The sorry state of Orang Asli health

The recent disclosures made by Dr. Selva Vathany Pillai concerning malpractice and the misappropriation of resources by hospital authorities at the Gombak Hospital, brings into stark focus, the social and health status of this community.

The Orang Asli, (aboriginal peoples), who are the most marginalised community in the country continue to suffer the loss of their lands through resettlement, logging, mining, dam construction, golf course development, plantation schemes, regroupment and assimilation into mainstream society.

Orang Asli rights to their ancestral lands are not recognised by the state; as such they have been increasingly dispossessed of their lands and suffer destruction of their subsistence base. Government policy has been to regroup and resettle them to grow cash crops and food. Land pressure and lack of state assistance and support have led to increasing hardship. Today some 80 percent of Orang Asli live below the official poverty line.

Consider the following health indicators:

•  In the 1980s life expectancy at birth among the Semai orang asli was some 35 years. (For West Malaysians it was 68-72 years).
•  Orang Asli had an incidence of tuberculosis twice the national average between 1951 to 1971. By 1995 the rate for Orang asli children was three times the average in Perak state.
•  In 1991 and 1992, Orang Asli averaged 48% of all malaria infections, recorded in west Malaysia (comprising less than 1% of the population). In recent years, they have averaged over 70% of the cases.
•  The crude death for Orang Asli was 1% per year for the period 1984-87, twice as high as the West Malaysian average (0.5%).
•  Infant mortality rate was 5.2%, more than three times the West Malaysia average (1.6%).
•  Among Malaysian women giving birth at home in 1994, 42 died; 60% of these (25) were Orang Asli.
•  A 1995 study showed that Orang Asli women are the most malnourished adult group in West Malaysia , with 35% of them suffering protein-energy malnutrition.
•  Anemia is widespread in Orang Asli women. In one study, Temuan orang asli women had an average haemoglobin level of 9.9 g/dl (gm/100ml) far below the acceptable level of 12 –15 g/dl.
•  Recent studies find 23% to 68% of Orang Asli children underweight, while 41% to 80% are stunted in their growth.
•  Serological tests reveal that 82% of Orang Asli showed prior exposure to dengue-virus illness.
•  In 1994 leprosy was 23 times more prevalent in Orang Asli than in the general population.
•  In 1990, only 67 of 774 Orang Asli villages (9%) contained a medical clinic.

Despite the dismal findings, the Orang Asli community have failed to receive the attention they deserve.

Today, the Orang Asli remains the most unhealthy community in Malaysia , an expression of their marginal status in society. Malnutrition is a serious problem among the Orang Asli, and Orang Asli women are the most malnourished adult group in West Malaysia. This is due to a lost of foraging and farm land, increase in river pollution, dietary inadequacies; the level and frequency of infectious diseases, intestinal infestations and discrimination.

Orang asli women have high levels of iron and folate defiency, worm burdens and malaria. This has only made worse the nutritional degradation among the most vulnerable groups i.e. women of childbearing age and young children.

The Orang Asli have always foraged for a variety of food resources even when they were ‘farmers’ and they enjoyed high quality food with interesting variety if seldom in large quantities. As these sources of food dwindle they are forced to buy modern foods e.g.sugar, processed flour, sweet condensed milk, tinned food, and cooking oil resulting in unhealthy, unbalanced and scarce nutrition. Studies have revealed that aneamia is a significant cause of ill health among Orang Asli women; and maternal and childhood goitre has not seen much improvement between 1951 and 1995.

Maternal health is central to both maternal and infant survival and the health and vitality of Orang Asli communities. The nutritional status of Orang Asli children have been described as poor by various studies. In 1987 it was found that 54 percent were underweight and 66 percent stunted. Other studies have confirmed that widespread malnutrition exists among Orang Asli children; and the frequency of stunting range from 44 percent in infants to 80 percent in 2 to 6 year olds.

Researchers have concluded that the ‘nutritional status of Orang Asli children is perilous’. Because of serious childhood malnutrition in addition to intestinal worms and other problems, Orang Asli children face severe impairment to their physical, intellectual and social development. The grim health statistics reveal that maternal and child ill health and malnutrition in Orang Asli communities needs to be urgently addressed.

Even the Orang Asli Hospital in Gombak has seen little improvement. Critics have pointed out the ‘temporary’ wooden structures at Gombak Hospital built in 1959 by Orang Asli workers, still house patients. Hospital staffing still lacks specialists in various medical disciplines. Nor is health education properly addressed by the current medical bureaucracy for the Orang Asli. According to the head of Gombak Hospital Orang Asli health was not well served by the ‘staff attitude’ at medical facilities.

Under the law, all aspects of their lives are ‘managed’ by the Orang Asli affairs department (JHEOA). In short they are wards of the state with little say over their own affairs and lives.

The Orang Asli community must be involved in deciding their priorities and their needs as only they know their problems best. In this regard, the mobilisation of the active support and involvement of the community is fundamental to their health improvement.