[A study on tuberculosis cases among over-staying foreigners]

An analysis was made on eighty-four cases of tuberculosis (TB) among over-staying foreigners during the past 9 years at Minatomachi Medical Center. All of them did not enroll in any health insurance system because they were illegal immigrants. Most of them were in their twenties and thirties. The ratio of male to female was four to one. By ethnic origin, the proportion was highest among Filipinos (30%), followed by Koreans (23%), Pakistanis (13%) and Indians (7%). Half of them had been in Japan for more than two years. Most patients sought care due to symptoms rather than as a result of the efforts of public health centers to screen foreigners. The proportion of extrapulmonary TB among all types of TB was 35% overall. Compared with pulmonary TB cases, patient's as well as doctor's delay was more marked among extrapulmonary TB cases. Forty cases were treated at Minatomachi Medical Center and forty-four cases were referred to another hospitals. The default rate including repatriation was as high as 41%, and the reasons for this high defaulting rate were as follows: 1. Language barrier, 2. Worry for loosing work during treatment, 3. Worry for high medical costs because of no coverage by a health insurance scheme, 4. Lack of information on medical systems and TB, 5. Worry for forced repatriation by the immigration office. In addition, some cases were not followed up due to unkind behaviour of attending physicians. The following measures are needed to prevent the epidemic of tuberculosis among overstaying foreigners and our societies. a) To provide free medical check-ups b) To provide easy access to medical facilities c) To utilize the tuberculosis prevention law d) To follow up patient thoroughly and strictly e) To explain TB in their mother languages f) To change the immigration law and its system g) To make liaison with other organizations such as medical facilities and NGOs, including foreign ones, and exchange informations h) To build good human relations with patients.