Every month, our "Close UP" series introduces a selected organization in Tokyo who aims to promote international exchange and the support of foreign residents in their community. For this month, we feature AMDA International Medical Information Center, which was established 18 years ago to provide medical consultation services over the phone to foreign residents who have difficulties finding appropriate medical service due to the language barrier. Dr. Yoneyuki Kobayashi, President of the Center, tells us about the organization's roles and future goals.
Dr. Kobayashi hopes to increase the number of doctors who support the activities of the AMDA International Medical Information Center.
AMDA is an international non-governmental organization whose volunteer members provide global emergency humanitarian aid, mainly in the medical and health-related fields, in case of disasters, conflicts, and other situations. When I was young, my dream was to work overseas and help people in other countries. In 1985, while I was working at the Yamato Municipal Hospital in Kanagawa Prefecture, I became a contract doctor for the Yamato Indochina refugee's remission center. As I saw patients from countries like Cambodia and Laos who managed to escape wars in their home countries and arrive in Japan, I came to realize how difficult for those people who do not speak Japanese to find a place where they can receive necessary medical service. That's why I decided to open my own clinic where foreign residents may receive medical attention just like other Japanese residents. It is my policy and also the AMDA's common ideal that regardless of the nationality of patients, their dignity as human beings must be respected. My clinic, Kobayashi International Clinic, opened in January, 1990. On the day after we were featured on the local TV news, we started receiving an enormous amount of phone calls asking about our service. It became obvious to me that a certain organization needed to be established to connect these foreign patients and medical institutions. I drew a blueprint for the plan and talked to my friends whom I knew through AMDA about how important it is to build such an organization. Six people agreed to join the plan and each donated 1 million yen. The AMDA International Medical Information Center opened in the following year, 1991.
From foreign patients, the most frequent question we get is where they can find doctors who understand their languages. The Center's staff counselors listen to the patient's conditions very carefully, select appropriate medical service providers, and give the information to the patients. On the other hand, many hospitals and clinics call us when they have foreign patients who cannot communicate with them or cannot pay the bills and need assistance of some welfare programs. For many cases, the problem cannot be solved in one phone call and requires follow-ups; we do lots of telephone interpreting too. For example, there was a case in which one clinic called us to help them assist a patient from the Philippines who could only speak Tagalog. We told the clinic to ask the patient to come back, if possible, on Wednesday afternoon when the Center has a Tagalog translator on the job. On Wednesday, the patient visited the clinic again and called the Center from his cell phone while his doctor was next to him. With the help of our translator, the patient was finally able to tell the doctor what was wrong with him. Compared to on-site translation services which have many restrictions, telephone interpreting is accessible from anywhere in the country and can serve a great deal of purposes.

Multilingual signs are posted throughout the Kobayashi International Clinic.
The first thing is to increase the number of cooperating medical institutions on the list by collecting information about doctors and institutions who are actively accommodating non-Japanese patients. Since hospital doctors often transfer from one hospital to another, it is unclear if those who can see foreign patients will be working at the same hospital after a certain period of time. Therefore, it is more ideal that each community has locally-based doctors in private practice who can accept foreign patients at any time. When accepting foreign patients, many medical service providers feel anxious and concerned about various things such as miscommunications due to a language barrier, different cultures and customs, the patient's ability to pay, and so on. I think it is also very important for those who are experienced in serving foreign patients to hand down in a systematic manner their knowledge of how to deal with foreign patients without causing troubles. To help healthcare providers, the Center has published several guidebooks written in both Japanese and other languages about key questions for situational conversations during the consultation, how to give medication information to patients, and such. To increase the number of new providers who are willing to start accepting foreign patients, we are also making efforts to promote the understanding of the foreign patient services by providing information and organizing educational activities. Some doctors have joined us after reading our newsletters. AMDA doctors who have worked overseas sometimes offer to cooperate with us as well.
Seeing foreign patients at a local clinic, I always encounter real-life cases which keep me aware of what really needs to be taken care of for them. There have been patients who didn't understand the national health insurance system well and wanted to take tests that are not covered by it. I know many foreign people who don't read Japanese would throw away a notice from the city about tokutei kenshin (specific medical exam or so called "metabolism check") thinking it was an ad or something. I always forward these issues that I come to recognize during the practice at my clinic to the Center so that we can improve its services, including the telephone consultation, to meet the latest demand from the perspectives of both patients and providers. The number of foreign residents who live in Japan for a long period of time is increasing, and many of such long-term residents may rely on their own networks within the foreign community to find a doctor. However, there are also new comers and those living outside the foreign community who are in needs of our support. For doctors including myself who practice privately, providing foreign patient care means making a contribution to the international society without leaving Japan. We cannot just leave our patients behind to help people in need in distant countries. It is my belief that building a healthcare system which provides foreign residents with secure lives will advance the internationalization of our society in Japan. I hope our efforts will continue to receive support from more Japanese people in many local communities.
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