Japanese explore Nepali workforce for caregiving sector

Dr Todani Seiji, Yukio Wada, Shinichi Hottaand Sano Hieo visited Nepal to explore opportunities for recruiting Nepali workers for their companies. Dr Seiji is president of Seijinkai Medical Corporation and owner of Todani Hospital in Hiroshima, Japan, was inspired by Dr Iwamura, an assistant professor at his medical school, to donate to Dr Iwamura Memorial Hospital in Bhaktapur, Nepal. Wada, Director of the Nursing Care Division at Daiki Angel Help Co, Ltd, and Chairperson of The Restaurant of Mistaken Orders Association, pioneered a new approach to dementia care in Tokyo and launched the global award-winning Restaurant of Mistaken Orders project. Hotta, MBA graduate from Bond University, Japan, has served as a director and CEO in the healthcare sector. He is currently the Chair of the International Welfare Medical Management Support Association and CEO of Shinichi Hotta Office, Inc and Hideo is a former Japanese government officer. Excerpts:

Dr Todani Seiji

Dr Iwamura served as an associate professor at the Tottori University Faculty of Medicine, where my father studied as a student.

I have heard that when Dr Iwamura first arrived in Nepal, access to running water and electricity was minimal or nonexistent. Despite such challenging conditions, he not only treated illnesses but also focused on educating people about hygiene and providing medical care to improve their quality of life. Dr Iwamura believed that medicine is not solely about curing diseases but also about supporting and enhancing people’s lives. Both my father and I, as physicians, strongly align with this philosophy.

The first step toward progress is implementing a universal health insurance system, enabling citizens to live and work with peace of mind. The next crucial step is improving sanitation. In Nepal, the development of water supply and sewerage systems is of paramount importance.

For the first time in Nepal, we have hired two male caregivers. I hope they will gain in-depth knowledge of Japanese healthcare and hygiene practices and bring that expertise back to Nepal, contributing to the country’s progress.

Yukio Wada

Taking advantage of the privatization of my former employer, the Japanese National Railways, I decided to resign. At that time, I was actively involved in a citizen movement advocating for better train accessibility for people with disabilities. This experience inspired me to pursue a career in social welfare, ultimately leading me to the field of elderly care.  

When I entered this field in 1987, individuals with dementia receiving care at home faced immense challenges. Limited social care systems often left families with no choice but to hospitalize their loved ones when they could no longer manage care at home.  

Over the years, improvements in elderly welfare systems allowed people to transition into elder care facilities. However, the prevailing approach was primarily about “sheltering and protecting” residents. In 1999, a transformative shift occurred with the introduction of group homes for individuals with dementia. These homes catered to smaller groups, focusing on personalized care. This also marked a philosophical change in caregiving—from merely performing tasks for individuals to a supportive model of “watchful assistance”, empowering people with dementia to participate in daily activities and maintain a sense of normalcy within their community.  

In 2003, Japan demonstrated global leadership by replacing the stigmatizing term ‘chiho-sho’ (a derogatory term for dementia) with the more respectful term ‘ninchi-sho’ (dementia).  

Despite these advancements, my innovative caregiving methods faced criticism. After a television broadcast showcased the daily lives of residents in my group home, I was accused of neglect and abuse. Critics argued that allowing residents to make their own choices—such as deciding what to eat, cleaning, shopping, and not locking the facility's front door—was unacceptable.  

The impact of my approach, which contrasted sharply with traditional caregiving practices, drew significant attention, including a full-day observation by officials from the Ministry of Health, Labour, and Welfare. Interestingly, it was the media that most resonated with my initiatives. Television programs and magazines began covering our work, culminating in a feature on NHK’s Professional.  

During the filming, a pivotal moment unfolded. Residents had chosen to prepare hamburg steak for lunch, shopped for ingredients, and cooked the meal with staff. When the food was served, it turned out to be dumplings instead. Initially, the program’s director, Oguni, nearly corrected the ‘mistake’. However, seeing everyone enjoy the meal without concern prompted him to reevaluate his perspective. This experience inspired the concept of ‘The Restaurant of Mistaken Orders’.  

I had also envisioned creating a space where individuals with dementia could work and earn money. Combining this idea with Oguni’s concept, we brought The Restaurant of Mistaken Orders to life.  

The project involves a unique team of professionals outside the healthcare sector, including leading creators from Japan’s top advertising agencies, bringing expertise in launching socially impactful initiatives. We also collaborate with industry organizations, fostering a collective effort to drive change.  

Additionally, we travel across Japan to respond to invitations and media requests, using these opportunities to raise awareness about dementia and caregiving. Our goal is to engage both the general public and professionals in meaningful discussions on these topics.  

Nepal is on the cusp of facing caregiving challenges. While family members will likely remain central to caregiving, I believe the future lies in developing a system where professional caregivers are trained to collaborate with families. This would foster a society that provides better support for care recipients.  

To create a caregiving system tailored to Nepal’s unique needs, it would be valuable to incorporate diverse perspectives, including alternative approaches like mine. Drawing from varied experiences will be crucial to building a caregiving system that effectively supports Nepal’s population. 

Hideo Sano

I visited Nepal for the first time in 1988 while working as a staff member for Fukuoka Prefecture. I came as part of a project to accept technical trainees from Nepal. Compared to that time, Kathmandu now feels like a vibrant city. Today, many Nepali people choose Japan for study or employment opportunities. I hope that more Nepali citizens will continue to come to Japan and contribute to addressing Japan's aging population and low birth rate.

Shinichi Hotta

Many Nepali people are taking advantage of the specific skills program to challenge themselves in Japan’s caregiving sector. Nepali citizens, who are accustomed to living in extended families and have a strong tradition of respecting elders, tend to thrive in this field. In caregiving facilities in Japan, they are performing exceptionally well, often matching or even surpassing workers from other countries. Additionally, Nepali people generally have a high aptitude for learning Japanese, with soft and clear pronunciation. They also tend to avoid self-assertion, which aligns with Japanese cultural norms. This has contributed to the growing popularity of Nepali workers in Japan, with many caregiving facilities hiring them as repeat employees.