Medical sector faces hard choice amid aging society


As Japan gropes for solutions to the imminent labor shortage amid the rapidly graying population, the failure of a private-sector project to import nurses is a bitter reminder of the hurdles involved in attracting and keeping foreign professionals here.

In 1990, Mototsugu Arao, chairman of the Hyogo Prefecture-based hospital group Senreikai, embarked on a bold experiment to bring in Filipino nurses, as immigration laws were revised to open Japan’s heavily protected medical sector to foreigners — albeit only for four years in the case of nurses.

But because Japan does not recognize other countries’ medical licenses, the 13 nurses who joined the project first had to pass a Japanese-language proficiency test. Next they had to complete a three-year curriculum at a nursing school and then pass a national exam to again be licensed as a nurse.

Of the 13, only Arlene Estrada Narca and Nelida C. Flores made the cut.

Both were smart, resilient and well-liked for their cheerfulness. Arao’s group, which invested tens of millions of yen in the nurses’ schooling and other expenses, had hoped that after working here for four years both would help serve as a bridge to bring in more compatriots.

That was not to be.

Narca went back to the Philippines in April 2002 to marry a man she met in Japan, then dropped out of contact. Flores left a year later and began looking for Japan-related work in Manila but is now looking to go to the U.S.

After all, Flores has seen fellow Filipino nurses working all over the world, from the Middle East to Europe to North America. “These things should be decided by governments, not me,” Flores said of her decision not to play the “bridge” role, speaking in fluent Japanese from her home on Mindanao Island.

Indeed, the Japanese government does not appear to have given serious thought to this matter.

But it will soon have to, and weigh the cultural and socioeconomic consequences of enhancing trade in people as bilateral negotiations on free-trade agreements with such “labor exporters” as the Philippines and Thailand unfold.

But the Health, Labor and Welfare Ministry maintains that the supply-demand gap in nurses will soon be resolved.

With various programs in place, the number of nurses in Japan will reach 1.3 million — including 56,200 newly registered nurses — in 2005, which is nearly the number needed, said ministry official Yasunori Wada.

“We are not facing an imminent, dire shortage of nurses,” he said.

The ministry has no medium to long-term projections on the supply and demand of nurses, Wada said. While the graying of society will no doubt increase the need for nurses, shortages will be resolved “through the extension of current measures,” such as efforts to bring back nurses who have left their jobs to have children, he said.

“There was a far greater shortage of nurses 10 years ago,” Wada said. “We have no plans to bring in foreigners as a solution for the demand-supply gap.”

If Japan does decide to open up its health-care sectors — either as a concession for FTA deals or simply due to depopulation — it will need to make sure the rights of foreign workers are protected, says Lia Eugenio of Pastoral Center for Migrants (PACEM) in Kawasaki.

A consultant for PACEM, a nongovernmental organization that helps foreign workers in Japan, Eugenio said she has “mixed feelings” about the possible inflow of Filipino nurses and caregivers, as she has witnessed the plight of entertainers, engineers and other Filipino workers over the years.

Eugenio said many Filipinos arrive in Japan without basic knowledge of the country, including its environment and culture. Potential workers need to be thoroughly briefed on Japan beforehand, so they can make a responsible decision on whether to come here, she said.

She also worries that the nurses might be exploited, as has been the case in Britain.

“There are always double contracts,” she said. “Some of the nurses (in Britain) say that in the Philippines, they signed a contract to this employer, but when they come to the U.K., there is another contract that they have to sign” with benefits and agreements significantly less than originally promised.

There are already warning signs.

Rumors that Japan may soon accept caregivers has already created a massive “training” frenzy in the Philippines, with some schools offering six-month courses together with false promises of jobs in Japan, according to Japanese doctor Kazuhiro Takahama, who now lives in Manila with his Filipino wife and is a voluntary advisor to a local hospital.

“The promoters and brokers who have dispatched Filipino ‘entertainers’ to Japan are now looking at the caregiver-staffing business as the ‘next easy job,’ ” he said. “There are already more than 500 caregiver training schools in the Philippines (targeting overseas markets such as Japan).”

Takahama added that if Japan is going to import Filipino labor, it must also think about how to reintegrate them back into local society. As it stands, few good jobs are available for Filipino returnees, which is partly why they end up overstaying their visas in Japan, he said.

Takahama envisions a system where the community of retired Japanese in the Philippines — which currently numbers 800 — hires these returnees to take care of them in their old age.

“Japan should not treat them as disposable labor,” he said.

Arao, for his part, said his group has given up on the idea of sending more nurses to Japan, saying that for such projects to work, the health ministry must first acknowledge there will be a shortage of nurses and then take steps to accept foreigners.

“Tell me if you have a good idea,” Arao said. “All I can say is I’m very disappointed that the project didn’t last.”