Our Orang Asli Children Are Dying: Do We Care?

By Dr Amar-Singh HSS | 23 April 2019

From 2012 to 2017 the government spent RM 2.3 billion on a “river of life” project in Kuala Lumpur, but it was not willing to spend RM 15 million yearly to feed Orang Asli children.

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I often wonder if our nation wants to hear truth or just cover-up the reality? Also I wonder if we will ever get serious about the important issues facing marginalised communities that have no voice?

The recent uproar over inner city (KL) children being malnourished is good but there is a disproportionate silence about the long standing malnutrition of our Orang Asli children.

We hope, with the birth of a new Malaysia and a new government that focuses on the needs of the people, that truth and reality can be shared about our Orang Asli sisters and brothers.

Fact 1: The vast majority of our Orang Asli children are malnourished & it is worsening

(Read here: Don’t have enough food to eat on a day to day basis)

Numerous studies, over decades, have shown that 70-80% of Orang Asli children are underweight or stunted in height by school going age. What is more worrying is that malnutrition rates are increasing in Orang Asli children due to extensive loss of habitat.

A recent study we did on Orang Asli children in Perak (1329 children in the state under 2 years of age) showed that 40% were malnourished by 2 years of age (Clinical Research Centre Perak 2016).

The real figure is much higher as many (40%) had poorly plotted growth charts that could not be evaluated. It must be remembered that we in Perak, under the Ministry of Health, have the best re-feeding nutrition programme for Orang Asli children and yet we cannot halt this malnutrition crisis among Orang Asli children.

Fact 2: Orang Asli children die at a rate 6-8 times higher than other Malaysians

The true mortality for Orang Asli children is not easy to determine as we are not able to document all those that live in the interior. But available data suggests that the death rate in these children is 6-8 times that of the national average.

This means that for every 1 Malay, Chinese or Indian child that dies, 6-8 Orang Asli children will die. The true difference is probably higher.

I have been involved with this community for more than 3 decades and have observed a deterioration in their health and economic status over the last 30-40 years. In the past we rarely saw malnutrition among the children and they would die predominantly from malaria.

In the past 20 years the vast majority of Orang Asli children die as a result of underlying nutrition.

They are not able to cope with a simple diarrhoea or pneumonia infection due to chronic malnutrition. The primary reason for poor health and the high prevalence of malnutrition are external social factors affecting the Orang Asli people including resettlement schemes, logging and river silt pollution; all resulting in a loss of traditional protein sources.

Fact 3: The Death Trap of government resettlement schemes and the extensive logging around Orang Asli villages

The government resettlement programmes for the Orang Asli are a death trap for many; they worsen malnutrition by removing food security.

In addition, despite a new government, we continue to see the extensive logging activities around Orang Asli villages, often deforesting their area completely.

NGOs working to uplift the Orang Asli people have shared how there is no change and possibly a worsening of logging activities in the past year. This has resulted in the Orang Asli people losing their natural supermarket protein sources (the forest and rivers) as their forests have been logged and rivers polluted.

The simple diagram above shows the factors that have been affecting this people group for years and are the major causes for poverty and malnutrition.

Fact 4: Jabatan Kemajuan Orang Asli (JAKOA) is ineffective and not trusted by some Orang Asli people. The Orang Asli people are seldom consulted and involved in decision making about their programmes affecting them and are not in control of JAKOA.

This is an uncomfortable reality.

JAKOA is a department with a poor track record and not always trusted by some of the Orang Asli. It would be good to evaluate what proportion of top management of JAKOA, nationally and in each state, are staffed by Orang Asli people. It would be ludicrous to run a department for a people group staffed by those who are not from that community and do not appreciate their struggles, culture and needs.

JAKOA always seem short of funds and are not even able to fund the basic transport for children with chronic illness to come to hospital for review by paediatricians.

It would be good to audit the development and financial budgets that are given to JAKOA and see where the money has been spent (the socio-economic development budget given to JAKOA in 2016 was close to RM 200 million).

Fact 5: What Works & Suggestions to support our Orang Asli children

Initiatives that have developed and brought benefit include (short-term):

  • Some years ago, a few of us advocated for the healthcare needs of the Orang Asli to be moved from Jabatan Kemajuan Orang Asli (JAKOA) to the Ministry of Health so that we can support these children. This transfer of health responsibilities to MOH has allowed us to make meaningful inroads into the well-being of these children.
  • Written protocols on resuscitation of malnourished Orang Asli children – these are vital as malnourished children respond differently to treatment and we require the support of paediatricians.
  • Acute re-feeding protocols of malnourished children – we have to be careful how we feed decompensated, malnourished children and this is best done in regional centres with expertise.
  • Proactively identifying children with severe malnutrition and rescuing them before they become ill. We cannot wait for children with severe malnutrition to get ill but need to boost their nutrition before it happens.
  • Establishing re-feeding centres in larger villages and health facilities in the interior. This is the single most important stop-gap measure to save these children. Community-based feeding programmes have led to a 90% reduction in Orang Asli childhood mortality in areas where we can implement it. The key is to give every Orang Asli children, under the age of 5 years, one protein-energy meal every day.

Suggestions to improve their outcomes include (long term):

  • One very important action must be the total re-vamp of the Jabatan Kemajuan Orang Asli. JAKOA is best placed under the PM’s department (currently an “orphan” department) and be staffed predominantly by the Orang Asli people.
  • The Orang Asli people need meaningful socioeconomic development that is sustainable and culturally acceptable. Development plans must be discussed with and involve the Orang Asli people. We cannot import our ways but must listen to their suggestions and ideas. Remember for the Orang Asli it is vital we respect and preserve their culture/way of life and spiritual beliefs. We need to understand, empower and work with them to enable them to take control of their lives, community and health needs.
  • Halt all logging actives around Orang Asli villages and stop any resettlement programmes.
  • It is important that the government work with the major NGOs supporting the Orang Asli people as they often are better equipped to understand this community and make successful initiatives.
  • Significantly increase funding for health and development programmes involving the Orang Asli children and community, especially the community-based feeding programmes is critical. As a comparison, from 2012 to 2017 the government spent RM 2.3 billion on a “river of life” project in Kuala Lumpur, but it was not willing to spend RM 15 million yearly to feed Orang Asli children less than 5 years of age nationwide. What an indictment of our humanity – a river is more important than an entire people group and children’s lives.

Close to one year ago (28th May 2018), I made a plea to the new government to save these children.

Now one year later the situation has worsened.

I understand from colleagues and NGOs on the ground that the vital life-line, the community-based feeding programme for Orang Asli children, is again plagued with interruptions in funding.

I cannot understand why we cannot get our priorities right as a government and people – saving lives is far, far more important than building more buildings or having mega projects. We elected a government to save the people not enrich capitalists.

Can I suggest that instead of expensive ‘learning trips’ overseas by our politicians and senior civil servants, that in 2019, they instead spend a month living at an Orang Asli village in the interior; eating their food, living their lifestyle and understanding their hardships (without an entourage and media coverage please). Perhaps then real resources will reach them.

We have already lost many of our Orang Asli children due to government inaction.

The children cannot wait for some plans tomorrow.

Today is their day or we will lose more of them.

Dr Amar-Singh HSS is Advisor of the National Early Childhood Intervention Council (NECIC). He was previously a Senior Consultant Paediatrician and Head of the Paediatric Department, Hospital Raja Permaisuri Bainun, Ipoh. Recently retired, he worked in the public healthcare sector for over 36 years.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
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