and Ethelette Ennis, act as interpreters for deaf patients when dealing with doctors and nurses in the center's examination rooms. With subtle movements of fingers and hands, the interpreters convey complaints of soreness and discomfort from patient to doctor and relay explanations and instructions from doctor back to patient. None of the doctors is trained in sign language.

In contrast, the deaf services' psychologist is a skilled sign language user, one of a handful in the country. He is Allen Sussman, a professor of counseling at Gallaudet College for the deaf in Washington, who travels once a week to Baltimore to help patients at the Witzke center cope with stress and depression.

In counseling, Walters noted, it is important for psychologist and patient to deal "one on one" without the encumbrance of an interpreter. Hence the need for someone like Sussman, who is deaf. "When you get into areas of people's innermost thoughts," Walters said, "it's hard to handle through a third party."

The deaf services program opened at the Witzke center in 1980 with a federal government grant designed to help sensitize medical staff members to the needs of deaf people.

"We started with one patient," recalled Walters, "and we've been building ever since."