Malaysiakini-SM Mohd Idris: The sorry state of Orang Asli health

The sorry state of Orang Asli health

SM Mohamed Idris
Mar 16, 10
7:44pm

 

The recent disclosures made by Dr Selva Vathany Pillai concerning malpractice and the misappropriation of resources by hospital authorities at the Gombak Hospital bring 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, re-groupment 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 the lack of state assistance and support have led to increasing hardship. Today, some 80 percent of the 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).

• The 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 the 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%). Their 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 remain 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, the 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 deficiency, worm burdens and malaria. This has only made worse the nutritional degradation among the most vulnerable groups ie, 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 food eg, 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.

The writer is president, Consumers Association of Penang.

Malaysiakini-Dr Lim Teck Ghee: Tyranny of the Malaysian bureaucracy

Tyranny of the M'sian bureaucracy

Dr Lim Teck Ghee
Malaysiakinin, Mar 5, 10
5:53pm

 

During the last few days we have had two clear examples of how tyrannical and vicious the Malaysian bureaucracy can be, and how unyielding it is to any reform measures or initiatives. This Mr Hyde side of the Malaysian bureaucracy is not the usual dark side that the Malaysian public is familiar with – one associated with inefficiency, laziness, poor service, abuse of power or corruption.

It is one that is part and parcel of the hidden racially-charged context of our institutions and it smacks of the ideology of Malay dominance – or even Malay supremacy – that the civil service has come to personify. This is the dark side that is generally kept away from public scrutiny and accountability, not only because it runs against the grain of what a modern, progressive and representative civil service is, but also because it is regarded as politically incorrect to discuss or analyze it.

The first example appeared just two weeks ago when a courageous whistle-blower, Dr Selvaa Vathany, a doctor from the Orang Asli Affairs Department (JHEOA) Hospital, Gombak made startling claims of rampant malpractice, misappropriation of resources and other wrongdoings by the hospital staff and associated agencies of government dealing with the Orang Asli. Selvaa is not your ordinary whistleblower.

Providing details on the importance of healthcare and medical assistance for the Orang Asli – their children are 15 times more likely to die from malnourishment compared to other children – she revealed that for entire communities 'essentials given out are limited to one to two bottles of cooking oil, six to eight tins of canned food, two packets of 400g Milo, 15 to 20 small packets of milk powder, 10 to 20 diapers, two bottles of detergent and 10 to 20 pairs of slippers, per visit. These are distributed at random. If the villagers are lucky, distribution could be as frequent as once in every two to three months'.

She noted that 'a tin of infant milk is divided into six small packets with 15 to 20 packets distributed to a village of between 250 to 500 people'. All of this is strong circumstantial evidence that resources meant for Orang Asli communities are hijacked, possibly by the very people entrusted with the responsibility of distributing them to these vulnerable groups.

At her press conference, she also pointed to an institutional defect in which individuals without medical training and incapable of following Health Ministry protocols and standards were made hospital administrators and were appointed from the Rural and Regional Development Ministry.

Most tellingly, she pointed to an extensive cover-up of the scandal with little or no follow-up to the complaints made to the Prime Minister's Department, Rural and Regional Development Ministry, Health Ministry, Chief Secretary, Public Service Department and Malaysian Anti-Corruption Commission (MACC).

The only follow-up that has taken place appears to have been the thuggish and unacceptable response of the team from the Rural and Regional Development Ministry who 'questioned the complaint…made by the Orang Asli in an unprofessional manner', and threatened and attempted to intimidate them.

For her professionalism and integrity in speaking out on behalf of a marginalised and impoverished community, Selvaa is now being transferred to Kedah where presumably she will be left to rot and to rue her courageous challenge of the status quo.

The second example also relates to the Orang Asli and it concerns the response of the Orang Asli Affairs Department to the demand for increased representation at the management level in government agencies formed to handle Orang Asli affairs. According to the group raising these concerns, the JHEOA is staffed by over-80 percent non-Orang Asli, resulting in decisions not favourable to their needs and the marginalisation of Orang Asli voices in important policies that affect their livelihoods.

This is not the first time that such concerns have been raised. During the past 50 years we have had a constant stream of written petitions, memoranda, press statements, expert reports and academic work that have drawn attention to the way in which the government has violated the basic rights of the Orang Asli and analysed how the JHEOA and associated government agencies have been the main instruments for control and repression of the community. In response, the government has simply ignored them or opted for delaying tactics.

In this particular instance, in typical foot-dragging response, the department's director-general Mohd Sani Mistram said that the group should have gone through the 'proper channels' to air their grievances and that it was an 'internal matter' between the Orang Asli and the department.

Both these cases – the punishment meted out to a whistleblower and the cold shoulder treatment of legitimate Orang Asli grievances – epitomise how dangerous it is for our democratic system to remain silent or passive in the face of an increasingly out of touch and unrepresentative civil service. They are the tip of the iceberg of many unexposed and undisclosed abuses that needs to be put in the spotlight of public scrutiny.

At the end of the day, the most effective public scrutiny that can realistically have an immediate impact on these cases of rogue individuals and agencies of the civil service that are throttling the Orang Asli is that coming from Malay intelligentsia and Malay civil society.

Indeed, some Malay colleagues have shown goodwill in helping the Orang Asli to correct some of the 'historical injustices' that have been perpetrated on the original inhabitants of the Peninsula. It could make a difference if Malay leaders are willing to take up the case of Selvaa and stop her victimisation by the Rural and Regional Development Ministry. 

At the same time, more Malaysians of conscience need to step up to the plate if the Orang Asli community is to regain their rightful place in the country.