Thursday, August 09, 2007

Health care for the Orang Asli: Consequences of Paternalism and Non-recognition

The Orang Asli are the indigenous minority peoples of Peninsular Malaysia. In 2004, they numbered 149,512, representing a mere 0.6 percent of the national population.

Like other indigenous peoples the world over, the Orang Asli are among the most marginalized, 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 reduced to 6.5 percent, the rate for Orang Asli remains at 76.9 percent. The official statistics also classify 35.2 percent of Orang Asli as hardcore poor, compared to 1.4 percent nationally. (Zainal Abidin 2003)

Orang Asli concept of health and illness
Traditionally in Orang Asli settings, when a person suffered an illness that was serious enough to warrant some action, it became a concern of the whole community. Like most traditional communities, the Orang Asli have long perceived disease as being the result of a spirit attack, or of the patient’s soul being detached and lost somewhere in this world or in the supernatural world. The Orang Asli also believe that both their individual and communal health are linked to environmental and social health. If there is too much pollution, for example, or too much blood spilled, and taboos governing correct behavior have not been followed, then disease and even death will strike.

Healing is often a community effort. The shaman or healer (who may also be the midwife in some communities) is an important anchor in the traditional Orang Asli health system. As Wolff noted, the intimate ties created between patient and healer in a traditional framework reinforce a strong sense of socio-medical reciprocity that government officials or western-trained 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 socio-cultural context. Traditional healers and their methods are thus unlikely to disappear easily from Orang Asli culture.

Furthermore, the Orang Asli’s traditional medical system is an ordered and coherent body of ideas, values and practices embedded in a given cultural and ecological context. Health is viewed as a communal or kinship responsibility, that taboos and all other practices related to maintaining health and preventing illness are necessary, 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 maintaining their health and sustenance.

Orang Asli health today
The most recent review of the Orang Asli’s health situation shows that the crude death rate for Orang Asli is twice that for all of West Malaysia. It is worth emphasizing here that most Orang Asli lack food security. With the majority of them living below the poverty line, their narrow margin of survival makes the Orang Asli’s health situation precarious. They are also vulnerable to natural hazards and the whims of ecosystem destruction by others.

Paternalism and Insensitivity
The Department of Orang Asli Affairs (DOAA) is tasked to manage and control the affairs of the community. Under the current set up, the Orang Asli are treated as wards of the state. The Orang Asli, therefore, are not recognized as a people, but rather as individual subjects requiring large doses of governmental support in order to assimilate them into mainstream society. This underlying attitude extends well beyond legal and land matters, and into the realm of health policy and healthcare for the Orang Asli as well.

The underlying assumption in state policies is that Orang Asli’s backwardness is a result of their way of life and remote location. Government policy therefore is to introduce strategies and programs to integrate them into the mainstream. Such an objective has ramifications for the Orang Asli, even in aspects of healthcare delivery and their general health situation.

Viewed as backward and ignorant, the Orang Asli are often blamed for any outbreak that happens within their communities. For example, in July 2004, when a university study found out that high levels of Escherichia coli in Tasik Chini lake caused rashes and diarrhea in some Orang Asli living in five lakeshore villages, the minister in charge of Orang Asli affairs 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 problem only started when the authorities dammed the Chini River to prevent the lake water from flowing into the Pahang River. Moreover, the university study plainly said the contamination was due to improper sewage disposal by a local resort and by the Tasik Chini national service camp at the lakeside.

Development planners and policymakers commonly assume that Orang Asli health will improve if the Orang Asli accept development programs designed for them or accede to resettlement elsewhere (usually with cash-crops as the main means of subsistence). The reality is far from this.

The poor nutritional status of Orang Asli children living in regroupment schemes shows that the scheme’s social objectives are not being met. For example, Orang Asli children living in resettlements still have a poor nutritional status.
In hospitals and medical institutions, Orang Aslis are often treated with ridicule and derision. Two studies conducted in 2001 and 2004 showed that Orang Aslis were adamant to go to hospitals because of the unfriendly and rude treatment they got from staff.

The Orang Asli have been treated as not-so-deserving beneficiaries of government assistance, rather than the other way round. This situation is further worsened by discrimination and the formal denial of Orang Asli inherent rights, such as their rights to their traditional lands and resources. Those responsible for Orang Asli health (or for that matter, their overall well-being and advancement) could not or did not want to see the link between Orang Asli wellbeing and good health on the one hand, and their need to be in control over their traditional lands and resources on the other.

With increasing pressures to privatize healthcare in Malaysia, and the unwillingness of the state to accord the political and social recognition that is due to the Orang Asli 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, and with it, the delivery of a more sensitive and effective healthcare system.

By Colin Nicholas and Adela Baer
The original article of this appeared in Health Alert Asia Pacific Issue No. 10, 2007 (Supplementary issue). For copies of the newsletter, please email