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Tuesday, May 9, 2006
UNHEALTHY LANGUAGE BARRIERS
Universal access -- if you speak Japanese
By TOMOKO OTAKE
Despite 2 million foreign residents and calls for internationalization from within, Japan has a long way to go before becoming a multilingual society. The current state of health care is no exception. Be it university hospitals with cutting-edge research facilities or your neighborhood dental clinic, few medical institutions in Japan are capable of serving patients in a foreign language.
So for Millie Pang, a 36-year-old Danish-Chinese who has lived in Japan for 3 1/2 years, it was only natural to look for a facility that caters to foreigners when she became pregnant about two years ago.
Language is the No. 1 concern for foreigners receiving health care here, Pang said. "When you are sick, you can't explain fully if this is your second language," Pang said. "You are really ill, tired and you might have fever. So the last thing you want to do is to go translate. You don't have the energy."
Pang said she was happy with her experience at the Tokyo Medical and Surgical Clinic in Minato Ward, especially the care she received from Dr. Hideki Sakamoto, an obstetrician/gynecologist who was educated in Japan and the United States and who speaks English and Spanish.
Doctors such as Sakamoto are a rarity, however. And not everyone can commute to -- or afford care at -- clinics such as Tokyo Medical, which does not accept Japanese public health insurance.
Sakamoto himself says many Japanese hospitals that operate within the public-health insurance scheme tend to have overwhelming patient loads, which makes it difficult for physicians to explain the illnesses, treatment options and medications -- a process that can take more time when doctors and patients don't speak the same language.
"At university hospitals, it is just not feasible to spend 30 minutes for each patient," said Sakamoto, who spent years at Nihon University Hospital, before moving to Tokyo Medical. "That's just not how the Japanese system was designed."
This is not to say that the Japanese system is designed to be off limits to non-Japanese speakers. English is a prerequisite for many doctors here, especially if they routinely need to consult English-language medical journals and attend overseas conferences. But hospitals in general have little incentive to offer foreign-language services, partly because foreigners account for a small percentage of their business and they receive no special financial support from the government.
Aside from the language, cultural barriers can make medical experiences here uncomfortable. As an example, Sakamoto cites the curtains that traditionally separate patients from doctors in gynecological exam rooms. The curtains, which conceals a woman's face during an exam, were probably introduced in the days when Japanese women felt embarrassed to have their bodies examined, Sakamoto said, noting that he doesn't have them in his clinic.
The gap between Japanese doctors and foreign patients can have serious repercussions. According to a 2005 report on maternity care for foreigners written by Dr. Hiroya Matsuo, professor of obstetrics and gynecology at Kobe University, foreigners are "a high-risk group in health care," due to language and culture problems. The report stated that the mortality rate among foreign pregnant women and infants here is "two or three times higher" than that of Japanese.
As stress is a common cause of illness, good communication ability is key to treating stress-related illnesses. Many illnesses often require psychiatric care, said Dr. Yukio Matsui, head of the allergy and rheumatology division at St. Luke's International Hospital, where 2 percent of all visitors are foreigners. He said that around 70 percent of all patients at the hospital have some kind of stress-induced illness.
"Understanding the mental factors behind the various symptoms requires a high level of communication between doctor and patient," he said, conceding that, as it is, there are "almost no" doctors at his hospital who can handle that challenge in a foreign language.
To respond to foreigners in need, grassroots groups have been set up to provide interpreting services. However, the number of available interpreters falls far short of demand, and their status is unstable, as there is no public certification for medical interpreters, said Mitsuko Tsuruta, director of MIC Kanagawa, a nonprofit group that dispatches medical interpreters to hospitals. Some groups are too underfunded to provide adequate training and remuneration for the mostly volunteer interpreters, while others are having a hard time finding patients because neither patients nor hospitals are aware of the availability of interpreting services.
Even if a foreign patient has an interpreter, some hospitals are reluctant to treat them, especially those who have overstayed their visas, due to the widely held belief that they don't pay their bills, Tsuruta said.
"Some hospital administrators or clinic doctors ask upfront whether the patients have money," she said. "One time, when we asked if we could display our group's flier in a waiting room, the hospital's administration refused, saying it would end up in more unpaid bills."
While problems abound, there are also signs of hope. Kobe University's Matsuo is now developing a multilingual medical interpreting software program tailored for use in obstetrics/gynecology clinics and pediatric ER. The software, which provides automatic translation of medical terms and phrases from Japanese to English, Chinese, Portuguese and Spanish, is now being tested at four hospitals in Japan. Such software would be particularly useful in emergency situations, when interpreters often aren't available, Matsuo said.
St. Luke's has long had a reputation as a foreigner-friendly institution, which offers English and French-language orientation to first-time visitors. Four years ago the hospital added English to its Japanese signs and last month it launched an English Web site. Matsui said St. Luke's is considering offering even more special attention to foreigners from next spring, possibly with the assistance of U.S.-trained nurse practitioners.
But St. Luke's, a private institution whose hospital operations are in the red, will have to charge more for these frills. Its prospective clinic would operate outside the public-insurance scheme, Matsui said, adding that patients would have to cover all of their medical costs.
At the end of the day, poor communication causes Japanese patients to suffer as well. It could be argued that foreigner-friendly hospitals are more accommodating to all patients, since the effort to communicate with foreign patients can improve what is often a one-way relationship between doctors and patients in Japan.
As Tsuruta of MIC Kanagawa recalls from the group's encounter with a typical doctor here: "A doctor told our interpreter that he would prescribe tonpuku [a dose of medicine]. The interpreter asked him, 'What is tonpuku?' He said, 'Tonpuku is tonpuku!'
To help relieve language headaches
Need medical attention or simply some guidance? Here are several of the public resources available that can help you find a doctor in your area and familiarize you with the Japanese national insurance system:
AMDA International Medical Information Center
Since 1991, this nonprofit group has provided information by telephone on medical/welfare and insurance systems and doctors who speak foreign languages. In the Tokyo office, volunteers take inquiries 9 a.m.-5 p.m. in English, Korean, Thai and Spanish. A Portuguese-speaker is available at the same hours on Mondays, Wednesdays and Fridays; a Tagalog speaker is available on Wednesdays. In Kansai, English and Spanish speakers are available Monday through Friday, 9 a.m. to 5 p.m. Call the group for more information on Spanish and Chinese services.
In emergency situations, staff can interpret by phone.
AMDA will offer a free medical consultations for foreigners on May 14, 11 a.m.-3 p.m. at Tokyo Cathedral Sekiguchi Kaikan in Bunkyo Ward. Call the group at (03) 5285-8086 (secretariat) or (03) 5285-8088 (counseling). For inquiries in Kansai, call (06) 4395-0555.
Himawari (Tokyo Metropolitan Medical Institution Information)
A medical counseling service provided by the Tokyo Metropolitan Government, Himawari takes calls in English, Chinese, Korean, Thai and Spanish. Call (03) 5285-8181, 9 a.m.-8 p.m. daily.
Hyogo International Association
This Hyogo Prefecture-affiliated group offers general information on living in Japan, including hospital referrals in English, Spanish, Portuguese and Chinese. The association also has a list of medical institutions that offer services in foreign languages at: www.hyogo-ip.or.jp/jp/info/info04_a.htm Call (078) 382-2052, 9 a.m.-5 p.m., Monday-Friday.
Tabunka Kyosei Center (Center for Multicultural Information and Assistance), Hyogo
This nongovernmental group has a Brazilian doctor who provides medical counseling by phone and in person twice a month. Call (078) 453-7440.
This nongovernmental organization dispatches on-site interpreters at no cost for patients receiving care at 16 designated hospitals in the prefecture. It offers interpreting services in Spanish, Portuguese, Chinese, Korean, Tagalog, English, Thai, Vietnamese, Cambodian and Laotian. Patients need to make a reservation in advance. Call (045) 314-3368, 9 a.m.-5 p.m., Monday-Friday.
Zenkoku Jichitai Kyokai (Council of Local Authorities for International Relations)
This group supervises international associations across Japan. Guides on living in Japan, including tips on health care, can be downloaded in many languages at www.clair.or.jp/tagengo/