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.”
Wahyudin, a 28-year-old caregiver candidate from Indonesia, summed up the frustrations felt by foreign health workers eager to begin a new career and life in Japan.
“It is very difficult for us to pass this test in a short amount of time, especially when you know you’re only going to be given one chance,” he said, adding that the test was more a test of the candidates’ Japanese skills than of their abilities as nurses and caregivers.
Under the economic partnerships agreements reached with Indonesia and the Philippines, Japan’s health service was supposed to take on as many as 1,000 foreign workers.
But after an initial surge of enthusiasm, more hospitals and care facilities are opting out of the scheme amid complaints that training foreign staff is too costly at a time of shrinking budgets.
The government has responded by promising subsidies for hospitals that take on at least one nursing candidate, and help with the trainees’ living expenses.
But Nakamura believes the blame for the scheme’s failure is bureaucratic, not financial.
“It is obvious that there is a tremendous need for health workers from Indonesia and the Philippines to come and work in the nursing care field,” he said. “It is not that hospitals don’t want them; they are pointing out an administrative flaw in the system that prevents them from raising their hands.”
Significantly, the most encouraging noises have come from the people who stand to benefit most from the scheme — the sick and the elderly. According to a health ministry survey, more than 90 percent of elderly and disabled patients said they were satisfied with the quality of care provided by Indonesian trainees.
Wahyudin, who acts as an unofficial spokesman for other Indonesian health workers, pleaded with the Japanese government to tweak the examination to give foreign candidates a fighting chance of success, and the option of retaking should they fail the first time around.
“We are determined to do our best in our jobs and to qualify as caregivers,” he said. “Please don’t crush our dreams.”