KUALA LIPIS, May 2 – At 16, while I was still in secondary school and focused on playing video games and keeping up with the latest anime, Wak Sari had already dropped out of school to care for her ailing grandmother.
Her grandmother was the last remaining member of her family and was dying from what the government doctor diagnosed as a ‘fever’.
As I continued to follow the typical trajectory of secondary school students, procrastinating on assignments and socialising with friends, Wak Sari had to administer medication to her grandmother and watch as her condition deteriorated rapidly.
At the age of 16, she had already laid her grandmother to rest and gotten married, all while I was in secondary school.
On March 19, 2023, seven years later, I found myself sitting diagonally across her in the great hall of the batin’s house, cross-legged on ribbons of peanut-brown bamboo slats arranged vertically to form the floor beneath us.
I was there on assignment with my colleague and friend, Navittra, having accepted the opportunity to join the Federation of Private Medical Practitioners’ Association Malaysia (FPMPAM) on their monthly outreach programme in the deep mountain forests of Pahang, provided that the weather and roads permitted us to do so.
In 2019, the first Orang Asli Medical Post was established in Kampung Dayok in Pos Lenjang in Kuala Lipis, Pahang, by the “DrsForAll” initiative under FPMPAM.
Despite the challenges posed by Covid-19, the medical post has managed to weather the storm with the help of a rotating team of doctors and Orang Asli medics who have been trained by FPMPAM and certified by St John Ambulance of Malaysia (SJAM).
Dr Steven Chow is not your typical president, with his silvery wispy hair and a bristly grey moustache. He is not the kind of person you would expect to see jolting and bouncing in a four-by-four on a dirt road up a mountain, but that was exactly where he was on the second day of our trip.
Dressed in a pair of bright neon yellow pants, a beige FPMPAM vest, and a matching fedora, he hauled boxes of medicine and supplies out of his silver Hilux, set up tables and chairs, and directed the team on where to place everything. Despite his unconventional appearance, his enthusiasm and dedication to the cause were evident in everything he did.
We were in an empty church in Kampung Cerewes, situated alongside the same river as Kampong Dayok. The church was a concrete building with a corrugated, blue tin roof supported by a skeleton of wooden planks.
The entire structure resembled a shipping container with its long unpainted grey walls interrupted occasionally by glassless square windows. The church had two wooden doors, one at the front and the other at the back, serving as entry points.
Seeing that the building was hardly in use, Dr Chow had gotten permission from the batin and church elder to use the building as a makeshift clinic.
While the team of three doctors, three Orang Asli medics and four volunteers – myself included – rushed about, setting up tables and chairs for the registration station, consultation sections, and dispensary, a steady stream of Orang Asli began to fill the building.
The patients, mostly women and children, entered through the backdoor, congregating at the rear of the building and filling the hall with lively chatter. If not for the stethoscopes, medical records, and medication, one could easily mistake the scene for a social gathering rather than a medical outreach programme.
The transition from setup to open was seamless, happening without any fanfare. One moment, the team was arranging boxes on folding tables, and the next, patients were forming a thick line at the registration counter, manned by three Orang Asli medics and Suke, a nutritionist from Big Pharmacy who, like me, had come along for the ride.
Dr Chow seemed pleased with the setup and grabbed two tins of Resurge, a nutritional milk powder provided by Big Pharmacy. They had been receiving around 30 tins every month for the past three years. He then asked Navittra and I if we would like to speak to the batin.
Naturally, we agreed.
Meeting The Head Of Kampung Cerewes
The batin’s house, distinguished by its larger size among the traditional structures, sat opposite the clinic on a low hill that rose gently from the ground in a gentle slope that tapered out into flat, slightly bumpy land.
The steps that led up to the house were rough, uneven planks. Widely spaced, it made going up and down tricky even with the handrails to grab onto.
Stepping into the gloom, I tasted a scent both familiar and foreign. It sat thick upon my tongue in a cloying sweetness that gave way into the thick mouldy green of forest moss tinged with the sharp gluey bitterness of cheap cigarettes.
At first, I couldn’t quite identify the scent, but it wasn’t until I took a seat in front of the batin that it triggered a sense of familiarity.
Batin Nyak is a wrinkled but sturdy elderly man of 60 who sat quietly amongst a group of men who looked to be between their 30s to late 40s and one woman — Wak Sari.
He sat before us with a rolled-up cigarette tucked behind his ear and accepted the two tins of milk that Dr Chow had brought as a gift. As pleasantries were exchanged, he would occasionally lean forward and dribble saliva down into the space between the planks.
Though not overflowing with raisins and spices, the scent of paan was unmistakable. The men in the room were chewing a simple blend of daun sirih (betel leaf), buah pinang (areca nut), and tembakau (tobacco), and spitting the juices down the widened slats. Even in the dimly lit hall, it was not hard to catch the bright red lips the colour of crushed cherries or see the withered teeth, eroded by years of chewing.
It is a traditional indulgence, Dr Chow told me later on, that the medical team were trying to stop by educating the Orang Asli on the dangers of chewing betel nut whenever they come into the clinic.
“We do encourage them to stop as well as educate them on the dangers regularly when they come to the clinic. This will be an uphill task.”
Though the chewing of betel nuts is a common cultural practice across Asia, betel nut chewing is not a habit that should be taken up.
Classified as a stimulant drug, the betel nut induces relaxation, happiness, and alertness, as well as, palpitations, high blood pressure, nausea, diarrhoea, psychosis and a wealth of other side effects. And long-term chewing would cause discolouration of the teeth and gums, mouth ulcers and gum disease, oral cancers, and heart disease, among others.
A 2019 study published in BMC Oral Health, titled “Oral Health-Related Quality of Life among Indigenous Children aged 11-12 Years in Malaysia”, surveyed 249 Orang Asli children from Cameron Highlands, which is located two days away from Kampung Cerewes.
The study revealed that most of the children were found to be chewing betel nuts, and there was a significant occurrence of caries and gingivitis among them.
After the pleasantries, Dr Chow returned to the clinic to assist with medication dispensing, leaving us in the care of Batin Nyak for the interview.
Traditional Orang Asli Diets: Rice And Tapioca
Though I was the journalist on the scene, it was Navittra who led the interview as she launched a volley of questions, many of which, unfortunately, went unanswered.
The men were reticent with their responses, often lapsing into long winding conversations in the Semai language, filling the air with injunctions and derisive laughter when asked questions such as whether they had noticed changes in their community due to the FPMPAM initiative, what challenges they faced in their daily lives, or if they received sufficient aid from the government.
In the end, it was Wak Sari who finally bridged the space that ran between us. Angling for a deeper insight into their lives and the level of government aid they received, I began asking questions that centred on their day-to-day lives.
“Kerja ladang (plantation work),” she said with a shy, nervous laugh when I asked what they did for work. “Kerja kebun (gardening),” added Batin Nyak in his soft cottony voice as he sliced open a green areca nut.
Either emboldened by their responses or weary of our relentless questioning, a man sitting beside Wak Sari and feeding a baby let out a half sigh and said, “It’s like this, the aid from JAKOA (Department of Orang Asli Development) is like people giving us rice. It may not be enough. But what truly brings us peace is what we do ourselves, like cultivating plantations, planting paddy and tapioca, and growing all sorts of other plants, including chilli.”
Wak Sari’s description of plantation work was more reminiscent of a humble home garden than the vast acres of land typically depicted in magazines, travel posters, and documentaries.
A 30-minute walk from their village, both men and women work the fields on a daily basis. According to the man, life there is different from life in the city where people need to head out to various shops and grocers in order to obtain food.
In the village, all they need to do is to head out into the field and reap the fruits of their labour, be it tapioca or mountain rice. If there is an excess of food, the Orang Asli would venture out of the forest and sell it, though this does not yield much as the price for their vegetables tends to fluctuate. Thus, for him what they get is enough and life in this village is not that arduous.
Be that as it may, it was difficult for me to characterise their diet as balanced, especially after observing the children with their hollowed eyes and sallow skin.
“Rice or tapioca,” Wak Sari said with a giggle when Navittra asked her what she cooks for breakfast.
“Rice and tapioca leaves.”
Women from different villages often give a similar answer that their diet mainly consists of rice and tapioca, which are carbohydrates. Although chickens can be found roaming around the villages, crowing at odd hours of the day and pecking at the ground as they conduct their rounds, the Orang Asli do not usually catch them for food.
“Tak tahulah,” said the man as he adjusted the baby, “I feel it’s because we have reared the chicken. Maybe it’s love.”
Protein for the Orang Asli comes from two sources: the river rushing through the mountains and the Pakistanis who make daily trips into the forest peddling chicken, fish, vegetables, household garments and items, and even ice cream.
During my visit, I saw two Pakistani vendors making their way across the different villages that lay scattered across the mountain in an old Perodua Kembara and a kapcai motorbike. According to Dr Chow, these vendors have been serving the area since before FPMPAM came to this remote mountain area in 2014.
Although adults can manage on such a carbohydrate-heavy diet, infants and children have different needs. Based on the information given by the men in the hall, toddlers appear to rely on nutrition milk powder provided by FPMPAM doctors and whatever food they can obtain from the government clinic in Lenjang.
Batin Nyak explained, “The milk for older children is similar to what the doctor gives, which we can obtain from the clinic in Lenjang. It is meant for children who are not healthy. If they are healthy, they do not receive it.” The other men nodded in agreement.
When asked what the babies drink in the absence of milk formula, the answer was vague, and it seemed that the babies are breastfed until they are old enough to consume the same foods as their family.
As for school-going children, they are slightly more fortunate when it comes to having a balanced diet.
Three girls, all schooling at the Pos Titom primary school, had mustered the courage to enter the hall. Their stealthy sneaking, popping next to Wak Sari, and clustering around her in a playful huddle, reminded me of a skulk of foxes darting out of their hollows, too curious to stay away.
The eldest, leader of the troop, speaking through Wak Sari, told us that they ate three times a day at school, a diet of rice, vegetables, chicken and meat.
When I contacted Dr Chow a little later to gain insight into the common health issues faced by the Orang Asli, he told me that malnutrition was like an accepted way of life.
“You would also have noticed malnutrition is rampant. Almost all the children in the more remote areas have protein-calorie malnutrition.”
Fighting Malnutrition And Illness In A Remote Village
Seeing the children clustering around Wak Sari and seeing her treat them with the gentlest of touches, Navittra inquired about the size of her family, asking how many children she had.
“None. I don’t have children.”
“How many years were you married?”
“10,” she said with a sad little smile.
“Have you gone to the hospital? Get a checkup?”
“I have. I have.”
“Did the doctor say anything?”
“The doctor said there is nothing wrong.” Her voice trembled with sadness, though she didn’t let any tears fall. As she looked down at her lap, the ripples in her voice were palpable, making us all feel her pain.
At only 23 years old, she appeared older due to her time spent under the Malaysian sun, but her demeanour was still youthful, with girlish giggles and a hesitant manner.
“When did you get married?” asked Navittra after learning her age.
“Sixteen,” she laughed as she shielded her face behind her hands. Her story did not add up, leading us to suspect that she was married off at the age of 13.
Wak Sari told us that she had only stayed in school till standard six. As she had no parents, she was forced to leave school to care for her ailing grandmother, wasting away with what the visiting doctor told her was a fever, and after her grandmother had passed, she immediately got married.
“Because my grandmother had a fever. Because of that I didn’t go to school. I looked after her because there was no one to look after her. There is only me. I looked after her till she died.”
“What did she die of?” I asked.
“Didn’t the doctor come?”
“The doctor came and said nothing,” said Wak Sari.
I was left perplexed by her statement and unsure about what to make of it. However, Navittra said she had spoken to a few of the Orang Asli about the causes of mortality in their community, and they had mentioned that fever was a common cause of death. This led her to believe that the Orang Asli considered fever to be a disease rather than a symptom of an underlying illness.
The realisation disturbed me, and I refocused my attention on Wak Sari.
“Did they give you medication for the fever?”
“They did give medication. But at that time, it was difficult for doctors to come here. It was difficult. The doctor didn’t come back because there was no road like now. Before this, they would come using a raft on the river.”
“They also came using a helicopter,” interjected another man known as Bah Pa. “It was a little difficult, not like now.”
The ‘now’ they are referring to is still no better.
Failing The Most Vulnerable
Piecing together the account given by the people present in the hall, it seems that the Orang Asli in the area can avail themselves of three medical facilities: Klinik Desa Lenjang, Klinik Kesihatan Pos Betau, and Hospital Orang Asli Gombak.
However, “access” may not be an accurate term to describe their ability to reach these facilities. The nearest clinic available to them is Klinik Desa Lenjang, which is staffed by nurses and is primarily visited by the people of Kampung Cerewes for baby formula.
“If we are sick, we go to Betau,” said Batin Nyak.
Klinik Kesihatan Betau is situated around an hour away from the village, and its accessibility hinges on whether the sick individual or someone close to them possesses a car or motorcycle that can be used for transportation.
“The doctor will bring us to Betau. If there is no doctor, we take ourselves there. If there is a car, we take the car. If there is none, we take the motorcycle. We live in poverty. Where can you find a car around here?” said a man from the back of the room.
According to Navittra, the Orang Asli Hospital in Gombak primarily conducts outreach programmes at villages like Kampung Cerewes. While the Pakistani vendors and FPMPAM doctors visit the village frequently, the hospital’s doctors only come to the village once every four to five months. This is in contrast to the daily trips made by the Pakistanis into the forest and the monthly visits by the FPMPAM doctors.
“But they come once every four to five months. There are many [doctors] who come and check everyone. High blood pressure, tuberculosis, vaccinations,” said Batin Nyak.
When I asked whether they thought the doctors visited them enough, all Batin Nyak said in his soft murmur was, “Memang tak cukup (definitely, not enough).”
“It’s definitely not enough. But we have a clinic at Lenjang. If we don’t have the clinic at Lenjang, we might feel that it is definitely not enough. But the people in Gombak [Hospital], in this village, if there is a case: malaria or TB (tuberculosis), maybe they will come.
“If there is none, they won’t,” said Bah Pa.
As I type this article and listen to parliamentarians discussing access and road building to improve the situation of Orang Asli communities, I cannot help but feel a sense of detachment. Their grand plans and projects seem like a distant possibility while people are dying from simple illnesses like fever in the present.
Politicians sit in their plush chairs and blather on “passionately” and endlessly into slim black mics about improving the lives of the Orang Asli, yet all I hear is a line from Shakespeare’s Macbeth: “It is a tale told by an idiot, full of sound and fury, signifying nothing”.