During one of her medical-interpreting lessons in July, teacher Yoshiko Ishizaka, 77, brought up the case of a former student who was dealing with schizophrenia.

The principal of Tokyo-based International Medical Interpreter Academy used the example to engage her class in a discussion on the difficulties of interpreting while assisting patients with complex mental conditions.

“As an interpreter, you need to make patients feel comfortable so they open up. If you put yourself in their shoes, you’ll know what kind of help they need,” she told the class.

The academy is one of a growing number of institutions training students to become interpreters amid a tourism boom that includes people seeking quality medical treatment in Japan.

“Even if you don’t face any inconveniences in your daily life, if you stay or live abroad, you still may have trouble with communicating your health issues,” she said in a recent interview at the school.

Ishizaka’s program draws students from across Japan, but the teacher calls her popularity a sign of the growing interest in medical assistance services that cater to foreign people.

According to the health ministry, 31.19 million people visited Japan last year and the government hopes to raise that to 40 million next year, when Japan will host the Olympics.

Medical emergencies are only expected to grow. Based on a survey by the Japan Tourism Agency from November 2018 through February, the government estimates 5 percent of visitors encounter sickness or injury while in Japan.

Yet few medical institutions are prepared to treat patients whose primary language isn’t Japanese. As of July 3, only 65 nationwide had been officially accredited as facilities that can accept foreign patients.

Instituting a nationwide upgrade in medical interpretation services is on the agenda of an intergovernmental team set up last year to craft strategies for improving health services for foreigners — especially emergency services.

The task force is working on creating a network of institutions with a centralized consultation center to facilitate the dispatch of both patients and interpreters and prevent communication problems.

Starting next year, the government also plans to change the licensing system for medical interpreters to raise their quality. As part of this program, the health ministry set up the International Society of Clinical Medicine and tasked it with overseeing the medical interpreting program, starting from 2020.

At present, many interpreters are either certified under programs offered by medical interpreting schools and groups or working without certification.

Ishizaka of the International Medical Interpreter Academy said she was aware of demand for more interpreters. She teaches interpretation from Japanese to English and vice versa, but the school also has a Chinese-language program with two Chinese teachers who are former doctors.

Ishizaka highlights the complexity of performing medical interpreting that may have a direct impact on treatment as well as recovery.

“I always tell students that interpreting and interpreting in health care are two different things,” she said.

Ishizaka also emphasizes differences in health care systems, forms of treatment and services and other cultural differences as things they must know about and be capable of communicating as part of their role as medical interpreters.

“One of the first problems foreigners may stumble upon is the difference between insurance systems, and there needs to be someone who can explain it to them — such knowledge can help prevent cultural differences from affecting a patient’s treatment,” she said.

Many people with experience in travel or in health care show interest in interpretation programs like Ishizaka’s as a way to deepen their medical knowledge.

“It’s a very responsible job,” said Miho Ohashi, a student who spent 11 years in the United States and now works as a professional translator and interpreter.

Ohashi, 45, believes that the quality of services can affect treatment.

Marina Kurokawa, a student from Tokyo who previously worked for a publishing company, plans to pursue a career in medical interpreting as well.

What sparked her interest was an encounter with a foreign tourist who was looking for a hospital and asked whether medical expenses and services could be covered via the tourist’s credit card benefits.

“I want to help out foreigners who need medical care, but to do so I need to acquire adequate medical knowledge,” Kurokawa, 33, said.

Medical interpretation schools and their students welcome government-sponsored certifications as a tool for finding stabler work and a chance to provide services of a higher standard.

But medical practitioners are concerned the reforms may inadvertently worsen certain problems the government is desperately trying to address, notably foreign access to medical services — including medical tourism — amid a raging tourism boom.

For example, by catering to the needs of tourists — many of whom are wealthy and speak Chinese or English — Japan’s new setup may marginalize other elements of its foreign community, including those who speak different languages and those with low incomes.

As a result, Takashi Sawada, a physician who heads the Minatomachi Medical Center in Yokohama, worries that revising the interpretation system in this manner may eventually open up a wide health care gap between and well-heeled travelers and residents no longer able to afford treatment.

Under the plan, medical institutions will need to provide interpretation in person or by tablets and videophone systems to win certification as capable of admitting foreign patients.

Although the cap for on-site interpreting services remains undecided, the government has given the green light to charging patients for them under the plan.

“(After the reform) smaller clinics may no longer be able to cover the cost of such services, or the patients will be forced to cover the fee for interpretation,” warned Sawada, a member of the Kanagawa Workers’ Medical Cooperative.

Sawada worries the cost of hiring interpreters will escalate and cause certified interpreters to seek stabler jobs with higher salaries at institutions in the medical tourism industry or at private clinics where patients seek treatment at their own expense.

The Kanagawa Prefectural Government allows some, mainly private, medical institutions using its interpretation arrangements to charge fees up to ¥1,000. But few do that, Sawada said.

Every year, the prefecture dispatches interpreters who help on a voluntary basis in about 7,000 medical emergencies or during treatment.

Sawada lamented that the government’s plan for tourists may eventually leave a large group of foreign residents in limbo.

“There’s emphasis placed on travelers and interpretation into Chinese or English, but the growing foreign population in Japan hails from countries where none of these languages is spoken,” and many can’t afford to pay high medical costs, he said.

Serina Okamura, an associate professor at International University of Health and Welfare in Tochigi Prefecture who advises the government-wide task force, agrees with criticism that the government’s scope is limited.

At a symposium on health care strategies for foreign people in Tokyo in May, she expressed concern that despite the various scenarios being examined, the government has yet to come up with measures to prepare all medical institutions, especially in the countryside, for foreign patients.

She worries the measures may lead to hospital capacity issues, especially in the areas most popular with tourists.

“But in rural areas, medical institutions that until recently didn’t have to treat foreigners are now more likely to encounter, for instance, an Indonesian national in urgent need of medical care,” she said. “At this point, it’s impossible to predict when a foreign patient will seek treatment or in what condition he or she will be.”

She also worries about the sustainability of health care for the foreign community, including interpretation services.

“To make the scheme work in the longer run, if the number of tourists continues to grow, medical institutions will require more finances and more staffing than is planned,” Okamura said.

Contributing writer Hinano Kobayashi assisted with this article.

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