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Language barriers at Japanese medical institutions put foreign patients at risk: expert

by Tomoko Otake

Staff Writer

Here’s a little-known, unnerving truth about health care in Japan: for non-Japanese, the death rate is higher than that for Japanese.

According to the health ministry, the age-adjusted mortality rates for Japanese men and women stood at 544.3 and 274.9 per 100,000 people, respectively, in 2010, the latest year for which statistics were available. In contrast, the rates for non-Japanese men and women were 674.4 and 349.6, markedly higher for both sexes.

The lack of detailed statistics, such as the number of deaths by nationality, defies further analysis of the gap in health outcomes.

But Takashi Sawada, a physician and director of the Minatomachi Medical Center in Yokohama, says the higher death rates are probably down to one thing: the language barrier.

“Some might argue that the foreign population is inherently at a higher risk, such as more of them being sick before arriving in Japan,” Sawada said. “But I don’t think that’s true, because the causes of their deaths are pretty much the same as ones for the Japanese population.”

The leading cause of deaths for both Japanese and non-Japanese groups is cancer, followed by heart disease, strokes and pneumonia. Only the rate of suicides among Japanese men — 29.8 per 100,000 — was higher than that for non-Japanese men, which stood at 27.5.

While the statistics are old, the environment that has led to these findings has changed little. As a clinician who has cared for patients of various nationalities and backgrounds for more than 25 years, Sawada says he has witnessed “countless” cases in which patients’ health was compromised by the language gap.

“We recently did a check-up for Nepalese residents,” Sawada said. “A woman in her 30s said she hadn’t had periods for more than 10 years, yet she had never consulted a doctor in Japan because she wouldn’t have understood what the doctors would say. There are people like that everywhere.”

A Japan Times survey of foreign residents in February also showed many respondents cite the lack of language support as one of the shortcomings of Japan’s health care system.

The language issue first started becoming a major problem in the early 1990s — when the number of non-Japanese residents started to spike — with the country opening the doors to immigration by Brazilians and Peruvians of Japanese descent.

At the same time, the ranks of people whose visas had expired but continued to stay on for work swelled. As of the end of 2000, some 232,000 out of the 710,000 foreign workers in Japan were overstayers, according to the labor ministry.

These people rarely went to doctors — unless they got severely sick — because they did not have health insurance and could not afford the full cost of care, according to Sawada.

That changed in the 2000s, when the government started deporting overstayers en masse and toughened visa requirements from certain countries. By 2016, the number of overstayers had fallen to 63,000 while the legal foreign worker population had grown, topping 1 million for the first time.

This means that most non-Japanese living and working here today are covered by the public health insurance scheme.

The mortality gap that remains despite the universal health coverage worries Sawada, who maintains that each local government should create a publicly funded medical interpreter system, given that access to health care is a basic human right.

Sawada says community-based medical interpreters are widely available in many European countries, as well as Canada, Australia and in federally funded hospitals in the U.S.

In these countries, public health authorities understand that medical interpreters are essential not only to help patients make informed decisions but also to prevent accidents and lawsuits, he says.

Having medical interpreters available as part of basic community services also saves on medical resources, too, by nudging more people to seek treatment before they get severely sick, at which point massive procedures requiring large amounts of manpower may be necessary to save lives, he argues.

“Interpreters are not only important as far as patients’ rights go, but they also make economic sense,” he said.

In addition, early interventions are critical to counter infectious diseases, whose spread can threaten communities, not just individuals.

While Japan has no laws that mandate hospitals to use medical interpreters for non-Japanese-speaking patients, some community-based nonprofit groups have worked hard to train volunteer interpreters and have persuaded hospitals to accept their assistance.

One pioneering example is MIC Kanagawa, an NPO in Yokohama that, with financial support from Kanagawa Prefecture, started a pilot project to dispatch interpreters to hospitals across the prefecture in 2002. In fiscal 2015, medical interpreters covering 12 foreign languages were dispatched 6,699 times through the group.

But there are still not enough of them, says Sawada, who serves as one of the directors at MIC Kanagawa, adding that, amid a recent surge in the number of technical interns from Vietnam, there’s a big shortage of Vietnamese-speaking interpreters at the moment.

Meanwhile, an ongoing drive by the central government to attract more tourists ahead of the 2020 Tokyo Olympics, including “medical tourists” from abroad to turn the nation’s health care service industry and know-how into a money-making sector, has led to some, albeit limited, state funding for training and placement of medical interpreters.

Expecting the tourism demand to grow, some private-sector businesses have rushed to open schools or courses to train medical interpreters, mostly in English and Chinese.

But Sawada says these services — which cost a lot more than what nonprofit groups currently charge patients — are geared toward affluent short-term visitors from abroad and will do little to improve the health of average foreign residents in Japan.

Naomi Morita, a Japanese-English interpreter with more than 15 years of professional experience, says medical interpreting services in Japan are “in huge flux.”

Morita makes a living as a conference interpreter in addition to being a part-time lecturer of medical English at Tokyo Medical University who occasionally teaches at a school for would-be interpreters. She also has volunteered to translate for foreign patients through MIC Kanagawa.

“I have long told my students you cannot really count on medical interpreting as a source of income,” she said. “But in the last few years, expectations have grown that medical interpreting can be a career, and many young people are now entering the field.”

In December, Morita, along with other veteran interpreters, set up the Nationwide Association for Medical Interpreters. She said that, despite various initiatives being undertaken by the central government and businesses to train medical interpreters for tourists, there is no mechanism through which to absorb the opinions of professionals on the ground.

The group currently has 66 members covering 12 languages.

The group hopes to help the government address issues surrounding the profession, such as how to balance the need for universal, affordable access to interpreters with the need to reward them adequately.

Morita and Sawada agree that, ultimately, it is the voices of foreign patients that count the most. “We really want to hear from the residents themselves. If more people say medical interpreters are needed in society, it would empower us to protect their health,” Morita said.

Regional medical interpreter dispatch services

Here are some regional organizations that have solid experience in dispatching medical interpreters:

MIC Kanagawa:

Mie International Exchange Foundation:

Multilanguage Center FACIL:

Center for Multicultural Society Kyoto:

Aichi Medical Interpretation System:

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