Story by SANTHA OORJITHAM
The Star | 23 March 2015
Infant mortality and communicable diseases are still a problem among Orang Asli communities.
DORANI Gumba is looking forward to going back to his village in Hulu Perak next month. The 31-year-old Temiar has spent the past year at the Orang Asli Hospital in Gombak, Selangor, being treated for leprosy.
A Ministry of Health (MOH) team had visited his village, Kampung Desaria in the RPS Banun resettlement scheme, and brought him in for screening. They were able to screen four more of his family members, who tested negative for leprosy, but three of his younger brothers refused to be screened. “In our village, some run away when the health team comes in because they are afraid of giving skin samples,” he explains.
Dorani’s story provides a glimpse into the challenges of providing healthcare to the Orang Asli in Peninsular Malaysia, which stakeholders hope the 11th Malaysia Plan (11MP) will tackle. For many in the interior, access to health services is difficult. Health indicators for the community show there is a long way to go before the orang asli catch up with the other ethnic groups and city-dwellers.
For example, leprosy has been eliminated in the country’s general population, meaning there is less than one case per 10,000, according to MOH statistics. But among the Orang Asli, the disease is fluctuating: 20 Orang Asli out of 100,000 had leprosy in 2002, 13 in 2006, two in 2007, and 10 in 2013.
“The recent floods exposed a lot of problems”, says Dr Colin Nicholas, founder of the Centre for Orang Asli Concerns. The number of orang asli with communicable diseases such as leprosy is on the rise, he notes. He reckons that many of these illnesses are made worse, or caused, by malnutrition but that is often not recorded as the cause of death.
The late Dr John Malcolm Bolton, a British doctor, set up the Orang Asli Hospital in Gombak (HOAG) in 1960 and organised paramedics who visited the Orang Asli communities with basic medications. He arranged medical evacuation if necessary. All this, except for the hospital, stopped in the 1990s, reports Nicholas.
But since the MOH took over responsibility for orang asli health from the Department of Orang Asli Development (Jakoa) in 2012, he says, there have been proper personnel and medication. At the Betau resettlement scheme, for example, there had been a hospital since 1977 but there was no doctor. After the MOH took over, they appointed a doctor.
Jakoa is still in charge of ferrying the orang asli from the interior to receive treatment and, according to director-general Datuk Hasnan Hassan, there are transportation problems. “If there is an emergency, for example at night, it is costly to take them to the nearby clinic or hospital,” he says.
His department collaborates with the Fire and Rescue Department and the MOH. “With MOH’s strength, expertise and funds, I believe treatment and healthcare for the Orang Asli.
A symbol of the changes is Dr Izandis Mohamad Sayed, HOAG’s first Orang Asli doctor and its first public health physician. He was born in the hospital, where his mother was a telephonist (his father worked with the Orang Asli Affairs Department, as Jakoa used to be known), and lived there till he was nine years old.
He knew some of the doctors and was inspired to study medicine.
“I feel a need to help my people,” he says.
Dr Izandis joined HOAG in mid-2014 and heads its Public Health Section which is responsible for nutrition, disease control, health promotion, mother and child health, and primary care via mobile teams. He sees Orang Asli health issues as related to public health – communicable disease, infant mortality and maternal mortality – although lifestyle diseases such as diabetes, hypertension, and alcohol-related liver failure and liver carcinoma are now emerging.
“There have been some successes but we are still struggling to meet our goals,” he says. Malaria was rampant in the past decade but by 2012 there were no malaria deaths reported among the Orang Asli. The number of tuberculosis cases among the community has also dropped to the same rate as the general population.
But more orang asli babies and toddlers die, compared to the general population. In 2012, 16 out of 1,000 orang asli infants died below the age of one and 21.7 out of 1,000 orang asli children died before the age of five. By comparison, the national infant mortality rate in 2010 was already 6.8 out of 1,000 and the under-five mortality rate was 8.5 out of 1,000.
HOAG’s medical officer Dr Nurul Fadzilah agrees that malnutrition is still a problem for the Orang Asli. “They do not have enough calorie intake, so they are more susceptible to diseases,” she says.
Protein malnutrition happens when the Orang Asli can no longer fish and hunt, deduces Datuk Dr Amar-Singh HSS, senior consultant community paediatrician at Hospital Raja Permaisuri Bainun in Ipoh.
“When they are resettled, they lose access to the rivers and forests, because the resettlement areas are surrounded by logged forests,” he points out.
Access to treated water and sanitation is a prerequisite for good health. Dr Izandis rates orang asli access as “ok”. Under its Water Provision and Environmental Cleanliness (Bakas) programme, the MOH is providing gravity feed water systems in the interior, and sanitation.
“There are cases without access but things have improved a lot,” he says.
As for access to health services, it has improved since the 1960s, the public health physician says. For example, Pos Manson in Cameron Highlands used to be very far from the nearest clinic or hospital but now there is a road.
The Orang Asli can travel out easily to get treatment, and medical teams with doctors, medical assistants, nurses, pharmacists and an environmental health officer can go in.
But for 70% of the Orang Asli living in the interior, it is a problem, he says. The MOH has a mobile team and flying doctor services. And there are Orang Asli health centres in the interior, for example at Kuala Betis in Kelantan, RPS Betau in Pahang and RPS Kemar in Perak.
The MOH is also dealing with malnutrition among the Orang Asli. There are 25 community feeding centres and trained local Orang Asli volunteers (whom MOH pays) to deal with the issue, Dr Izandis says. Since 2012, 1,752 Orang Asli children have also been receiving food baskets.
There had been many cases of malnutrition in Hulu Perak but the district health office has taken over and there has been a very big improvement, he adds.
“We catch children as soon as they leave the normal curve of what the weight should be,” explains Dr Amar- Singh. “We don’t allow them to enter that malnourished level. We discuss every death, and there are very few.”
But, he warns, “We have not solved the problem. We are fire-fighting and sending them back to their villages where nutrition is still poor.”
Under the 11MP, Dr Izandis wants new strategies to solve the problem of access to health services for those living in the interior.
He suggests Klinik 1Malaysia, static clinics, and health and medical teams in the villages and resettlement schemes. But perhaps the real answer lies in a return to the days of the late Dr Bolton.
“In his time, there were trained Orang Asli paramedics and health volunteers,” says Dr Izandis. Half of the HOAG staff then were Orang Asli, whereas only a quarter of them are now.
“Orang Asli patients can be shy and can have taboos, an inferiority complex, and communication barriers,” says the doctor, so recruitment should take that into account.
“The best strategy would be for a few from each kampung to be trained as paramedics, midwives, etc, and have them give health services to their community.”
That would not only overcome access problems and be better for the patients socially and psychologically, but it would also motivate the community, he believes.