Overview of Health Care Interpreting in Japan

The Critical Link 5, the only international congress dedicated to the advancement of community interpreting, was held in Parramatta, Sydney in Australia, from April 11 to 15. The theme for this conference was "Quality in interpreting: a shared responsibility." More than 400 participants from all over the world gathered to discuss the many issues related to the quality of community interpreters. I attended the conference as a panelist of "The Perspectives of the Primary Participants on Quality in Interpreting," and presented our paper, "Overview of Health Care Interpreting in Japan," which was co-written by NISHIMURA Akio, MIC Kanagawa's Program Adviser, and MIZUNO Makiko, the J.E. Chairperson.

Japan = a developed country?

Many people have the impression that Japan is a developed country. However, in the field of health care interpreting, this is not so. Japan has a short history of health care interpreting, and it can be said that Japan is a developing country in this field.

International population in Japan

What do you think is the largest non-Japanese ethnic community? Chinese? Korean? That's right. First is Korean and second is Chinese. How about the third and fourth? American? Give up? Unfortunately, the statistics show that America does not always win. Well over 90 percent of foreign residents come from either Asia or South America.

What do you think is the size of the population? The whole non-Japanese population of Japan is 2 million. A population of 2 million makes it just 1.6% of the entire Japanese population, which is now 127 million. Compared with Australia, where one quarter of the population was born overseas, the number is much smaller.

Let's take a closer look at the population.

The international population has been rapidly increasing during the last 20 years. Amongst the new comers, Limited Japanese Proficient people (LJP) have especially been increasing. According to a study by MURAKI Shigehiro, the number of Limited Japanese Proficient people is only 600,000 in Japan. Based on the research held in 15 municipalities, MURAKI estimates 36,000 Limited Japanese Proficient people visit a health care setting every day throughout Japan.

MURAKI also concludes that less than 12% of Japanese hospitals have English speaking staff. However, this is not true, because the "English speaking staff "is generally not capable of communicating in English. He further states that less than 1% of hospitals have staff capable of communicating with patients who speak languages other than English.

The Japanese government does not attempt to support this population, because it believes that the number is not big enough. However, I believe, 36,000 is enough to deserve some attention. It can be concluded that Japan has not established a system to support the international population, because the number, at least for the government, is insufficient.

Past and present activities in Japan

Let's move onto the past and present activities in Japan. In the 1980s, people did not have a clue about health care interpreting. At that time, ad hoc interpreters, including bilingual family members, relatives, friends, or even complete strangers tried to support non-Japanese patients.

In the 1990s, a group of bilinguals started volunteer interpreting and in 1994, the first NPO for health care interpreting was established in Yamagata, which has a large Chinese population. In 1995, hospitals started to hire full-time bilinguals as in-house medical interpreters. After 2000, the number of NPOs began to increase and by 2004, they were present in 21 prefectures. Last year, we held the first national symposium about health care interpreting in Yokohama. Now we have a national network, which is similar to the National Council in the United States.

As you can see, we have only a 10-year history in community interpreting. It is much shorter than in Australia, which has more than a 10-year history in community interpreting.

Three models of health care interpreting in Japan

Let's move onto the present activities of health care interpreting.

There is no national system for health care interpreting in Japan. There are several organizations, and each organization has its own style. However, we can roughly divide these styles into three models: the NPO model, the In-House Interpreting model, and the NPO-Hospital-Municipality model. Let's begin with the NPO model.

1. The NPO Model

In this model, the NPO consists of 10-100 volunteer interpreters. When a non-Japanese patient requires health care, he or she can contact the NPO. The NPO finds a hospital for the patient and sends an interpreter there. Some NPOs have good relationships with hospitals, and in these cases, the patient can contact the hospital directly. This is the most common model in Japan, and the interpreters in this model are mostly volunteers. They can be paid for their transportation costs, but the fees are usually less than $30. Most interpreters have not been properly trained as an interpreter, so their language skills and interpreting skills are usually not sufficient. Most NPOs have their own original training program, which focuses on basic medical knowledge or a code of ethics. However, these programs do not cover interpreting skills. In many cases, these NPOs are not financially supported by the local municipality. They depend on grants or donations.

2. The In-House Interpreting Model

In this model, a hospital hires bilingual staff in order to provide sufficient care for non-Japanese patients. This model is the least common in Japan, because only hospitals located in high-density foreigner populated areas need to hire these full-time workers. These interpreters are full-time employees, but their duties are not only interpreting. Most of them, again, are not properly trained as interpreters. Their own training program focuses on medical terminology or knowledge, not on interpreting techniques. When patients arrive who speak languages other than the language of the hired interpreters, the hospital must outsource for an interpreter.

3. The NPO-Hospital-Municipality Model

In this model, NPOs cooperate with hospitals and the municipality. The NPO trains and supports the interpreters and also educates the hospital staff about the proper way in which to work with health care interpreters. The municipality supports the system not only financially, but also by giving certification to the interpreters so that they can work professionally at hospitals.

This model is also limited to areas which have a large international population. Again, even in this model, the interpreters are not professional. Some interpreters are trained as professional interpreters, but most are not. They have many interpreters, and can cover a wide variety of languages. Here is a good example of this model, MIC Kanagawa. This is a leading organization in Japan, which created a widely accepted training program. It also hosted the first national symposium, which was held in Yokohama last year. MIC Kanagawa has 148 interpreters, covering 10 languages. They receive about 2,500 cases yearly. In the selection process, the candidate's language and communication skills are tested. The interpreters are required to maintain their skills throughout MIC's original training program. Coordinators support the interpreters by organizing training sessions and providing counseling. The fee for interpreting, including transportation, is only $30 and is paid by MIC Kanagawa. The patients are not charged. Financial support from the Prefecture of Kanagawa is very limited, so financing is the largest issue faced by MIC Kanagawa.

Issues in Japan

Regarding public awareness, Australia has many non-English speaking people, and thus the need for health care interpreting is widely accepted. In Japan, the Limited Japanese Proficient population is only about 600,000, and far fewer people understand the importance. The public, including many doctors, don't realize how critical the situation is for a person who lacks language proficiency, and they assume that interpreters are just a waste of time and money and better off in volunteer circles.

In terms of skills, Australia has more advanced health care interpreting training programs. In Japan, we are still discussing the role of health care interpreting. The largest challenge is that we don't have a consensus of the standard skills needed. There is a big gap between volunteer and professional interpreters. Most programs do not focus on language or interpreting skills. It is very important for interpreters to learn proper session management, the code of ethics, and medical terminology. However, basic language and interpreting skills should come first. We need to include the input of professional interpreters in the training programs.

The job issue is the most important. Australia has immigration policies which make it compulsory for the government to provide language support to Limited English Proficient (LEP) patients. Health care interpreting is a profession in Australia. However, Japan has a lack of health care legal support for the international population. It is not compulsory for the government or hospitals to provide interpreting services. Therefore, health care interpreting has yet to become a profession in Japan. And as we have fewer true bilinguals, it will take more time to train interpreters in Japan than in other countries.

The Solution

Let's move on to how we should solve these problems. Each of the three pillars in the solution is equally important. One pillar is useless without the other two.

The training program becomes pointless without the people or jobs. If we manage to gather a group of interested people, but don't provide the skills training or jobs following the course, the trainees will have nothing to do. If hospitals and governments are convinced to create professional interpreter positions but there are a lack of people or training programs, there won't be anyone qualified to fill those jobs.

The key to building the three pillars effectively and simultaneously is through public awareness. The more people that become aware, the more who will get involved, and the skill level as well as the chances for establishment of a national system will rise.

Raising public awareness is extremely important. We attempt to spread the word through national and international discussions on the issues of skills, jobs, and people.

In 2006, we held the first national symposium on health care interpreting, and approximately 200 people from all over Japan gathered in Yokohama to discuss the issues. The conference established a nationwide network to continue the dialogue, and the second meeting was held in Kyoto last February. Moving on to the next stage, MIC Kanagawa held the first international symposium and invited three experts from Australia, America and Canada. They discussed the training issues and concluded that we required our own style to gain acceptance in Japanese health care situations. The Japan Association for Health Care Interpreting in Japanese and English (J. E.) The J.E. was established to promote health care interpreting as a profession in Japan.

The reason we focus on English is because the language has more educational materials and advanced programs. There are more English interpreters and job opportunities in English. This means English-Japanese health care interpreting is closest to becoming a profession in Japan.

In addition to the interpreter training course, we offer participants the opportunity to explore other aspects of Medical Communications including translating, editing, and the like. We aim to raise medical communicators not only in the interpreting field, but also in translating and editing.

J.E. provides training programs that cover interpreting techniques, basic language skills, and medical terminology as well as the code of ethics, session management, and pragmatic role playing.

Although many of the participants are volunteers, they come out in large numbers. Seeing the public interest in the field is fueling our push to create national standards and subsequently create a legitimate profession. Thus, by continuing to raise public awareness with our courses and events, we believe we can build the three pillars of Jobs, People, and Skills simultaneously.

The Perspectives

We believe that discussion of the following issues is needed:

* Should we establishment a nation-wide standardized program or a variety of programs? Is certification required? If so, what about the languages that have far fewer bilinguals?

* Can we make medical interpreting a profession? What about in languages other than English? Will we be able to get government support?

* How can we get interpreters for languages with fewer bilinguals?

It can be concluded that we should raise public awareness and keep national and international discussions about these issues. By continuing to raise public awareness with our activities, we need to convince the government about the importance of health care interpreting.