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Medical bills mount for ‘fired’ Tokyo English teacher fighting cancer, HIV

Waseda-linked school refuses to renew contract as costs of chemo, operations leave Briton struggling to make ends meet

by Simon Scott

In the shower one day, long-term Tokyo resident Neil Grainger noticed that the birthmark on his back had changed color. Concerned, he went to the local clinic, but the doctor assured him it was nothing to worry about.

Three or four months later, the mole began to bleed. “I could only wear dark-colored shirts in case it bled during the day,” he says. “If I banged into something, I would get blood on my shirt.”

The 44-year-old Briton then went back to the doctor, and on July 17 last year, after undergoing a series of tests, he was diagnosed with a malignant melanoma.

Then, just a couple of days later, Grainger was dealt another huge blow.

“I got a phone call from the hospital on the Friday and they said, ‘You have got to come back in. We have done some blood tests and have found something else.’ So within three days I found out I was HIV-positive as well. I was diagnosed with cancer on the Wednesday and HIV on the Friday.”

On July 31 he was admitted to hospital and the tumor was removed. Around the same time, he also underwent a plastic-surgery operation where skin taken from his buttocks was grafted onto the area of his back where the cancerous tissue had been.

“I didn’t know it at the time, but [the tumor] was like an iceberg growing underneath. It was one of the largest-ever skin cancers taken from someone in Japan — over 5 cm in depth.”

Grainger says that although he was not aware of it at the time, he ticks many of the boxes for vulnerability to skin cancer.

“I had a birthmark — having a birthmark over a certain size increases one’s risk. Also, I am a Brit living in Japan and not used to the UV here.”

He adds that although he exposed himself to the sun, it was never excessively.

“I have never been a sun freak. That doesn’t mean to say I have never spent days at the beach or the pool, but I am not one of those people who spent a lot of time sun tanning — not at all.”

Although the surgery was successful, Grainger’s troubles were far from over. The cancer had spread to his lymphatic system, and in September he had the lymph nodes on the right side of his body removed.

To prevent the cancer from returning, he also had to undergo an extensive program of immunotherapy. Cancer immunotherapy involves stimulating or strengthening the patient’s immune system in the hope it will reject and destroy tumors. It is a less aggressive form of treatment than chemotherapy, but Grainger still had to endure a harsh regimen of six rounds of multiple painful injections. Each round lasted two weeks and required six jabs in his back and three in his arm daily.

The operations and immunotherapy meant Grainger was forced to take increasing amounts of time off work, which created a whole new raft of problems.

From 2005 until last month, Grainger worked full-time as an English tutor at Waseda University International Corp., a language-school company with more than 200 employees whose main business is supplying additional English courses to Waseda students.

Grainger says that in 2012, despite undergoing two major surgeries, he managed to work about half of August, but was forced to take all of September off. This, he explains, was in part due to a peculiarity in the Japanese health insurance system that discourages workers from taking half-days off sick.

This quirk meant that if he took off half a day, he would get only half a day’s wage, but if he took off a full day, he would be compensated with two-thirds of a day’s pay. Therefore, on days he had to go to the hospital in the morning to receive his injections, he felt compelled to take the full day off, especially considering his mounting medical bills.

Then, in February the following year, just seven months after being diagnosed with cancer and HIV, Grainger was shaken by more bad news: Waseda International “told me they were not going to offer me another contract.”

“At this point, I was actually cancer-free,” Grainger explains, “and I was just having treatment to stop the cancer coming back, so their cutting me off seemed incredibly harsh — basically, they were saying I either stopped having the treatment that was preventing the cancer coming back, or I lost my job.”

Upon hearing the news, Grainger says he was shattered. His job at Waseda was not just some part-time gig to earn a bit of extra pocket money, but his career. And prior to the cancer diagnosis, his future at the company had looked bright. In 2011 he was promoted to senior tutor and took on additional responsibilities outside the classroom, such as teacher training and program administration. According to Grainger, at that time he was promised he would be moved onto a three-year contract once this one-year contract expired.

His work record was also blemish-free, he says. “I have been pretty much a golden boy since I have been there: zero complaints. I was constantly the one who was told I was giving more to the program than anyone else.”

A formal evaluation of Grainger’s work performance was carried out by Waseda International in April 2012 — just three months before he was diagnosed with cancer. On the Employee Evaluation Report, Grainger’s overall work performance is rated as “excellent,” the highest grade.

To quote from the “supervisor evaluation” section of the report: “Neil, you have made a very good transition from Tutor to Senior Tutor. You are very enthusiastic and keen to take on new tasks, which is great. You work well with other Senior Tutors and have already presented a workshop successfully. . . . It has been great to see you volunteer to take on the Lesson Help BBS project. . . . I hope you keep doing a good job as a Senior Tutor next year.”

These comments suggest that Waseda International was not only more than satisfied with Grainger’s work performance, but that they saw him as having an important role to play in the future of the company.

Yet this all changed after Grainger was diagnosed with cancer, he says, and from that point on, management began to look for ways to cut him loose. “They just don’t want people on their books who are a bit of a burden to them,” he says.

According to Grainger, after he launched a campaign to convince the company to change its mind, Waseda International finally relented and decided not to let him go at the end of March when his contract expired. But rather than being given the longer, three-year senior tutor contract he had been expecting, the company put him on a six-month one which, Grainger says, was basically an “enforced leave of absence” and a steppingstone to getting rid of him altogether.

“[Waseda International] fired me, basically,” he says. “So, I wasn’t only fighting for my life, I was fighting for my job as well. Clearly they weren’t on my side. I felt incredibly disillusioned and disappointed, because I had worked so bloody hard for them over the years.”

As the battle to keep his job dragged on, Grainger faced another bombshell: A routine CT scan in April revealed the cancer had returned — and spread.

“On the day I was supposed to get my forms telling my work [that] I was fit to go back and my treatment was finished, the doctors said they had found four tumors in my lungs. That was pretty tough.”

In the diagnosis and treatment of cancer, stages from 0 to IV are commonly used to classify the progression and severity of the illness, with Stage 0 being a noninvasive benign tumor and Stage IV being the final stage, where a tumor has metastasized, or spread, to other organs in the body. With the discovery of the tumors in his lungs, Grainger’s cancer was upgraded from Stage IIIB to IV.

“Up until that point I had been having injections to prevent the cancer coming back,” Grainger says. “From that point onwards, I needed to change to this toxic chemotherapy.”

To date, Grainger has undergone five courses of aggressive chemotherapy, which was administered intravenously while he was an in-patient at hospital. Aggressive chemo, which kills fast-duplicating cancerous and healthy cells, is notorious for its terrible side-effects, such as hair loss and nausea. However, Grainger says he been lucky not to have suffered those ailments.

“My problem has been terrible itching. It’s been unbelievable, to be honest. It’s like you are crawling with insects.” He has also experienced loss of appetite.

Grainger’s fears that his days at Waseda International were numbered were confirmed in May — the same month he began chemotherapy — when he received a “notice of nonrenewal” letter from the company. This document outlines the reasons his employment at the school was terminated.

To quote: “A decision regarding any further contract renewal would be based on work attendance and the determination of Mr. Grainger’s performance of work duties. Based on the doctor’s certificate dated May 7, 2013 Mr. Grainger is unable to work from May 1 to the end of July.

“WIC [Waseda International Corp.] has therefore determined that Mr. Grainger is unable to satisfy attendance and work duty requirements detailed in the employment contract.”

In response to written questions, Waseda International said they are unable to talk to mass media about specific employees but were willing to give general comment about company policy.

Yukihisa Nakao, managing officer of the company’s language education department, said the decision to renew an employment contract or not is based on work performance and attendance, and “not on whether absences are due to an illness or other circumstances.”

“I would therefore like to stress that any belief that our company would terminate an employee’s contract due to illness is mistaken,” he says.

Mistaken or not, Japanese law does allow employers to terminate employees who are too ill to work.

“Management can legally fire someone if they are too sick to fulfill work duties,” says Louis Carlet, general secretary of the Zenkoku Ippan Tokyo General Union. “The law is cruel on this point.”

Carlet says the key issue for Grainger from a legal standpoint would be whether there was a “reasonable expectation” of contract renewal.

Carlet thinks Grainger would have a good chance of overturning the dismissal if he went to court.

Grainger would have to show that despite the six-month fixed-term contract he was placed on, he still had a reasonable expectation that it would be renewed, Carlet says.

This would be “because of the many one-year renewals” he had been given in the past, “because other teachers are usually renewed and because the renewal process is a formality. Court might take a couple years, but if he wins, he would get all back pay.”

Grainger would also have to convince the court that he did not miss enough days to constitute nonfulfillment of work duties, he adds.

Whether he has a case or not, the cold, hard reality for Grainger is that, as of Sept. 30, when his contract expired, he is not only extremely sick but also jobless, with little hope of future employment. And now, after undergoing 14 months of costly cancer treatment, he is struggling to make ends meet.

“All of a sudden, I was facing three operations in a month, plus a session of chemotherapy,” he says. “The money you just have to find from nowhere is horrendous.”

Although Grainger was enrolled in a private health insurance program through his job with Waseda International, that only covered 70 percent of his skyrocketing medical bills. “It works fine if you have to go in for a small operation, or you have a cold or something, but when you are in hospital every month over and over again, earning less, paying out more, it is a double whammy. Thirteen months of that has taken its toll. So, basically I am desperate for money — every month is a constant struggle.”

Grainger says he has received no additional support from Waseda International, such as offers to help out with outstanding hospital bills. He also says that management has shown a total lack of empathy with his situation. “They just don’t care. They haven’t visited me in hospital, or even sent flowers. They have never even asked me how I am.”

He stresses that although he feels very let down by the management at Waseda International, his fellow teachers at the school have supported him 100 percent.

Nakao from Waseda International says a health and safety committee is in place at the school to “promote the prevention of health problems and to maintain the health of employees.”

“Our company employs staff members who are responsible for personnel-related duties, and who are able deal with health — including mental health — concerns of employees at any time,” he explains. “With regards to any employee who is hospitalized due to a nonwork-related illness, it is not a common practice among Japanese companies to have a company representative visit the employee in hospital or to send flowers. Therefore, it is not fair to say that the company does not provide support to its employees just because these specific actions were not taken.”

Despite the huge series of challenges he has had to face, Grainger remains surprisingly upbeat. “I’ve got a really good support network here and some really good friends and everyone has been amazing and helped me out a lot,” he says. “Cancer has been like an affirmation of my friendships. It sorts the men out from the boys — you know who your friends are. I’ve never been a person who has been particularly comfortable asking for help from other people, and then suddenly I was in a position where I had to. I was overwhelmed.”

Good friends aside, there is no denying that Grainger is staring death in the face. “They have virtually told me my survival chances are zero. If you get malignant melanoma, you die of it. That isn’t to say you die of it the next day, or the next week, or even the next year. I would have been dead already if I hadn’t come to hospital when I did. I would have been dead before Christmas — 100 percent.”

Yet Grainger says he no longer lives every day in fear of dying. “I don’t really think about it like that anymore. Everything is a bonus.”

In fact, Grainger says, in many ways, his cancer has been life-affirming — even liberating.

“Having to face it and realize that you are a human being, a living creature, and whether you die sometime this year or sometime next year or in a few years’ time, or when you are supposed to die of old age, whenever that may be, you will eventually die.

“Everyone has to face it at some point in their life, and once you have done that psychologically, it is a freedom. It sets you free.”

Walk the line and support Grainger

On Sunday, Nov. 3, Neil Grainger and a group of his friends are planning to take a 40 km walk around the Yamanote Line in Tokyo.

The event is a fundraiser to help cover the mounting cost of Grainger’s medical expenses for his cancer treatment and to raise money for several cancer charities.

People can get involved by sponsoring one of the walkers or making a donation online.

A charity walk/run is also being held the day before the Yamathon, on Nov. 2, in Sandwell Valley in the English West Midlands.

For details of both events, go to www.yamathon.com. Additional information about Grainger’s case and coping with illness in Japan can be found at www.supportneil.com and www.sickinjapan.com.

Send comments on this issue and story ideas to community@japantimes.co.jp.

  • hudsonstewart

    It’s a sad story, but unfortunately it’s happening more and more to people around the world. I have heard stories of cancer patients being fired without warning in the US for missing too many work days (I believe the FMLA allows for 12 weeks of unpaid leave per year). I worked with a man who was on a 1-year contract at a university in the US and when he was hospitalized with pancreatic cancer he was told that there was no way his contract (and health insurance) could be renewed.

    Employers should do all they can to accommodate sick employees by working with them to create flexible working schedules. A reduction in pay or unpaid leave is still preferable to being fired.

  • TO

    How terrible! But, I am glad that Mr. Grainger is getting a good amount of support from his friends. I bet there are many many Graingers, and I really hope this “Yamathon” will mobilize individuals and organizations that are essentially in the same trench to work for more systemic changes in law and company policy so that similar sufferings will be reduced: cancer and other seriously sick patients, poor/low/middle income folk, people in casual/insecure employment, over-stayed people, labor unions, etc. At minimum, I hope the events will get a lot of media attention and public sympathies.

    I’ll keep my fingers crossed, Mr. Grainger! Please stay strong!!

  • Steve Novosel

    To be fair, it could just be a common practice in your company, but not in others.

    Though it seems from anecdotes I have heard from others that it is indeed common practice to do so.

  • Neil Grainger

    Thank you all for your kind and compassionate messages of support. I am Neil, by the way (the person this article is about). I would also like to thank Simon (the journalist who wrote this article) for the time and effort he put into writing about my experiences, both good and bad, over the last year. A lot of people should be very proud of how they have responded to my problems, and I hope that my story acts as a catalyst for change for the small group of people who responded to the events of my life in an inhumane and immoral way. Change never happens overnight, but hopefully one day, other people may not have to experience the difficulties I have had to endure with my company should they be unfortunate to become ill too. Thanks again, Neil.

  • Mike Wyckoff

    Very Sad ! My heart goes out to you.

    I have heard of companies doing this a lot, and as a manager myself, I understand the financial side, but not having a heart is something that corporations are all too good at !

  • hoofin

    I am curious about this sentence:

    “Although Grainger was enrolled in a private health insurance program
    through his job with Waseda International, that only covered 70 percent
    of his skyrocketing medical bills.”

    Was this a shakai hoken plan (kenko hoken)? I understood that with the national plan, there is some kind of cap on out-of-pocket for serious illnesses, and I assume all the employer kenko hokens have this rule, too.

    Neil is not the first foreign English teacher to get riffed by the employer, once they find out about cancer. This also happened with Catherine Campbell and Berlitz, around 2009-2010.

    • jdd

      As a longer term resident, I do have health coverage, and even buy extra/supplemental. I have had this from the start, since opting out (as with the eikaiwa industry) was not possible.

      There is a monthly cap on out-of-pocket expenses.

      Neil, could you please clarify:

      –details of your health coverage/policy (policies?), and if there’s a monthly cap or not.

      –during the time of your employment in Japan when you signed up for coverage (from the get-go, or later, after working a while).

      My sympathies for your condition.

      • kayumochi

        I would like to know more about the cap on out-of-pocket expenses as well.

      • Kei Nikaido

        Monthly cap on medical expenses is 100,000 yen per household. In case of zero income the healthcare is free.

  • Starviking

    There might be problems with getting care/treatment interrupted and fitness to travel.

    • nunyabidnessfoo

      if he can walk 40 km around Tokyo I’m sure he could get on a plane for 10 hours

  • Ben

    I will have to disagree with your post on several points. I was the program supervisor for a chain of language schools for over eight years, so I have quite a lot of experience on the subject.
    1. A large majority of English language teachers in Japan are only here for a few years, and this is especially true of women. Very few stay beyond that because there are few options to advance unless you learn the language.
    2. Japan doesn’t badly need to communicate with the outside world for the sake of their economy. They’ve been doing quite well for the past fifty years, aside from the asset bubble. What the Japanese need to do to improve their economy is to have less regulation and more babies.
    3. All foreigners working in Japan are actually required by law to have national health, but many companies skirt this law in order to lower their costs. And if a foreigner wanted to join national health, they can. But because the monthly costs are quite high, and because they can get cheaper health insurance from other companies, most opt out.
    Your nom de plume says a lot about your bias against Japan.

    • japancritical

      In response to your points:
      1: Of course a lot of the teachers you worked with only stayed a few years. For example, did your language schools pay their health and pension contributions? Did they give them full time permanent employment and rights after a few years work? If so, please name these companies and their current employment practices. Why, should anyone stay with a employer if they are only going to be treated like the writer of this article. This is common practice in Japan, and you know it.
      2.Yes it does. Japan is in an atrocious state. Inflation is skyrocketing and wages are stagnant. Have you not been following the trade deficit? Anyway, if Japan didn’t need language teachers, they would not let them into the country to work so easily. The point is, Japan is not doing English language instructors a big favour by letting them in. They need to learn English, but they are not prepared to afford teachers the same employment rights as native Japanese.
      3.This reinforces my point. IMO, the J Gov turns a blind eye to this as they don’t want to care for foreigners or be landed with their pensions. They just want the fruits of their underpaid labour. If companies did this on masse to Japanese workers, they’d be up in court in jig time.

  • Ben

    I am very sorry for your plight, Mr. Granger, and I wish you all the best with your walk-a-thon around the yamanote. My father recently passed away from liver cancer, and the last few years of his life were always a question mark. I will be donating via paypal.
    I just wonder about the responsobility of Waseda to keep you on if you will miss tremendous amounts of days due to your health. If you were in remission and able to fulfill your work duties as outlined in your contract, that is one thing. But you are basically forcing Waseda to pay two people to fulfill your job: you and the person who has to cover for you. As a former manager, I find that situation untenable.
    Perhaps it is better if you find work via 7act or do some other part time teaching that is suitable to your situation. If you are willing, and able to work, there are lots of teaching jobs available.
    Once again, I wish you all the best.

    • japancritical

      That post says a lot about you Ben.

  • Paul

    Shoddy treatment. My thoughts are with Neil and his family and friends.

  • Neil Grainger

    Thank you, Casos. Yes, many British citizens are unaware of the new laws being passed in the UK preventing British passport holders from receiving healthcare and preventing them from returning to the UK with their spouses unless they can guarantee quite ridiculous levels of income. I fear that most will only find out when they actually try to return. I’ll do my best to get better. Neil

    • Elizabeth Kato

      It may be possible for a spouse to enter the uk via a carers visa.. but I don’t want to give false hope as I have not looked into the situation with detail.

  • Neil Grainger

    Yes, I am aware that some people are jumping on the “racist” bandwagon, that was not my intention. I know many Japanese people from my time in hospital that are in the same position as me, so it clearly is a nationwide, even worldwide problem, and nothing to do with my job here in Japan or that I am a foreigner.

  • japancritical

    In response to your post and Ben’s, (so we don’t go around in circles):
    Ben has already admitted that it’s pretty much policy for employers of foreign ELF instructors to underpay them and defraud them of health and pension coverage. You and he don’t have a problem with this. OK, but people considering coming to Japan to work need to know that they are being exploited and ripped off (with the cooperation of foreigners such as yourself and Ben) and could end up in a situation similar to Mr Grainger..
    You are both completely distorting the rate and amount of “transitory” workers coming to Japan. IMO, you are doing this because it suits your employers, the J-Gov and your own job security, to keep a revolving door of employees who don’t know their rights and won’t agitate for decent pay and conditions.
    Opportunities for English teachers outside Eikaiwa are just as precarious and prone to exploitation, and you and Ben know it. Mr Grainger’s case is just one example. People teaching at universities, colleges and schools all across Japan are on one year contracts and are routinely dismissed when their employers feel like it. You are misleading people. You are also keeping the standard of English teaching in Japan deliberately low in order to accede to current discriminatory practices. Well done.
    I will repeat, people should not come to Japan to work as English language instructors under the current situation. They will be ripped off and lied to, with the support of guys like you who just want to feather their own beds.

  • Kamemura Hidetoshi

    Hi Neil
    I’m really touched and concerned by this news. What can I do for you? I’m teaching English in the private high school. I’ve already talked about this article in my English class and me and the students discussed the problem surrounding your situation which is out country’s problem. We understood it needs to be changed. But right now we are wondering if there is something we can do. I wanna join the Yamathon or at least support it. So let me know if there is anything I can help. Hidetoshi

    • Neil Grainger

      Hi Hidetoshi. You are welcome to walk with us, but I have to be careful of the number of people walking else it could become a safety risk. However, there is room for one more if you would like to join. You can contact me through the http://www.yamathon.com website and I will provide you with any information you need. If you can’t walk on that day, you could do some fundraising either by yourself or with your students, and the charities and myself would be eternally grateful for any help you can offer. Kindest regards, Neil.

  • Elizabeth Kato

    It may be possible for a spouse to enter the uk via a carers visa.. but I don’t want to give false hope as I have not looked into the situation with detail.

  • kayumochi

    Be thankful you are not in the USA Neil. You could easily rack up a million dollar medical bill there even with insurance. Why don’t you go back to the UK if the Japanese medical bills are a problem? Good luck!

  • hudsonstewart

    Your jaded views (understatement!) are preventing you from understanding my argument. As I’ve already said, the situation is just as bad for Japanese workers in Japan who are stuck in temporary/part-time jobs (as well as other people around the world). Actually it’s probably worse considering the high starting salary of an eikaiwa teacher in comparison. I doubt anybody can take you seriously when you argue that the Japanese government is conspiring to keep foreign workers in transitory positions (I wonder which ministry they’ve set up to take care of that?), but if you’re arguing for equality with Japanese, then the first thing to do is to LOWER the salaries of eikaiwa teachers so that they are more on par with Japanese salaries.

    How am I supposed to post statistics of the presence of “good secure permanent jobs with full benefits for foreign teachers in Japan”? Do you think there’s an agency out there collecting such stats? Is it necessary for me to conduct a survey in order to argue what is obvious? “Post stats” is such an overused argument. Do a search for “teaching license in Japan” and you can read of numerous people who discuss their experiences of becoming certified middle/high school teachers in Japan with permanent positions and benefits.

  • M. Smitty

    If employees in Japan feel obliged to invite thier employers to thier weddings, then surely, by a way of reciprication, employees might think about visiting sick employees in hospital. Common practice or not, what is so difficult about showing a bit of compassion, and acting like human beings?