An outbreak which led to the death of 15 members of the Bateq Orang Asli group in Kampong Kuala Koh, Gua Musang in May and early June 2019 shocked not only Malaysians but was also drew international attention.
Various Causes of Death
Various causes of death have been stated by Ministers. The initial post-mortems on Romi Hamdan and Puja Joh, both adults, who died on 29 May 2019 and 6 June 2019 were reported to have revealed lobar pneumonia.
The Health Ministry attributed the outbreak to measles with 43 out of 113 cases (38%) tested positive. This announcement was reported to have been met with disbelief by the Bateq people and non-governmental organisations.
A grandmother, Som Yai, who lost her husband and three adult children reportedly stated “I’ve never seen something like this before.” She had a hunch that it was due to the water there.
The Orang Asli department Director General reportedly stated that the community was not satisfied with the report that raw water from the area’s rivers was not contaminated. The village chief, Mohamad Pokok, reportedly stated that this was because a manganese mine was located only 100m from the river and water catchment area.
The Deputy Prime Minister stated that water samples from the manganese mine and nearby water catchment areas taken by the Department of Environment and announced on 12 June 2019, were free of contaminants.
It was reported that there was illegal manganese mining in an area near Kampong Kuala Koh. How many mines there are in the area is not known.
A medical team from the Federation of Private Medical Practitioners Associations of Malaysia (“FPMPAM”), comprising senior general practitioners, dermatologist, obstetrician and gynaecologist, and nurses, who did a medical camp for the Bateq tribe on 28 April 2019 reported that the area is reasonably accessible by road and that the entire village sought help from the medical team.
They did not run away into the jungle to hide, which was contrary to the narrative from the Health Ministry.
The FPMPAM medical team did not see anyone with measles in the 140 villagers who sought medical attention.
There were many cases of “children with upper respiratory tract infections, diarrhoeal illness, worm infestation, skin infections with scabies, Tinea imbricata (a widespread skin fungal infection) and malnutrition. Many of the children had multiple infections and gross malnutrition.” (Source: FPMPAM press statement 4 July 2019)
The team reported “There was no running water. All the water tanks were empty. Pipes were broken. All we had was the bottled water that we brought along for the patients and the medical team. With no running water, the standard of sanitation was terrible.”
The FPMPAM medical team also took samples from the village’s water supply which were sent for analysis. The findings were:
- The water from three sources in the village was equivalent to Class III and NOT suitable for human consumption unless it extensively treated;
- There was unacceptable faecal contamination of the water as indicated by high faecal coliform count in one study;
- The content of manganese was consistently above safety levels set by the Health Ministry;
- Samples from one source was found to have manganese level that was 25 times (2,500%) above the acceptable safety level.
(Source: FPMPAM press statement 4 July 2019)
In short, the water supply was toxic.
The Health Minister stated on 6 July 2019 that laboratory tests and post-mortems on the first three deaths revealed measles and its complications.
The post-mortem reports on 12 bodies who died on 2 May to 6 June 2019 were “indeterminate cause of death.” The results of toxicology, heavy metals and entomology studies are still awaited.
The Health Minister in a written Parliamentary reply on 8 July 2019 stated that the Health Ministry will not form an investigation committee into the deaths as measles was the cause of the deaths.
Unanswered Questions
There are many unanswered questions that have arisen from the mysterious deaths in the Bateq community.
The pneumonia in measles is typically interstitial and predominantly bilateral, not lobar, and that there were 1,934 measles cases nationally in 2018 with six deaths. However, superimposed bacterial and/or fungal infections may occur in the immunocompromised.
As measles is an infectious viral disease transmitted by droplets from the nose, mouth or throat of infected person(s), the question arises as to who introduced the infection (“index case”) to the Bateq community.
The Department of Environment did not state whether samples were taken from the water supply of the Bateq community.
Apart from the FPMPAM medical team, who else took samples of water consumed by the villagers for analysis?
Did the villagers have manganese poisoning? Was there other metal poisoning? Were the villagers tested for manganese and other metal poisoning and, if not, why not?
Were any tests done on the villagers who appeared malnourished and, if not, why not?
Was their malnourishment due to the their being cut off by the plantation and mine(s) from the jungle from which they depended on for their survival.
It is pertinent that a definitive diagnosis was only found in 3 (20%) deaths. Were the cause(s) of death in the other deaths the same, and, if so, what was the rationale for thinking so?
Inquest
An inquest is a judicial inquiry when a death is a sudden and unexplained, when the cause is unknown, or the death is unnatural.
According to the Attorney General’s Chambers, an inquest is “carried out when there is reason to suspect that a person has died in the following manner:
- sudden;
- unnatural;
- by violence; or
- cause of death is unknown and in situations where the law requires an inquiry.”
“Public interest requires that inquiries of death should be held as soon as possible after the death is reported.”
There are several circumstances in which an inquest is held and they include, among others:
- “where a dead body is discovered in mysterious condition and it is not known how the person came by his/her death;
- where an inquiry has the possibility of exposing important fault or danger not already known;
- where the view of the family of the deceased or members of the public are such that an inquiry is likely to assist and maintain public confidence in the administration of justice, health services or other public agencies;
- where in any death that when considered with other deaths in similar situation indicates that there may be an unexpected increase of danger in a particular location, area, family, industry or activity.”
Coroner’s Inquest Indicated
An inquest is indicated for the Bateq deaths simply because it fulfils the criteria of the Attorney General Chambers in the preceding paragraph.
With so many more questions than answers, it is surprising, to say the least, that the Health Ministry has not provided convincing arguments that there is no need for an investigation unlike the Home Affairs Ministry which has not ruled it out.
Truth should not be a casualty when there are so many unexplained deaths.
Dr Milton Lum is a past President of the Federation of Private Medical Practitioners Associations, Malaysia and the Malaysian Medical Association.
This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organization the writer is associated with.
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