Woes of foreign nurses, caregivers in Japan

Jusuf Anwar, Indonesian ambassador to Japan, has bewailed the overly stringent Japanese national examinations for foreign caregivers and nurses. Out of the 500 Indonesians who took the examinations in 2008 and 2009, only two have passed and have become certified nurses.

Anwar revealed this concern at the “First Public Forum on Indonesia” held on July 23, 2010 at the Kyoto University Center for Southeast Asian Studies.

The problem, he said, is the “kanji” character proficiency part of the examinations. An added burden is that when they fail their exams on the third try, the nurses are obliged to leave the country immediately.

The examinations are part of the criteria introduced by the Tokyo government in line with the Indonesia-Japan Economic Partnership Agreement (IJ-EPA) provision on allowing foreign caregivers and nurses to practice their profession in Japan. The IJ-EPA took effect in 2008 but two years after, Ambassador Anwar said he doubted its usefulness unless the examinations can be made less rigid to enable more Indonesian nurses and caregivers to qualify.

He urged that, rather than emphasizing the “kanji” writing abilities of the nurses, the examinations should concentrate on the competence and technical abilities of the examinees. On this point, Anwar was certain that more Indonesian nurses would easily qualify, given their past experiences working in Japan, even if only in a “kenshusei” (trainee) capacity, and from the gathered testimonies of their patients. And for those who fail, they should be allowed to stay and work for at least one year rather than abruptly ending their employment, Anwar added.

Observers see Japan’s decision to allow the certification of foreign nurses and caregivers as being prompted by concerns over the country’s rapidly aging population and the lack of competent professionals to care for elderly Japanese.

The Japan Times has reported that more and more senior Japanese are left to fend for themselves and many die alone in their homes. The Times reported that in Tokyo alone, “People over 65 who died alone in their residence, including by suicide, stood at 2,211 in 2008, compared with 1,364 in 2002.”

The Japanese Health, Labor, and Welfare Ministry has denied any connection between “accepting foreign caregivers” and “the manpower shortage in health care.” This is belied, however, by a health ministry survey cited by the Times that shows “about 60 percent of hospitals and about 50 percent of welfare facilities that have accepted Indonesian candidates (say) they offered them jobs hoping to improve staff levels.”

Philippine nurses, too

The Philippine Overseas Employment Administration (POEA) announced in early 2009 that Japan was poised to hire 1,000 foreign nurses and caregivers over the next two years subject, of course, to their passing the language proficiency examinations.

This was a concession included in the controversial Japan-Philippines Economic Partnership Agreement (JPEPA).

The woes of Indonesian health care practitioners resonate in the case of their Filipino counterparts. Since the Philippine program began last year, only one Filipino, Ever Lalin, has successfully hurdled the Japanese tests.

In May 2010, Japan Today reported that another batch of 116 Filipino nurses and caregivers left for Japan to undergo a six-month language and cultural course after a screening program that the POEA described as “more rigorous.”

During this training program, the Filipinos will receive a monthly allowance of $400 (about P18,400). Those who pass the Japanese certification and become regular nursing or caregiver staff will get a salary of $1,600 (about P73,600) or more a month.

Nursing associations in both Indonesia and the Philippines have expressed dissatisfaction with their respective EPAs with respect to the hiring of nurses and caregivers to work in Japan.

In a position paper issued as early as 2007, the Philippine Nurses Association (PNA), through its president, Dr. Leah Samaco-Paquiz, said that the JPEPA “shortchanges the professional qualifications of Filipino nurses and exposes them to potential abuse and discrimination.”

Dr. Paquiz cited the Japan Nursing Association’s own call for reforms and improvements in their own country’s nursing system in terms of “improving the working conditions, salaries, and benefits of Japanese nurses before Japan allows the entry of Filipino nurses.”

Dr. Paquiz also pointed out that Indonesian nurses under the IJ-EPA “got a better deal” compared to Filipino nurses, as the former are required to have “only three years of formal nursing education and only two years of work experience,” and are not required to pass an Indonesian licensure examination before they are allowed entry into Japan. Filipino nurses, on the other hand, “are required to have had four years of formal nursing education plus three years of work experience, in addition to having passed the licensure examination in the Philippines.”

The major gripe of the PNA, however, centers on the degradation of the Filipino nurses’ position in that, despite having acquired “four years of higher education…, proof of competence via a Philippine license to practice…(and) three years of solid work experience,” the nurses will end up simply as trainees under the supervision of a Japanese nurse for up to three years until they pass the Japanese licensure examination.

Dr. Paquiz adds: They also risk having virtually zero employment rights in Japan as they are considered neither employees nor workers under Japan’s Immigration Control Act. Specific provisions committing Japan to international core labor standards and the protection of the rights of migrant health workers are also absent in the agreement.

The PNA also decried the high language skills required, noting that they “constitute an almost impregnable barrier” to the nurses’ entry. Given these “unnecessarily stringent requirements, (Filipino nurses) will most likely end up providing cheap labor and quality nursing care as nursing trainees in Japanese health care facilities.”

Dr. Paquiz ends the PNA’s position with the plea not to commoditize the nursing profession by classifying nurses as a mere economic category under the JPEPA.

Unfair labor?

The PNA’s fears appear to be confirmed by Emily Homma, a resident of Saitama prefecture who has been assisting Filipino nurses and caregivers. In a February 11, 2010 letter to the Japan Times, Homma charges that the JPEPA has “placed many Filipino nurses and caregivers working in Japan in a miserable situation where they are subjected to unfair labor practices, extreme pressure to pass licensing exams in Japanese, cramped living conditions, and poor salaries.”

On the other hand, the Indonesian National Nurses Association, through its president, Achir Yani, “has called on the Japanese government to be more flexible in the national nursing exam….”

Yani, a University of Indonesia professor, also suggested that a “kanji” pronunciation aid be allowed and that the examinees be given four chances (instead of three) to pass the tests.

Kyodo News reports that Japanese Foreign Minister Katsuya Okada had met with Indonesian and Filipino officials in January 2010 and promised “to consider addressing the language issue for foreign nurses.”

At the July 2010 forum at Kyoto University, however, Ambassador Anwar said he has repeatedly raised this issue with the Japanese government but his efforts to have the examination rules relaxed have been in vain.

And given the niggardly passing rate for Indonesian nurses and caregivers, Ambassador Anwar says that “the future of the program to alleviate the problems associated with Japan’s aging society is not so bright.”