KUALA LUMPUR, Feb 23 – Orang Asli children in Peninsular Malaysia are 11 times more likely to die under the age of five compared to children from major ethnic groups, according to Dr Amar-Singh HSS.
Indigenous children aged below five in Sabah and Sarawak have a mortality rate 1.7 times higher than children of Malay, Chinese, and Indian ethnicity, according to the consultant paediatrician and researcher.
Using data on under-five deaths in Malaysia in 2016 as a proxy, Dr Amar pointed out that while Malaysia’s gross data on childhood mortality suggests that the country has achieved the Sustainable Development Goals target of reducing neonatal mortality to as low as 12 per 1,000 live births and under-five mortality to at least 25 per 1,000 live births, the lack of disaggregated data hides the staggering health care disparities faced by marginalised communities.
Speaking at the Medico-Legal Society of Malaysia’s (MLSM) “Speaking for the Unspoken – Children of a Lesser God” webinar on Saturday, Dr Amar said despite considerable improvements in the health status of the general population in the past 50 years, Orang Asli health has not significantly changed and has deteriorated.
He said the poverty rate for Orang Asli remains high at 80 per cent as many remain in the hard-core poor category. Childhood malnutrition rates among Orang Asli children continue to be high and increasing, with 60 to 70 per cent of children found to be malnourished by 5 to 7 years of age.
A study conducted by Dr Amar’s team on Orang Asli children aged below two years in Perak showed that over 40 per cent were malnourished.
Dr Amar said access to health care remains inconsistent for the community, depending on interest from local health authorities.
“The Orang Asli community in Malaysia is viewed by some as sub-human (proto-human); even some health staff seem disinterested and look down on the community. There is also mistrust of the health services by some Orang Asli communities,” Dr Amar said.
In 2019, there were 641,880 Orang Asli visits to MOH health services for primary health care, including 102,960 antenatal, 6,332 postnatal, 129,314 child health and 110,626 home visits, according to the Ministry of Health’s (MOH) 2019 Annual Report.
MOH health services targeting four weekly visits to Orang Asli communities in remote villages using the Orang Asli Mobile Team, were able to conduct only less than two-thirds (66.2 per cent) of its targeted visits for 2019, with logistical issues such as damaged roads, extreme weather conditions, and damage to vehicles, limiting travel.
The Flying Doctor Services based in Kinta, Perak, managed only 41.6 per cent of 173 planned flights to remote Orang Asli villages for 2019, limited by weather conditions and technical issues with aircraft.
Dr Amar said there is a need to develop community resilience in health and health access via the use of paid village health teams that are supported by MOH health services.
“Access to health care is a significant problem purely because of locations. I don’t think we should penalise Orang Asli for living where they want to live.
“I think it’s a much healthier place to live than the city and they can retain their culture there better than if they come and live with us. What should we do about them?
“I think we need culturally acceptable and sensitive health strategies. I think we need to develop community resilience in their own communities, their own villages, and I think the only way to do this is by having paid village health teams.
“These are people with satellite phones who will be trained in early recognition of illness in children, call out quickly, and can then get a vehicle of some sort to rescue this child, and can institute some form of early care in the villages,” Dr Amar said.
Intercultural Trauma In Orang Asli Children
Apart from health care access, Centre for Orang Asli Concerns (COAC) coordinator Colin Nicholas also said there is a general lack of interest to assess the health impacts on Orang Asli children that stem from efforts to try and integrate them into mainstream society.
“The children suffer a different, additional impact in the drive to change their mindset to enter mainstream society, through the schooling system – the hostel system, in particular.
“Orang Asli children frequently find themselves caught between their indigenous languages, customs, and values, and those of the new, wider community.
“Orang Asli children are now experiencing a kind of intercultural trauma as they are separated from their families through the residential schooling approach as early as seven years old. Parents don’t get to see their children for one term or until you have access to see them, so you (as a parent) don’t know what’s happening there,” Colin said.
He said there are “many horror stories” involving the hostel system, including rape and suicide cases, and the health impact of such practices are not being studied or talked about.
“There are many issues involving mental illness among Orang Asli children, physical and sexual abuse, self-harm and suicide, exposure to drugs, and alcohol addiction.
“Dropping out of school early also leads to a tendency to early child marriages and teenage pregnancies. There are also cases of incest and increasingly, more physical abuse.
“So, these are emerging trends in the Orang Asli community, and they are only beginning to come up. But in other societies that face the same root situations, the social problems have reached alarming and very visible proportions,” Dr Colin said. “We should not wait until it reaches this stage before we act.”
Colin added that health for the Orang Asli community cannot be separated from their cultural, historical, and social context.
