A 2008 Economic Partnership Agreement allows a number of Indonesian and Filipino nurses and caregivers to train and work in Japan. But the compulsory national exam and the level of language the overseas workers must pass is for most too difficult - no Indonesian nurses passed last year's exam.
Presenter: Bo Hill
Healthy Seventina, Indonesian healthcare worker trainer; Dr Yuko Hirano, associate professor health sociology, Kyushu University
HILL: It's a job that, for many Indonesian and Filipino nurses, would appeal simply because it's a chance to earn a better salary then they would at home. But as nurse trainer, Healthy Seventina, explains, there are many obstacles on the way.
SEVENTINA: In Japan and Indonesia - different. The equipment, so difficult. And then about the examination - so difficult.
HILL: Ms Seventina's Indonesian trainees study four to six hours a day for six months at home, and then another six months in Japan just to qualify for the training. They then have three chances to pass the national licence exam - which is conducted in Japanese.
SEVENTINA: So difficult because there is hiragana, katakana, and kanji - kanji's so very difficult.
HILL: And it's the ability of overseas nurses to use kanji, which consists of tens of thousands of Chinese characters, that concerns the Japanese Nursing Association. In an email to Radio Australia, JNA's executive director, Shinobu Ogawa, says no nurse can do without kanji in a healthcare setting in Japan. He says, for example, a kanji character for 'right' is very similar to the one for 'left'. Mr Ogawa says if a nurse confuses them, a tragic accident may occur. Healthy Seventina says of one thousand graduates from the training school in Java, just 30 were able to qualify for training in Japan, and of those, just five passed the national exam, giving them the right to work as nurses. At a meeting earlier this month in Tokyo, the Japanese Foreign Minister assured his Indonesian and Philippines counterparts that his government would consider addressing the exam's language problem, but Dr Yuko Hirano, a sociologist at Kyushu university, says it's unlikely to happen.
HIRANO: The latest news I heard was the Ministry of Health and Welfare say they've rejected making the exam easier.
HILL: The Japanese Nursing Association's Shinobu Ogawa says a dependence on anything from overseas is risky and therefore a policy seeking foreign healthcare providers will never be supported by the Japanese people. Medical sociologist Dr Yuko Hirano has followed the success of the foreign worker program since the deal was signed in 2008. She says the JNA attitude reflects wider community values, which makes the obstacles for the Indonesian and Filipino workers even higher.
HIRANO: Since the EPA started, huge argument's been going on here. And many of those people are saying it's too early for the Japanese society to acommodate those foreigners because we have a still strong stereotype against those foreign workers in Japan, easily connected to the idea that if you introduce the foreign labour to the health sector, then the health sector, or health-related labour will be spoiled.
HILL: And Dr Hirano says while the nurses and caregivers are struggling to make the grade, a lower standard of national exam would put them at a greater disadvantage in the long run.
HIRANO: If you make the national board examination easier, for example conducting the examination in English, of course many Filipino nurses or the Indonesian nurses will pass the board examination. But we have to think about this. Again, we are a very conservative society, and then politically, socially, psychologically, we are not welcoming the foreign people. So if you offer examination in English and even if you pass it, you will be concerned by Japanese people "you cannot pass the Japanese language, you passed the English, so you're the second level of nurse." You know, in other words, I can say that the national board examination itself will be let's say, you know, the passport to get in, to work in our society, the Japanese society, to work with the equal level, the equal opportunity with Japanese people.
HILL: With similar agreements expected to be signed by Japan with Thailand and India soon, and Nepal also hopeful of one, Japan's strict policy could be set to cause even greater problems.