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HealthCareForTheOrangAsli:
ConsequencesofPaternalism
andColonialism
Published:09September2004

HEALTHCAREFORTHEORANGASLI
ConsequencesofPaternalismandColonialism

ColinNicholas
CenterforOrangAsliConcerns
AdelaBaer
OregonStateUniversity

RevisedmanuscriptofapaperpresentedattheworkshoponHealthcareinMalaysia,Asian
ResearchInstitute,NationalUniversityofSingapore,911September2004.PublishedinCheeHengLeng&Simon
Barraclough(2007),HealthCareinMalaysia:TheDynamicsofProvision,FinancingandAccess,pp.119136.

TheOrangAsliaretheindigenousminoritypeoplesofPeninsularMalaysia.Theyare
thedescendantsofPleistoceneerainhabitantsofthepeninsula,thatis,longbefore
theestablishmentoftheMalaykingdoms.TheOrangAslipopulationgrewfrom
54,033in1969to92,529in1994,atarateofalmost2.3percentperyear(Lim1997).
In2004,theynumbered149,512,representingamere0.6percentofthenational
population.
Like indigenous peoples the world over, the Orang Asli
are among the most marginalized communities, faring
very low in all the social indicators both in absolute
terms and relative to the dominant population. For
example, while the national poverty rate has been
reducedto6.5percent,therateforOrangAsliremains
at a high 76.9 per cent. The official statistics also
classify 35.2 per cent of Orang Asli as hardcore poor
(compared to 1.4 per cent nationally) (Zainal Abidin 2003). It is not surprising,
therefore,thattheOrangAslilagveryfarbehindinbasicinfrastructureandinpolitical
representation.Thesameistrueforliteracyandeducationalattainment.In1990only
14 per cent of Orang Asli villages had a school. The literacy rate for Orang Asli in
1991was43percent,whilethenationalratewas86percenthowever,notallOrang
Aslichildrenattendschoolandin1995,68percentoftheattendeeshaddroppedout
at the primary level (Lim 1997). This dropout rate means that no more than 30 per
centwerefunctionallyliterate.
In this chapter, we examine the development of health care services for the Orang
Asli by the colonial state and its later trajectory under the postcolonial,
developmental state. We will argue that the British colonial state had a paternalistic
attitude toward the Orang Asli. In conjunction with the exigencies of fighting the
communists during the Emergency era (19481960), this attitude led to the inception
of the Orang Asli health care services. Within this paternalistic framework, medical
professionals in the colonial service provided services that improved Orang Asli
health.Nevertheless,thepaternalisticframeworkalsoledtheBritishtoestablishlaws
and institutions that treated the Orang Asli as wards of the state, not as an
indigenous people with particular rights to land and resources. In the postcolonial
period, fundamental changes occurred in the nature and the role of the state, and
concomitant changes also occurred in state attitudes toward the Orang Asli. In this

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context, the healthcare system that had been developed with paternal care has
retained its original structure but not its substance or spirit. In the hands of a highly
ethnicised, postcolonial state with a narrow Malay nationalist agenda, the paternal
structures, of which the health care services is one, have worked against the
interestsoftheOrangAsli.

OrangAsliconceptofhealthandillness
Traditionally in Orang Asli settings, when a person suffered an illness that was
seriousenoughtowarrantsomeaction,itbecameaconcernofthewholecommunity.
Other ailments, such as skin diseases, evoked no general concern as they were
consideredtobeharmless,sincethevictimscouldstillfunctionnormally.Likemost
traditional communities, the Orang Asli have long perceived disease as being the
resultofaspiritattack,orofthepatientssoulbeingdetachedandlostsomewherein
this world or in the supernatural world (Gianno 1986: 6). The Orang Asli also believe
thatboththeirindividualandcommunalhealtharelinkedtoenvironmentalandsocial
health.Ifthereistoomuchpollution,forexample,ortoomuchbloodspilt,andtaboos
governingcorrectbehaviourhavenotbeenfollowed,thendiseaseandevendeathwill
strike (Endicott 1979, Howell 1984). The Orang Asli believe that such illnesses are
better treated by incantations and ritual, rather than by modern medical practices.
Treatment is usually given through healing ceremonies, coordinated by one or more
shamans,andinvariablyinvolvingthewholecommunity.
Thus, as opposed to the biological concept of
disease, the Orang Asli concept of illness is
culturespecific(Kleinman1973).Healingisoften
a community effort. The shaman or healer (who
mayalsobethemidwifeinsomecommunities)is
an important anchor in the traditional Orang Asli
health system. As Wolff (1965) noted, the
intimate ties created between patient and healer
in a traditional framework reinforce a strong
sense of sociomedical reciprocity that government officials or westerntrained
doctors are rarely able to replicate. It is not surprising therefore that the Orang Asli
have an intense desire for healing to be integrated within their local sociocultural
context. Traditional healers and their methods are thus unlikely to disappear easily
fromOrangAsliculture.
Furthermore, rather than being a mishmash of mumbojumbo, the Orang Aslis
traditional medical system is an ordered and coherent body of ideas, values and
practices embedded in a given cultural and ecological context. Infused in all this is
the presumption that health is a communal or kinship responsibility, that taboos and
allotherpracticesrelatedtomaintaininghealthandpreventingillnessarenecessary,
and that any breach by one individual will have repercussion on others. The Orang
Asli are also very clear about the link between maintaining their environment and
maintainingtheirhealthandsustenance.

OrangAslihealthandhealthcareincolonialtimes
DuringtheBritishperiod,mostOrangAslidietswerenutritionallysatisfactory(Bolton
1972: 799). Noone (1936) contended that Temiar who have less contact with outside
society were generally healthier than those with more contact. As Jeyakumar (1999)
and Kuchikura (1988) have observed, when Orang Asli traditional territories are left
intact,undiminishedandunappropriated,theyprovideadequateproteinandahealthy
varietyoffruitsandgreenvegetables.
ThisdoesnotmeanthatOrangAslilivinginthepastweredevoidofhealthproblems.
On the contrary, in the 1930s, for example, the Temiar were known to have malaria
and other fevers, bronchitis, boils, scabies, wounds, neuralgia, dental caries,
intestinal worms, and yaws [1] (Baer 1999). At that time, modern health care was
largely unknown. A few Orang Asli who happened to live near a friendly tin mine or
rubber estate did receive basic medical assistance from the companys firstaid
provider.Also,someEuropeanexplorers,gamehunters,railroadsurveyors,andeven
colonial officials, in a humanitarian spirit, provided medical supplies to some Orang
Aslicommunitiesthattheyvisited.
Moreover, during this time, the encroaching outsiders brought new pathogens to
Orang Asli areas. Smallpox, cholera, typhoid, flu, syphilis, and other lifethreatening
maladiesbecamealltoocommon(Baer1999:156,note57).Thesediseases,against
whichtheOrangAslihadnoimmunity,killedmanyOrangAsli,evenwipingoutwhole
villages, and contributed to the longstanding Orang Asli fear and distrust of
strangers. The Batek, for example, reported that before 1942, their population was
muchlargerthanitisnowandthatmanyhaddiedindiseaseepidemicsbroughtinto
theirlandsbyencroachingMalays(Endicott1997).
However,mostOrangAslididnotseeanymedicalpersonneluntilaftertheonsetof
the Emergency in 1948, when British troops invaded interior areas to combat
Communist insurgents operating from there. As we shall see below, this was the
impetusfortheauthoritiestoactinapositivemannertotheOrangAsli.Inparticular,
OrangAslihealthandhealthcare,whichuntilthenhadreceivednoattentionfromthe
colonialgovernment,begantoattractofficialconcern.

Theimpactoftheemergencyandtheestablishment
ofGombakHospital
Soon after the British reoccupied Malaya at the end of World War II, they regained
controlofthetownsandsettledareas,andastheyharriedtheCommunistinsurgents,
the Malayan Communist Party withdrew its followers to camps in the forests. These
roadless, inland areas offered both concealment and the opportunity to sway the
forest Orang Asli to the insurgents cause, whether on the basis of intimidation, or
pastfriendship,orbymisinformingthemaboutthepoliticalsituation.OrangAsliwere
enlistedasmessengers,informers,andgrowersoffarmproducetofeedthecamps.
To protect the Orang Asli from this situation and thereby weaken Orang Asli aid to
the insurgents, the British herded Orang Asli into hastilybuilt resettlement camps
duringtheearlyyearsoftheEmergency(194860).Asmanyas7,000OrangAslidied
in these squalid camps from disease, malnutrition and depression (Polunin 1953
Carey1975).Whenitbecameobviousthatthistacticwasafailure,theBritishbegan
to build forts and associated amenities for the Orang Asli in the forest. These
amenities were meant to win their loyalty, but while most forts had a functional
medicalpoststaffedbyamedicalorderly,onlytwomedicaldoctorswereavailableto
pay regular visits to the many Orang Asli villages located near these forts or further
afield(Bolton1968).
With the Communist insurgency widespread
and ongoing, the medical posts at the forts
had little effect on the overall health of the
Orang Asli. For this reason, the government
built a special hospital for Orang Asli in 1957
[2]. This was a significant historical
development for Orang Asli health services.
Run by the Department of Aborigines (Jabatan
Orang Asli, or JOA), its first medical director
Dr.J.MalcolmBoltonplannedtoprovideahospitalwherethefamilyofanillperson
couldaccompanyhimorher.ItwasthoughtthatthiswouldencourageOrangAslito
seektreatmentatthehospital,asitwasbelievedthattheirprimaryfearwasleaving
their familiar forest surroundings and their family (Bolton 1973a, b Harrison 2001).
There were two main advantages to this plan: first, it made the patient more
comfortable at the hospital and second, accompanying family members could be
givenmedicalexaminations,especiallyfortuberculosis(Bolton1973a).Theideawas
tocreateahospitalthatintegratedintoOrangAslilife.
Bolton recognised that western medicine and traditional medicine occupied different
niches in the healing spectrum and so had the potential to be complementary rather
thancontradictory.HerealisedthattheOrangAslididnottolerateoracceptlongterm
hospitalisationasanecessarymeanstoregainhealth.Suchhospitalisationnotonly
cut off the patients from their forest environment and their community but also from
accesstotheirtraditionalhealersandtreatments(Bolton1973a).
However,oneofthekeyreasonsforthesuccess
of this programme to encourage Orang Asli to
stay in the Gombak hospital was the fact that
patientsthereusuallyhadarelativeonthestaff
who spoke their language, understood their
wishes and fears, and could explain to them the
origin of their disease and the purpose of the
treatment given (Bolton 1968). The original staff
at the hospital had no medical training, but they
were provided with practical training in government hospitals (Bolton 1973a). By
1963,143ofthe161medicalstaffatGombakwereOrangAsli[3].
By 1972, there were 139 inland medical posts for Orang Asli, all staffed by trained
Orang Asli personnel (Bolton 1973b). Flying doctors and nurses periodically visited
many interior areas, sometimes travelling onward by boat or foot (Kinzie et al. 1966
Sjafiroeddin 1968). Emergency helicopter evacuation to hospital was also provided,
as was iodized salt to goitreprone areas. Furthermore, since neonatal and infant
deathratesaswellasmaternaldeathrateswerestillhighinthe1960s,prenatal
andobstetriccareatGombakwasgivengreatattention(McLeod1971).Motherswere
tested and treated for anaemia, malaria and intestinal helminths. Iron, folate and
vitamin supplements plus a good diet were provided. Xrays were screened for
tuberculosis. Accompanying family members were also tested, treated, housed, and
fed. Iron and vitamin tablets were provided for newborns. Moreover, in the 1970s,
GombakHospitalwastrainingmidwivesforinvillagedeliveries.
In retrospect, while this era in Orang Asli healthcare delivery was motivated by the
desire of the government to win the hearts and minds of the Orang Asli (and so
deprive the Communist insurgents of valuable help and information), it was the
dedicationandempathyofindividualmedicalpractitioners,notablyDr.Boltonandhis
teams of volunteer doctors and nurses under the programmes of organisations such
as CUSO (Canadian University Services Overseas) and CARE (Cooperative for
Assistance and Relief Everywhere), that resulted in significant improvements in
Orang Asli health services, as well as an increasing willingness of the Orang Asli to

accept modern medicine alongside traditional healing. The introduction of western

medicinewas,afterall,themainthrustofthehealthprogrammethen(Polunin,1953).
TheOrangAslisrightstotheircultureandtraditionswererespectedbyBoltonsstaff,
inorderthatthehealthprogrammewouldnotbejeopardised.

Postcolonialdecline
The Emergency ended in 1960 with the retreat of the Communist forces, and the
nationgainedindependencefromBritainin1957.AlthoughtheOrangAslihealthcare
services was largely continued, by the late 1970s there were signs that it was in
decline [4]. This prompted Khoo (1979), an officer working in the JOA, to publish a
plan to improve the JOA medical services for Orang Asli as it became more
Malaysianized.Hisfirstprioritywascommunityeducation[5].Secondwasmaternal
andchildhealth,giventheexistinghighmortalityandhighundernutrition,aswellas
maternal depletion [6] among Orang Asli mothers. Third was control of diseases
suchasmalariaandtuberculosis,fourth,improvementincurativeservices,andlast,
thegatheringofinformationonhealthproblemsthatis,research.
Unfortunately, these proposals were not put
into effect. By the 1980s, several reports were
published asserting that the medical services
for Orang Asli under the JHEOA (Jabatan Hal
Ehwal Orang Asli, or the Department of Orang
Asli Affairs, the new name for the JOA) were
inadequate. Veeman (1986/87), for example,
wroteabouttheattitudeofthegovernmentand
the scarcity of medical personnel. She noted
that maternal and infant death rates were still high and that Gombak still had no
facilitiesforhandlingbirthcomplications.Amongotherproblems,primaryhealthcare
was still not available to all Orang Asli and travelling medical teams were lax in
makingtheirscheduledrounds.Lambrosandcoworkers(1989:6)alsoreportedthat
antimalarialprophylaxis:
is infrequent if not nonexistent. Fansidar and chloroquine have not been freely
available to the Orang Asli. Medication is only available when they become so sick
thattheymustleavetheirforestdwellingsandtravellongdistancestoseekmedical
careataclinicorhospital.
These reports correctly identified the gradual slackening in the medical and health
careoftheOrangAsliinthe1980s.Unfortunately,thesituationdidnotimproveinthe
1990s.Bythen,itwasreportedthatonly67of774villages(9percent)ofOrangAsli
villages had clinics (Lim 1997), compared to 139 medical posts active in the early
1970s(Bolton1973b).

OrangAslihealthtoday
Direct and indirect health effects on the Orang Asli were recently reviewed (Baer
1999).Amongthefindings,thecrudedeathrateforOrangAsliistwicethatforallof
WestMalaysia(Ngetal.1992).Intermsofwomenshealth,sexratiosforOrangAsli
today, as in the past, favour men that is, the women die off at earlier ages
(Department of Statistics 1997). Indeed, the maternal death rate for Orang Asli in
1995 was much higher than for other Malaysians. The Orang Asli suffered 4.8 per
centofthesedeaths,althoughtheymadeuplessthan0.6percentofthepopulation
at that time [7]. As Hema Apparau reported in 2002, Orang Asli women have the
highestrecordedratesofpostpartumhemorrhageandpuerperalsepsis,farabovethe
ratesforothergroups.
In terms of infectious diseases, Orang Asli children in
Perak have three times the incidence of tuberculosis as
the state average, and Orang Asli of all ages have 5.5
times the state average (Jeyakumar 1999). Despite their
verysmallpopulationsize,OrangAslihad51.5percentof
themalariacasesrecordedinPeninsularMalaysiain2001
(JHEOA 2005: 22). In 2003, this proportion had increased
to 53.6 per cent (JHEOA Gombak Hospital 2004). For
1994, the leprosy rate for Orang Asli was 23 times higher
than for others in West Malaysia (Fadzillah 1997). The
incidence of leprosy is also on the increase among the
Orang Asli, from 8.74 reported cases per 100,000 of the
population in 1998 to 19.63 in 2002 (JHEOA Gombak
Hospital 2004). Also, the old diseases and infections that have plagued Orang Asli
for as long as they can remember still plague them today. These include skin
infections such as scabies, worm infestation, diarrhoea (sometimes resulting in
fatality),andgoitre.Infact,althoughgoitreiseasyandcheaptoprevent,uptoathird
ofOrangAsliadultsaregoiteroustoday,whichisaboutthesameproportionthathad
goitre 50 years ago (Baer 1999). A new disease, HIV/AIDS, has also been found
among the Orang Asli. Data from the JHEOA hospital in Gombak in 2004 revealed
thattherewere31casesofHIV/AIDSamongtheOrangAsliin2003.
Orang Asli women and children are especially vulnerable to nutritional deficits and
attendant intestinal parasitism. Lim and Chee (1998) found that the nutritional status

of the 34 Orang Asli women they examined in Pahang was generally not
satisfactory.Theirmeannutrientintakelevels(exceptforVitaminC)werebelowthe
requiredminimum,whiletheirmeanironintakeswereaboutonequartertoonethirdof
therequiredlevel.InPahang,35percentoftheSemaiwomenstudiedbyOsmanand
Zaleha(1995)hadproteinenergymalnutritionand64percentweregoiterouseven35
percentofthemenhadgoitres[8].InPerak,73percentoftheTemiarwomenand
48 per cent of the Temiar men studied had intestinal worms (Karim et al. 1995).
Moreover, the vast majority of Orang Asli children are underweight and stunted
(ZalilahandTham2002).ThissupportsthefindingsofOsmanandZaleha(1995)who
found that 80 per cent of Orang Asli children studied were undernourished and
stunted. Many of the children also had intestinal worms and protozoa, anaemia,
dentalcaries,andvitaminAdeficiency(Kasimetal.1995Ariffetal.1997Norhayati
etal.1995,1998Rahmahetal.1997).
It is well to emphasize here that most Orang Asli lack food security (Zalilah and
Tham 2002). With the majority of them living below the poverty line, their narrow
margin of survival makes the Orang Aslis health situation precarious. They are also
vulnerabletonaturalhazardsandthewhimsofecosystemdestructionbyothers.

Stateideologyandpolicies,andtheJHEOA
The British established the Department of Aborigines (JOA) in 1950 during the
Emergencyperiod,toprotecttheOrangAsli.Thisdepartment,nowtheDepartment
of Orang Asli Affairs (JHEOA), controls the Orang Asli through Act 134: Aboriginal
Peoples Act, 1954 (Revised, 1974). Under this Act, the JHEOA is empowered to
create and regulate Orang Asli settlements, appoint and remove headmen, control
entryintoOrangAsliabodes,controlthecropsOrangAsligrowandtheusageoftheir
lands among other arbitrary powers. Since the provisions of the Act effectively
destroy the autonomy of the Orang Asli, they directly contradict the concept of
indigenousrights(Nicholas2000).Notably,thisistheonlypieceoflegislationthatis
directedataparticularethniccommunity.
There is an obvious fissure between the actual situation of Orang Asli health today
andJHEOAgoals,statedinthefollowingverbatimextractfromtheirwebsite:
To create an individual, family and community of Orang Asli who are healthy and
productivebyahealthsystemthatisfair,easilyaccessible,disciplinedandadaptive
tochangeinresponsetoenvironmentandcustomer'sexpectationwitheverystratum
besides encouraging individual responsibility and social participation towards
improvingthequalityoflife[9].
This fissure is an outcome of state ideology and the way the Orang Asli and the
OrangAsliproblemareperceivedandadministered.TheOrangAsliareregardedas
wards of the state and the JHEOA, their godparent. That the relationship is
conceptualisedasoneofparentandchildisreflectedinvariousways.Forexample,
Jimin Idris, JHEOA DirectorGeneral from 1986 to 1992, frequently asserts that he
had to care for 70,000 children, from the womb to the grave. That the Orang Asli
are to be treated as children is not something new. In a matter involving an
application for land by some Orang Asli towards the end of the nineteenth century,
the British Resident wrote that, They must be provisionally treated as children and
protectedaccordingly,untiltheyarecapableoftakingcareofthemselves(Selangor
Secretariat/2853/1895). McLellan (1986: 91) further maintains that the JHEOA has
continued the British paternalistic and the Malay feudal patronage role toward the
OrangAsli,soitsettlesclaimsanddecidespolicywithoutactivelyinvolvingoreven
consulting those concerned. The Orang Asli, therefore, are not recognised as a
people, but rather as individual subjects requiring large doses of governmental
supportinordertoassimilatethemintomainstreamsociety.Thisunderlyingattitude
extends well beyond legal and land matters, and into the realm of health policy and
healthcarefortheOrangAsliaswell.
The underlying assumption in state policies is that Orang Asli backwardness is a
result of their way of life and remote location. Government policy therefore is to
introduce strategies and programmes to integrate them into the mainstream. What
exactly this mainstream refers to, is not clearly spelt out. But from early policy
proclamations and current development programmes, it is apparent that this four
decadesoldobjectiveoftheJHEOAisbasicallyaboutmouldingalloftodaysOrang
Asli into mainstream Malay society. Such an objective has ramifications for the
OrangAsli,eveninaspectsofhealthcaredeliveryandtheirgeneralhealthsituation,
as this chapter argues. Primarily, however, as discussed by Nicholas (2000), it sets
theideologicalandpoliticalbasisforsubjugatingapeople.
WhenMalayawasgrantedpoliticalindependencebytheBritishcolonialistsuponthe
defeat of the Communists, the Malaybased political party, United Malays National
Organization (UMNO), rode to political power on the crest of Malay nationalism.
Subsequent nation building was based on the historical pact that accorded special
privileges to the Malays in exchange for citizenship rights for the nonMalay
immigrant population. The special position of the majority Malay population was
premisedonthenotionoftheirindigenousstatus.Assuch,thehistoricalprecedence
oftheOrangAsliwasdifficulttoacknowledge.Eventually,thewayinwhichthestate
tried to resolve this incongruity was by policies that attempted to assimilate the
Orang Asli into the Malay population. The Orang Asli were treated differently and

separately but never fully recognised as an indigenous people with all the rights that
are conventionally accorded to indigenous peoples by international custom. These
rights include recognition as an autonomous people, recognition of the right to
traditionallyoccupiedlands,recognitionoftherighttopractice,maintainanddevelop
theirculture,languageandreligion,andrecognitionoftheirtraditionalknowledgeand
indigenoussystemsandtherighttoprotectandpromotethese.
The nonrecognition of these rights has directly brought about the fate of the Orang
Asli,intermsoftheirpoorsocioeconomicstatusandpoliticalinconsequenceand,as
wearguehere,theabysmalstateoftheirhealth.

Dominance,authorityandcontrol
The paternalistic institutions inherited from the British accorded to the Orang Asli
[10]auniquepositionthatallowedthemtobetreateddifferentlyfromothersectorsof
Malaysiansociety.IntheabsenceofawillingnesstorecognisetheOrangAsliasan
indigenouspeoplewithinalienablerights,andinthecontextofaparticularethnicised
politics, the state translated this difference into dominance and authority over the
Orang Asli. As will be seen from the examples given below, this dominance and
authoritywasoftenmanifestedindiscriminationagainst,andcontrolover,theOrang
Asli. Unfortunately this has been as true for Orang Asli health care as for other
aspectsofOrangAsliliving.

Scapegoating
Blaming the victim instead of oneself appears to be quite commonplace in
administrative dealings with Orang Asli, especially in matters about health. For
example,inOctober1985,when23FELDA[11]settlersinTrolak,Perak,camedown
withjaundice,thehealthauthoritieswerequicktoblamethenearbySemaivillageand
to call for its resettlement. This call was made on the possibility and feelings that
the Semai were contaminating the water supply by their unhygienic practices.
Although another 1,057 people in the district had come down with jaundice in the
preceding month, no drastic action like resettlement was suggested for nonOrang
Asli communities. As it turned out, the cause of the outbreak was insufficient
chlorinationatthetreatmentplant(TheStar18February1985,2December1985).
InFebruary1997,whentwoJahHutchildrenin
Kuala Krau, Pahang died from an overdose of
antimalarials irresponsibly dispensed by a
health department team, the authorities denied
itwastheirfaultandsuggestedthatthedeaths
were due to the parents negligence. A
coronersinquiry,however,ruledthatthecause
of death was in fact an overdose of anti
malarials (Toh 2000, Nicholas 1997, Baer
1999). Notably, this was the fourth fatal incident arising out of the antimalaria
programmeinthesamestate!
Recently, in April 2004, when four Semai children died within five days with
symptoms of vomiting and diarrhoea, the authorities were quick to attribute the
tragedy to salmonella poisoning and, consequently, the poor hygiene of the Orang
Asli (Husairy Othman 2004). The government reiterated that it could only provide
proper health facilities and infrastructure if the Orang Asli were resettled. The Health
Minister who made this comment did not realise that RPS Terisu in Cameron
Highlands, where the tragic deaths occurred, was a resettlement scheme and had
been so for many years! [12] The cause of the deaths was eventually found to be a
rotavirusinfection.
Even more recently, in July 2004, when a university study found high levels of
EscherichiacoliinTasikChinilakethatcausedrashesanddiarrhoeainsomeOrang
Aslilivingintheirfivelakeshorevillages,theMinisterinchargeofOrangAsliaffairs
immediately suggested that the Orang Asli be resettled into one place so that they
can attain proper amenities. However, as the village batins there pointed out, the
problemonlystartedwhentheauthoritiesdammedtheChiniRivertopreventthelake
water from flowing into the Pahang River. Moreover, the university study plainly said
thecontaminationwasduetoimpropersewagedisposalbyalocalresortandbythe
Tasik Chini national service camp at the lakeside! (The Star, 26 July 2004, 27 July
2004,29July2004).
Such blameshifting on health problems reveal the underclass status of the Orang
Asli. No dominant social group would accept such allegations without a counter
challenge, and no politician would dare to pit himself against a group that could
jeopardise his own position. Such attitudes about Orang Asli also clearly show how
those responsible for promoting Orang Asli welfare and health are themselves ill
informed or ignorant of the issues involved. Worse, they wield their authority and
dominancebybackingmeasuresthatwouldfurthermarginalisetheOrangAsli.

Insensitivity
Theofficialstanceofauthorityanddominance,coupledwithignoranceofOrangAsli
culture, is sometimes reflected in an insensitive technocratic way of handling

problems.Forexample,in1996,whenthePresidentoftheMalaysianAssociationof
Maternal and Neonatal Health revealed that 60 per cent of the 42 mothers who died
during home births in 1994 were Orang Asli (Sunday Star, 29 September 1996), the
Minister responsible for Orang Asli Affairs immediately ordered that the seven
existing Orang Asli healthtransit centres be turned into Alternative Birthing Centres
(ABCs)(John1997,2004).
This official order may appear to be decisive and prompt, but on the ground, it had
drastic repercussions. For one, Orang Asli motherstobe were warded for about a
month before the delivery date to wait out their time. Not only was this
psychologicallystressfulforthewomen,italsoplacedaheavyburdenontherestof
the family, especially for those families living near subsistence. Home births were
discouragedandinsomecasesforbiddenbylocalhealthstaff[13].
Orang Asli mothers still prefer home delivery because institutional delivery not only
createsproblemsfortherestofthefamily,itisalsoculturallyunfriendly.Itmaybe
truethatbyencouraginginstitutionaldeliveries,maternaldeathrateswilldecline,but
a more sensitive way of implementing this policy would be to create conditions that
allowOrangAslimotherstofeelmoresecureandcomfortable,aswellasmitigatethe
problems faced by families. Another way to reduce Orang Asli maternal mortality is
totrainresidentmidwivesandmakeavailabletelephoneandtransportservices.
The myth of development and resettlement: Inability to see traditional resources as
necessarytohealth
Development planners and policy makers commonly assume that Orang Asli health
will improve if the Orang Asli accept development programmes designed for them or
accede to resettlement elsewhere (usually with cashcrops as the main means of
subsistence). The reality is far from this, based on the known regroupment failures,
suchasatBusutBaru,RPSBanun,Bekok,RPSKedaik,KualaKohand,RPSTerisu
[14].
The poor nutritional status of Orang Asli children living in regroupment schemes
showsthattheschemessocialobjectivesarenotbeingmet.Khor(1994:123)wrote
that:
Some 15 years after relocation, the nutritional status of Orang Asli children in
regroupment schemes can be described as poor with a moderate to high prevalence
of underweight, acute, and chronic malnutrition. Their dietary intakes are deficient in
calories and several major nutrients. There exists an oversimplified assumption
that introduction to cashcropping will lead to increased income, which will provide
more money for food, and in turn result in improvement in nutritional status. ... In
reality, relocation entails cultural uprooting and lifestyle changes which may not be
overcomebytheprovisionofphysicalfacilitiesandeconomicincentivesonly.
Such lamentable conditions in these myriad schemes is due to the narrow
subsistence base and psychological disenfranchisement caused by uprooting Orang
Asli from their traditional territories. While the authorities argue that Orang Asli
regroupmentdoesnotnecessaryentailrelocation,therealityisthatthelocalresource
base declines because it must be shared with others who have been moved in from
theirownhomelands.ThisisamajorcauseofpoornutritionamongtheOrangAsli.
In reality, resettlement is often not for the purpose of improving Orang Asli health or
lifestyles, but for other reasons such as security (resettling Orang Asli during the
Emergency), making way for public projects (the Kuala Lumpur International Airport,
the Universiti Kebangsaan Malaysia campus, highways, dams),or even making way
forprivateprojects(housingdevelopments,golfcourses,resorts,othersettlers).Itis
made possible because there is no legislation protecting the Orang Asli as an
indigenouspeoplewithinherentrightstotheirtraditionalterritories.

ThestateofOrangAslihealthcaretoday
The Orang Asli health care services is now made up of 125 treatment centres
(designated locations where a mobile clinic visits periodically), 20 transit centres
(centres where patients and accompanying persons are housed while waiting to be
transferredtoahospitalfortreatment),and10healthclinics(JHEOA2005).Thereis
anunderstandingbetweentheMinistryofHealth(MOH)andtheJHEOAsDepartment
of Health and Medicine, whereby the MOH provides services to the areas that are
accessiblebylandtransportation,leavingtheinteriorvillages,numbering323villages
outofatotalof869,totheJHEOA.
Nevertheless,therearemajorshortfallsinhealthserviceprovisiontotheOrangAsli.
The JHEOA itself, in its Orang Asli Community Health Action Plan (JHEOA 2005),
pointstothelackofcomprehensivehealthservicesintheinteriorvillages[15].The
samedocumentattributesthefallingadmissionsrateinGombakHospital,nowa166
bed hospital, to the shunting of Orang Asli patients to MOH facilities. There are,
however,otherorganizationalproblemsthatmayberelatedtothis.
Since the early 1990s, there has been no governmental recruitment of Orang Asli
paramedics or health providers. This is diametrically opposite to the policy adopted
byDr.Boltonandhisteaminthe1960s.Therehasbeennoofficialreasonforthisbut
somepastofficersofJHEOAhaveattributedthisstateofaffairstotheprejudicesof

certain JHEOA decisionmakers, while the JHEOA on its part contends that there
werenoqualifiedapplicantsfromtheOrangAslifortheseroles.
This time period was also marked by a high level of corruption in the JHEOA as
acknowledged by a former senior officer of the JHEOA (Mohd. Tap 1990: 84, 104).
NewspapersevenreportedthathospitalstaffhadturnedpartsoftheGombakhospital
premisesintodaylightgamblingdens(BertitaHarian,3March1984,10March1984).
There were also cases of Orang Asli girls (accompanying their sick relatives) being
abused or asked to engage in prostitution as well as cases of ambulance drivers
asking for monetary incentives in order to send recovered patients back to their
village[16].
Orang Asli were often treated condescendingly or berated when some minor error or
omission occurred. As such, many Orang Asli said that they did want to go to the
hospitalbecausetheemployeesdidnottreatthemwithrespect(cf.Gianno2004:64)
orbecausetheywereinsensitive,discriminatory,andunfriendly(Harrison2001).
This is not to suggest that there are no instances of
exemplary dedication and sensitive dispensation of
healthcare to the Orang Asli today. We acknowledge that
particular individual healthcare providers be they
doctors,nursesorparamedicshavedisplayedthesame
genuine concern and responsibility so admirably exhibited
by the early volunteer doctors and nurses under the still
remembered supervision of Dr. Bolton in the 1960s and
1970s.
However,theseindividualsaretheexceptionandaremore
likely to be attached to medical centers of the Ministry of
Health rather than the JHEOA medical service. It is not
uncommontohearJHEOAdoctorsattributingtheirsacrificetoservetheOrangAsli
to their pity for the people. Also, it is no longer a priority in the Orang Asli medical
service to have firstline Orang Asli health workers who can support and clarify
technicalmattersfortheirhospitalisedrelatives.Theintroductionofaprogrammeto
trainvillagelevelOrangAsliHealthVolunteers(SukarelawanKesihatan), although an
excellentidea,hasunfortunatelyyettoachieveitsdesiredgoals.
Orang Asli health care has indeed taken a beating in the past two decades, not for
lack of resources or knowledge of what needs to be done, but primarily because the
political and ideological basis of the Orang Asli problem has not been corrected (or
even acknowledged). The Orang Asli have been treated as notsodeserving
beneficiariesofgovernmentlargesse,ratherthantheotherwayround.Thissituation
is further worsened by discrimination and the formal denial of Orang Asli inherent
rights,suchastheirrightstotheirtraditionallandsandresources.Thoseresponsible
for Orang Asli health (or for that matter, their overall wellbeing and advancement)
could not or did not want to see the link between Orang Asli wellbeing and good
healthontheonehand,andtheirneedtobeincontrolovertheirtraditionallandsand
resourcesontheother.
With increasing pressures to privatise healthcare in Malaysia, and the unwillingness
ofthestatetoaccordthepoliticalandsocialrecognitionthatisduetotheOrangAsli
as the first peoples on this land, it is difficult to see how Orang Asli healthcare will
improve through the initiative of the state and its functionaries. It remains a major
project, therefore, for the Orang Asli to assert the recognition of their rights as a
people,andwithit,thedeliveryofamoresensitiveandeffectivehealthcaresystem.

Notes:

1.Althoughtheseearlierstudiesdidnotmentiongoitre,itshouldbenotedthatlackofgoitrewasunusualamonginland
groups.
2. This was first sited in Kuala Lipis, Pahang, and later moved to a forested area in Gombak, Selangor. Thereafter, it
has been called the Gombak Hospital. See the JHEOA website, http://www.jheoa.gov.my/ehospital.htm (accessed 16
September2005).
3. It should be noted that the daily cost for a patient at Gombak Hospital was only 28 per cent that of other
government hospitals (Bolton and Snelling 1975). This low cost probably reflected the fact that the budgeted
expenditureperpatientwasfarless,ratherthanthatthehospitalhadfoundwaystorunitsservicesmoreefficiently.
4.YettheCommisionerforOrangAsliAffairsthen,IskandarCarey,maintainedthatthegovernmentsaimwastoraise
the standards of health and hygiene for the Orang Asli, an aim he thought had already been fulfilled (Carey 1976). He
also wrote that 120 Orang Asli were paid a monthly allowance to distribute medicines in villages. This was a laudable
practice but was far from comprehensive since these 120 people could not serve all the 629 Orang Asli villages in the
country(1969censusdata).
5.TheproblemwithtraditionalaetiologywasthatOrangAslididnoteasilyaccepttheneedforpreventivemedicine:If
the spirit causing malaria had departed, why continue taking tablets? (Bolton 1973a: 1122). But they were willing to
accept antimalarial tablets (quinine) as it was thought that the bitter taste they gave to the blood kept the evil spirits
away.
6.Thephysiologicalilleffectsofhavingmanypregnancies.

7. Personal communication between Adela Baer and Ravindran Jegasothy, of the Department of Obstetrics and
Gynaecology, Seremban Hospital, 2002, and author of Sudden maternal deaths in Malaysia, a case report, J. Obst.
Gynaecol. Res. 28 (4): 186193, 2002, which reported that MOH records were analyzed by a national committe of six
obstetricians and gynaecologists, a physician, an anaesthetist, an health administration personnel and a nursing
matron.Afterreadingthispaper,AdelaBaercorrespondedwithRavindranJegasothyaboutthesituationforindigenous
women.
8.Instarkcontrasttothe35percentSemairate,only7.5percentofruralMalaywomenstudiedhadthismalnutrition
(Osman and Zaleha, 1995). In related work, Osman and coworkers (1993) found that the food intake of Semai adults
resettledatBetauinPahangaveragedonly1143kcal/day.

9. http://www.jheoa.gov.my/ehospital.htm(accessed9May,2005)
10.Nootherethnicgroupinthecountryhasagovernmentdepartmentassignedspecificallytooverseeitsprotection,
wellbeingandadvancement,oranactofparliamenttolegislateeveryaspectofitssociety.
11.FederalLandDevelopmentAuthorityschemes.
12.RPSstandsforRancanganPerkumpulanSemula,orregroupmentscheme.
13.Threatsofrefusingtoregisterthebirth,ofrefusingaidintheeventofadifficultbirth,andoflayingcriminalcharges
in the event of a tragedy, have been used. One anecdote of the experience of a Mah Meri woman may be used to
reflect the insensitivy with which Orang Asli women are often treated (personal communication with Reita Rahim, April
2004).OnthedaywhenthecommunitycelebratedtheirHariMoyang(AncestorsRemembranceDay)inFebruary2004,
a nurse from the district hospital, about 15 kilometres away, came to her house and took her away to the ABC without
informing any family member. After a frantic search, the family found her, but was only able to bring her home after
much insistence and promises to ensure that she complies with the medication prescribed. The nurses said that they
were following instructions, and they needed to ward her due to her low iron and red blood cell levels. Be that as it
may,thewayshewasremovedwashighlyquestionable.
14.Inthe1960s,halfoftheSemaqBeriinaresettlementcentrediedfromcholera(Morris1997).
15. In this document, the lack of comprehensive health services in the interior villages was singled out as the reason
forthehightuberculosisinfectionrates.
16.PersonalconversationsbetweenColinNicholasandOrangAslihospitalassistantsbasedinGombakHospital,1993
1994.

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