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Friday, Jan. 4, 2008
THIS FOREIGN LAND
The doctor will see the moneyed and insured, but less fortunate also ail
By JUN HONGO
Third in a series
The physicians who work at Kinya Hirata's upscale clinic in the Roppongi Hills complex in Tokyo are fully bilingual.
"About 10 percent of our daily 300 patients are non-Japanese," said Hirata, a heart surgeon and director of Roppongi Hills Clinic. His facility is equipped with laboratories for instant blood and urine tests, as well as a ¥200 million CT scanner.
According to Hirata, Roppongi Hills developers demanded that the clinic, which opened in October 2003, "be able to properly attend to foreign patients."
English magazines are provided to waiting patients, and for those reluctant to share a waiting room, there is a VIP lounge available for an initial charge of ¥2.1 million and an annual fee of ¥630,000.
"The clinic is free from the distinctive alcohol odor common in hospitals," the clinic's Web site proudly asserts.
As the foreign population grows in Japan — 1.5 times in the last decade — the number of those in need of medical assistance has likewise increased, making medical care for non-Japanese a necessity.
But as disparities widen among the 2 million registered foreigners living in Japan, some without proper insurance or medical translators are being left behind.
Hirata said his facility is not intended solely for the wealthy, but because of its location, most of its foreign patients are employees of Japanese units of foreign financial companies and are well-insured.
Those without insurance sometimes pay the full charge in cash, he said. In fact, all uninsured patients are required to pay ¥30,000 as a deposit and to cover the first consultation fee.
"I'm afraid we cannot provide our service to those who cannot afford the payment," Hirata explained.
Like every Japanese, foreigners working full time for a company are entitled to join the Employee Health Insurance plan, under which employer and employee divide equally the cost of insurance premiums.
But this luxury is limited to those with work visas, while some companies, including English-language schools, have wriggled out of the obligation by granting only part-time status to workers.
Foreigners and Japanese alike, those without Employee Health Insurance are required to join the National Health Insurance program.
But even though the amount of National Health Insurance premiums is calculated on the basis of local resident tax and assets, foreigners without the legal right to be employed in Japan have a difficult time covering the cost.
In addition to the lack of affordable health insurance, illegal entrants and overstayers are more likely to avoid visiting hospitals when faced with fear of deportation.
Taeko Kimura, an activist aiding underprivileged foreigners, said the situation is practically hopeless for the uninsured, some of whom live in cramped apartments and suffer infectious diseases, including AIDS. Many of the foreigners Kimura looks after are on provisional stay while applying for refugee status, or reside in Japan illegally.
Kimura said that while illegal aliens may not be entitled to public health insurance, leaving their medical needs unattended risks triggering an outbreak of infectious diseases that could affect the overall population.
According to the Justice Ministry, 954 people filed for refugee status in Japan in 2006. But while a 2005 revision of the Immigration Control Law established a new provisional stay permit for those applying for refugee status, Kimura charged that the revision did more harm than good by not allowing the temporary residents to have a job.
Kimura, who has worked with nonprofit organization Ajia Yuko-no Ie (Friendly Asians House) supporting mostly Myanmar refugees, explains that many of her walk-ins live in six-tatami rooms with eight people jammed into bunk beds.
"Once a Myanmarese is recognized as a refugee, there is a slight chance that he or she might get employed" and thus can afford to pay for public health insurance, Kimura said, noting, however, that the threat of deportation dissuades those staying illegally who fall ill from seeking medical help, while others on provisional stay are not entitled to work in Japan — and thus are not covered by any medical insurance.
"And even if they attempt to return to Myanmar because of their disease, things are complicated because the junta does not permit re-entry of refugee applicants overseas," Kimura said.
Some 100 foreigners contact Kimura's NPO each day, seeking advice, medicine or a job. Over the past decade, 66 people the group was involved with have died.
In December 2001, Kimura received a call from a Myanmar man in Tokyo who said his younger brother, who was in Japan illegally, was ill. Her group arranged for a hospital to take the brother, where he was diagnosed with terminal tuberculosis and AIDS. He died four days after being taken to the hospital.
"Lack of government aid is causing so many difficulties," Kimura complained, suggesting the government is irresponsible in not giving provisional refugees the right to work while also doing nothing to help illegal aliens who need urgent medical care.
Legal status is not the only problem for foreigners in need of medical support. The Mie Prefectural Government recently revealed that a pregnant non-Japanese woman — whose nationality has not been disclosed — was rejected from seven hospitals in 2006 after delivering a baby alone at her home because she could not speak Japanese.
Mie officials also said the woman had not consulted a doctor during her pregnancy.
Although some hospitals in central Japan, including Aichi Prefecture, have employed medical translators to handle the large number of Brazilian and other Latin American residents, such services are generally in short supply.
Medical translation in Japan is not an established profession, and many of those who do it are volunteers.
Megumi Matsunobe of MIC Kanagawa, a nonprofit organization that dispatches medical translators to local hospitals, said government support is inadequate.
Founded in 2002 with subsidies from the Kanagawa Prefectural Government, MIC has about 170 volunteer medical translators who have completed the group's training sessions and are certified by the prefecture. The organization supports non-Japanese patients in 10 languages, including Vietnamese, Portuguese and Tagalog.
But even though demand is strong — the group receives more than 200 inquiries a month — MIC's contract with Kanagawa expires at the end of March, and the group has yet to decide how it can continue its operation and offer the ¥3,000 for each translator.
Matsunobe said many hospitals refuse to accept patients who do not speak Japanese, while those without medical insurance are often shunned. Ultimately, she said, it's up to the government to do something.
She said the government should start by recognizing the need to protect the rights of all migrant workers and their families — regardless of their legal status. To that end, the central government should help cover the fees for medical translators for foreigners, she said.
Hospitals must be required to hire medical translators, Matsunobe said. She wants to see the state create a system that would organize and dispatch professional translators to hospitals and clinics that need them.
"This is a matter of life and death," she said.