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Japan needs nurses, stat

Japanese program to recruit foreign nurses struggles as its elderly population swells.

Models dressed as nurses
Models dressed as bandaged nurses take part in a film promotional event on June 22, 2006 in Tokyo. (Junko Kimura/Getty Images)

TOKYO, Japan — It was supposed to be the perfect solution to a seemingly intractable problem: how to care for the sick and elderly in a country suffering from a declining, and quickly graying, population.

Japan’s decision in 2008 to invite nurses and caregivers from Indonesia and the Philippines to fill gaping holes in its health service was hailed as proof of a new spirit of openness in a country that has traditionally shunned large numbers of skilled workers from abroad.

But three years after the first batch of trainees arrived from Southeast Asia, the scheme, for all its good intentions, is in tatters.

Of the 254 Indonesian and Filipino health workers who took the first round of Japanese-language nursing examinations this year, just three were successful.

Yet in hospitals and care facilities across Japan, the need for an influx of new staff is clear. More than one-fifth of Japan’s population is over 65, and people in that age group will account for more than 40 percent of the total population by 2055, according to projections by the National Institute of Population and Social Security Research in Tokyo.

The government, meanwhile, is predicting a huge shortfall in the number of caregivers for the elderly within the next two decades.

But rather than being welcomed as the potential saviors of a public service that is close to breaking point, foreign nurses have encountered inflexible bureaucracy, language skills that would test most native Japanese speakers, and a local nursing community that views their presence with barely concealed contempt.

Under pressure from the Japan Nursing Association, which has consistently opposed the hiring of large numbers of foreign nurses, the government requires foreign candidates to take the same test as their Japanese counterparts.

The examination contains thousands of kanji characters and complicated medical terminology: It is so fiendishly difficult that Sentaku, a respected political journal, has described it as a “de facto ban on foreign nurses coming to Japan to work.”

Foreign nursing candidates, who must be qualified in their own countries, are given six months of language tuition before beginning a minimum of three years of work experience in Japan. They must juggle work and independent study, and are given only one chance to pass the exam. Failure means an immediate return home.

While the overall pass rate for this year’s exam was an unusually high 89.5 percent, among Indonesian and Filipino candidates the success rate stood at a measly 1.2 percent.

“The nursing association was always opposed to the scheme,” said Hirohiko Nakamura, a Liberal Democratic Party member of the upper house who has campaigned to lower Japan’s barriers to foreign workers.

“When negotiations began with the Philippines government, opponents tried to limit the number of foreign nurses to between 10 and 20. That makes me feel ashamed. The attitude seemed to be, ‘There is no way we can have foreigners’ hands touching the bodies of Japanese patients.’

“I was overjoyed when this system was put in place, so when I see how it has worked out, I am bitterly disappointed.”