[COLUMNIST] Prioritising the health and wellbeing of the Orang Asli

THE Orang Asli, the oft-overlooked and “invisible” aboriginal communities of Peninsular Malaysia, constitute a small minority population who are stereotypically marginalised, discriminated and oppressed. As of 2022, the Orang Asli community is 178,197 out of a population of about 32.7 million people – according to the latest data ( from 2021) as maintained by the Department of Orang Asli Development or Jakoa (see “Disease among Orang Asli community in Malaysia: a systematic review”, Muhammad Hilmi Mahmud, Ummi Mirza Baharudin & Zaleha Md Isa, BMC Public Health, 2022).

The majority of Orang Asli are from the tribes of Senoi, Proto-Malay and Negrito.

Under the Federal Constitution, as per Article 160(2), the term “aborigine” is synonymous or equivalent to the Orang Asli communities of the Peninsular. The term, “Orang Asal” (“original peoples”), on the other hand, is all-encompassing and inclusive of all the indigenous peoples of Malaysia, including the Malays alongside the natives of Sabah and Sarawak.

All in all, the indigenous of Malaysia are known as Bumiputera (“children of the soil”) or occasionally referred to by the term, “pribumi” and endowed with and recognised by their “special position” under Article 153 of the Constitution.

The welfare of the Orang Asli community is also accorded protection under Article 8(5)(c) of the Constitution – which allows for a quota to be set aside for the recruitment of the Orang Asli in the civil/administrative service (“a reasonable proportion of suitable positions in the public service”).

There’s also a specific legislation known as the Aboriginal Peoples Act (1954) – “An Act to provide for the protection, well-being and advancement of the aboriginal peoples of Peninsular Malaysia” – which focusses on their “immediate priorities”, i.e., land-related issues (including reservation and rights of occupancy) and basic educational access.

Other than land-related issues and basic educational access, the policy priorities for the Orang Asli also include

• provisions of facilities and amenities (such as electricity and clean water supply – and even Internet connectivity together with the digital devices i.e., laptops, tablets, smart phones);

• eradicating hardcore/extreme/absolute poverty;

• (re)settlement into urban life, educational attainment (especially tertiary and Tvet – technical and vocational education and training) and not least,

• access to healthcare across the board – from rural clinics, including mobile and flying (primary care) to hospital services (secondary and tertiary care).

The health disparities between the Orang Asli and the rest of Malaysians remain in stark contrast on the whole.

The Orang Asli also suffer from tropical diseases that’s not typical in the mainstream population. These mainly involve soil-transmitted helminth (STH) – intestinal worms infecting humans that are transmitted through contaminated soil. The highest prevalence recorded in a study was 98.4% among 122 Orang Asli from seven groups in the states of Perak, Selangor, Johor and Pahang where researchers used real time PCR (polymerase chain reaction) method to diagnose STH.

In fact, the general health status of the Orang Asli health has only deteriorated.

For example, Orang Asli children are 11 times more likely to die under the age of five compared to children from major ethnic groups, according to Dr Amar-Singh HSS (“Under-Five Orang Asli Children Death Rate 11 Times Higher Than Main Ethnicities”, Alifah Zainuddin, CodeBlue, February 22, 2022).

For the rest, they are exposed to a high rate of malnutrition and anaemia. In fact, 60 to 70 percent of Orang Asli children are determined to be malnourished by the time they are 5 to 7 years old.

And these rates of childhood malnutrition are continuously rising due to absolute and hardcore poverty and high cost of living.

As it is, the nutritional status of Orang Asli is typically low, especially among women and children.

For example, it’s found that among adult Orang Asli from the Che Wong tribe (Pahang), 13.8% of men and 25.0% of women were underweight. This is attributed to “[f]actors such as poverty, low diet consistency, inappropriate cultural values, lack of dietary awareness, poor hygiene practices and elevated helminthic infestations …” (see, “Nutritional Status of Orang Asli in Malaysia”, The Malaysian Journal of Medical Sciences. 2022 June, 29(3): 17–29).

As for anaemia, women are more prone to this condition where, they sustain increase blood loss during menstrual cycle and pregnancy.

In this, Orang Asli women experience a further issue of poor menstrual hygiene and, by extension, period poverty as they lack the money to purchase the sanitary pads.

Orang Asli females who are unable to purchase menstrual products have to rely on coconut husks, newspapers and banana leaves as an alternative for the pads and tampons. Poor hygiene practice can cause urinary tract infections and issues with the reproductive organs in the long-term, if not addressed.

Recently the Ministry of Health (MOH) and the Selangor state government announced the provision of free sanitary products as a means to address period poverty.

In light of this, the relevant stakeholders should provide policy focus on the Orang Asli communities as well, especially in the rural and remote areas, in addressing period poverty.

Prior to the 15th general election, the Institute of Public Health of the MOH had been conducting a joint survey with Jakoa to measure and analyse the health status of the Orang Asli (“The first Orang Asli health survey kicks off”, New Straits Times, July 16, 2022). According to the then Health Minister Khairy Jamaluddin, the purpose of the survey is to “… provide evidence-based input to the ministry and other agencies in formulating new strategies to improve public health”.

The joint-survey involve health checks based on “… anthropometry measurements [i.e., looking at physical measures of a person's size, form, and functional capacities] according to age groups; blood pressure measurement, finger prick blood tests to measure glucose, cholesterol and haemoglobin levels; and hair and nail sample collection for all age groups in 14 selected villages for heavy metal exposure testing”.

The survey was meant to be completed on September 13, 2022. However, there has been no updates since and the results have yet to be publicly announced.

The unity government – via MOH and Jakoa – should report on the current progress and development of the joint-survey and announce measures to tackle the prevalent health issues of the Orang Asli (distinctive as well as in common with mainstream population such as “stunting” among children, non-communicable diseases/NCDs, e.g., hypertension, diabetes and cholesterol).

As part of the health problems experienced by the Orang Asli, the lack of access to clean water is another crucial issue.

In terms of consumption, the Orang Asli have been exposed to untreated water for a long time now.

Due to logging and development, the rate at which rivers and water catchments have been polluted is rapidly increasing, and consumption bring serious health problems such as diarrhoea, typhoid and polio.

What’s needed, therefore, is a holistic and comprehensive view which looks at the health and wellbeing issues of the Orang Asli from an “organic” view (indeed, in consonant with their own worldview and analogous with their “natural habitat”).

That is, where the health issue is also at once, simultaneously, an issue of lack of access to clean water and vice-versa and so on.

EMIR Research would now like to recommend the following policy proposals to the relevant stakeholders:

1. Building a systematic database of Orang Asli

The government should make it a priority to ensure that all Orang Asli are registered and given a national registration identification card (MyKad). At the same time, a separate and distinct database of Orang Asli should be developed which would specifically cater to their needs and welfare. The database would, for an interim period, be based on both MyKad details and other sources (such as collected by Jakoa).

The aim is to have all the data and information digitalised – which can then be integrated into the wider and mainstream initiative such as the National Digital Identity (IDN).

2. Conducting health and medical outreach with unemployed and retired doctors

Currently, the MOH has been conducting periodic medical routine for the Orang Asli communities through the Orang Asli Mobile Team. However, due to unpredictable weather, logistical and, especially, manpower issues, the visits tend to be limited and constrained.

To ensure for a consistent and systematic medical check-up regime for the Orang Asli, the MOH should consider absorbing unemployed doctors who have performed their two-year housemanship stint and another two years of compulsory service as contract or permanent doctors alongside rehiring retired doctors.

To further enhance the functionality of this team, strategic partnerships should be set up with private healthcare providers and non-governmental organisations (NGOs) such as charities and religious bodies. This expanded team can be renamed as the Health and Outreach Team (HOA) that will focus on providing medical screenings, etc. to all remote and rural settlements.

Medical check-ups and screenings should be inclusive of blood, eye, urine, body mass index (BMI), nutrition-focused physical examinations (NFPEs) and blood pressure tests.

3. Adopting and prioritising a broad-based, strategic partnership with Orang Asli NGOs

There are many NGOs and volunteers that have been advocating for and working closely with the Orang Asli community for decades now. For instance, the Centre for Orang Asli (COAC), Jaringan Kampung Orang Asli Se-Malaysia (JKOASM) and the Federation of Private Medical Practitioners’ Associations Malaysia (FPMPAM).

The government via Jakoa should adopt a broad-based, strategic partnership with these NGOs to provide the Orang Asli communities with first-aid kits, AEDs (automated external defibrillators), fire extinguishers, etc. as well training at least a certain number of persons with the necessary life-saving skills like performing CPR (cardio-pulmonary resuscitation), Hemlock procedure, rescuing a drowning swimmer, etc.

Also, training for Orang Asli midwives so that they will be better prepared to provide auxiliary support or personally handle the labour/prenatal care, delivery stage, postnatal care (e.g., infection prevention, diet and nutrition).

In conclusion, it’s hoped that the government will take additional effective measures to mitigate what could well be considered to be a health “crisis” (in its own right) faced by the Orang Asli communities and close the gap with the rest of the population.

Health and wellbeing strategies for our Orang Asli communities should be regarded as part and parcel of their integration into the nation’s overall development.

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Jason Loh and Jachintha Joyce are part of the research team at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.

** The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the position of Astro AWANI.