The Medical Interpreter as the Community Interpreter: A Case study of MIC Kanagawa

The Medical Interpreter as the Community Interpreter: A
Case study of MIC Kanagawa

Gilles-Abuloph Nicolas Frew

Summary:

This paper discusses how MIC Kanagawa, the medical interpreters’ association in Kanagawa Prefecture was started. Discussing the collaborative efforts between the local government and the local nonprofits, the paper argues how such collaboration was made possible by the bond of individual ‘actors.’ The unique Japanese system of allowing full-time public officials to be engaged in nonprofit organizations as board members also helps government-sponsored nonprofits start up with very little funding. In conclusion, the paper argues that the medical interpreter is more of an interactive participant in the patient’ story-telling than he/she is an organizational gatekeeper.
 

1. Medical interpreter as community interpreter

Community interpreting, according to Roberts (1994) is ‘to enable people who are not fluent speakers of the official language(s) of the country to communicate with the providers of public services so as to facilitate full and equal access to legal, health, education, government, and social services’ (p. 127). In many cases, the clients for community interpreters are immigrants and refugees, both adults and children. While the adults often work in difficult conditions, their children may face problems of acculturation. The settings can be hospitals, doctor’s offices, schools police stations and various offices which handle immigrant matters relating to housing and social security.
Compared to conference interpreting, the range of languages needed is enormous and the language levels quite different and diverse. Instead of well-educated clients, the clients of community interpreters may have regional dialects and they may be illiterate. Faced with life-threatening or legal issues and placed in strange surroundings, they may be worried and afraid. Moreover, the organizational professionals, i.e., doctors, nurses, police officers or social workers are usually in a hurry and may feel pressure to complete their own tasks within a limited timeframe. In these difficult circumstances, community interpreters must be skillful in their interactions with both clients and service providers, utilizing not only their language expertise, but also their cultural knowledge and interpreting know-how.
In the case of medical interpreters, they sometimes must convey messages involving terminal illness and are expected by medical professionals to give patients emotional support.
In Japan, most community interpreters are volunteers, not paid employees of companies or organizations, making their professionalization difficult. In the 1980’s faced with a rapid increase of foreign workers, Japan’s lawmakers in a Lower House judicial-affairs meeting¹, discussed implementing a law governing the services of medical interpretation that, by implication, would have acknowledged the rights of illegal residents’ to be provided with medical treatments. Although such a law was not enacted, in that meeting, medical professionals were re-assured that they could attend to patients, irrespective of their visa status. In that Diet meeting, there was also official recognition of the necessity of providing medical interpreters services for immigrants and refugees, and recognition of the rights of medical interpreters to protect the patient’s privacy and if needed, not to report to the police about the visa status of the patients since many overstayed immigrants whose visas expire could not go see doctors for fear of being arrested, which can deprive of their basic human rights to get medical assistance.²
However, in Japan there is no mandate that forces medical institutions to hire interpreters. Nor is there usually a budget set aside for this purpose. Although many medical institutions face communication problems when treating foreign patients, they do not have licensed medical interpreters on staff.
The startup members of MIC Kanagawa were trying to solve these issues, with the objective of instituting a national licensing program for medical interpreters. In this paper, I am going to discuss how MIC Kanagawa began as a collaborative effort between the local government officials, leaders of grassroots nonprofits and a medical clinic.
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¹Parliament Standing Committee on Justice answer in November, 1989
²International Medical Interpreters Association (IMIA) which was started in 1987 states this clearly in their code of ethics. See the website: http://www.imiaweb.org/code/default.asphttp://www.imiaweb.org/code/default.asp
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2. The background of MIC Kanagawa

The 1990s in Japan was the decade of ‘New Comers’ as an unprecedented flood of immigrants came from South America (i.e. Nikkei) to work in labor-shortage sectors of Japan⁴. Unlike the ‘Old Comers’ who were mostly from Korea or China and who had settled before the WWII, the ‘New Comers’ had little knowledge of the Japanese language or the country’s customs. When the central government was slow to recognize the situation, several local governments started to address the problem.
For example, Oizumi town in Gunma Prefecture attracted large numbers of Brazilian factory workers, so officials began to translate official documents into Portuguese. Many sign boards were also written bilingually or trilingually. In similar fashion, the forward-looking Kawasaki City government launched an advisory board of foreign nationals to help understand their needs and problems. The advisory board noted, for example, that while foreign nationals were paying taxes to the government, they were often unaware of social and administrative services available to them⁵.
The Kanagawa prefectural government also decided to launch a governor’s advisory board, selecting 24 members to represent immigrants’³. Launched in 1998, the board continues to this day, with membership renewed every year.
Upon advice of the board, the Kanagawa prefectural government decided to set up two nonprofits, the Sumai Support Center, an agency which helps foreign residents find rental properties and jobs and MIC Kanagawa, a multilingual medical interpretation service. The latter organization was formed in 2001 in response to a ‘problem’ noted by the board: when immigrant workers had to go to a doctor, they frequently asked their children to take a day off from school to accompany them as ‘interpreters.’ This meant their children were forced to miss school; moreover their translations were often inadequate for medical treatment.
Now, however, MIC Kanagawa (Multi-Language Information Center Kanagawa) can dispatch spoken-language medical interpreters to medical institutions such as the hospitals and clinics in Kanagawa Prefecture for the patients with LJP (limited Japanese proficiency).
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³http://www.discovernikkei.org/en/journal/2009/1/22/nikkei-latino/
⁴The background and history of this advisory board is stated in Kanagawa prefectural government home page: http://www.kisc.meiji.ac.jp/~yamawaki/kyosei/gaikokujinkaigi.htm
⁵The need of medical interpreters is mentioned there and the prefecture immediately responded by starting medical interpreters start-up committee in 2001. http://www.pref.kanagawa.jp/uploaded/attachment/574172.pdf
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3. Collaborative support of the local government and the NGOs

In a way, MIC Kanagawa was a brainchild of both the local government and a network of local NGOs which assists foreign residents in Kanagawa prefecture. Seed money was given by the local government and the first chairman and director of the board, Akio Nishimura was sent from the prefectural government. Nishimura was a local government employee who had conducted preliminary research by visiting several existing nonprofit medical interpreters’ services.
Nishimura believed there should be a system of national licensing of medical interpreters. “In order to do this, we have to collaborate with organizations which are commercial-based,” he said. In his view, alliances with for-profit and fee-based interpreters’ associations would make their collective voices “heard” by the government. However, critics of licensing felt such a system would lead to developing a system of high-paid interpreters who serve only well-to do foreigners who come to Japan to get a top medical treatment⁶.
According to Nishimura, “some former left-wingers who worked with us did not like this idea (of professionalization) since their motto was to help destitute people who need public support and that is why we were working hard developing a training program by scraping up limited resources,’(Nishimura, May 2010 interview).
One of those who questioned Nishimura’s licensing plans was the founder of the Minatomachi Medical Clinic in Yokohama City, Hiroshi Hayakawa. The clinic was one of the first medical institutions to serve foreign residents in Kanagawa Prefecture. The clinic had initiated a medical insurance system called ‘MF-MASH’, which provided affordable healthcare insurance to the indigent. Hayakawa’s clinic already had ties to a number of organizations which were providing medical interpretation services on a volunteer basis. These included: TELL (Inochi-no-Denwa, established in 1971⁷), AMDA (Association of Medical Doctors of Asia, established in1984,⁸AWC (Asian Women & Children’s Network, established in 1996⁹) and ANY (AIDS Network Yokohama, established in 1993¹⁰).
Hayakawa believed that the need for medical interpreters could be met by mobilizing non-profit resources and that an alliance with for-profit organizations was not necessary.
“We launched a mutual aid program to support foreign workers ineligible for Japanese national health insurance. The member of MF-MASH (Minatomachi Foreign Migrant Workers’ Mutual Aid for Health), will pay \2,000 a month for medical services. In exchange, their medical bill at the Minatomachi Medical Clinic will be met at 30 percent of actual cost. The insured foreign workers can get full medical cover.” (Dr. Yoshiomi Tenmyo, Minatomachi Medical Clinic, 2013, May interview).
The clinic was originally established in 1979 by contributions from local dock workers at the Port of Yokohama. But as the handling of cargos in the Port decreased after the late 1980s, the number of foreign workers who worked as day laborers in Kanagawa-based small factories and construction companies started to increase. When injured or falling ill, they came to the clinic for treatment, referred there by Kanagawa-based support groups of foreign workers. In 1987, the clinic formally started treating foreign patients with the support of multi-lingual medical interpretation service.
Dr. Tenmyo adds, “Many illegally working foreigners who are suffering from illness hesitate to see doctors because they fear they may be deported if they go to hospitals. And there were few hospitals that accepted them in those days.¹¹”
 
Officially MF-MASH started in November, 1991. Within three months, it gained a membership of over 200 people who came from 20 countries.¹²As it continued to grow, in 1994, the total number of the members in MS-MASH was 3542 (409 female) from 55 countries (MF-MASH News No. 8, June, 1994).
There was another group of people in Yokohama City (in Kanagawa Prefecture), working on creating a medical support system for the foreign residents, which eventually became the ‘Gaikokujin Iryo to Kotoba no Mondai wo Kangaeru-Kai or the Meeting for the Medical Care for the Foreign Residents and Languages.’
Sponsored by Kanagawa Prefecture Council of Social Welfare Volunteer Center, the first meeting was held on February 22, 1999. The hosting members of the meeting were from the Minatomachi Medical Clinic in Yokohama, Saiseikai Kanagawa Hospital, Katorikku Yokohama Kyoku Tainichi Gaikokujin To Rentaisuru Kai or Diocese of Yokohama Catholic Church Meeting for the Fellowship of the Foreign Residents and Japanese.
The Yokohama Association for International Communications and Exchanges also invited medical personnel from hospitals and clinics, including personnel from city associations and town “lounges” of international communications and exchange. Administrative personnel from Kanagawa Prefectural Government and Yokohama City Government also joined the meeting.
Hiroshi Hayakawa, Chief of Medical Secretariat at Minantomachi Medical Clinic and Vice Chief Director of MIC Kanagawa, recalls.
“It was almost a miracle that all the members from different fields could get together and share what we all were feeling for and thinking about the foreign residents’ medical care. I didn’t know what was going to happen at first then, of course, but as time went by, we recognized that all of our thoughts were mutual and we all wanted to establish the system, which should be supported by the medical professionals, government, and language interpreter organizations. As my hospital alone could not take care of all the patients who should be hospitalized, had to have special examinations, or needed surgical operations. Then I could ask Katsumi Matsuno, director at Medical Social Worker at Saiseikai Kanagawa Hospital to allow some patients to be treated in his hospital. It was hard in those days but we worked together. Incidentally, Mr. Matsuno is currently serving as Chief Director at MIC Kanagawa.”¹³
In those days, most medical institutions refused to provide medical services to foreign patients, claiming that the patients and the medical staff could not communicate because of the language barrier, according to Hayakawa. The partnership between Hayakawa and Matsuno had a significant impact amongst the foreign residents in Kanagawa Prefecture.
After the first meeting of February 1999, they began holding the meeting regularly, involving more people and more nonprofits. The list of the members of the first Medical Interpretation System Review Committee counted 28 in 2001 August 1, with 27 supporting organizations.
“Fortunately we found there was a special fund we could receive from the government at the time. That was set aside for the 2002 FIFA World Cup in Yokohama City. It was a real trigger for establishing MIC Kanagawa.”¹⁴
“The 2002 FIFA World Cup gave MIC Kanagawa a chance to organize the project with a modest fund. We started the activities, making non-official volunteer organizations and the local governmental organizations working together. In April 2002, thanks to these activities, MIC Kanagawa officially started its activities as “Medical interpreting service for foreign residents in Kanagawa Prefecture Support Model Project.”¹⁵
Mr. Akio Nishimura has been a public official working for Kanagawa prefectural government for more than 25 years. When the prefectural government decided to start up a nonprofit called MIC Kanagawa in 2002, his boss sent him to the board as Chief Director. Nishimura, having worked as one of the coordinators for the advisory council of Foreign Residents in Kanagawa Prefecture, took strong interest in the discussions. He went and studied the system at several volunteer groups which were dispatching medical interpreters. After serving the MIC Kanagawa as a board member for three years, he was transferred to another section in the prefectural government. Yet his informal assistance to MIC Kanagawa continues to this day.
“Kanagawa has been favored by foreign people to settle down in Japan since its capital city of Yokohama opened the first international port in 1859. We also had the resettlement Promotion Center for Indo-Chinese refugees in 1980s through the 1990s in Yamato City (west of Yokohama City). So it was natural for the local government to do something about problems involving the foreign residents. To receive a proper medical treatment came as one of the priorities in the list.”
He felt the need among the foreign residents to have access to the medical institution, particularly after the 1990s, when the number of Asian workers and South American Nikkeis increased in the prefecture.

Adapted from Kanagawa Prefectural Government’s homepage<http:// www.pref.kanagawa.jp/‎>
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⁶In MIC Kanagawa, medical interpretation services are available in ten languages, i.e. Cambodian, Chinese, English, Korean, Laotian, Portuguese, Spanish, Tagalog, Thai, and Vietnamese. Except for a few languages including English, most of these languages are not commercially viable and, therefore, not offered by fee-based organizations.
⁷http://www.find-j.jp/zenkoku.html
⁸http://www.amdainternational.com
⁹http://www.awcnetwork.org/
¹⁰http://www.netpro.ne.jp/~any/
¹¹‘Yokohama clinic comes up with scheme to fund health care for foreign workers,’ The Japan Times, February 22, 1991.
¹²‘Over 249 members already,’ MF-MASH News First Issue, February, 1992.
¹³Interview with Mr. Hiroshi Hayakawa, May, 2013.
¹⁴Interview with Mr. H. H, May, 2013.
¹⁵Interview with Mr. H. H, May, 2013.
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