Japan's Gingerly Caregiver Plan

With the world's fastest-aging population, Japan has a growing need for nurses and other caregivers to staff its elderly-care facilities. Asian nations have many well-trained nurses and other caregivers who need jobs. The solution: import more nurses and care workers from Southeast Asia to fill gaping holes in the health care system.

A match made in heaven, one might think. Over the past two years Japan has attracted about 1,000 caregivers from the Philippines and Indonesia under separate Economic Partnership Agreements (EPA) with the two countries. They were to spend three or four years working in Japan, then pass a stiff qualifying exam to stay.

The first exam results this summer were extremely embarrassing both to Japan and to the countries supplying the health workers. Of the approximately 1,000 Filipinos and Indonesians who took the exam, exactly three passed the test, a pass ratio of a little more than one percent! Those who failed had to go back to their home countries.

Japan has always been torn over the question of importing more migrant workers into their country. On the one hand it feels a certain duty to extend a helping hand to Asian countries, and it certainly has a growing need to find more workers willing to perform jobs that Japanese called the "three Ks" – kitsui (difficult), kitani (dirty) and kiken (dangerous). Care giving, and to a lesser extent nursing, fits into the kitani category, since it involves feeding, bathing changing the diapers of elderly Japanese.

On the other hand, the Japanese genuinely don't like immigrants.

The irony is that the caregiver program was designed in part to counter the bad publicity and ill-will Japan has earned for an earlier program designed to attract Asian migrants under the 1990s Japan International Training and Cooperation Organization.

Nearly 200,000 Asians have come into Japan, many of them Chinese, ostensibly to learn technical skills, but the program has been criticized as simply a way for Japanese factories to exploit and abuse cheap labor. This dark side of the of Japan's labor was highlighted recently in a New York Times article.

The nursing and caregiver program was meant to be different. From the very beginning it was agreed by the three countries involved that the Asian caregivers would be paid equally and treated equally with Japanese counterparts. They apparently didn't take into consideration the difficulty that the foreigners would have comprehending the test.

The qualifying exam in Japan is in two parts, a practical test and a written exam which is given in Japanese, requiring among other things that the candidates read and understand Kanji, or Japanese characters, something that takes Japanese years from kindergarten through high school to master. (Neither the Philippines nor Indonesia uses a Chinese script).

It is, of course, desirable that the foreign caregivers be able to converse with their elderly clients and to have enough basic literacy to read notices and keep medical logs. There is no reason to believe that a large percentage of the candidates could obtain these basic language skills. Indonesian caregiver Wahyudin spoke to a recent gathering of foreign journalists in fluent Japanese.

Indeed, the National Nurses Examination is so difficult that on only about 50 percent of Japanese nursing candidates who take it pass. Hirohiko Nakamura, a member of the House of Councillors, the upper house of Japan's bicameral parliament, said the test is full of "trick" questions designed to trip up the candidates.

"Not even Taro Aso could pass it," he joked, referring to the former premier who often stumbled over Kanji. More seriously he said that reading the exam questions gave him a sense of meanness and a feeling of disgust.

Wahyadin said a few simple changes would make the exams fairer for foreigners and help salvage the program. He asked that the examiners to rewrite the test questions using more simplified language. As it is, the test includes technical Kanji that even ordinary Japanese would find difficult to read. He added that candidates should be allowed to take the test two or three times before being sent home.

Japan's professional associations are well known to be tenacious defenders of their interests and often closely allied with government politicians, and the nurses are no different. The Japan Nurses Association (JNA) vigorously opposed the foreign nursing program from the very beginning. It even tried to limit it to a handful of 10-20 nurses.

"There is a feeling [among some] that there is no way that we can have foreign hands touching the bodies of Japanese," said Nakamura. "Without foreign pressure there is no way this would have come about in the first place," he said. Even now some senior civil servants in the Ministry of Health continue to oppose the scheme.

It was the JNA which lobbied the government for a number of strict conditions meant to hobble the program, of which, of course most notable was the requirement that the caregivers had to pass the national examination within three years. The test is so difficult for foreigners that it constitutes a de facto ban on the importation of nurses from Southeast Asian countries, critics maintain.

The Asian caregiver must also pass a qualifying examination in his or her own country before even being allowed to come to Japan. But other countries, such as the United States, recognize these qualifications and require nothing more. It's only a matter of time before Japan moves to mutual recognition as professionals, Nakamura said.

The question of importing more Asian migrant workers tends to cut across party lines. Some politicians are for opening up Japan, some are against. Nakamura, a vocal proponent of an open door, is a member of the usually more conservative Liberal Democratic Party (LDP). There is no mystery where he stands: "If we don't open doors to Asia we could see the collapse of the country," he said.