By Dr Jeyakumar Devaraj

There are at present 19 distinct ethnic Orang Asli groupings in Peninsular Malaysia with a total population of 105,000, constituting 0.5 per cent of the Malaysian population. They represent one of the most marginalised and impoverished groups in Malaysian society.

Having worked in Perak, which is home to about a third of the Orang Asli in Malaysia, I have had numerous opportunities to meet and treat Orang Asli patients over the past 13 years. My talk to you is based on these experiences. First, I will give a brief over-view of the health status of the Orang Asli, then discuss the underlying causes ill-health among them, and end with some comments on the role and responsibility of the Medical Profession.

The incidence of infectious diseases among Orang Asli is much higher than for the non-Orang Asli population. For example, the incidence of tuberculosis (TB) among Orang Asli in Perak is about 240 per 100,000 or 5.5 times that of the Perak population overall.

Not only is their incidence of TB higher, it is also more severe as they often present late, and they also have a much higher incidence of TB spine and meningeal TB.

Malaria is endemic among Orang Asli and they account for half to three quarters of all cases of malaria in Peninsular Malaysia.

Malaria and tuberculosis are cited here as indicator illnesses. A host of other infectious illnesses, notably upper respiratory tract infections, and acute diarrhoeal illnesses in children are also much more common in the Orang Asli population as compared to the general Malaysian population.

Small surveys carried out in Tapah Hospital, Perak, revealed that the incidence of complications of childbirth were much more common among Orang Asli mothers as compared to the general population.

Moreover, the birth weights of Orang Asli neonates were much lower than their other Malaysian counterparts.

Khor Geok Lin's study of the nutritional status of Orang Asli children in the Batang Padang District of Perak documented very clearly the considerable malnutrition among Orang Asli children.

Professor Sham Kasim's 1986 study of 23 Orang Asli kampungs (Table 6) found that "resettlement of the Orang Asli has not improved the nutritional status of their children. It may even have contributed to a deterioration of their health and nutrition status."

Smoking is prevalent among the Orang Asli population, including women and children. Consequently the incidence of chronic obstructive airway diseases is high among the Orang Asli. Consumption of potent cheap beverages with high alcoholic content is increasingly common among Orang Asli men, and is a cause for concern.

Documented HIV infection does not seem to be common as yet though cases have been noted.

Most medical researchers tend to assume that ill-health among Orang Asli is primarily due to ignorance and cultural practices. Sham, for example, in his otherwise excellent paper on the nutritional status of Orang Asli children, concludes that "this practice (of using condensed milk as a weaning food) stems from ignorance regarding breast feeding and financial constraints". He continues that "A number of food taboos will have to be overcome before any change in the dietary habits of the Orang Asli can be instituted effectively."

However, a careful reading of surveys of the dietary practices of Orang Asli, such as JM Bolton's Food Taboos among the Orang Asli in West Malaysia, reveal that the Orang Asli diet is quite adequate if they have access to foods normally assessible to them in their traditional habitat. It is only when their traditional economic activity is curtailed by resettlement to new area, or the "development" of the forests around them that their food practices result in inadequate protein intake.

Their depressed health status is directly linked to their socio-economic situation. The Orang Asli of Peninsular Malaysia were and are hunter-gatherers with some communities practising shifting cultivation. Both these economic activities require access to fairly large tracts of land. For example, a normal sized family would require 5 to 7 acres of land for hill padi cultivation each year. These plots can only be re-used for padi cultivation after a fallow period of 4 to 7 years.

The Orang Asli's access to land has been quite severely circumscribed by the political and economic developments around them which have displaced Orang Asli from their lands twice in the past 50 years. The first displacement occurred in the 1950s when the British relocated Orang Asli from their remote jungle homes to sites closer to the main roads to prevent Orang Asli communities from supporting the communist insurgents. The latter had developed a close and mutually beneficial relationship with the Orang Asli.

Over the past 20 years the Orang Asli have found that the lands that they have occupied since the 1950's are now being eyed by the government and developers for logging, plantation activities, highways, and townships. Sections 6 and 7 of the Aboriginal Peoples' Act (134) empowers the "State Authority" to designate certain lands as Orang Asli reserves within which no other community can conduct any form of agricultural or logging activities.

However, Orang Asli living in that area are not given title grants to the lands so gazetted. Furthermore, subsection 3 of Section 7 empowers the "State Authority" to declassify Orang Asli reserves if and when it wishes to do so. This declassification of Orang Asli land has occurred time and again, and has further depressed the economic viability of the Orang Asli way of life.

Logging and extensive clearing of the forests in their vicinity reduces the amount of jungle produce that the Orang Asli can harvest, depletes the wildlife and muddies their rivers leading to a drastic drop in the availability of fish.

This encroachment onto their lands and the resulting impoverishment of the community, has forced many younger adults to come to the towns and join the bottom rungs of the urban work force with the unfortunate corollary that quite a few Orang Asli women have become commercial sex workers.

Apart from causing economic and physical hardships, "development" has also disrupted the traditional lifestyle and value-systems of the Orang Asli in a very profound way – the subversion of their traditional leaders. The Headman held an exalted position in most of the Orang Asli groups. He was their leader in times of strife, and their arbitrator in disagreements involving members of the group.

The loggers who moved into recently declassified Orang Asli lands recognised the authority of the traditional leaders, and undertook various steps to win them over. Many companies pay the headmen monthly "allowances" for acting as their publicity relations officers. Several companies also give presents to win over the headmen.

In many places Orang Asli communities are ambivalent about their traditional leaders who just one generation ago were held in high esteem. This subversion of their leaders has adversely affected the social cohesion of the Orang Asli communities. The vexing issue of increasing alcohol consumption has to be understood within this larger context.

The health problems of Orang Asli communities are but the epiphenomenon of their progressive marginalisation. The dominant free-market socio-economic system is impinging upon and over-running the traditional subsistence system of the Orang Asli.

The continued integration of Orang Asli into mainstream society is a certainty, and no one can turn the clock back. In fact even the Orang Asli do not want the clock turned back. They want development – but one that puts their needs as a major priority, and at a pace that does not tear their socio-cultural system apart.

If health professionals wish to improve the health status of Orang Asli, they should: