Atty. Winzel Gamaro, RN, MAN (Philippines)
Interviewed on February 12, 2022
Looking back on your experience of working in a medical setting in Japan, what do you like about Japanese-style nursing?
Nurses in Japan work in groups, as a team. In the Philippines, because of lack of manpower, one nurse usually looks after several patients, at times even one whole ward. Filipino nurses help each other too, of course. But because there is lack of manpower, sometimes a nurse will find herself caring for more than ten patients, with only one nursing aide assisting him/her.
In Japan, there are team leaders. There are like two teams in one ward. Every member of the team has his/her assigned patients to take care of—for instance, around four to five patients. While those patients are his/her responsibility, the other team members will still come to her rescue and assist her, and vice versa.
Are there any differences when it comes to hospitals and nursing styles between the Philippines and Japan?
Yes, there are differences. But these arise most probably because of the differences between the patient population of Japan and that of the Philippines.
In Japan, patients are predominantly geriatric (elderly), which is not the case in the Philippines.
In the hospital I worked at, I cannot be very accurate but I think the patients we cared for were ninety years old and above. One hardly finds ninety-year-old patients in Philippine hospitals. The life expectancy in our country is 70–72 years, I think.
How did you learn about the EPA program?
I became a nurse in the Philippines in 2004. Because I wanted to work abroad, I took a series of exams to be able to work as a nurse in the USA. But due to the recession in America, I entertained the thought of trying to work in another country. (Note: The United States temporarily stopped receiving Filipino nurses during this time.)
Then one evening while watching television, I saw the EPA program on the news. I think it was 2010.
Since when did you start working in a hospital in Japan?
I started working in Kyoto Kujo Hospital in November 2011.
I left my nursing job in the Philippines in the late 2010. After that, I took part in the predeparture Japanese language training program at the Technical Education and Skills Development Authority (TESDA) for about two to three months.
I arrived in Japan in May 2011 as part of the third batch of EPA nurses. We had our five-month Japanese language training at the Association for Overseas Technical Cooperation and Sustainable Partnerships (AOTS) in Toyota, Aichi Prefecture.
In November 2011, I went to Kyoto Kujo Hospital, my employer in Japan. There, I worked only in the morning, took lunch break, then studied for the Japanese Nursing Examination from around 1:30 PM to 5:30 PM.
After work, I would often go to restaurants, like Saizeria, to eat dinner and study until 2:00–3:00 AM. I really wanted to pass the Japanese Nursing Board back then.
What was it like to pass the National Nursing Examination?
I passed the National Nursing Examination on my second attempt in 2013. Before passing the exam, I was merely a member of the support staff. But when I passed the examination, they gradually allowed me to do nursing interventions. I now work on an equal footing with Japanese nurses. That’s when I truly felt the language barrier.
What was particularly difficult?
For example, writing the nurse’s notes in Japanese was extremely difficult. I also had a hard time accurately understanding the vital nuanced expressions in Japanese.
In order to adequately care for patients, we nurses have to assess, analyze, and process lots of information that we get from our observation of and communication with patients. We consider not just the visible symptoms they may have but also the ones they are communicating (even those that can be read between the lines).
It was tough because I was not very good at understanding the spoken Japanese. Add up the Kyoto dialect. It was really hard to understand what the patients were trying to convey at times.
That does sound tough. I suppose there were other patients who, for various reasons, were reluctant in sharing their symptoms with you.
That was not exactly the case. Actually, the Japanese elderly were kind to me. It was more of me being unable to understand what exactly they were saying sometimes. I feared that because I was not getting the information I needed to know before any intervention can be given to my patient, the latter could be harmed or will not be given proper care.
In such cases, when I was not confident about what I heard from the patient, I had no other option but to ask a colleague or my supervisor for help.
Also, during team meetings (nurse conferences) where the hospital staff would share information and exchange opinions, I had a hard time verbalizing my assessments and opinions [in Japanese].
Was there a patient that left an impression on you in Japan?
There is one that I will never forget. There was a patient who, upon learning that I was from the Philippines, would keep apologizing to me every time I took care of him. “What are you apologizing for?” I asked. He said, “I’m apologizing for what the Japanese army did to your countrymen during the war.”
I thought that the war was long over, but to encounter a Japanese person like him who has not forgotten about the past and apologized to me made me feel glad.
Had you been homesick at times?
Yes, most of the time.
It is part of the Filipino culture to keep “close family ties.”
I have a very close-knit family. So I suffered from homesickness all throughout my stay in Japan. Had my mother or sibling lived with me in Japan, I would have stayed a bit longer.
What do you often do to overcome sadness from homesickness?
To overcome sadness, I would often go to church even late in the evening to pray to God. I also walked for one to one and a half hours from AEON Mall to my ryou (dormitory). I likewise focused on studying, because I badly wanted to pass the nursing board exam back then.
After work, I would go to a restaurant or a shopping mall and study up to the wee hours.
I found the streets of Kyoto very safe. You won’t be frightened to walk at 2:00 or 3:00 AM in there.
What do you think could be changed about the EPA program to make it better?
I would suggest giving [the EPA candidates] necessary information prior to hiring them: an overview of the Japanese culture, the Japanese nursing system and its differences from the Philippine nursing system, and the language barrier not only in daily life but also most especially in the hospital setting. They have to know the pros and cons, and the situations they will most likely encounter. If they are discouraged by all these, maybe they should not enter the program in the first place.
Mental preparation is vital. A mentally prepared nurse who is fully aware of what he/she will be facing and still chooses to proceed will likely to stay longer in Japan. More so after he/she has passed the board exam.
Please tell us what you have been doing since you went back to the Philippines.
When I came back to the Philippines in 2014, I initially planned on going back to Japan to study at Nagasaki University as a research student. I also wanted to pursue a master’s degree. I wanted to pursue research on how to help improve the passing rate of Filipino nurses taking the Japanese board exam. And Prof. Yuko Hirano of Nagasaki University was very willing to help me back then. However, my family persuaded me to stay in the Philippines.
After going home in 2014, I went to law school, got hired at the local government unit (LGU) of Dolores, Quezon, while still studying law, and passed the 2019 Bar Examination in 2020.
In those times, I never stopped communicating with Hirano Sensei and Yoneno Sensei. Even though I have kind of changed my field of work, still I want to keep helping and contributing on researches conducted for the benefit of Filipino nurses working in Japan.
Even if I was not able to pursue the research study, I still want to help my fellow Filipino in whatever way I can—even in small ways.
In January 2020, I went to Osaka upon the invitation of Yoneno Sensei and her team. There I met Indonesian and Vietnamese nurses too. I think the study was funded by Toyota Foundation. It was led by Yoneno Sensei.
I want to keep my ties with the Japanese researchers/professors in pursuit of improving the EPA program for Filipino nurses. I was once one of them. And I had a firsthand experience on how it was. Even on how to pass the Japanese nursing board.
At present, I am still working at the LGU of Dolores, Quezon, while also doing private practice of my profession as a lawyer.
Now that you are working in a different field as a lawyer, do you think your experiences in Japan are still significant today?
Yes, definitely. Living alone abroad plus the language barrier helped me grow mentally as a person. Along with being independent, I think Japan has unleashed the strength of a woman within me.
The rigors of law school while working were extremely difficult. But because of my experiences in Japan, I have developed coping skills against adversity and stress, which I was able to use while studying law and even now as I work as a lawyer.
Looking back, the journey was never easy, but in every mountain to climb, one needs to pray hard and work hard because, as they say, the view from the top is breathtaking.