Life in Japan as a foreigner is not always easy, especially if you become sick and don’t speak the same language as your doctor.

There is a handful of foreign doctors, mainly practicing in the Tokyo metropolitan area, and a limited number of Japanese doctors who speak English. But for a foreigner living in a rural area who can’t speak either English or Japanese, finding the necessary help can be a daunting proposition.

Currently, medical services for foreigners are tightly limited under a reciprocal government arrangement — only five doctors from Britain, one from the United States, one from France and seven from Singapore are allowed to practice in Japan in exchange for the same number of Japanese doctors who can practice in those countries.

In a surprisingly bold step, however, the government recently decided to allow doctors from any country to practice in Japan, as long as they see patients of their own nationality.

The details will be worked out by the end of fiscal 2003, but the basic idea is to have municipalities or private entities ask the national government to call in doctors from specific countries. They will be allowed to practice in Japan after going through a simplified medical exam in English.

The move is part of Prime Minister Junichiro Koizumi’s plan on special deregulated zones. Some of the regulations, including the one on foreign doctors, will be lifted nationwide.

“This is a big change for the basic principle of Japan’s medical system,” said Toshihide Hinoki, deputy head of the Cabinet Secretariat’s office for special deregulation zones.

Hinoki said municipalities that have a large foreign community, including Nagano and Gunma prefectures, are facing a serious demand for foreign doctors who can provide medical services and mental support in their mother tongue.

Metropolitan areas with many foreigners, including Tokyo’s Minato Ward, also have a high demand for more foreign doctors, he added.

“Many municipalities have already shown interest,” Hinoki said. “We’re expecting a lot of specific requests to come by the time the new system is in place.”

Nagano Prefecture requested foreign doctors when the government accepted deregulation proposals from municipalities in January. The foreign doctor proposal and 123 other items were approved Feb. 27 by Koizumi’s panel on special deregulated zones.

Foreign residents account for nearly 2 percent of Nagano’s population, including 17,000 Brazilians who mainly work at factories, and a large number of wives from Thailand, the Philippines and China, according to prefectural officials.

Yumiko Uchisaka, head of a local nonprofit organization that demanded that the prefecture propose to the national government that foreign doctors be allowed to practice in Nagano, said numerous foreign residents suffer from high blood pressure, diabetes and other chronic ailments.

“In many cases, these problems are caused by stress from hard working conditions and a different way of life in Japan,” said Uchisaka, who is a doctor.

“They get relatives to send medicine from their home countries,” she said. “It’s not that Japanese medicine does not work for them, but they are anxious about seeing Japanese doctors because of the language and psychological barriers.”

Her organization, the Hokushin medical network for foreigners, provides counseling, holds gatherings of foreign residents and sends out volunteer interpreters to help them get information about medical services.

But even if interpreters help patients at clinics, their number and language ability regarding medical terms are limited, Uchisaka said.

Among the Brazilian factory workers are doctors who are licensed to practice medicine back home, she said. They engage in other work because they are not allowed to practice in Japan.

“It will help a lot if these people can provide medical services for fellow Brazilians here,” she said.

Nagano officials said they plan to start by requesting Brazilian doctors, but they eventually aim to have doctors from other countries as well.

“Foreign residents, who are also Nagano citizens, should have access to medical services that meet their demand,” one official said.

Under the leadership of reformist Gov. Yasuo Tanaka, Nagano has been a pioneer in calling for deregulation in the medical field.

It was also Nagano that made the most controversial proposal — for allowing private stock companies to run hospitals — an idea the health ministry and medical associations tried to block until the last minute.

The official said that the day after the proposal was made, leaders of Nagano’s medical association came to the prefectural office to protest, claiming that bringing in foreign doctors or allowing private firms to manage hospitals would destroy the nation’s medical service.

“Their resistance was really tough,” the official said. “But we wanted to make a breakthrough and prove that local voices could change things at the national government, and we did.”

Other deregulatory steps that would make foreign residents’ lives a little easier include allowing foreign students to stay in Japan for up to 180 days to look for a job after their student visas expire, allowing spouse visa holders to work up to 28 hours a week and extending the visa for foreign engineers engaged in information technology to five years from the current three.

These changes were made based on proposals from municipalities.

Hinoki of the deregulation office said foreign firms and associations, including the American Chamber of Commerce in Japan, are fully entitled to make deregulatory requests in the same manner as Japanese firms and municipalities.

“If they feel any inconvenience living or working in Japan because of the barrier of regulations, they should make requests for special deregulation zones,” he said.

His office will accept deregulation proposals during at least two more periods, from June 1 to 30 and Nov. 1 to 30. More will likely follow.

“We’ll be able to make visible changes in the special zones,” Hinoki said. “And if it works, we’ll simply expand the deregulation nationwide.”

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