Introduction The era of “International Migration” has arrived in Japan, where communities are becoming multicultural and multiethnic. We cannot talk about the Japanese society without mentioning the coexistence that brings the symbiosis of different people. It has become obvious that diverse people of different races, nationalities, backgrounds, cultures and languages have to live altogether in mutual respect. At this point, when we think of “Medical health care for foreign residents”, we ought to first think that without a sound, harmonious community, there is no way to secure the health of foreign residents. In the materialization of a multicultural society it can be said that the medical health care of foreign residents is absolutely necessary, as indispensable as soil is for plants. Objectives This workshop intends to answer to the following questions: What is the appropriate social framework for foreign residents and citizens to live safely and securely? What kind of medical health care system would allow foreign residents to exert their right to health? from different points of view and a discussion with the participation of all the attendants. Contents Ms. Y. Kojima will speak on the problems of foreign children school unattendance, concrete support and policy building to solve the problem. Mr. Y. Nakamura will make a presentation on how a sound society should be considering community multiculturalism and the dramatic speed at which Japanese society is facing internationalization. Ms. L. Herrera will speak about the medical interpretation problem. Mr. R. Khaled will address the topic of the health needs of foreign residents' medical health care from his experience in the field. Mr. D. Arudo, author of “Japanese Only-The Otaru Hot Springs Case and Racial Discrimination in Japan” (Akashi Bookstore 2003) will talk about the reality of the internationalization in Japan from his own experience, a topic to which he has devoted many years. We will listen to the meaning of living as a foreign resident in the community. In addition, we have asked Mr. T. Sawada to appoint any questions from the floor. This workshop approaches diversity and decision in the Japanese society, aiming to contribute to a society which is kind to all its members. We are looking forward to your attendance.
Introduction That all children, regardless of their nationality, have the right to be educated is stated in the “Conventions on the rights of the child” has been also ratified by Japan. However, in truth, education for foreign children living in Japan takes the form of a “special favor” conceded to them. The real situation shows that foreign children living in Japan are not guaranteed elementary school educational organizations international standards. Objective To grasp the actual condition and propose policies to solve the problem of school unattendance in one, we conducted a survey. Until now there was no data available on the situation of foreign children school attendance and unattendance. Methods Kani city in Gifu prefecture, known by its large foreign resident population, was selected as pilot community. The cooperation of the city and prefectural authorities, the municipal board of education, the international exchange center was obtained. Data collection took place among foreigners of all nationalities in schooling age, between April 2003 and March 2005. Results The data collected allowed the clarification of the situation of foreign children school attendance and its causes. Although the study had as a basis the data on registered foreign citizens provided by Kani city; we also gained cooperation from residents and communities. In other words, “all” children, even those who were not counted on the city data are included in the study. There was a large ratio of school unattendance. Discussion Kani city Mayor launched the “Program to guarantee foreign children education” which included the “Zero school unattendance” project. The program as well as data collection have been carried jointly among the government, civil society, etc. and has been taken as a “model” to achieve “Zero school unattendance” along the country.
Kani city, Gifu is yet a typical small local town of 100,000 populations but has Japanese Brazilian and Filipino increased recently and shares 7% of total population that is a foreigner residing town. The foreigner residing towns to be called are facing similar several issues at every place. The working and educational environment for the people as the migrant worker from Central and South America and their health condition which is the most important became worsen. 4 years ago in Kani city, we made a survey for the educational environment of the children of foreigners for 2 years period, which was reported in public and gained favorable evaluation from several sectors. Nowadays we are promoting to assure their social status who live in the local community. They are working as same as Japanese, and sometime to do the job that Japanese would not, but it seems that they are ignored on their treatment in the social life. If they spoil their own health, their life planning may cause a serious problem. Once they dropout, they may not have any chance to recover themselves. This means the “healthy condition” of the local society will be damaged before long. Therefore, we started the foreign nationality citizen's committee where we can maintain not only the individual health but also to be healthy local society from the concept that the foreign residents would not rely on the local society but they act themselves as the citizen and the local residents to participate with the local activities so that they can enjoy their independency, health, pleasure and hope.
There are about 2 million foreigners living in Japan, a country known by its outstanding health indicators. However, when it comes to foreign residents, differences in access to health care arise. It is known that the language barrier plays an important role in preventing and delaying access to care. The purpose of this communication is to bring to discussion some selected cases that stand the need for medical interpretation policies that ensure foreign residents their right to access health care with equity and medical interpreters the sufficient conditions to perform their roles.
The foreigner's population in whole Japan is increasing up to 2.5%, while in Shizuoka prefecture it is 3.0% in Hamamatsu it is much higher up to 5.3%. Health problem is a major item in the daily life, while about 36% of this category has not any health insurance, in order to receive the medical services in the medical facilities. Community participation is an essential factor for the foreigners, in order to be in touch with the Japanese mothers and children. The lack of this kind of coordination may some time result difficulties in education of the children, regular health check and medical care of the foreign families. Results: Among 220 patients sixty four percent of all patients had medical insurance, while remaining 36% had to pay for the whole expenses. Among those who had medical insurance 50% of acute diseases, and 60.6% of chronic diseases responded to continuous treatment, while in self-payment category only 40% of acute cases, and 21.6% of the chronic cases had efficient compliance. The compliance to the treatment in both acute and chronic diseases were higher in those foreigner patients who had medical insurance. In those who had not any insurance poorly compliance to continuous treatment were obtained. Conclusively community participation as well as, medical insurance for foreigner patients is a necessary item for living in Japan, in order to support their healthy and happy life.
Before we talk about adequate medical care for non-Japanese, we must consider just how adequate and accepting the system itself is to guarantee it. Japan still has difficulty seeing non-Japanese as residents, immigrants, and taxpayers, and even the highest levels of government operates under the assumption that “foreigners will come here, make money working for our industries, and then just leave”. It is not that long ago when government agencies were saying that “non- Japanese don't qualify for Kokumin Kenkou Hoken--they aren't Kokumin”, or citizens. I have also heard of doctors refusing to treat non-Japanese because they thought it would be too much of a nuisance, and mental health institutions telling non-Japanese to go back to their own countries for treatment. Of course, I generally hear about good treatment in Japan as well, but there is room for improvement. The biggest step is to pass a law and draw up rules stating that all patients, regardless of nationality or national origin, are guaranteed medical treatment. I will talk about some of the obstacles in Japan to acceptance of non-Japanese residents from the standpoint of a naturalized Japanese citizen.
Since the 1960s, Japanese nurses have been working as international nursing collaborators with or for the people in developing countries in order to promote health through transferring nursing knowledge and skill. However a number of nurses reported that they did not have enough competencies as international nursing collaborators. The objectives of this study were: a) to describe the experiences of Japanese international nursing collaborators whose mission was transferring nursing knowledge and skill and b) to determine their learning needs as international collaborators, and to design educational programs (graduate program) based on the results of survey. The participants of this study were twenty-seven nurses who had had an international collaborative mission and stayed in a developing country for more than one year. Semi-structured group or individual interviews were used in order to describe activities process and leaning needs as international collaborators. The interview data were analyzed using content analysis from the viewpoint of competency and learning needs. Nurses reported needs in two major areas: Fundamental Competences and Knowledge, and Required Competences for Development of International Collaborative Tasks. Fundamental Competences and Knowledge consisted of nine components: (1) cross-cultural experiences, (2) acceptance of cultural differences, (3) professional experience, (4) degree and qualifications, (5) philosophy of nursing, (6) language, (7) interdisciplinary knowledge for international cooperation activities, (8) knowledge about own project, and (9) knowledge on theories of international cooperation. Required Competences for Development of International Collaborative Tasks consisted of thirty components which were divided into four phases (personal competences, preparation and planning phase, implementation phase, and after project.) Based on the result of this survey the investigators designed the international nursing graduate program. The program has started from the academic year of 2005 at the investigators' college. The progress of students' learning and outcomes of these educational programs should be monitored using formative evaluation.
Introduction During the course of primary health care activities in Khammouane province of Lao PDR by non- profit organization, international support and partnership for health, an exceedingly high infant mortality rate was recognized in some villages. As thiamine deficiency was strongly suspected for the main cause of the high mortality, the household survey with an emphasis on nutritional aspect and the measurement of thiamine level in the blood of mothers as well as their breast-milk were carried out for the confirmation. Methods The survey was conducted at Sibounhouane sub-district (Group 1) with the highest infant mortality and Hatkhamhieng sub-district (Group 2) with the lowest mortality. Fifty families of the two groups, each consisting of randomly selected 25 families with less than one year old infant(s) were interviewed by using prepared questionnaire. The body weight of both mother and infant was measured and blood and milk were taken from the mother. Results The ethnic minorities of the group 1 consisted of Lao Lum (44%) and Lao Theung (56%), whereas only Lao Lum in the group 2. The economical indicators and the mother's educational level in the group 1 were inferior to those in the group 2. There was no significant difference in the methods of preparing staple glutinous rice, likely to flux thiamine and intake of thiaminases between the two groups. High infant mortality rate was documented in the group 1 whose clinical symptoms were mostly consistent with those of infantile beriberi. The concentration of thiamine in the blood and milk of mothers in both groups were considerably lower and significant reduction of thiamine level was observed in the group 1 than the group 2. Nevertheless, both groups of those infants tended to be inadequately fed with the foods except for breast-milk during their early infantile phase. Conclusions The low concentration of thiamine in the blood and milk of mothers was strongly suggestive that infantile beriberi due to thiamine deficiency was the principal cause of the infant mortality in the study region. We hereby surmise that thiamine deficiency could be extensively prevalent in Lao PDR than the currently studied areas because of their traditional preparing methods of staple dietary rice, postpartum food taboos and intake of thiaminases. For the prevention of infant death due to severe thiamine deficiency, necessary measures including the exchange of information among the institutions concerned, adequate thiamine supplementation and nutritional counseling have to be urgently adopted.
It has been estimated that by 2010, there might be more people living with HIV in Asia than in Africa. There is an urgent need for a safe, effective, accessible and affordable AIDS vaccine suitable for use in Asia. Factors that may hinder the development of AIDS vaccines in Asia include: 1) difficulty in recruiting adequate number of trial participants due to the low incidence of HIV infection in the general population and in defined population groups at high risk for HIV; 2) circulation of multiple HIV genetic subtypes and recombinant forms, and 3) unique geographical diversity of populations, cultures, social and political backgrounds. A proposed strategy to accelerate the development of an effective AIDS vaccine for Asia could be the constitution of a collaborative regional network in support of AIDS vaccine research and development. Collaborations would include 1) promoting the conduct of additional epidemiological studies and establishment of regional vaccine trial cohorts to reach adequate sample size for efficacy trials, 2) developing a regional platform for the conduct of clinical trials at multiple sites and harmonization of legal, regulatory and ethical frameworks to facilitate the review and approval processes, 3) strengthening the regional clinical research capacities and human resources for efficient development and testing of various vaccine candidates; and 4) promoting the development of regional capacities and infrastructures for vaccine production for the conduct of all phases of clinical trials, licensing and future public health use. A collaborative regional network in support of AIDS vaccine research and development will also require strong political commitment and leadership by all regional and international partners playing a significant role in the region.
SHARE started Health Education Promotion Project in East Timor in 2002 and has been actively engaged for over 4 years. The political and social unrest in the spring of 2006 produced as many as 150,000 internally displaced persons (IDPs), almost one sixth of the total population of the country. Viewing a dire situation in which people were placed, SHARE launched humanitarian assistance in 20 camps from August through December 2006. The interventions carried out were, among others, monitoring malnourished children with UNICEF, health education/promotion and mobile clinic in IDP camps, and supportive activities for Bairo Pite Clinic. The health education cumulatively reached 753 persons in 20 camps. Main health topics covered were sanitation, nutrition and skin infections. The mobile clinic in the Metinaro Camp was carried out 12 times seeing 1,227 persons. Main diseases identified were upper respiratory tract infections, skin infections and acute watery diarrhoea. We think that; i) coordination with donors in compliance with East Timorese national policy on IDPs is essential, ii) NGOs with experience in long-term health promotion can have an important role to play in emergencies, iii) even in an emergency situation, focusing on primary health care is important from the early stage of humanitarian assistance, iv) it is vital to take sustainability of those activities into account from the planning stage.