There is an interesting opinion piece on the Asahi English site (thanks JapanProbe) on the Japan’s program to train Indonesian nurses started last year, under a bilateral economic treaty:
POINT OF VIEW/ Atsushi Takahara: Foreign nursing trainees face unfair hurdles
… Having finished a six-month Japanese-language study program, they started working in January and February. All of them are qualified to work as nurses in their home country and many of them have a lot of nursing experience. But most of those I met expressed anxiety and frustration.
This is because of the system that requires them to pass Japanese state exams within specified periods. If they fail, they must return to their home country. Would-be nurses have three chances to sit for the exams in three years of their stay. Conditions are tougher for aspiring care workers. Since foreign trainees are required to have actual working experience in Japan for at least three years before they can take the exam, they only have a single chance to pass in four years.
The language barrier weighs heavily on them. In particular, learning kanji characters is very difficult. For example, they must struggle with such technical terms as jokuso (bedsores) and senkotsubu (sacral region) that are difficult to read and understand, even for the average Japanese. Holding a Japanese-Indonesian dictionary, one trainee lamented: “I feel as though my head is about to burst.”
Under the comprehensive EPA, Japan accepts the trainees from Indonesia in exchange for the economic benefits, including abolition or reduction of tariffs on its exports of cars and electronic equipment. The government stands by the traditional policy of refusing to accept unskilled foreign laborers. Therefore, the government’s stance is that the acceptance of nursing trainees this time is a form of personnel exchange and is not meant as a measure to address a labor shortage. The government’s cold attitude seems to be a reflection of such a position.
After the government-sponsored six-month language training in Japan, the nurses must either study on their own or receive assistance from their workplaces to get their Japanese levels up to that of a practicing nurse’s. All for an all-or-nothing attempt at Japanese nursing qualification after four years! Sure, that’s what the program has been from the beginning, but I think what Takahara is trying to say is that what started as unfair remains unfair and should be changed.
So let me get this straight – in order to fulfill the letter of a treaty requirement that benefits Japanese companies with tariff relaxation, the Japanese government has decided to use these already-qualified nurses as pawns and in the process waste years of their lives. A similar fate no doubt awaits the Filipina nurses slated for acceptance under a similar bilateral arrangement with Japan.
According to an overview of potential benefits of the Japan-Indonesia “economic partnership agreement” (EPA) (PDF) released at the time of signing in August 2007, Japan is the largest single export destination for Indonesian products. Japan, for its part, chiefly benefits from Indonesia’s abundant natural resources (a key factor in their decision to invade during WW2). The country is Japan’s second most important supplier of liquid natural gas after Australia. LNG provides 35% of the household gas supply in Japan, according to Wikipedia. As with most trade agreements, the sheer number of line items and flood of statistics makes it tough to get through in a matter of hours let alone minutes, but suffice to say this agreement provides considerable tariff reduction, promises of market access, and non-tariff regulatory reforms that all serve to lower the cost and hurdles to doing business in either country. Also like other bilateral trade agreements, Japan is likely getting the better deal thanks to Japanese companies already superior competitive position.
Though I loved studying kanji and pursued it with a passion, I am a spoiled American and that was when I was in my prime learning years in my late teens and early 20s. These experienced nurses, who are in this country to make a living and previously had little inclination to study a foreign language, must find the task quite daunting (and distracting from the actual practice of care-giving). If my experience with a much simpler examination is any indicator, Japan’s exam culture will be no joke for a tightly regulated profession like nursing.
Could no compromise be found to help actually make this program work? Of course, that would assume that the Japanese government wants the program to work. As the op-ed notes, the acceptance of these nurses was essentially a token gesture to the Indonesian government, not a good faith effort to do right by anyone, either the nurses who want to work in Japan or the hospitals, patients, and other stakeholders in Japan. While I cannot know the intentions of the crafters of this program (it appears to have been hammered out through bilateral negotiations led by the foreign ministry), it’s entirely possible that they’d prefer to see these programs fail so other countries won’t demand their inclusion or expansion in future economic negotiations.
This points to a possible problem with making these decisions within the framework of comprehensive trade agreements rather than Japan unilaterally deliberating on its own future. While I understand the rationale of international “free trade” agreements as a way to circumvent narrow national interests for the greater good of efficient economies, the tight restrictions on these nurses constitute anything but free trade. And as part of a treaty covering billions of dollars in trade and the entire economies of two countries, how can 208 nurses hope to be anything but a footnote?
But once negotiated, this program has in fact benefitted from a relatively high level of scrutiny, since it is a pilot program, the foreign, Muslim nurses stand out, and ironically because they are negotiating tools in high-level bilateral trade ties. As Takahara notes, “If the trainees go home feeling angry with Japan’s ‘cold policy’ and such a reputation spreads, it could cause a deterioration in Indonesian public sentiment toward Japan. ” For that reason and the real need to find solutions to Japan’s aging society, the government and the public have an interest in seeing programs like this succeed, though whether that interest will translate into a fair shake for these nurses or better results down the line is another issue entirely.
Takahara and I may be proven wrong to conclude that the nursing exam is just too hard for most of these nurses, but I doubt it. As unjust as the Indonesian nurses’ situation sounds, perhaps the experience of these programs can open the issue to more public criticism and maybe some solutions (Takahara seems to be in favor of giving the nurses more time to pass the test and more flexibility and support in general). That way, what began as a farce can be turned into a workable program.
21 thoughts on “Asahi op-ed: Indonesian nurse program a cruel joke”
“Though I loved studying kanji and pursued it with a passion, I am a spoiled American and that was when I was in my prime learning years in my late teens and early 20s. These experienced nurses, who are in this country to make a living and previously had little inclination to study a foreign language, must find the task quite daunting (and distracting from the actual practice of care-giving). ”
word of wisdom comes from our ex-PM.
At least when Bush said you could be a C student and still become president, he really was a C student. The thing with Aso is he CAN read kanji, just not at the level of those snobs who write those “commonly misread kanji” books. It’s strictly an issue among native speakers, much like people will joke “Can you speak Japanese?” to a native speaker but would ask the question seriously to foreigners. Will one of these nurses become prime minister one day? That would be cool, but I doubt it somehow.
Not sure about PM,but if a former Finnish clergy/Korean journalist and Taiwanese model can be a member of the diet,well,the chance is not zero.
But yeah,they better learn to read if they are serious about dealing is human health care.
To be a nurse in Japan they’ll need to pass the same test as everyone else, sure. But if they never make to the requisite Japanese level (which you have to admit is pretty high), why not allow them to stay doing the lesser work they are doing now? It feels like they are being strung along.
That said, there are numerous hospitals in Japan that are preparing to accept them, giving them time and space for study, providing lessons in everything from nursing in Japan to Japanese shrine visits, providing cheap accomodation, and assigning mentors, giving mock exams, and the like – it is not as if they will just be chucked in the deep end. They are given time, space, education, and financial aid to help them qualify.
I wonder however what incentives the GOJ is offering the hospitals to take them….
“It feels like they are being strung along.”
No argument about that.And considering the wages they would get by working as the nurse in Japan.I think the investment will be well paid off.
Adamu, I enjoyed your analysis, but I had chocked up the different concerns about having a growing population of foreign nurses to plain old Japanese xenophobia.
I was speaking recently with a Japanese friend who teaches at a test prep school for Japanese preparing to enter nursing college. He wanted to ask me a question because he was responsible for preparing a set of mock questions for the English section of the exam. I asked him how important he thought English was for nurses, and whether or not Japanese (different dialects, polite speech, etc.) should be tested as well.
After having that conversation, I find it ironic that foreigners are also trying to become nurses, and struggling with a foreign language to try and pass a qualifying exam. The naive part of me just wants to create a language exchange so that everyone with aptitude can end up gainfully employed as a nurse in a country that is desperately lacking personnel in the healthcare industry.
X-posted to my shared items
Great opinion piece on the Indonesian nurse importing debacle. If ever there was an instance of people making poor decisions based on vague understandings of demographics, this is it. People know Japan is getting old, people know that other country’s people want to come work in Japan.
But it’s not really happening.
And when it does, it’s not a fair agreement, it’s a PR stunt, or both. Japan has effectively already decided not to go the path of foreign labor supporting their economy. If the stunt of importing Indonesian care givers was supposed to make the politicians look competent, it didn’t work.
“And when it does, it’s not a fair agreement, it’s a PR stunt, or both.”
Well.why is this “not a fair agreement”?Alan?
Demanding basic linguistic ability for someone working in the hospital is “not a fair agreement”? Hiring illetrate as staff could cost you a class action if something goes wrong.
If Indonesia is serious about sending their citizens to work in Japanese facility,why are they only sending people with zero Japanese ability in the first place? Why doesn’t Indonesian government offer Japanese class while they were still in Indonesia? Why are they only relying Japanese counterpart on everything?
The Asahi article only condemns Japanese attitude toward Indonesia,as if this is 19th century like unfair relations.It failed to point lots of things including Japan has been the largest aid donar to Jakarta and Indonesia for almost 50 years.
Indonesia could take the steps of Thailand,where the demand was to send massagers instead of nurse.But instead they chose the way of the Phillippines,where there are relatively a good number of women who can speak Japanese due to their working experience as hostesses and many nurse schools for oversea works.
And it’s a PR stunt indeed because this is the very first group to show up.We still don’t know whether this scheme works or not but to make it so,one doesn’t take much imagination that Indonesians must put some effort into it.Although they seem to be catching the most necessary skill of foreigners in Japan.Complaining,that is.
“Japan has effectively already decided not to go the path of foreign labor supporting their economy.”
First off this is against the reality,.Foreigners are hired in simple manual labor in manuafacturing sector here in Japan and it’s increasing inspite of recession.
Secondly,even if Japan decided not to go the path of foreign labor supporting economy,so what?
The merit of accepting foreign labor is to exploit cheap labor at the cost of lower class and labor union.Hardly an alturism,but a contracted slavery in away.
There are many reason for Japanese to feel reluctant about having foreign labor apart from xenophobia.
The problem isn’t just with the language requirement, it is with the comprehensive nursing exam. Nurses, like doctors, tend to specialise after their training and expecting them to learn a foreign language, retrain and learn about areas of the medical field they have never intended and do not intend to enter is just, to use a highly sociological term, silly.
Of course, they do this in the United States too (and I know you don’t like national comparisons that don’t involve doughnuts, Adam, but there is a point here). However, in America there is a release valve. Many of the functions that nurses perform overseas (drug trial recruitment and monitoring, for example) have been opened to people who have not taken the state-wide comprehensive nursing exam. Thus “nurses (and, by the way, doctors)” who are not “nurses (and doctors) in America” do get to stay on doing a job that might be roughly equivalent to what they might be able to do – but may not generally do – at home.
Unfortunately, however, because there is no requirement to pass the nursing exam, there is little incentive to becoming fully qualified, especially given the onerous nature of the test. The United States misses out on employing some health professionals who are damned fine practitioners in their own fields. The other downside is that (and I have this on the authority of anecdotalism) because certain fields are open to just about anyone, there is a higher degree of negligence by untrained staff than there would be overseas, where these areas are only open to those with adequate training. So maybe Japan is right to be restrictive in this sense, after all.
I think Japan should adopt what I believe is model in most advanced nations, that is, recognise the training meted out in certain universities and nursing schools overseas. Then simply make it a requirement for anyone to pass a comprehensive language exam – maybe 2 kyu for nurses, 1 kyu for doctors – before they are allowed to practice their craft. They can learn the specific vocabulary as part of their job training. And then if there is a call for a visa system to allow and incentivise nurses to come to Japan, structure it along those lines.
Nothing to say except… great post.
Alan: What you are saying misrepresents what I wrote. On what evidence do you base the conclusion “Japan has effectively already decided not to go the path of foreign labor supporting their economy”? Japan’s top business lobby is still calling for expanded access to low-skill foreign labor, there are already thousands of foreigners working in factories, construction, agriculture, and even convenience stores and McDonald’s on various programs, and one very prominent former immigration official named Sakanaka argues passionately for Japan to adopt a formal immigration policy. The number of legal foreign workers has exploded in the last decade or so. Does that sound like the government has dug in its heels and decided not to allow immigrants in?
I am sorry if you mistook this one post for a comprehensive look at the state of immigration in Japan. It would be unwise to over-interpret the importance of this one program and jump to conclusions about Japanese society as a whole. That this program as currently designed probably won’t work does not necessarily lead to a hopeless conclusion.
For more reading I would recommend this story from the Japan Times on Sakanaka’s campaign:
Bryce: I am a little hesitant to suggest relaxing the nursing qualifications just to accommodate foreign workers because in that case wouldn’t you want to open the deregulated jobs to Japanese citizens first?
Of course business lobbies for expanded access to low-skill foreign labor. They need it, the entire nation is desperate for low cost labor. This is the so-called “little Japan” versus “big Japan” debate. But in order to make a difference, they’re going to need a LOT of workers to come in because they are loosing a LOT of workers. Some have called for something like 10 million foreign workers by 2050, and others have said that 10 million immigrants by then would be more of a ‘cap’ rather then a ‘goal’ for the influx of foreign labor.
The demand is huge, but I never meant to say anything about demand. There are tons of hospitals that will welcome foreign care givers if given the chance, but the point is that the government doesn’t want that to happen. If the nation had any intention of stepping up to the plate and make the changes needed to get huge numbers or workers to come into the country, then foreign workers wouldn’t be there on the ‘revolving door’ policy in the first place. They would be there as a permanent part of Japan’s production machine. The Indonesian nurse program is just one example of a poor excuse for implementing permanent programs that accomplish this.
@Aceface: I don’t know where you got the idea that foreign workers are increasing in spite of the recession. My impression was that they were the first ones to be cut. They were offering to pay Japanese Brazilian immigrants to go back home to Brazil. Being sent home early due to the recession hasn’t worked out well for many Chinese workers either.
Japan, or at least the government of Japan, doesn’t like the sound of becoming an “immigrant nation”. I question how much of the current foreign worker population is firmly settled in the nation versus being there on a contract that still allows their employer or the government of Japan to ask them to leave (the country) whenever they feel like it. Even with this unfavorable and one-sided arrangement, I don’t doubt that there will be an endless supply of citizens of developing nations who are more than willing to work in Japan, but that’s not a path to integrate those workers into Japanese society. And so far, Japan don’t seem to like that idea.
A formal immigration policy would be a responsible and coherent approach to addressing the current situation, I agree that that should happen. But I have significant doubt that it will. The people, and epically the government, would rather ignore the issue and use flagship programs like the Indonesian nurses to make it look like they addressed it.
I would be happy to be proved wrong, but my impression is that much of the leadership of Japan has already resigned themselves to the decreasing population, decreasing workforce model of the future that only intermittently relies on foreign labor, firstly by relocating factories overseas, second by revolving door temporary workers, and only lastly by actually immigrating people into Japan. I think this is the most likely scenario, and I think we need to accept that. As such, the Indonesian nurses will doubtfully be the beginning of something new, but a program that goes counter to the current, where foreign labor is purported be well trained, welcome, and well integrated into society.
“Bryce: I am a little hesitant to suggest relaxing the nursing qualifications just to accommodate foreign workers because in that case wouldn’t you want to open the deregulated jobs to Japanese citizens first?”
The problem is that there are no Japanese willing to take on jobs as nurses, and frankly, given the way “nurses” are viewed in Japan, I don’t blame them.
Anyway, I think you have read me wrong, and that is perhaps my fault. My last post was rushed and perhaps a little incoherent. I am not suggesting that Japan “deregulate” some of the positions open only to nurses. That’s the way the system works in the U.S., and in general, I don’t think it is a good thing.
I am also not suggesting a relaxation of nursing qualifications. The exams required to enter the profession in some other countries are just as stringent (or more so) as in Japan (or the United States). So Japan’s task should be figuring out which national health systems insist on high standards in their training. they should then recruit nurses by waiving the requirement to sit a comprehensive exam if they have already been through such training.
Japan issues driver licenses on this basis: some licenses are instantly convertible to Japanese ones (for a fee), some aren’t. It depends on the integrity of the foreign system in question. If you can push two tons of metal around in public without a Japanese test when you are fully qualified to do so elsewhere, I don’t see why you can’t hand a doctor a scalpel under similar circumstances.
The language barrier is a canard. I doubt foreign nurses destined for roles in, say, gynecology will need to know the Japanese for testicular cancer. If it is necessary, they can learn it on the job. Or they can take “specialist” courses, as is the case when they specialise in their own country. As long as Japan insists on the test it will lose qualified and competent foreign nurses seeking work abroad to other countries.
“This is the so-called “little Japan” versus “big Japan” debate. But in order to make a difference, they’re going to need a LOT of workers to come in because they are loosing a LOT of workers. ”
Never even heard about this “little Japan” versus “big Japan”debate on immigration(There were such argument on imperialism back in the 20’s,but).And Japanese economy is hiring A LOT of workers,mostly in overseas which is same thing as hiring them within Japan in terms of Gross National Product.
“Some have called for something like 10 million foreign workers by 2050, and others have said that 10 million immigrants by then would be more of a ‘cap’ rather then a ‘goal’ for the influx of foreign labor”
”Japan, or at least the government of Japan, doesn’t like the sound of becoming an “immigrant nation”.
If ever there was an instance of people making poor decisions based on vague understandings of Japanese argument on immigration, this must to be it.
“Some” who have called for “something like 10million”foreign workers by 2050 is actually the task force of “The road to Japanese style immigrant nation”which are organized by the league of diet members of the leadiing Liberal Democratic Party and Keidanren and Ministty of industry and commerce came up with the number of 18milliom by 2030.
”But I have significant doubt that it will. The people, and epically the government, would rather ignore the issue and use flagship programs like the Indonesian nurses to make it look like they addressed it.”
And Indonesian workers are not considered as immigrant in neither Jakarta or Tokyo.As Adamu had wrote,it is associated with the liberarization of service sector that connect with free trade agreement.
“I don’t know where you got the idea that foreign workers are increasing in spite of the recession. ”
I got the idea by doing research for my own assignment on Brazilian unemployment
in Aichi prefectrure from December 12 of 2008 to Feburuary 15 of 2009.
Your “impression” is correct as long as it concerns to “Nikkei-jin”,Latinos of Japanese ancestry who have special permited labor visas.However when it comes to “foreigners”,you might also wants to learn a bit about “trainee”programs.Many factories firing Brazilians has been replaced by these trainees from Vietnam.
“My impression was that they were the first ones to be cut. They were offering to pay Japanese Brazilian immigrants to go back home to Brazil. Being sent home early due to the recession hasn’t worked out well for many Chinese workers either.”
Global financial crisis isn’t made in Japan malaise.It was made in Wall street.You just got the wrong country to accuse.
And at least Brazilians were better than many temps from Okinawa who also got laid off and didn’t recieve a yen for their return ticket.Lots of Brazilians do own house back home with money they earned by working in Japan,but not the Japanese who has to live in the high living cost of the country.
And Chinese are replacing the vaccum of Japanese and Brazilians in many factories with wages like 250 yen an hour in Tokai region.I also found out that in yesterday news,SHARP decided to close down plasma display panel TV factory in Kameyama,Mie(known for making 世界の亀山モデル and huge portion of the workers are Brazilians）and start building them in China.Actually the recession does work in favor of the Chinese in a way.
“I don’t doubt that there will be an endless supply of citizens of developing nations who are more than willing to work in Japan, but that’s not a path to integrate those workers into Japanese society. And so far, Japan don’t seem to like that idea.”
The whole argument on foreigners living in Japan had been revolved around the Koreans for the past fifty years.And they have been demanding mostly on one thing.That they want to stay Korean and do not integrate into Japanese.Which is why they had demanded the abolition of public school for Korean children and fired all Japanese teachers in late 40s.Also demanded ministry of education and local educational committee to contact with parents with kids in schooling age,since they shouldn’t be send to Japanese schools,but Korean schools,which is why in Japan,foreign parents with kids are not obliged to send their kids to Japanese public educational institution.Education is their right,but not their obligation.
If Japan don’t seem to be like the idea of integrating foreigners,than it probably comes from past lessons of imperial years.Turning variety of ethnic groups into monotonous Japanese.
“but my impression is that much of the leadership of Japan has already resigned themselves to the decreasing population, decreasing workforce model of the future that only intermittently relies on foreign labor, firstly by relocating factories overseas, second by revolving door temporary workers, and only lastly by actually immigrating people into Japan. I think this is the most likely scenario, and I think we need to accept that.”
Why? I know I won’t.And you are not a Japanese.No?
“I would be happy to be proved wrong”
Glad I could help someone becoming happy,but next time you leave comment,make them more fact oriented.
”Also demanded ministry of education and local educational committee to contact with parents with kids in schooling age”
not to contact with parents,is correct.Rant out.
I don’t have access to that report, but I believe 18 million by 2030 is a bogus number. In order to maintain the same population level, which isn’t going to happen one way or another, they would need 17 million immigrants by 2050. 10% of the current population would be 12 million anyway.
It’s a completely impossible number.
Well,I’ve already done my own share of accepting immigrants to my family so I’ll let others worry about that!
@Aceface pick up Michale Weiner’s book on The Illusion of Homogeneity perhaps some of Harumi Befu’s work on Ethnicity and Nihonjinron discourse.
You are apparently not very aware of the whole issue the Nikkeijin and Zainichi have on this issue or have only been reading Japanese literature work on this issue. I don’t know where you are getting your bogus numbers from but its clear you have not done much (if any) real research on this topic and just quoting from various blogs and articles (which would explain your poor language/writing skills in some parts while in other parts are well written). In any case pick up a book and get your facts straight if you intend to make argument worth acknowledging.
One.Problem with my poor language /writing skills comes from the fact that I’m not a native English speaker and I didn’t graduated Georgetown.But I take your “other parts are well written” as a compliment,Thank you very much.
“You are apparently not very aware of the whole issue the Nikkeijin and Zainichi have on this issue or have only been reading Japanese literature work on this issue. ”
Whoa.Yes I whole heartly admit I’m not aware of the “whole issue the Nikkeijin and Zainichi” have on this issue.But hey,where was I wrong regarding my discussion with Alan here?
And two,why is ONLY reading Japanese literature work on this issue would be a problem to discuss the matter that Alan was pointing?What does”Homeogeneity”and “Nihonjinron discourse” has anything to do with my argument?
(Anyway I’ve read Befu years ago when I was in college.I thought it was too much focused on Nihonjin-ron and took it too seriously.)
I’m more than happy to learn from future Japan studies student like you probably be enlightened but still,I have this idea that we are more than just Japanologists define us in English literature.
“I don’t know where you are getting your bogus numbers from but its clear you have not done much (if any) real research on this topic and just quoting from various blogs and articles ”
Actually,I did quite a few research.It wasn’t exactly an academic one,perhaps.It was just an old school door to door and chat kind with Brazilian emigres.
And not only I quote from various blogs articles.I actually wrote one myself.
And which “bogus”number are you reffering to anyway?My “bogus” number I quote came from the website of Nihon Keidanren.Don’t blame me.I too think that institution is pretty bogus myself.
“In any case pick up a book and get your facts straight if you intend to make argument worth acknowledging.”
Okay.Present your facts and make some argument worth acknowledging,then.
I’m ready to surrender anytime.
18 million by 2030 sez Ministry of Economy and Industry quote came from the report of 「人口減少に対応した経済社会のあり方」日本経済団体連合会2008年１０月14日
On foreign trainee program.
On Zainichi education
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