China: assistance challenges

Assistance & Repatriation Review | April 2019

The remarkable progression of the Asian market has seen Chinese tourists and businesses becoming ever-more active across the globe. With the resultant growth in the need for local assistance services, Executive Officer of Emergency Assistance Japan (EAJ) Takaaki Chiyo looks at the challenges of language barriers in his line of work and explains how these obstacles can be overcome

Over eight million Chinese people travelled to Japan in 2018, which is an increase of over one million from the previous year, and for this year’s Lunar Chinese New Year period alone, about seven million Chinese citizens are estimated to have travelled somewhere abroad. Japanese businesses have been trying their best to prepare for this significant market: for instance, one of the most recognised ski resorts in Northern Japan has started providing ski lessons with Chinese-speaking instructors in an attempt to match the recent Chinese market shift from consuming tangible products to seeking cultural experiences.¹ 
Japan, despite being a neighbouring country of China, is certainly no exception to those countries being overwhelmed by the impact of language barriers and cultural differences when meeting and dealing with Chinese clients and travellers. That other parts of the world struggle even more comes as no surprise, and the fact that assistance companies in these countries are in need of strategic approaches to handling cases involving Chinese patients – or dealing with Chinese hospitals treating foreign patients – is clear.
Medical translation
When considering the areas of medical assistance most affected by the language barrier, the first that comes to mind is medical translation, where sensitivities can be triggered if the bridge between languages is not forged correctly. There are two main points to consider in this regard – the use of translators and the issue of trust:
Failure to dispatch translators with the appropriate language skills can lead to a badly communicated diagnosis, whereby information is not relayed accurately, causing unnecessary upset for patients and their families. For example, there was a case in Japan some years ago in which a Nepalese boy was diagnosed with a brain tumour and had only three months to live. The translator did not understand the word for ‘life expectancy’ in Japanese and gave the parents a contradicting diagnosis: that the boy would be fine. The article noted that it was immediately apparent that there was miscommunication, as the parents continued to smile after being told the diagnosis. The hospital hired another translator and after an eight-hour word-for-word translation of the medical diagnosis, the parents were told the true outcome and were able to properly comprehend the situation.2
The risks of miscommunication in medical translation can also lead to numerous other issues, from medical mistreatment to an inability to collect payment for outstanding bills. 
A question of trust
Our Chinese-Japanese translator in Shanghai (who is from Japan) revealed some of his experiences of medical translation in China – describing difficulties in communicating specifically with Chinese patients. First, he said, before the medical translation even starts, one must gain a patient’s trust, as, generally speaking, it can be hard for some Chinese people to trust someone they have only just met. The translator’s experience of China is that people tend to trust their acquaintances more than others and, surprisingly, information from the internet is regarded as more trustworthy than that received from an unknown person – doctor or not. However, when these patients are influenced by word of mouth and the internet, it can lead to misinformed expectations of the medical service, which later results in complaints; although this is applicable to any nationality. 
This trust issue lies not only with the patients but also with the medical providers. In some difficult cases, our translator has had experience of some medical providers in China who assumed that medical translators would not be able to fully understand the medical terms and, as a result, the informed consent process ended up being insufficient and, yet again, resulted in problems for the patients. The key, then, is to ensure effective communication.
Communicating effectively
Based on our experience, the following strategic approaches should be implemented to ensure the best possible avenue of communication in assistance cases:
Always provide an opportunity to communicate with the patient and the medical provider at the earliest possible opportunity in order to manage all parties’ expectations. More specifically, ask the patient or doctor to kindly speak more slowly, if necessary, to let the translator catch up in order to provide a high-quality translation.
Utilise supplemental written information with both patients and medical providers. This will avoid misunderstandings and confirm whether there is any content that has been missed out. 
When looking at the impact of different expectations among different cultures, a key consideration for the assistance industry is medical infrastructure. When it comes to China, there are three things to consider in this regard: medical service and hospitality, fees for the medical service and cleanliness.
Medical provider classification
As many are aware, there is a classification system for medical providers and facilities in China – for the medical facilities, this is a combination of the three-tier system and the subsidiary three grades, which results in a total of nine levels; and for the providers, there are three grades of title after the associate. These classifications apply to both public and private hospitals, so the factors we are discussing below should be seen as supplemental information for the classification of each provider and facility.  
Growth in the privatisation of hospitals has been escalated by a fast-growing wealthy population. Like in many other countries, the largest difference between public and private medical providers is the fee structure – in China, private hospitals charge a much higher fee, which can be up to 10 times more than that of public fees. The difference in the fee structure is mostly reflected in the level of hospitality service provided and not so much in the medical service. While public hospitals mostly provide a wide variety of medical services, which are considered of a much higher level than those available in the private sector, private hospitals mostly specialise in a specific medical area and distinguish themselves by providing luxurious hotel-like suite rooms for the patient and their family to stay in. Also, they often come with escorts located in multiple locations within the building to help the patient with anything they need, including taking care of the registration documents and caring for their personal needs. Since private hospitals cannot always secure the most experienced doctors as public hospitals are able to, some doctors from public hospitals with higher-ranking titles occasionally work at private hospitals too. 
Having said this, the characteristics described above can apply to both private and public facilities depending on the area the facility is in and its specific circumstances – so it is actually quite difficult to generalise. 
Cleanliness in medical facilities is a fundamental requirement and is one of the determining factors when it comes to choosing a medical provider in any culture. Private hospitals in China are mostly spotless, while in public hospitals you might occasionally witness a stained floor or walls with some cracks in the exterior of an old building – although nothing too critical. A Japanese dentist who has worked in China for a while told us that the regulation for sanitation is very strict in China. Their acute awareness of sanitation and care can be seen in the tools they use – such as dental drills that are almost always disposable.
As the global economy and political situation changes rapidly, the importance of having local guidance to help navigate processes in a foreign country cannot be over-estimated. We, as a medical assistance company, can only arrange for medical services according to the patient’s needs, but it is important to be aware of the different options and what each one involves. 
At EAJ, we have created a variety of checklists for assessing medical providers in different structures and according to their areas of medical provision. These allow us to maintain our own standards by using quality medical facilities all around the world, despite their various differences. ■


Takaaki Chiyo, executive officer of EAJ, has been involved in the industry since the establishment of the company, gaining in-depth knowledge through his time spent living in the United States, China and South Asia over the last decade, and developing management strategies for the business’ operations and for its networks for inbound and outbound medical assistance. Mr Chiyo is also president of EAJ China, serving this dynamic market through the company’s rapid advancement of digitisation.