CHARM

Among industrialized nations, Japan has long been regarded as having strict immigration control. The number of immigrants in Japan is estimated to be around 3 million people, which is around 2.5% of the entire population, a 10.7% increase from the previous year. (Sugiyama, 2023). This is in part a result of a new immigration law that went into effect in 2019, which was designed to increase the number of workers (Pollmann & Yashiro, 2020). It is no secret that Japan is undergoing a demographic crisis, with an extremely low birthrate and shrinking population. The increase in immigration brings many problems, such as cultural and language barriers, work issues, housing discrimination, childhood education, and inadequate access to healthcare. It is this final issue – healthcare for immigrants in Japan – that this article will focus on.

The problems that immigrants face when it comes to their health have many causes, including language barriers, lack of information, residency status, and cost. It is important for Japan to support its immigrants in various ways in order to create a society that is comfortable for them to live in. For this reason, NGOs and other organizations in Japan have been formed to support immigrants who are having difficulties living in Japan. When it comes to supporting immigrants’ health-related issues, one such NGO is called the Center for Health and Rights of Migrants, or CHARM.

Founded in 2002, CHARM is an organization that supports and collaborates with HIV-positive immigrants and people who speak languages other than Japanese, with the aim of creating a society where all people can live in good health. One might think that AIDS is not a big problem in Japan, but according to the AIDS Prevention Information Network (2023), in the three months between March and June 2023, 174 people were infected with HIV, 36 of whom were foreign nationals. Compared to the year before last and the year before that, the number of foreign nationals infected is on the increase. Therefore, the presence of CHARM is important for HIV-positive people, especially for foreigners.

CHARM’s Support Activities

Over the years since its foundation, CHARM has been expanding its range of support services for immigrants. At first, they started providing telephone counseling on sexual and reproductive health issues in four different languages: Spanish, Thai, Tagalog, and English. Then, in 2004, they launched a website (CHARM, 2023) in three different languages with the help of an Australian website designer. It can be viewed in several languages so that people from different countries can find more information in their native language about HIV, about CHARM, and its past and upcoming events. In 2012, CHARM began holding health counseling sessions for foreign residents at eight different locations in Osaka prefecture jointly with support groups for foreign residents. This expanded to ten locations a year later. Following this, in 2018, CHARM began holding free health counseling sessions for foreign residents in collaboration with the other organizations.

Foreigners often need advice on where to go if they get sick, what the necessary expenses will be, what to bring, etc. This is particularly true if they are HIV positive and lack health insurance, which all people living in Japan are required to have. CHARM will provide support on the types of cautions, benefits, and help with any language barrier. In addition CHARM provides a lot of information to support women in particular, such as the difference between HIV and AIDS, and detailed information on infection routes and countermeasures. Also, when an immigrant wants to go to a facility or hospital, CHARM will provide medical interpretation and accompaniment support services to foreigners living in the Kansai area, as well as what to expect and what is needed when receiving ARV (antiretroviral) therapy treatment in Japan. CHARM will provide information on the testing process, how to read test results, and offer consultations on testing and testing locations with multi-lingual support. Their strength of support is telephone consultation for HIV sexually transmitted diseases in foreign languages, face-to-face consultation for positive persons and their partners, accompanying support, and HIV medical interpretation services in English, Spanish, Chinese, and Portuguese.

CHARM’s Contributions Beyond Japan

In 2022, CHARM held the Asian Forum on HIV and Migration to commemorate their 20 anniversary. Through it, NGOs and health care providers were able to learn more about the reality of HIV medical care in their countries and how to create an environment where HIV positive people who migrate can continue their treatment with peace of mind. At the forum, English was used as the main language to explain the process and challenges of accessing HIV medical care in different countries, and to exchange opinions with people from different countries. Countries that participated in this forum were Thailand, Vietnam, Myanmar, Taiwan, Indonesia, Japan, and South Korea. By publishing the results of this forum, people were able to learn about the HIV treatment systems in each country. In addition, by disclosing details about the organizations that participated in the forum, people could learn who they could consult directly.

Interview

We visited the CHARM office in Osaka on June 29th, 2023 to learn more about what CHARM is doing for immigrants and to find out more about immigration issues in Japan. We interviewed four members of CHARM, each working in a field, to learn about various aspects of immigration. They answered all of our questions and gave us insightful perspectives on the immigration issue that we could not have thought of on our own. It was a valuable experience that we could not have learned from the Internet alone.

Interviewees
Ms. Aoki Rieko (head of the secretariat）

Ms. Ihara Noriko (medical Interpreter Support Staff)

Ms. Takeno Midori (consultant for HIV-positive foreigners)

Mr. Mohammad Masum Billah (English-speaking telephone consultant)

Q: What is the main purpose of your activities?

Ms. Aoki Rieko: The main goal is to create a society in which all people in Japan can live a healthy life. It is a very big issue, so it is not enough for individuals to make efforts, but the society as a whole needs to work in this way, and all the people living there need to have an awareness that it is normal to live healthily. In order for this to happen, laws need to be established, education needs to be provided, English language institutions need to be established, appropriate information needs to be provided to foreign nationals, and many other things need to be done. As a small organization, we mainly provide information, consultation in foreign languages, opportunities, and assistance to solve the problem of communication difficulties with doctors, especially in the medical field.

Q: Are there any specific aspects of the local or national government systems that you would like to see improved?

Ms. Aoki Rieko: In Japan, there are many people whose visa status closes off entrance to medical care. Refugees are not covered by the national medical insurance, so not all of them have access to medical care. There are people who come to Japan for various reasons, so I would like to see the discrimination based on status of residence be eliminated. Insurance and visas should be obtained immediately upon arrival. When refugees suddenly get sick, they want to see a doctor, but they can’t because they can’t talk to the doctor.

Is CHARM taking care of that kind of support?

Ms. Aoki Rieko: Yes, but it is not possible to do everything. There are many cases where we are refused by the system because there is no law itself, even if we go to the contact point.

Q: We understand that CHARM has been active in this field since 2002, and we were wondering if there have been any improvements or changes from 2002 to now?

Ms. Aoki Rieko: The immigration law was revised in 2012, and until then, all foreigners were subject to the same restrictions. Until then, foreigners had to register with all local governments, and anyone could register. Once registered with a municipality, the municipality had to take care of the foreigner regardless of whether or not he or she was a resident of that municipality. But since 2012, refugees have not been able to register and do not have resident status. It’s like, “Why should we (the local government) take care of them if they are not registered?” They have become really strict. Although NGOs are now doing this, since 2012 the government has not been in a proper relationship with them, so there is a clear separation between those who can receive medical care and those who can’t. Until then, there were people who could get health insurance at the counter, and when I started my activities, there were people who were receiving welfare benefits. The people at the window were able to make that decision if necessary, but since we are following the government manual, it has become very difficult to deal with each individual case.

Q: What are some of the most confusing or difficult issues to resolve with regards to immigrants?

Ms. Aoki Rieko: We can’t really decide on this one because it is a daily occurrence, but I would say the lack of a system is the most difficult. This is where the government system does not provide access to medical care. Another problem is that the people in charge at administrative offices and medical institutions do not know about the medical system. The most vulnerable people are those who do not have resident status, and there is a system in Japan that these people can use. However, there are many people who do not know about it.

Q: What are the most common problems you have been involved with?

Ms. Aoki Reiko: Not being able to communicate in a foreign language is a big problem. Refugees don’t even know where to go in the medical field. Even if you go to a big hospital and think you will be seen anyway, it is difficult to enter through the entrance and get to the doctor, and they don’t know how to fill out a medical record. I think it is difficult to go through the initial consultation procedure. It is even more difficult if it is their first visit to a doctor as soon as they arrive in Japan. Once they get to the doctor, they can only manage to speak with gestures and a little English.

Q: Do you have any major goals for the future?

Ms. Aoki Reiko: Rather than a goal, we are increasing the number of languages as the need arises, and the number of languages we need to support is constantly changing. We need to develop a system and train people to be able to respond to such changes, but it is difficult to plan and execute such a system. However, we are not able to respond to all people, but our goal is to improve our quality so that we can properly respond to infectious diseases. It is not easy to do so, but the term “infectious diseases” covers a very wide range, so I hope that we can cooperate with medical institutions and government agencies to establish a system that can properly respond to new infectious diseases such as the coronavirus that has occurred this time. Although we started with HIV, HIV is not an infectious disease but rather a chronic disease that requires medication for a long time until death. There are other people who live their lives while taking such drugs, such as those with intractable disease or diabetes. If such people do not take the medicines, their lives will be in danger, so it is necessary for them to continue their treatment. I personally think it would be a good idea to gradually expand support for people who are undergoing continuous treatment, but I think the government still needs to consider whether we can establish a system and whether it is really possible to do so.

Q: What has been the personal impact on you of assisting immigrants?

Ms. Takeno Midori: I speak English better than before.

Ms. Aoki Reiko: When everyone was working here, everyone started speaking English.

Ms. Takeno Midori: As for myself, I think that just by having a Japanese person accompany them, the attitude of hospital receptionists softens towards the client, so I was able to see the current state of Japanese society objectively by working with non-Japanese people.

Ms. Ihara Noriko: I have become more patient. I was very surprised at first, because even if an interpreter was available, there are people who cannot come to the hospital on the designated date and time for a variety of reasons. However, it is not the interpreter’s responsibility, and I believe that it is through situations like this that interpreters learn more about the language, so I try to think about how to make things work out in situations like this.

Mr. Mohammad Masum Billah: I have been working here for three months since April, and I think I have more opportunities to learn more about infectious diseases, as I have learned more about what I knew only by name. I have been able to deepen my understanding of infectious diseases by studying with nurses and infectious disease specialists.

Reflections

During the research project, we shared a lot of information with two young researchers from the Instituto Tecnológico y de Estudios Superiores de Occidente (ITESO), Guadalajara, in Mexico, and we also learned a lot about the current situation in their country. The major difference between Japan and Mexico on the issue of immigration is that Mexico has a very large number of immigrants moving to other countries, while Japan still has a large number of immigrants to accept. The name of their organization is El Refugio Casa del Migrante, which means “Migrant House Shelter” in English. One thing that El Refugio Casa del Migrante and CHARM had in common was that they both had deep relationships with many other organizations. We also learned that volunteers and donations are very important to each organization. What was also very moving was the fact that both El Refugio Casa del Migrante and CHARM started their activities because the doctors and founders were actively working for those who suffered. For immigrants, the support from the local community is very important.

The reason we decided to research the relationship between refugees and health is because we believe that being healthy is crucial for people to live long lives. When we learned that CHARM was established with the goal of ensuring that everyone living in Japan can have a healthy and safe life, we thought it was a perfect fit for our project. In recent years, the number of foreigners immigrating to Japan has been increasing, and our university also has a large number of foreign students, so this topic was familiar and interesting to us. It was a valuable experience for us to conduct extensive research on immigrants and have conversations with people who are actively supporting them.

Through the interview with CHARM, we learned that Japan is a less welcoming country for immigrants compared to the past and that it is important for us as citizens to support their health. When we asked members of CHARM if there was anything we could do, they suggested that students like us should interact with international students, actively engage in conversations with foreigners, and make friends with them, as this would greatly change our perception of foreigners in various aspects of life. Instead of just focusing on changing the image of foreigners, we realized that for those who haven’t had much interaction with foreigners may not know how to approach them and might find it difficult to connect with them. Therefore, we understood that rather than leaving communication barriers with foreigners unaddressed, gradually solving the problem requires us to truly see individuals and take a step towards them. It has been a wonderful opportunity, and we are grateful to everyone who has assisted us.

What can Japan do immediately to help immigrants?

Of course, it is very important to donate money and cooperate with organizations like CHARM. However, as the members of CHARM said, it is necessary for us to enjoy our daily life with foreigners and to know more about them. This awareness will help immigrants and make Japan a better place to live for them.

References

AIDS Prevention Information Network. (2023). 感染症法に基づくＨＩＶ感染者・エイズ患者情報〔令和5年3月27日～令和5年6月25日〕https://api-net.jfap.or.jp/status/japan/data/2023/2308/20230818_HYO-01-2Q.pdf

CHARM. (2023). https://www.charmjapan.com/

Pollmann, M. & Yashiro, N. (2020). RESOLVED: Japan Has Not Done Enough to Bolster Immigration. In Fodale, H. (Ed.Debating Japan, 3 (6). Center for Strategic and International Studies. https://csis-website-prod.s3.amazonaws.com/s3fs-public/publication/Debating%20Japan_Volume%203%20Issue%206_1.pdf

Sugiyama, S. (2023, July 26). Japan’s population falls while foreign residents rise to record. Reuters https://www.reuters.com/world/asia-pacific/japans-population-falls-while-foreign-residents-rise-record-govt-2023-07-26/

Researchers

Hello everyone! My name is Nana Matsumoto. I’m from Japan and I’m 19 years old. I am a student at Kyoto University of Foreign Studies in Kyoto. I live in Hyogo prefecture, and my house is very close to Osaka. In my university,  I am studying Spanish as a major and I am learning French as a second language. I am especially interested in learning grammar and history. I also like English and want to speak with many people in English, so I am conscious of studying at home. My hobbies are watching stage performances, dancing, and singing.

Hi everyone! My name is Kokoro Nomoto, and I am a student at Kyoto University of Foreign Studies in Kyoto, Japan, where I study Spanish and English. Studying Spanish can be challenging, but it is a very rewarding experience when I can understand certain words or concepts and have conversations with international students or speak to my teachers during class. It’s really enjoyable to see my progress and feel a sense of accomplishment.