Article Type : Research Article
Authors : Keiko Hattori
Keywords : Foreign patients; Communication; Medical institutions; Medical care for foreigners in Japan
While the number of foreign patients in Japan is increasing,
Japanese medical institutions are not prepared to accept foreign patients. Are
the medical institutions that are accredited to accept foreign patients, or
those that are indicated on the website of the Japanese tourist bureau as being
able to accept foreigners, able to communicate with foreigners without
problems? We conducted a survey in the metropolitan area of Japan on medical
institutions that can accept foreigners and the breakdown of foreigners living
in the metropolitan area, and discussed the communication problems of foreign
patients. The results showed that many foreigners living in the metropolitan
area of Japan could not speak English. In many of the medical institutions that
were able to accept foreign patients, the medical staff could only speak
English. The communication problem for foreign patients must be solved so that
foreigners living in Japan can receive equal access to medical care.
According to the
statistics of the Cabinet Office, the number of foreign residents in Japan as
of June 2020 is over 2.5 million. Some of them live in Japan, while others are
here only for a short period of time for tourism, study or technical training.
The number of foreign visitors to Japan exceeds 13 million a year and is
expected to increase further. The Japanese government has launched an inbound
policy and is focusing on services for foreigners in Japan. These services
include healthcare for foreigners. At present, due to the effects of the
coronavirus, very few foreigners come to Japan for tourism, but many foreigners
live in Japan for study or training purposes. Foreigners living in Japan face
language problems when they visit medical institutions. For this reason, there
is a growing number of medical institutions that accept foreigners and
initiatives for medical interpretation. Medical institutions that are open to
foreigners have multilingual displays and signs in their hospitals, not only in
English. Many hospitals also provide medical questionnaires in different
languages so that foreign patients do not have to worry about language.
Language support" is the most common medical information that foreigners
feel they need when visiting a medical institution in Japan (Bureau of Social
Welfare and Public Health, Tokyo Metropolitan Government, 2016) [1]. In medical
institutions, not only are more and more medical professionals confused about
how to deal with foreign patients, but also more and more foreign patients can
hardly understand the explanations given by medical professionals [2]. When
many foreigners visit Japan, there is a possibility that they may be involved
in unexpected accidents or disasters. How should healthcare professionals
communicate with foreign patients who visit medical institutions with anxiety
because they cannot communicate in their own language?
The purpose of this
study is to clarify the actual situation of medical institutions that can
accept foreign patients, and to consider the communication with foreign
patients.
Since there is likely
to be a temporary increase in the number of foreign patients to medical
institutions in the metropolitan area of Japan, the target of this study is the
six prefectures of Tokyo, Kanagawa, Chiba, Saitama, Gunma, Tochigi, and Ibaraki
in the Tokyo metropolitan area to identify the current status of medical
institutions in the metropolitan area accepting foreign visitors. We surveyed
the nationalities of foreigners living in the Tokyo metropolitan area from the
Statistics 2020 (STAT) of the Cabinet Office, and from the Japan National
Tourism Organization (JNTO) website, "List of Medical Institutions
Accepting Foreign Visitors to Japan," we determined the number of medical
institutions that accept foreigners in the Tokyo metropolitan area and the
languages they speak. The number of medical institutions that can accept
foreign visitors in the Tokyo metropolitan area and the languages they speak
will be surveyed. The number of medical institutions in the Tokyo metropolitan
area that can accept foreign visitors and the languages they speak will be
surveyed from the "List of Medical Institutions Accepting Foreign Visitors
to Japan" on the website of the Japan Medical Service Accreditation for
International Patients (JMIP). In addition, each medical institution's language
capability will be limited to "Japan Medical Service Accreditation for
International Patients". In addition, we will survey the job titles of the
language-supporters at each medical institution and investigate how many
medical institutions have nurses who provide multilingual services. All surveys
are available on the Internet, so there are no ethical issues [3-5].
The total number of foreign residents in Japan is about 2.9 million, of which about 560,000 are in Tokyo, 230,000 in Kanagawa, 170,000 in Chiba, 200,000 in Saitama, 60,000 in Gunma, 40,000 in Tochigi, and 70,000 in Ibaraki. By nationality of each prefecture, Tokyo ranked first with 220,000 Chinese and second with 90,000 South Koreans, Kanagawa ranked first with 70,000 Chinese and 27,000 South Koreans, Chiba ranked first with 54,000 Chinese and second with 26,000 Vietnamese, Saitama ranked first with 74,000 Chinese and second with 30,000 Vietnamese, and Ibaraki ranked first with 13,000 Chinese and second with 11,000 Vietnamese. Saitama Prefecture ranked first with 74,000 Chinese and second with 30,000 Vietnamese, and Ibaraki Prefecture ranked first with 13,000 Chinese and second with 11,000 Vietnamese. Gunma Prefecture was another first with about 13,000 Brazilians and second with about 11,000 Vietnamese, and Tochigi Prefecture was first with about 8,000 Vietnamese and second with about 6,000 Chinese. The following are the results of languages (JNTO) at medical institutions that can accept them. In Tokyo, the languages accepted were English, Chinese, Korean, French, Spanish, Portuguese, and others. Kanagawa Prefecture: English, Chinese, Korean, Portuguese, and others. Saitama Prefecture: English, Chinese, Korean, and others. Chiba Prefecture: English, Chinese, Korean, and others. Ibaraki Prefecture: English, Chinese, Korean, and others. Gunma Prefecture: English, Chinese, Korean, Portuguese, and others. Tochigi Prefecture: English, Chinese, Korean, and others. In each prefecture, most of the medical institutions that were able to accept patients were doctors (most of them spoke English), and a few of them had nurses who spoke English, Chinese, and Korean.
Table 1: Number of medical institutions that can accept foreigners (JNTO) and (JMIP).
JNTO |
JMIP |
|
Ibaraki Prefecture |
69 |
1 |
Tochigi Prefecture |
25 |
1 |
Gunma Prefecture |
61 |
0 |
Saitama Prefecture |
46 |
2 |
Chiba Prefecture |
20 |
4 |
Tokyo |
267 |
26 |
Kanagawa Prefecture |
57 |
6 |
Some of the medical institutions had Chinese and Korean nurses. In addition, some of them had medical interpreters available, but not all of them had medical interpreters. Next is the number of medical institutions in the Tokyo metropolitan area that can accept foreigners (JNTO) and (JMIP). In Tokyo, there were 267 JNTO and 12 JMIP facilities. In Kanagawa Prefecture, there were 57 (JNTO) and 3 (JMIP) facilities. Saitama Prefecture had 46 (JNTO) and 2 (JMIP) facilities. Chiba Prefecture had 20 facilities (JNTO) and 3 facilities (JMIP). In Ibaraki Prefecture, there were 69 (JNTO) and 0 (JMIP) facilities. In Gunma Prefecture, there were 61 (JNTO) and 0 (JMIP) facilities.
Figure 1: Foreign residents in Tokyo metropolitan area and major cities.
In
Tochigi Prefecture, there were 25 (JNTO) and 0 (JMIP) facilities. English was
the most commonly supported language in each prefecture. There were also many
facilities that spoke Chinese, and some that spoke Korean, Portuguese, and
Spanish. Doctors were the most common linguists, and in most of the medical
institutions, only doctors were available to foreigners. In addition, many
general hospitals and national university hospitals located in urban areas had
medical interpreters, medical coordinators, and telephone medical interpreters
available. As for nurses, there were nurses who could speak English, Chinese,
and Korean, but few other languages (Figure 1) (Table 1).
In terms of medical
institutions that can accept foreigners in JNTO and JMIP, the number of
facilities in JNTO was higher in all prefectures; the language support of most
medical institutions listed in JNTO is English, suggesting that no medical
institution can cover all languages of foreigners living in Japan. (JMIP),
which is accredited as a medical institution that can accept foreigners in the
Tokyo metropolitan area, had many medical institutions that could accept
foreigners in English. Although there are many foreigners of Brazilian
nationality in Gunma Prefecture, there were few medical institutions that
provide Portuguese services. In some cases, there are doctors who can speak
multiple languages but only a few nurses, and in other cases, there are
English-speaking medical personnel but the foreign patients do not speak English.
Therefore, multilingualism in medical institutions will be an important issue
for the future development of medical care in Japan. Since few medical
institutions have medical interpreters intervening, they may not be able to
deal with foreign patients. This is an issue that needs to be considered in the
field of medical care for foreigners in Japan, how to position medical care for
foreign patients, and in what direction to proceed. Most of the time, doctors
are the ones who communicate with foreign patients, while other medical
professionals are not able to communicate with foreign patients. How should
medical professionals communicate with foreign patients? It is difficult to
train nurses who can speak all languages and place them in each medical institution
for a multilingual and multicultural society. Although it is necessary to learn
medical English, we may have to consider training nurses to understand the
culture of the patients and to learn how to treat them, not only that. When it
comes to the issue of language support, it is necessary for the medical field
to take the initiative in making changes, such as deploying medical
interpreters and spreading the use of telephone interpretation. However, even
if the language problem can be solved, in order for foreign patients to receive
equal access to medical care, it will be necessary not only to learn medical
English, but also to understand the culture and religion of foreign patients
and get involved with them.
Japanese medical
institutions have communication problems with foreign patients who cannot speak
English. Japanese medical institutions urgently need to establish a system to
ensure that foreign patients do not have difficulties in communication.