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Services for the Health in Asian & African Regions (SHARE) - Aiming for a Society in which anybody can Receive Healthcare with Peace of Mind -

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Ms. Yuko Yamamoto, Program Officer,
Migrant Health Program for SHARE.

November’s Close Up introduces Services for the Health in Asian & African Regions (SHARE). In aiming to achieve a society in which all people can live a healthy life, both in mind and in body, SHARE is an international health NGO that in the regions of Asia, Africa and also here in Japan, promotes health and medical activities. It does so in order “to develop human resources and assist people and their communities in protecting their health.” In undertaking these activities, what SHARE hopes to achieve is for everybody to be able to receive basic healthcare and medical services, and to accordingly be able to improve their own health. On this occasion, in shining a light on the group's project in support of foreign nationals living here in Japan, we discussed with Program Officer Ms. Yuko Yamamoto the problems that foreign nationals have in accessing health and medical services, and the steps that SHARE is taking to resolve these issues.

Q. Please tell us under what circumstances SHARE was established?


A. SHARE came into being in 1983. When established, its core members were people such as doctors, nurses and students, etc., who were then involved in relief efforts to assist Indochinese refugees along the Thai-Cambodian border. These days, SHARE has overseas hubs in Thailand, Cambodia and East Timor. In Thailand, we are responding to an AIDS crisis, while in Cambodia we are involved in maternal and child health. In East Timor, meanwhile, we are working with regard to matters related to school health. As to what distinguishes SHARE as an organization, I suppose it is the fact that we mainly undertake activities in support of the health sector. In actual fact, when SHARE was initially established, like many other groups we intended to offer support of a medical nature. However, when dispatched to Africa to offer emergency assistance, what confronted our doctors was the reality of having the same patients repeatedly come in for treatment again and again for the same medical condition. Accordingly, we decided to switch the focus of our efforts to support of the health sector. This was because, by being able to prevent people from becoming sick to start with, we felt we would be able to fundamentally resolve their medical conditions. Furthermore, here in Japan as well, we act to support foreign nationals who experience difficulty when trying to access health and medical services.

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In Cambodia, where SHARE works in maternal and child health, it offers nutritional advice to mothers (L),
while in East Timor, SHARE is working hard at schools in the area of health education (R).
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Q. Why do so many foreign nationals living in Japan experience difficulty when trying to access medical institutions?

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Ms. Yamamoto shown here doing a telephone consultation. Apparently, there are also cases involving numerous telephone calls and email exchanges.
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A. Obviously, the language barrier is a major issue. For example, even if foreign nationals have the ability to converse in everyday Japanese, they can still experience difficulties when trying to explain detailed medical symptoms to doctors, or when trying to understand a diagnosis. Things can also be difficult if all the surrounding signage happens to be in Japanese. Thus, you could say that going to a hospital represents a hurdle in itself. Furthermore, among foreign nationals living in Japan on a shoestring budget while concurrently repatriating funds home, some are uneasy about seeking medical treatment because of the perceived high costs involved. Through free health consultation services where our counsellors will visit the public facilities or other locations where consultations can be held, and also via consultations that are conducted over the telephone, SHARE offers support to foreign nationals who have trouble accessing medical care. We can also offer subsequent referrals to medical institutions. Consultation requests are also fielded from foreign nationals who feel intimidated by both the language issue and the wider healthcare system here in Japan. In actual fact, SHARE receives so many requests for consultations because there are social workers, public health nurses, nurses and doctors who deal with foreign patients. Many of the consultations we do are of a general nature, in that we offer advice as how to best interact with foreign patients and overcome issues such as the language barrier, etc. Concerning such professionals who directly offer support to foreign nationals, the core of our activities is what might be best described as giving "lateral support" to them. This ensures that the patient is provided with proper healthcare.

Q. What about on the treatment frontline, how is the language barrier best overcome?

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Leaflets introducing SHARE’s activities and supporting the health of foreign nationals in Japan.
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A. Concerning many medical professionals, with respect to foreign nationals who seek treatment but are unable to speak Japanese, their attitude is one of there being a risk with treatment due to the inability to communicate. Conversely, the thought processes of these professionals don’t go so far as to think about the provision of an interpreter in much the same way as sign language or a wheelchair might be utilized to overcome a handicap. Accordingly, the professionals in question are unwilling to see foreign patients unless the patients themselves provide an interpreter. There are also cases of patients being sent home after receiving only very rudimentary treatment. Furthermore, the hospital in these interactions might demand that a patient be accompanied “by an interpreter even if that just happens to be a volunteer.” However, if the volunteer who accompanies a patient is a family member or acquaintance, this presents its own problems. What if the matters discussed during medical consultations happen to involve the explaining of surgical procedures or if they seek to obtain the informed consent of patients? These are definitely not topics to be interpreted in a voluntary capacity. I have heard of cases where voluntary interpreters have been children whose Japanese language ability exceeds that of their parents. They have sometimes been required to deliver very severe medical prognoses to other family members, and this trauma has resulted in the children themselves subsequently needing psychological care. What is required to improve this situation is to make medical institutions also appreciate the merits of introducing fully-trained medical interpreters. Specifically, they need to realize that the resulting merits do not just fall on the side of the patient.

Q. By introducing medical interpreters, what merits are there for medical institutions?

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A SHARE seminar for medical professionals.
Through such events SHARE conveys both the necessity of medical interpretation and how it may be best employed.
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A. Institutions can deliver their diagnoses more quickly by introducing medical interpreters. They can also better fulfil their ethical obligations with respect to explaining to patients their medical conditions and what treatment options are available, etc. Furthermore, the introduction of trained interpreters can prevent wrong diagnoses, and it also becomes possible to undertake smooth treatment practices through the development of trusting relationships with patients. Rather than relying on patients to drag along their own volunteers, even if a system of hospitals making provision for medical interpreters results in additional interpretation costs, in the final analysis such measures offer positive cost-performance and treatment expenses can also be controlled. In countries such as the United States, Canada and Australia, they have experienced a variety of wrong diagnoses and other problems because of the language barrier. Accordingly, at the national and municipal level, steps have been taken in these countries to create a system of medical interpreters who can be dispatched to the treatment frontlines as required. In Japan as well, there has been cooperation between local municipalities and non-profit organizations who specialize in the dispatch of medical interpreters, and through such agreements, we have seen some municipalities start to dispatch medical interpreters to hospitals. That being said, however, there is still some way to go in an understanding being achieved with respect to the cost of interpretation services.

Q. Is SHARE involved in the development and dispatch of medical interpreters?

A. As a project outsourced by the Tokyo Metropolitan Government, at SHARE we are involved in the development of interpreters who specialize in the topic of tuberculosis. Whereby there appears within the metropolitan area a foreign national who happens to be a TB patient, we dispatch interpreters to support the activities of public health nurses when they visit such patients in hospitals or in their homes, or when the patients themselves go to public health centers. Through the dispatch of interpreters and the consultations we provide, we see ourselves as having another role. This involves conveying a message to healthcare professionals vis-a-vis the merits and necessity of introducing medical interpreters, concurrently, it also means generating a groundswell of opinion from the treatment frontlines as to the necessity of a system of medical interpretation.

Q. As to the medical care of foreign nationals, what are your concerns at the current time?

A. In Japan as well, things are moving forward with regard to developing medical interpreters who are able to cater to the needs of foreign nationals who come to Japan for purposes of medical tourism. However, what worries me is that the idea of creating a system of medical interpretation for the foreign nationals who actually live here is being left behind. Furthermore, with the holding of the Tokyo Olympics, it is predicted that there will be a dramatic increase in the number of foreign tourists. However, rather than worrying about people who visit Japan for purposes of medical tourism, how will arrangements for interpreters be made if your average tourist to Japan ends up at a hospital seeking treatment? If things stay as they are, I can see the medical institutions becoming very frustrated. In the final analysis, irrespective of the distinctions between foreign nationals who visit Japan and those who actually live here, I believe that it is very important to develop a system of medical interpretation.

Q. If there is anything you would like to focus upon in the future, please tell me about it.

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A. Previously, SHARE has engaged in activities that supported Infectious diseases such as TB and AIDS. In the future, however, I would like to get involved in the fields of maternal and child health, and elderly patients, both of which represent rather large segments among foreign communities living in Japan. To be able to resolve health issues at the regional level in Japan, it shall be necessary for municipal health centers and public health nurses to become a little more visible to foreign nationals. Indeed, I believe we need relationships where people can easily consult about issues such as childbirth and elderly care. I would like for SHARE to cooperate with local municipalities and other organizations, to further include foreign nationals in the dialogue, and to think of ways that we can resolve such issues together. Rather than distinguishing between Japanese and non-Japanese people, as residents of the same environment, even though language represents a barrier, it would be good if everybody could complement one another.