At hospitals and clinics, communicating the names of illnesses,
explaining the consent form for an operation, and other medical
minutia can be a challenge for staff, even when talking to a
Japanese patient. When the patient is a foreigner, the language
barrier can magnify those challenges, which is where medical
interpreters come in.
Medical interpreters aim to explain medical workers' intentions
as precisely as possible to patients, and in turn relate the
patients' thoughts clearly to Japanese doctors and nurses. In
hospitals, where life and death decisions are made by medical staff
every day, these interpreters have a great role to play in the
welfare of foreign patients.
"Look up, please," and "We're going to apply this gel,"
translates certified foreigner supporter Mieko Shikayama, 65, for
Brazilian patient Lidjane Shimabukuro during an ultrasound exam of
her thyroid. She stays close to Shimabukuro, holding her hand as
she relays the ultrasound technician's directions in
Portuguese.
"Until now, even if I was in pain I'd just bear it," says
Shimabukuro, who until recently had had to hire a translator for
medical checks out of her own pocket. "There were no translators at
the hospital, so I often couldn't go. This is really amazing," she
enthuses regarding the medical translation offered here at
Izumisano Municipal Hospital in Izumisano, Osaka Prefecture.
"Even if you speak a little Japanese, you can't understand
difficult words like disease names or terms used in test results,"
says Shimabukuro's husband. "It's such a relief that we can also
say what we want to the doctors clearly."
The hospital is close to Kansai International Airport, and
foreigners brought in on emergencies are not uncommon. Thus, in
fiscal 2006 the hospital established an international outpatient
facility, providing medical translation in English, Spanish,
Portuguese and Chinese. The facility provides examinations by
appointment, and medical interpreters and certified foreigner
supporters -- who aim to become medical interpreters -- are on
standby from 9 a.m. to 3 p.m.
The service is provided free of charge, and the hospital has
been receiving visits from patients even from outside the
prefecture as word of the interpreters spreads. The number of times
the service has been used has been rising, from 88 times in fiscal
2006 to 427 times in fiscal 2008.
"There are different ways of thinking about medical care,
depending on one's culture and religion," says the hospital's head
of health management Kaori Minamitani, who also does interpreting
in Spanish and Portuguese. "Medical interpreting is very important
in preventing problems."
There are also entire regions in Japan that dispatch
interpreters to medical facilities with the support of non-profit
organizations (NPO). For example, local bodies in Kanagawa
Prefecture have taken on the expense of providing interpreters,
provided by the NPO Multi-language Information Center (MIC). MIC is
cooperating with 17 medical institutions in the prefecture and,
including instances when the NPO has decided independently to
dispatched interpreters, their services were used 3,561 times last
fiscal year. Furthermore, the NPO Center for Multicultural
Information and Assistance Kyoto provides interpreting services to
four hospitals in that city.
Unfortunately, such services are not available everywhere in the
country. Medical institutions are not duty-bound to provide
interpreting services, and the central government has no system in
place to take on the cost of interpreters as a part of medical
expenses. Additionally, the ability of the interpreters varies, and
the question of compensation in cases where a mistranslation causes
serious problems remains, leading many institutions to hesitate to
provide interpreters.
"Everyone has the right to an equal level of medical care," says
Izumisano hospital assistant director Mamoru Ito. "I hope that both
medical institutions and the government will work toward creating a
system where foreigners can seek care with peace of mind," he
concludes.
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The Mainichi also spoke to Izabel Arocha, president of the
International Medical Interpreters Association (IMIA) -- an
organization affiliated with some 2,000 medical interpreters in 15
countries -- concerning the importance of medical interpreters.
"When most people think of interpreting, they think about
conference interpreting or business interpreting. They don't
usually think about medical interpreting. But that is the area
where the most interpreters are needed all around the world. The
demand for this new specialization is much greater than the supply
of interpreters who are educated and qualified in (the medical)
setting. These are situations where a miscommunication or
misinterpretation could be the difference between life and
death.
"We're working hard now to standardize interpreter quality
through certification... and improving the working conditions of
(qualified) interpreters, so that they are able to stay in the
field. This is difficult because there are many, many
interpreters.
"(For example,) there are about 15,000-20,000 interpreters in
the U.S. working in the medical field, and their qualifications are
diverse. Some of them are highly qualified, highly-educated. Some
have PhDs and they have a lot of training in medical interpreting.
And some are... without enough English knowledge, and without
enough training, because the need is so great. (However,) we're
very close to launching a national certification system (in the
U.S.), the first one in the world that is specifically for medical
interpreting.
"(Medical interpreting) is not new in Japan (but) you have to...
increase awareness of this issue. (However,) I think Japan is going
in the right direction. What I admire about Japanese is that they
respect and value education... and that is really key. I think it
will make Japan... leap ahead.
"Health care is a right. If you want to have health care, you
need to communicate with the doctors, so communication is a right
as well."
(Mainichi Japan) June 13, 2009
◆外国人患者支える「医療通訳」とは。
医療の現場で日本人医師や看護師などと外国人患者とのコミュニケーションの橋渡しをするのが「医療通訳」。医療現場では、病名の告知、手術の同意書へのサインなど、日本人同士でも問題が発生することがある。外国人患者ならなおさらだ。医療者の意図を過不足なく患者に説明し、一方で患者の思いをすくい上げて医療者に伝える。生死にかかわる医療現場で期待される役割は大きい。
「上を向いて」「ゼリー塗ります」。市立泉佐野病院（大阪府泉佐野市）で甲状腺のエコー検査を受けるブラジル出身のシマブクロ・リディジャネさん（３０）には、認定外国人サポーターの鹿山ミヱ子さん（６５）が寄り添っていた。鹿山さんは手を握りながら技師の指示をポルトガル語に訳す。
今まで自費で通訳を雇って受診してきたリディジャネさんは「今までは痛くても我慢して、病院にはなかなか来られなかった。本当に素晴らしい」と笑顔を見せた。付き添っていた夫のジェフェルソンさん（２９）も「日本語が少し話せても病気の名前や検査の結果など難しい言葉は分からない。言いたいこともしっかり伝えられ安心」と話す。
関西国際空港に近い同病院には外国人の救急搬送も多く、０６年度から「国際外来」を設け医療通訳を配置した。英語、スペイン語、ポルトガル語、中国語の４言語に対応する。予約制が基本で、医療通訳者と、医療通訳者を目指す認定外国人サポーターが午前９時から午後３時まで待機する。
利用者に費用負担はなく、うわさを聞いた他府県からの患者も増えている。利用件数は０６年度の８８件から０８年度には４２７件になった。自らスペイン語とポルトガル語の通訳を務める同病院の南谷かおり・健康管理センター長は「文化や宗教からくる医療に対する考え方の違いもある。トラブルを防ぐためにも医療通訳は重要」と話す。
＊
民間団体の協力を受け、医療機関に通訳を派遣する地域もある。神奈川県では地元自治体が費用を負担し、ＮＰＯ法人「多言語社会リソースかながわ（ＭＩＣかながわ）」が医療通訳サービスを実施している。提携先は１７病院に及び、ＮＰＯ独自の判断で派遣した場合も含めると昨年度は計３５６１件の利用があった。また京都市内でもＮＰＯ法人「多文化共生センターきょうと」が市などと一緒に４病院に通訳を派遣している。が、すべての地域で同様のサービスがあるわけではない。
医療機関に医療通訳を配置する義務はなく、費用を診療報酬での点数の加算などで国が実質的に負担する制度もない。通訳者のレベルもさまざまで、誤訳からトラブルが起きた場合の補償問題もあり、医療機関が導入をためらう原因となっている。「本来、誰でも平等に医療を受ける権利があるはず。外国人が安心して医療を受けられる体制を作れるよう国も病院も努力してほしい」。市立泉佐野病院の伊藤守副院長は訴える。【渋江千春】
１５カ国約２０００人の医療通訳者が加盟する国際医療通訳者協会（ＩＭＩＡ）会長のイザベル・アローチャさん（４５）に、医療通訳の重要性について聞いた。
通訳にはさまざまなジャンルがあるが、世界で今最も必要なのは医療通訳。救急処置の現場にいたかと思えば、出産に立ち会う。患者の文化的背景を理解しつつ、医療スタッフと患者の言葉を漏らさず伝えることが命を救うことにつながるすばらしい仕事だ。
ところがあまりにニーズが多いため、米国でも１万５０００人から２万人いる医療通訳の中には専門的な訓練を受けていなかったり、語学力が足りない人もいる。他の分野に比べ報酬も１時間平均約２０ドル（約１９００円）と安い。待遇を改善するためにも、医療通訳者の能力を保証する必要がある。現在、米国で全国規模の認定制度を作る準備をしている。
十分な医療を受けるのはすべての人が持つ権利だ。日本でも取り組みが進んでいるので、今後の飛躍に期待したい。