AMEFA 一般財団法人アジア医療介護交流協会　Asian Medicare Exchange Foundation Association

2021年3月20日
タイ語通訳としてお世話になっている、パヤオ大学の八巻氏が日本人ロングステイヤーについて論文を発表しましたので掲載します。
AMEFAの現地における活動など詳細に記されています。

The Value and Wisdom of Active Japanese Elderly
-A New Model of Management long-term staying Japanese in Thailand
Isao Yamaki1, Jarunee Dibyamandala2, Charin Mangkhang3, Chettapoom Wannapaisan4
1 Ph.D. Student (Social Studies), Department of Curriculum Teaching and Learning, Faculty of Education, Chiang Mai University, Chiang Mai, Thailand
2, 3,4 Department of Curriculum Teaching and Learning, Faculty of Education, Chiang Mai University, Chiang Mai, Thailand
1 isao_key@hotmail.com,2 jarunee.d@cmu.ac.th, 3 charin.mangkhang@cmu.ac.th, 4 chettapoom@gmail.com

ABSTRACT
This research aims 1) to study how the changing role of Japanese long-term residents affected by the situation of the new coronavirus in Chiang Mai 2) to study the current problems facing Japanese long-term residents and how to resolve these issues. The research results were found that 1) allow permitting to work and able to do volunteer activities while getting a retirement visa might getting them more closely involved with Thai society. 2) The problems were found as follows: 2.1 concerning about their health, 2.2 Self-care expenses 2.3 the cost of living in Thailand is higher and the yen is falling and the suggestions for solving the problem was 2.4 there should have a good insurance for Japanese elderly long-term residents in Chiang Mai

Keywords
After COVOD-19, Community, Chiang Mai, Japanese long-term residents, Regional Activity
Article Received: 10 August 2020, Revised: 25 October 2020, Accepted: 18 November 2020

Introduction

On January 13, 2020, the Thai Ministry of Public Health announced that a Chinese woman was infected with a new strain of corona virus from Wuhan, China. This is considered the first patient in Thailand. While in Chiang Mai, the first case occurred on January 21, a male from Wuhan. Since then, the data up to August 2, 2020 of the new strain of the corona virus has accumulated 3,317 people, 58 deaths, the cumulative number of infected persons in Chiang Mai is 41 people. (Wikipedia, 2020) The Thai government has announced an Emergency Decree on March 26 to prohibit entry into risk areas, close risk areas, and carry out strict entry and exit measures from March 3 by prohibiting leaving residences from 10 am pm – 4 am. Since then, the number of new infected people has decreased. From June 1, the time for quarantine has been shortened from 11 pm – 3 am of the following day and the school regulations have been relaxed. In addition, shopping malls are open until 9 pm. The outbreak of this new strain of corona virus has a huge impact on the global economy. (Consulate of Japanese in Chiang Mai, 2020) Like in Thailand, EIC (Siam Commercial Bank Economic Intelligence) revised its Thai economic forecast for 2020 to a contraction of -5.6%, taking into account 4 key factors: 1) the world economy is in recession, 2) the number of tourists attractive would decrease more than expectations, 3) the impact on consumption from lock down, and 4) the latest monetary and fiscal measures. From the above, when considering Thailand in “Asian Economic Trend Analysis Report 2020”, 2020 Thai GDP is expected to contract at -4.8% and recover back to growth at 2.5% in 2021. (National Statistical Office of Thailand, 2020) Once considering the lifestyle of people from the National Statistical Office between 13-26 April 2020, online questionnaire from 43,448 people about the corona virus found that 70% do not receive benefits for government aid, 66% are elderly, therefore do not receive financial support for living. Regarding employment, information from the Naewna newspaper (online) on May 28, 2020, Mr.Tassaporn Sirisamphan, the Secretary-General of the National Economic and Social Development Board, reports that the current Thai society is predicted that 8.4 million workers are at risk of being unemployed, 2.5 million people are tourism workers, 1.5 million people are factory workers, 4.4 million people are non-tourism services. Furthermore, it is expected that 520,000 students who will graduate from May to July this year would not be able to find jobs. Therefore, employment support measures and assistance to the unemployed are urgently needed. (Naewna, 2020)

The government has issued measures to help those affected by the epidemic situation by allowing eligible affected people to register for healing for 3 months/ 15,000 baht. Registration began from March 28, 2020. Those who meet the criteria must have the following conditions: 1) must be a laborer, temporary worker or self-employed, 2) must not be in the social security system (except Article 39, 40), and 3) affected by Covid-19 such as business being temporarily closed, job termination or unemployment, working hours reduced, income decreases, etc. In addition to the above measures, the government also issued other assistance measures such as refunding electricity meter insurance fees, reducing electricity bills, free internet, refunding water usage insurance, etc. In terms of the measures for the disabled, they do not need to register at all as database already exists. The government will pay 1,000 baht / person via the integrated e-social welfare system. There are a total of 2 million people with disabilities in the system who receive government subsidies, divided into 2 groups: 1) 1.9 million disabled people who have already received

subsidies, and 2) 60,000 disabled people who have not received subsidies. (khruachieve,2020)

Apart from the remedial measures, which are from the central agencies to help all people in the country, various support activities were carried out by local agencies, the private sectors, and activities organized by the people themselves to help each other. From searching the website about news of activities to help people in Chiang Mai, it was found that many activities from various organizations were organized, i.e. 10,000 cloth mask distribution activity, the Ministry of Industry gave the Chiang Mai government to allocate and distribute to population to prevent the outbreak of COVID-19,(Chiang Mai News, 2020) commercial price reduction project to help people in the district level and stimulate the consumption of eggs in order to help farmers in Hang Dong District, providing life support bags to the people of Mae Hia Sub-district in 10 villages,(ICiang Mai PR, 2020) operated by Mae Hia municipality together with Saen Kham Terrace Restaurant to relieve the suffering for the underprivileged, patients, bedridden patients, volunteer groups working hard for the people, and household groups affected by the COVID-19.(Chiang Mai News, 2020) Furthermore, activities to provide survival bags and fresh eggs for Tha Kham district population, operated by the mayor of Tha Kham district, along with the management team, council members and staff of Tha Kham Sub-district Municipality,(Tha Kham Subdistrict Municipality, 2020) “Aomsin, Term Fun, Pan Suk, Yuk COVID-19” activity, operated by the GSB Director of RM 8, together with the GSB Assistant Manager of RM 8, to provide educational materials, computers, sports equipment, and Pun Suk bags for 3 schools in Samoeng District (Ban Mae To School, Ban Mae Yang Ha School, and Ban Huai Nam Jang School), activities for cooperative members and the general public are conducted by cooperative groups in Chiang Mai are included.(Chiang Mai News, 2020) To alleviate the difficulties, many cooperatives in Chiang Mai have allocated funds for the supply, use, consumption, rice, dry food, including the production of mask and alcohol gel distributed to members and the general public.(Thai Rath, 2020)

From the foregoing, it can be realized that the assistant activities for those affected by the corona virus are widespread in many areas of Chiang Mai. Chiang Mai Hospital also began an activity since April 24, and continued every Friday of each week under the name “CMH Charity Project to Fight the COVID-19”. As of June 5, it has been organized 6 times in 9 areas. Chiang Mai Hospital collaborates with 13 neighboring communities to regularly contact local health service volunteers. This time, there was also a discussion with the heads of the communities about the implementation of measures to support the spread of the COVID-19 virus as well. Chiang Mai Hospital has consistently held volunteer activities. On July 6, 2020, the hospital, together with the AMEFA (Asian Medical Exchange Foundation Association) of Japan, organized activities to provide daily necessities, food, and health check-ups for children in the care of Don Chan Temple. For the activity to assist the COVID-19 virus event, Dr. Bancha Jaitrong, acting hospital director, stated that “The Chiang Mai Hospital wants to assist people in the communities affected by the economy from the epidemic of COVID-19 with survival bags consisting of food and utensils, 50 bags a week until this epidemic situation will end. The hospital will provide local public health volunteers to help in selection of those who need. For those who are unable to pick up the survival bags, we will travel to distribute them to their households.”

The first 2 events of this activity were conducted by Chiang Mai Hospital without any other agencies participating. Since the 3rd time, the Far Eastern University, AMEFA and the members of the Chiang Mai Long Stay Life Club (CLL) have also participated in the activity. Far Eastern University entered into an MOU agreement with Chiang Mai Hospital on February 22, 2019 to send students to the elderly care program at the university’s Wellness Training Center to train in the hospital and assign Chiang Mai Hospital as one of the committee of care programs. On the occasion of helping this community, the university donated 1kg / 60 bags of jasmine rice grown on the campus for the 3rd, 5th and 6th of the activity. AMEFA is an organization adapting Japanese healthcare and care systems to suit the situation of each Asian country to solve the shortage of medical devices with new technologies such as remote diagnosis and the use of artificial intelligence (AI). In addition, it solves problems by producing medical personnel, nurses and care. It was established in May 2015. The organization’s doctors are currently providing free training and treatment in Burma and Thailand. The head office of AMEFA is located in Chiang Mai. In organizing this event, Thai directors therefore also participated in the activity. CLL is a Japanese association that resides in Chiang Mai with approximately 120 members. In proceeding this activity, the author contacted the leader of the CLL association, the president of the association and vice president then come to observe the 3rd activity. After that, information of the activity was brought to discuss with the members and they decide to donate from the 4th activity onwards. The CLL, a Japanese association, today has participated in 3 times for Thai support activities. Mr. Tsukigi Yoshihisa, President of the CLL Association, greeted the 4th event held at the Khuang Sing Phatthana Community: “We, the Japanese living in Chiang Mai, receive help from Thai people and Thai society, allowing us to live our lives happily. Due to the current state of emergency, we would like to do something to give back to Thai society, so we have participated in distribution of survival bags activity. ”

Due to the widespread of the new coronavirus. People who affected the most were: The elderly and self-employed, people who hasn’t permanent job. The part of the elderly, if a person with an underlying disease infected, the risk is much higher than the average person. The part of self-employed, when the company has financial interrupt, company was first reorganized by that reason many positions were lost. In Thailand as mentioned above, even no support from the Thai government, the people in the communities willing to help each other. Clearly seen as there are many volunteer activities in many areas. In this case, the Japanese elderly long-stay residents who live in Chiang Mai which independent from Japan and hold a Thai retirement visa, the president of CLL said, “The longer they

live in Thailand, the longer they stay. They felt strongly wanted to give back to the Thai society and collaborating with Thai people to help Thai society which was very welcome for long-term Japanese residents to have an opportunity to give back to the society theirs lived.” Therefore, participating in rescue activities from the outbreak of the new coronavirus that’s one thing to change the concept and existence of Japanese long-term residents from before.

Table1. Data of “CMH Charity Project Fight COVID-19”

Source: Created by the author by listening to CMH

Research Object
This research has the following objectives. 1. To study how changing role of the elderly Japanese long-term residents in Chiang Mai was affected by the situation of the new coronavirus. 2. To study the current problems facing Japanese long-term residents and how to resolve them.

Research Metrology
Analyze the research results of the researchers and analyzed from interviews with Japanese long-term residents living in Chiang Mai.

Research Result and Discussion
In terms of the idea of the Thai government towards Japanese long-term residents, Ito (2010:8-9) described the origin of the Long Stay measures in Thailand into 2 ways, namely, 1) The Ministry of Tourism wants to implement the Long Stay Tourism project by collaborative project with the Japanese government, and 2) Long Stay is a branch of tourism. Foreigners staying for long-time period would increase the country’s income. In addition, in 1998, the Thai Ministry of Tourism considered the duration of stay of foreign tourists to be reduced. The project “Long Stay Tourism” was proposed, which aims to allow tourists to stay in the form of a long stay and allowed the establishment of The Thai Long Stay Management Corporation Ltd., in December 2001 and began operating within the same year. However, the concepts of Japanese long-term residents and the Ministry of Tourism (TAT) and the Thai government are different. Thai government expected foreign long-term residents to spend to stimulate the economy, but most Japanese long-term residents are living with pensions, so they hope to live in the place with the cheapest cost of living. Long stay in Thailand is therefore chosen. Furthermore, some people move to stay in Thailand for a long time due to financial issues that make living in Japan with difficulties. It might therefore be different from what the Thai government had initially expected about the role of becoming the large consumers.

Based on one question in the author’s questionnaire, Yamaki asked 91 members of the Japanese Association of Chiang Mai about monthly income. Those indicated that they have monthly income more than 50,000 baht per month (30.7%) However, from the overall image, those with revenue between 10,000–30,000 baht are the largest number (33.0%), those with less than 10,000 baht are 25.3%. It can be seen that there are both those who can afford a large amount of money and those who do not have enough income to spend. Accordingly, Japanese living with a pension is not always the person who has the money to spend more comfortably than Thai people. There are numbers of Japanese people with a low income and a difficult life than Thai people as well. (Yamaki et al., 2020:183)

From the foregoing, it can be realized that the role of the Japanese residents whom Thai government expected for becoming large consumers. However, the number of Japanese long-term residents today is decreasing every year.

Table2. Number of Residents at the Japanese Consulate General in Chiang Mai in 2013-2018

Source: Created from List of overseas residents Japanese survey statistics table MOFA 2012-2019

The decrease in the number of Japanese long-term residents is due to various reasons, but reasons from the question of the president and former president of the Japanese Association, as well as the editors of the Japanese language magazines distributed for free in total for 6 people in 2019, it was found that there are people returning to Japan which can be categorized into 3 major reasons: 1) due to health concerns, 2) due to responsibility for their own medical expenses, 3) higher living costs in Thailand and Yen depreciation. For reason 1: Mr. Yamagishi Hiroshi, a member of the Japanese Society of CLL and JRCC (Japanese Residence Club of Chiang Mai), collected data from both associations in 2014 and 2019, it was found that the members of both associations (those who responded to the questionnaire in 2014 were 87 people, in 2019 were 80 people) with the average age of surveyed 2014 was 67.2 years, and 2019 was 71.3 years, increasing 4.1 years. The average duration of stay in Chiang Mai in 2014 was 5.6 years, while 2019 was 9.0 years, increasing by 3.4 years. According to the same survey on health, it was found that in 2014, there were 98.9% of healthy people, and in 2019, there were 52.5%, decreasing 46.4% from 2014. (Yamagishi, 2020) The survey illustrated that after 2000, Japanese long-term residents moving from Japan to Thailand have been getting older, and as they get older, health concerns are occurred. As for reason 2: The responsibility of medical expenses. This is not a personal

problem but is from the welfare system. Welfare conditions states that people who do not have a residence in Japan cannot use health insurance from the Japanese government, and the care insurance cannot be used in other countries as well. In Thailand, no private insurance is available for the elderly, even though the price of the insurance policy is very high, the elderly living with pension are unable to pay. Hence, most elderly who concerned about health choose to return to their home countries because they want to use health insurance and state care insurance for treatment and care. Reason 3: The cost of living in Thailand and Yen depreciation. The change in this economic situation is not a problem caused by individuals, residents therefore cannot solve any problems. As mentioned above, over the years, the number of elderly Japanese long-term residents living in Chiang Mai has decreased because they are getting older and are becoming increasingly concerned about health and are responsible for their own medical expenses at a relatively high price. The reason that there are no new residents increased is the same reason as item 3 as mentioned above, the cost of living in Thailand is higher and the yen is falling. The average duration of stay based on Mr. Yamagishi (2020) survey in 2019 is 9.0 years. When considering the exchange rate of the yen and the baht, the baht value in December 2010 (9 years ago) was at 100 yen: 36 baht. In the following years, December 2011, the yen strengthened to 100 yen: 41 baht, allowing them to live comfortably with pensions. However, in December 2014, the yen fell to 100 yen: 27 baht. Although the yen in 2016 rose to 100 yen: 32 baht, after that it was at 28 and not more than 30 baht ever since. (Exchange rates.org) Furthermore, when considering the minimum wage in relation to the cost of living in 2009, the minimum wage in Chiang Mai was at 159 baht per day. In January 2020, the minimum wage was at 325 baht, more than double compared to the year 2009 for pensioners receiving the same amount of money every month. (HR NOTE, 2020) When the yen is cheaper, the cost of living increases, the advantages of moving to Chiang Mai are less than before. After this, the number of elderly Japanese long-term residents would continue to decrease if there are no measures taken when dealing with the situation.

Previously, the role that the Thai government expects to Japanese long-term residents is the role of consumers only. But in real life situations, residents living with moderate pensions outnumber wealthy people. According to Duangkaew (2016:60, 71-72) proceeding data collection about the source of income of the 104 Japanese Association members, it was found that the respondents earn “pension” at 94.5%. From the same survey, about cultural exchange with Thai people (90 respondents) on the topic of “Learning Thai cooking and Thai dance which are Thai cultures from Thai people”, respondents who chose “Frequently” and “Sometimes” are at 10.0%, while “Rarely” and “Never” are at 90.0%. In the topic of “Introduction and Teaching Japanese Culture (i.e. Tea Making, Flower Arrangement, Fencing (Kendo) to Thai people” (91 respondents), respondents who chose “Frequently” and “Sometimes” are at 9.9 %, while “Rarely” and “Never” are at 90.1%. It can be seen that there is almost no personally cultural exchange with the Thai people. Questions about volunteer activities (with 92 respondents) in the topic of “Being volunteers for Thai people”, respondents who chose “Frequently” and “Sometimes” are at 43.5%, while “Rarely” and “Never” are at 56.5%. There are a number of Japanese volunteers participating in the Thai society, but according to the president of the CLL who stated that the members of the Japanese Association do not have a chance to do anything for the Thai society and they hope to continue to help Thai people in the area more and participate in activities to help Thai society. The assistance might not only be volunteering, but also financial aid activities such as donations. Robert J. Waldinger, professor of psychology at Harvard Medical School in the United States, stated in the TED Talk on “What makes good life? Lessons from the Longest study on Happiness”, about the importance of exchanging with others and Live life with others. One message was that, to determine whether a life is good or bad is not determined by reputation or money, but “Having a good relationship with other people makes us be with healthiness and happiness.” The findings could be summarized in to 3 items as follows: 1) Social involvement is useful, while loneliness will reduce your life expectancy. People who have relationship with their family and friends would feel happier than those who are less connected and be healthy and long-lived. Meanwhile, those who feel that they are lonely would have health problems since the middle age, decreased memory performance, and do not live long. 2) The important thing is not quantity or benefit, but quality. Having a good relationship would have various effects on health and increase life expectancy. Even if the body is sick with age, but people who have a good relationship with others would feel happiness every day. 3) Good relationships would not only help the body, but also the brain. Those who are very close to other people, even as they age 80, The ability to remember would not decrease as much as those who are not familiar with others. Illness and the period of care needed would arrive slower, although life expectancy is increasing. A moment in which you can live your life without any health restrictions is called “Good Health Life Expectancy”. Longevity is important, but longevity with good health is Quality of Life (QOL). In addition, living a good life is more important than maintaining good health. Interaction with others in society is therefore necessary.

If there is the need of resolving the reduction or increasing the number of Japanese long-term residents, the view towards Japanese long-term residents from the role of consumers who spend money in Thailand must be changed to a member in Thai society as ‘Partnership’ relationship. State of residence for retirees, which are prohibited from engaging in volunteer or work activities, might need to be partially modified, conditions for visa applications for retirees or o-visa approved by the Thai government nowadays, is required to be over 50 years old and have 800,000 baht deposited in a Thai bank account for more than 3 months. After the visa is approved, the account must have a balance not less than 400,000 baht or a pension received more than 800,000 baht/year. (Thai jiyu land, 2020) Conditions for working in visa should be added for retirees as well. In Japan, holders of “Student” status are allowed to work part-time for 28 hours a week. (Happy Japan visa, 2020) I, as investigator, have an opinion that Thailand should consider applying the same conditions to o-visa

status, too. The average age of members of the Japanese Association is 71.3 years, but the average age when first staying for a long period, according to the survey of Yamagishi (2020) in 2019, found that the age range 56-60 years is the most, representing 28.6%, followed by 61-65 years and 66-70 years equally at 25.0%. Japanese people aged 60 years are still strong and able to work regularly. Dauangkaew (2016:60) asked questions about “Occupation before Coming to Thailand” (with 110 respondents), it was found that “Employees” were at 51.6%, “Business Owners” were at 17.2%, “Civil Service” was at 10.9%. Most of them are experienced with their work. Allowing these people to utilize their work experiences to Thailand, resulting them to do the challenge, which are new works experiences generating income and vitality to the Japanese. Thai people would have new business opportunities and have the chances to learn and apply Japan’s skills, knowledge and technology. Regarding the health aspect, according to a survey by Mr. Yamagishi, 98.8% of the respondents answered that they are “Healthy and fulfilling” and “Have a chronic disease but no need support”, there is no concern about their health. It would be beneficial for Thai society if such experienced Japanese human resources could be actively utilized in Thailand.

In terms of medical expenses, this is a concern for long-term residents. First of all, private insurance is required so that Japanese seniors can comfortably get treatment in Thailand. It might be in the form of a Japanese group that is a member of the Japanese Association and members of other long-term foreign resident associations and is made in group insurance which is health insurance for long-term residents in Thailand specifically. If the medical expenses are covered, it is likely that more people would be admitted to Thailand without returning to Japan. The solution to the problem of Japanese long-term residents without residences in Japan is not able to use Japanese health insurance abroad. I consider that it should be proposed to Uozu City of Toyama Prefecture, the sister city of Chiang Mai, to accept long-term residents in Chiang Mai who have no residences in Japan, so that these residents pay taxes to Uozu City. Therefore, the conditions will be fulfilled which would make the health insurance coverage of Japan in Thailand available.

By solving the above problems, I expect that it would increase the number of Japanese long-term residents in Chiang Mai. As for other problems found, is a shortage of elderly care centers in Thailand, especially those who are suitable for long-term foreigners. Despite the aforementioned care facilities, they are quite expensive and not appropriate for living with pensions. Furthermore, living for the elderly together with foreigners with different foods and cultures has quite a psychological effect. Hence, a senior care facility particularly suitable for Japanese seniors and affordable for living with a pension would support them to comfortably continue living in Chiang Mai in the future.

In conclusion 1. changing roles of Japanese long-term residents living in Chiang Mai From the situation of the outbreak of the new coronavirus were consider as 1.1 permission for working and doing volunteer activities while getting a retirement visa might getting them more involved with Thai society. 2. Issues that arise in Japanese long-term residents and their solutions were found: 2.1 Concerns about their own health 2.2 self- responsible for their own medical expenses 2.3 the cost of living in Thailand is higher and the yen is falling. The suggestion was 2.4 the good insurance should be support for elderly long-term residents, which is the most urgent need.

Figure 1. Previous and New models of Japanese long-term residents in Chiang Mai

Conclusion

The widespread outbreak of the new coronavirus had a big impact on Japanese long-term residents of Chiang Mai. Living as a foreign country needs to be well prepare and often research new information. Moreover, they need to study various practices to prevent infection. In this situation, the Japanese are aware of being a part of society and try to think that what they can do anything for the community that they living? The role of a long-stay resident is often placed as a consumer which has benefits to the society in order to the economy condition. Actually, not all long-term residents will have wealth enough as they expect. Cultural exchanges will happen when long-stay residents get more involved with the society. Therefore, to convince Japanese long-stay residents to stay in Chiang Mai any longer after this situation. The urgent problems need to be resolve, including preparing well environment that suitable for them to living in their old age. First, private insurance is required for the elderly, which is the first priority. Moreover, allowing people who get retirement visa able to work may also help to solve the problem the number of the Japanese long-stay population was decline as well. Chiang Mai is a well development city for long-stay living. To increase in the number of long-stay residents and support an environment that is suitable for living which become a model for the rest of the world, Therefore, to increase the number of long-stay residents the government should not ignore as same as before

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