TOKYO >> During one of her medical-interpreting lessons this summer, instructor Yoshiko Ishizaka brought up the case of a former student who was dealing with schizophrenia.

The principal of Tokyo-based International Medical Interpreter Academy used the example to engage her class in a discussion about the difficulties of interpreting while assisting patients with complex mental conditions.

“As an interpreter, you need to make patients feel comfortable so they open up. If you put yourself in their shoes, you’ll know what kind of help they need,” she told the class.

The academy is one of a growing number of institutions training students to become interpreters amid a tourism boom that includes people seeking quality medical treatment in Japan.

Ishizaka’s program draws students from across Japan, and the teacher calls its popularity a sign of the growing interest in medical assistance services that cater to foreigners.

According to the health ministry, 31.2 million people visited Japan last year, and the government hopes to increase that number to 40 million next year, when Japan will host the Olympics.

That means more medical emergencies involving foreigners. The government estimates that 5% of visitors get sick or injured while in Japan. Yet few medical institutions are prepared to treat patients whose primary language isn’t Japanese. As of July, only 65 institutions nationwide had been accredited to accept foreign patients.

But a government task force aims to improve health services for foreigners, particularly emergency services. Next year, the government will begin revising the licensing system for medical interpreters, aiming to boost the caliber of their services. Interpreters are currently certified through medical interpreting schools and organizations, or not certified at all.

Ishizaka said there is increased demand for interpreters. Her school teaches interpreting for English- and Chinese-speaking clientele.

She said medical interpreting is complex. “I always tell students that interpreting and interpreting in health care are two different things.”

Ishizaka’s curriculum covers differences in health care systems, forms of treatment and services, and cultures. “One of the first problems foreigners may stumble upon is the difference between insurance systems, and there needs to be someone who can explain it to them,” she said.

Medical interpretation schools and their students welcome government-sponsored certifications as a means to providing a higher standard of service.

But others in the medical field are concerned the reforms will exacerbate problems the government is desperately trying to address: foreign access to medical services amid a raging tourism boom. Catering to the needs of tourists, many of whom are wealthy and speak Chinese or English, may marginalize members of the country’s foreign community.

Dr. Takashi Sawada, head of the Minatomachi Medical Center in Yokohama, is concerned that changes to the interpretation system could widen the care gap between well-heeled travelers and a large group of foreign residents who struggle to afford treatment.

“There’s emphasis placed on travelers and interpretation into Chinese or English, but the growing foreign population in Japan hails from countries where none of these languages is spoken,” and many can’t afford to pay high medical costs, he said.

Under the changes, medical institutions certified to admit foreign patients would be required to provide interpretation in person or via tablets or videophone systems — a pricey service.

“Smaller clinics may no longer be able to cover the cost of such services, (so) the patients will be forced to cover the fee for interpretation,” Sawada warned.

He is also concerned that certified interpreters will seek higher-salaried work in the medical tourism industry or at private clinics where patients seek treatment at their own expense.

Each year, Kanagawa Prefecture dispatches volunteer interpreters to about 7,000 medical emergencies and treatments.

Serina Okamura, an associate professor at International University of Health and Welfare in Tochigi Prefecture, agrees that the government’s scope is limited. She is an adviser in a government-wide task force on the issue.

At a Tokyo symposium in May, she expressed concern that despite the various scenarios being examined, the government has yet to come up with measures to prepare all medical institutions, especially in the countryside, for foreign patients.

“In rural areas, medical institutions that until recently didn’t have to treat foreigners are now more likely to encounter, for instance, an Indonesian national in urgent need of medical care,” she said.

She also worries about the sustainability of health care for the foreign community, including interpretation services.

“To make the scheme work in the longer run, if the number of tourists continues to grow, medical institutions will require more finances and more staffing than is planned,” Okamura said.

Writer Hinano Kobayashi contributed to this story.