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Yasutoshi Nishimura — the nation’s COVID-19 point man — paused momentarily at one point during a recent news conference, seemingly debating internally how best to broach discussion of virus clusters among foreign residents, a subject that could be a lightning rod for criticism and claims of xenophobia if handled poorly.

Not all foreign residents, the minister leading the government’s coronavirus response was careful to note, should be blamed for the spread of the virus. No prejudice or discrimination should be tolerated whatsoever, he said.

The caution with which Nishimura brought up the subject at the Nov. 12 briefing spoke volumes about its sensitivity, underlining the delicate balance the government is trying to strike between stopping foreign communities from becoming virus hot spots and preventing discrimination against them.

And some factors thought to be responsible for the recent emergence of these clusters, such as poor living conditions, large social gatherings and difficulties getting access to medicine, are not necessarily exclusive to foreign communities.

While the government is headed in the right direction with its proclaimed goal of ramping up multilingual services and improving medical access, experts say it must be careful not to contribute to the misguided narrative that foreign residents are by nature higher-risk — let alone sloppier about basic hygiene protocols — than native Japanese.

Cultures and habits

Officials, for their part, haven’t focused on foreign communities without good cause: Dozens of clusters centering on non-Japanese residents have popped up across the nation over the past few months, from international students cooped up in shared apartments to families gathering for meals.

On Nov. 13, Nishimura gently urged in a series of multilingual tweets coinciding with the start of Tihar, an annual festival celebrated in Nepal, that Nepalese communities in Japan abide by measures or prevent the spread of COVID-19 as they go about observing their tradition.

The government has said it will take into account factors typical of many foreign residents, including their penchant for hugging friends and family and the lack of a mask-wearing culture prior to the pandemic. Language barriers, it claimed, hamper their access to information on “basic anti-infection measures,” such as avoiding the so-called Three C’s of closed spaces, crowded spaces and close-contact settings. It also asserted that they “don’t have the habit” of visiting medical institutions even when they feel ill.

Yasutoshi Nishimura, the minister leading the government's COVID-19 response, speaks to the press in Tokyo on Nov. 12. | KYODO
Yasutoshi Nishimura, the minister leading the government’s COVID-19 response, speaks to the press in Tokyo on Nov. 12. | KYODO

The lifestyle of foreign residents came under scrutiny in September when Gunma Prefecture, the eastern part of which is home to a concentrated population of generations of Brazilian and Peruvian migrants, saw a surge in infections.

That month, an estimated 70% of the 90 new infections tallied in one week were traced back to foreign residents, prompting the town of Oizumi, one of the areas with the highest concentration of non-Japanese residents, to declare its own state of emergency.

A subsequent contact-tracing probe of these foreign clusters revealed that some of those infected had not only neglected to wear masks but ate and drank from the same plates and glasses as they enjoyed barbecues, went clubbing and dined en masse with families and relatives over the summer, said Kazuhito Nishi, a prefectural official in charge of intercultural policies.

In another high-profile case that shone a renewed light on living conditions typical of some foreign communities, an automotive school in Sendai saw 108 international students from developing countries test positive for COVID-19 as of Nov. 13, according to Mitsuru Ebina, deputy president of the Kadan Automotive Technical College Sendai.

The official cited their cohabitation at a school dormitory, where one room was shared by two students, as one of the possible reasons behind the clusters.

Young foreign students and technical interns commonly share homes with their peers as a way to save on rent.

“They are poor,” Maria Le Thi Lang, a Vietnamese nun at a Catholic church in the city of Kawaguchi, Saitama Prefecture, said of many of her younger compatriots — mostly students and trainees — who come to consult with her about a raft of problems they face living in Japan. “I’ve seen many of them share the same tiny rooms in groups of five or six.”

Sharing meals in large groups or living under the same roof are not a lifestyle exclusive to foreign communities. For some non-Japanese communities, though, it can be said their tolerance for physical intimacy among family members and compatriots is higher than that of Japanese, leading to a tight-knit lifestyle that routinely includes cozy socialization.

Iki Tanaka, manager of Tokyo-based YSC Global School | IKI TANAKA
Iki Tanaka, manager of Tokyo-based YSC Global School | IKI TANAKA

“You could say the scope of people they recognize as part of their family goes much broader than that of Japanese, extending well beyond uncles and aunts into distant relatives, whom they may easily hug and allow the level of physical contact that Japanese normally wouldn’t,” said Iki Tanaka, who as manager of Tokyo-based YSC Global School, has been involved in the support of many children with foreign backgrounds over the years.

But at the same time, she said, such affectionate gestures are a testament to the strong camaraderie they have cultivated to survive in a foreign country. Negating this sense of community, she said, “risks undermining their ability to help each other,” Tanaka said.

Still, as Tanaka agrees, any insinuation that foreign residents need to be better educated than Japanese on the basics of how to prevent COVID-19, such as wearing masks and eschewing crowds, may come across as condescending, or worse, reek of xenophobia.

The information on these basic preventive measures is “available in our own language too,” said longtime Nepalese resident Ganga Dangol, who heads a group called the Information Dissemination Network for Nepalese Migrants in Japan.

“Wearing masks, washing hands and keeping social distance has become part of our lives now — we do these as a matter of course. The idea that foreigners tend to ignore mask-wearing or social distancing is just untrue,” she said.

Language barriers

To ensure information will reach foreign communities more effectively and facilitate their medical access, the government says it will, among other things, beef up efforts to provide multilingual updates on websites and social media, strengthen cooperation with community leaders and equip hospitals with more robust translation services.

Dangol particularly welcomed the government’s stronger ties with influential community figures, as it often happens that no matter how vigorously officials update their websites with multilingual information, those who need it the most remain none the wiser unless it is shared on social media and community platforms.

The sheer amount of time it takes for municipal information to resonate with foreign communities raises the likelihood that those grappling with symptoms resembling COVID-19 first seek help from community leaders, rather than medical personnel, said Bhupal Man Shrestha, another longtime Nepalese resident who is founder of Everest International School Japan, the nation’s first international school catering to Nepalese children.

“When they’re feeling unwell, it often happens they first turn to their own communities for help, instead of directly consulting proper entities,” he said.

Bhupal Man Shrestha, founder of Everest International School Japan | BHUPAL MAN SHRESTHA
Bhupal Man Shrestha, founder of Everest International School Japan | BHUPAL MAN SHRESTHA

“Even if they are told to call up public health centers, they dither because they are worried about the language barriers, and it isn’t until they have arranged for someone they know to come along with them that they actually go visit these entities,” he said, adding the time spent going back and forth like this naturally risks delaying their initial response to the infection.

The dearth of multilingual translation services at public health centers remains an issue even months into the pandemic.

Although Tokyo has established a system called the Tokyo Coronavirus Support Center for Foreign Residents (TOCOS) that can connect foreign callers to public health centers via a three-party call in 14 different languages, many municipalities don’t provide the same level of support, said Hideo Maeda, who heads such a center in the capital’s Kita Ward.

“The need to avoid the Three C’s and other basic information is all but common knowledge now. What needs to be communicated more robustly in foreign languages is a practical explanation of how Japan’s own medical system works and what process you would need to go through here if infected with the virus,” said Maeda, who spoke about medical challenges facing foreign residents in Tokyo at the Nov. 12 government task force meeting.

Financial plight

Foreign residents’ compromised access to medical treatment can be caused not only by language barriers but also by financial difficulties, a factor that often pervades the most vulnerable of their demographic and ultimately compounds their infection risk.

Many of these marginalized non-Japanese, including those on provisional release status and pending approval for refugee status, are unable to get public health insurance. Those barely scraping by, then, tend to recoil at seeking what they’re worried might become expensive medical treatment until the eleventh hour, by which time the virus may have already spread among their families.

“Many of these foreign residents try to put up with their symptoms just by taking commercial drugs they brought from back home and wait until they get better. It’s not like they can casually drop by clinics and get prescribed medicine like Japanese do,” Maeda said.

“Even if they’re worried about the coronavirus, they still hesitate to access medical institutions because they’re afraid of fees.”

Tokyo Metropolitan Government officials and experts meet to monitor the COVID-19 situation on Nov. 12. | KYODO
Tokyo Metropolitan Government officials and experts meet to monitor the COVID-19 situation on Nov. 12. | KYODO

Although undergoing polymerase chain reaction (PCR) tests is now covered by public funds in many cases, the prospect of seeking doctors’ help, he said, still scares away some of those who do qualify for insurance. They are reluctant to even shell out the mandatory cost for an initial consultation with a doctor, which is typically priced at about ¥800.

But this doesn’t mean foreign residents are inherently at a higher risk than Japanese of contracting the virus.

What the situation has revealed anew is the harsh reality of how infectious diseases could spread faster, and with more dire consequences, among those relegated to the margins of society — foreign or not, Maeda said.

“The risk of them not being able to access medical institutions doesn’t exist as a result of them being foreigners, but of them being financially vulnerable, which is something that can happen to Japanese, too,” he said.

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