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Sunday, June 1, 2008

COUNTERPOINT

Is aging Japan really ready for all the non-Japanese carers it needs?


One of the cliches most bandied about in the Japanese business world is yareba dekiru. An English equivalent might be the title of Jamaican reggae star Jimmy Cliff's great 1972 hit, "You Can Get It If You Really Want."

There will always be vested interests in a political bureaucracy such as Japan's, particularly when the politicians are lining their vests with cash graciously offered by corporations that benefit from their benevolence. As a result, it becomes easy to blame power-hungry politicians and bureaucrats for their lack of initiative in responding to the needs of individuals. They seem to be erecting the highest barriers to change.

Here, though, it is more often than not the timidity, skittishness and apathy of the general population that stands in the way of long-overdue changes. So, if Japan is widely viewed as a society stuck in aspic, it is due as much to its chicken-hearted citizens as to its porcine politicians. If those citizens don't "get" change, it could be said it's because they don't "want" change.

An issue prominent in the news today illustrates this.

We all know that Japan is the old man (and woman) of Asia. There are more than 23,000 centenarians alive in this country today. No one knows how many there will be by mid-century; but estimates indicate that nearly one in three of the population will be over 60 by then. With the ever-declining birth rate and the tendency for children to chuff off and leave the old folks to their own devices, who is going to care for this debilitated army of the elderly?

The Japanese government has initiated steps to bring foreign nurses and carers here. In the middle of last month, the Diet approved a partnership agreement with Indonesia to allow 1,000 nurses and carers into Japan. (There is a similar agreement in the offing with the Philippines.)

According to this plan, the nurses and carers will be given a half-year of language lessons at hospitals and nursing homes in Japan — appropriate places for such training, as much of the vocabulary used is specialized.

When the announcement was made two weeks ago, I saw two news programs on television that covered it. Both interviewed people in the health-care industry. The spokespeople for the industry all mentioned how taihen (what an ordeal) it was going to be to accept these foreign carers. One of them used the word fuan (anxiety) to express how he felt about working with non-Japanese.

This strikes me as typical of Japanese attitudes toward change. No sooner is some initiative in society mooted than people start talking about how much of a strain it is going to be to adjust to it.

But ask the old people who are in dire need of care about "adjusting." (The ones interviewed on the programs said how grateful they would be for help — wherever it came from.)

The shortage of nurses in Japan is estimated to be 40,000, though this is a bare minimum. Given the grueling work schedules and the high turnover of nursing staff in Japan, the actual figure would probably be at least three times that under normal conditions.

In March, a survey of hospital staff conducted by scholars at Kyushu University's Asia Center revealed that while 46 percent of hospitals were in favor of hiring non-Japanese nurses, 62 percent refused to have anything to do with their training. Here is where "You Can Get It If You Really Want" turns into "You Can Ignore It If You Really Don't Care."

Certainly there are issues when it comes to hiring non-native staff. Communication is one of them, particularly at nursing-station handover, when details of patients' medical conditions have to be passed on. In addition, bringing nursing staff from less-developed nations leaves those nations with shortages of trained health-carers. This has even been a problem in Canada. The Canadian Nurses Association has predicted a shortfall of 100,000 nurses by 2016. This is in part because many Canadian nurses move to the United States, where the pay is better.

However, the trend all over the developed world is toward training and employing foreign-born carers. According to the World Health Organization, 30,000 nurses and midwives educated in sub-Saharan Africa were working in OECD countries in 2006. More than 20 percent of nurses in New Zealand are foreign-born. In Switzerland the figure is 30 percent. Compared to this, a few thousand non-native carers in Japan, where approximately 1.3 million nurses are in employment, is a drop in the ocean.

Japan should not only encourage such skilled immigration but should also subsidize the training of nurses in the developing world, seeing as Japanese will be benefiting greatly from the fruits of that training. Yet, we still see a great reluctance to even allow non-Japanese into the country in the first place.

In the Kyushu University study, more than 50 percent of those questioned said they either "did not desire" to have non-Japanese on their staff or they "didn't know" how they felt about it.

In Japan, where the reluctance to say "no" is well known, many "don't knows" — a full 33 percent of those surveyed — are really "don't wants." Clearly, the force against change here comes from people who would rather see Japanese nurses hideously overworked, lumbered with fatigue and back injuries, and patients given inadequate care, than having a few "outsiders" in their midst.

One might well ask if the people running hospitals here worry more about their profits than about the welfare of their nurses and the patients in their care.

I cannot imagine a more congenial environment for Japanese old people than one in which Japanese and non-Japanese health-care staff work together to improve their quality of life.

As for me, I turn 100 in 2044, and I would gladly offer interpreting services to just such an international staff of carers if someone would simply turn me over a few times a day and spoon-feed me sashimi or a nice bottle of Cabernet Sauvignon from the Philippines (room temperature, please).

Maybe by then Japan will have become a truly international nation with a populace unafraid to accept non-natives into every walk of life. I should live so long . . .



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