Wednesday, May 16, 2012

[Vital Signs Column] Reviewing JPEPA – Becoming a Japanese Nurse

Vital Signs, is the FIRST newspaper for the medical community. It caters to doctors, health workers and other healthcare professionals, bringing them the latest health news, scientific updates, as well as opinions, and commentaries on current issues impacting healthcare delivery in the country. You can read Alvin Dakis' columns on nursing & social issues named Nurse's Notes in every Vital Signs newspaper published every 1st & 15th of the month. 
May 1-15, 2012 Issue

I remembered when I was still in nursing school; this has been a topic which a lot of nursing leaders are talking about and many are against. I remembered they were in the news rallying and saying that JPEPA (Japan-Philippines Economic Partnership Agreement) will not be a good partnership agreement between Philippines and Japan.

I had those information and biases before I became actively involved in nursing politics and issues. I have no clear information whatsoever about JPEPA and how it works.

Until I got an invitation from the Department of Health to become one of the Panel Reactors to the 4th National Human Resources for Health Policy Forum to react on – who would have thought – JPEPA.

One of JPEPA’s objectives is to open up Japan’s labor market for employment of Filipino professional healthcare workers and to have mutual recognition of education or experience obtained, requirements met or licenses or certifications granted in the Philippines and Japan. This is one of JPEPA’s top bilateral & multilateral agenda.

But what has happened from the time JPEPA was agreed to be implemented by both parties? What happened to our nurses? During the entire presentation, I was more of focusing to the quality of life our nurses are experiencing there and of course the rate of the passing of the Japanese Nurse Licensure Examination. Here are some of the things I’ve learned.

The deployment and acceptance of Filipino nurses and certified caregivers to Japan is a government-to-government arrangement based on the Economic Partnership Agreement between the Philippines and Japan, particularly in the movement of natural persons. Sadly, we didn’t see this coming. The Philippine government works with JPEPA under POEA while JICWELS is the agency that deals for the Japanese government. JICWELS is not a government agency and therefore the Philippines are not communicating directly to the Japanese government official. According to the report made by POEA, in their last dialogue Japanese government agreed to have a direct engagement with POEA.

There are types of health workers who can enter Japanese shores under the implementing agreement in JPEPA and there are four:
1.      Candidate-Nurses
2.      Candidate-Caregivers
3.      Qualified Nurses
4.      Qualified Caregivers
Candidate nurses & caregivers are those who are still studying the Japanese language and culture but who are already in Japan. Their employers, some of them, allow them to study and review for the Japanese licensure examinations.  While qualified nurses & caregivers are the ones who passed the licensure exams.

The Philippines sent a total of 209 nurses from 2009-2011 with only 15 passing the Japanese Nursing Licensure Exams in 3 years. The highest of which was from the 1st Batch with 93 nurses then a sudden drop of nurses in the 2nd Batch with 46 and 70 nurses in the 3rd Batch. Nurses have a more unstable number of availing the program compared to caregivers.
Nurses receive a daily stipend of P435, daily food allowance of P350, free accommodation, uniform allowance and an emergency medical insurance. But even though these allowances were given only a few nurses would accept the JPEPA program.
Well there are a couple of reasons behind:
·         It is definitely not easy to learn the Japanese language in about 6 months – more so their writing system, Kanji. When JPEPA started, the Japanese Nursing Licensure Exam is in Kanji, and nothing in English. This became a total disaster for Filipino nurses taking the Board Exam. If in the Philippines where the exam is in English many students do not pass, how much more if it is in Kanji? Good thing recently the Japanese government is willing to change some familiar nursing & medical terms in the board exams to make it easier for international health personnel to understand the questions;
·         There were some complaints arising out of differences in the terms of employment of the institutions/hospitals were some reported that some institutions are more advantageous than the others. Some nurses/caregivers felt dissatisfied and thought that they have not been matched with the institutions that offered more superior package of benefits;
·         Many nurses who went to Japan had a lot of coping & adjustment problems like being homesick or sometimes getting early pregnancy which affected their performance and ability to focus on training. Many of them are facing early repatriation; and
·         Nurses also had some problems when they face transitioning from their language training to the actual-on-the job training where some amenities they enjoy during their language training is not provided.
During the presentation, there were some recommendations & proposals to improve JPEPA-MNP implementation, such as:
  • ·         JPEPA should institutionalize a standard working contract, where all of its nurses and caregivers should sign & follow. Currently, Filipino nurses follow the working contract of their different agencies and therefore follow different policies;
  • ·         Improve the training and deployment process under the Implementing Agreement between POEA & JICWELS and to ensure these initiatives are included;
  • ·         Extend the period of stay of candidate nurses to four (4) years (which was formerly 3 years) and to allow them to take the Japanese Nursing Licensure Exam after a year of their stay. Should the candidate nurse fail the first exam, he/she may be allowed to have 3 attempts to pass the exam from the 2nd to 4th year of stay;
  • ·         There should at least be one (1) month allocated in the six (6) month training in Japan for technical review of the Japanese nursing licensure exam aside from the basic Japanese language training; and
  • ·         Reduce the clinical work qualification requirement from three (3) years to two (2) years.
I added that nurses who are there in Japan should also be given equal access to labor rights protection and basic services. POEA and other government instrumentalities should have a regular assistance and check-up on their statuses so that we will know if the program is still functioning according to its goals.

Many young nurses still do not see Japan as a country that they can work and migrate to similar to other western countries. Unlike the Middle East countries where it is easier for them to work abroad, Japan has a lot of processes for foreign based health personnel and even though they are needing more nurses and trained caregivers, their culture and language would be a bit difficult for our professionals to learn in such a small amount of time.

The Philippine Nurses Association recommended that such language and acculturation training be initially introduced in the basic nursing curriculum perhaps as subjects where nursing students can choose from.

After hearing Administrator Hans Leo Cacdac of POEA presented JPEPA and its developments, I felt that there is a need for nurses to understand how JPEPA works and that they are not Registered Nurses when they arrive in Japan unless they pass the Japanese Nursing Licensure Examination because according to the response of Dr. Cora Anonuevo of UP Manila, many of the nurses do not even perform vital signs to their patients when they arrive in Japan and that made them very frustrated.

I believe that this program needs to spread to all schools & colleges of nursing and those students as early as 3rd Year College would know about this opportunity and if ever they decided to become a nurse in Japan they would know exactly what to do.

It is officially summer in the Philippines! And we are experiencing the summer heat again. Nurses know that summer is usually the time of the year where we do a lot of free circumcision services to young boys commonly called “Operation Tuli”.

I do remember about 2 years ago that there were some scandalous photos of nurses taking photos of young boys being circumcised without their faces covered and their underpants down. Those photos went viral and that it went to the headlines. Claims of pedophile nurses filled the news.

I would like to remind all nurses that there are ethical guidelines we need to follow during circumcision and “Operation Tuli”
  •     Nurses are not allowed to suture wounds unless trained according to Section 28 of the Philippine Nursing Act of 2002;
  •      Should nurses suture, it should be under the supervision of a surgeon;
  •    Suturing is not a nurse’s role – but more of assisting the surgeon during the operation and in health education and assisting clients;
  •    Nurses should remember that clients are protected by their Bill of Rights and minor clients are also protected by Children welfare laws. Taking photos without consent and exposing unnecessary body parts or even the identity of your clients are strictly prohibited, unprofessional and unethical; and
  •      Nurses should only assist clients, not force them to take the procedure if they do not want to. Explain to parents that children have the right to refuse the procedure should he wish to. Nurses must also educate their young clients the method, processes and rationale of circumcision in a simplified manner. However, the right of the person undergoing the procedure should prevail at all costs.
You may see the online copy of this article and so as all my previous columns in my blog: where I also write my other opinions and information on health & social issues.

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