Health Care For The Orang Asli: Consequences of Paternalism and Colonialism

Published: 09 September 2004



Consequences of Paternalism and Colonialism


Colin Nicholas
Center for Orang Asli Concerns

Adela Baer
Oregon State University

Revised manuscript of a paper presented at the workshop on Healthcare in Malaysia’, Asian
Research Institute, National University of Singapore
, 9-
11 September 2004 . Published in Chee Heng Leng & Simon Barraclough (2007), Health Care in Malaysia: The Dynamics of Provision, Financing and Access, pp. 119-136.


The Orang Asli are the indigenous minority peoples of Peninsular Malaysia. They are the descendants of Pleistocene-era inhabitants of the peninsula, that is, long before the establishment of the Malay kingdoms. The Orang Asli population grew from 54,033 in 1969 to 92,529 in 1994, at a rate of almost 2.3 per cent per year (Lim 1997). In 2004, they numbered 149,512, representing a mere 0.6 per cent of the national population.

Like indigenous peoples the world over, the Orang Asli are among the most marginalized communities, faring very low in all the social indicators both in absolute terms and relative to the dominant population. For example, while the national poverty rate has been reduced to 6.5 per cent, the rate for Orang Asli remains at a high 76.9 per cent. The official statistics also classify 35.2 per cent of Orang Asli as hardcore poor (compared to 1.4 per cent nationally) (Zainal Abidin 2003). It is not surprising, therefore, that the Orang Asli lag very far behind in basic infrastructure and in political representation. The same is true for literacy and educational attainment. In 1990 only 14 per cent of Orang Asli villages had a school. The literacy rate for Orang Asli in 1991 was 43 per cent, while the national rate was 86 per cent; however, not all Orang Asli children attend school and in 1995, 68 per cent of the attendees had dropped out at the primary level (Lim 1997). This drop-out rate means that no more than 30 per cent were functionally literate.

In this chapter, we examine the development of health care services for the Orang Asli by the colonial state and its later trajectory under the post-colonial, developmental state. We will argue that the British colonial state had a paternalistic attitude toward the Orang Asli. In conjunction with the exigencies of fighting the communists during the Emergency era (1948-1960), this attitude led to the inception of the Orang Asli health care services. Within this paternalistic framework, medical professionals in the colonial service provided services that improved Orang Asli health. Nevertheless, the paternalistic framework also led the British to establish laws and institutions that treated the Orang Asli as ‘wards of the state,’ not as an indigenous people with particular rights to land and resources. In the post-colonial period, fundamental changes occurred in the nature and the role of the state, and concomitant changes also occurred in state attitudes toward the Orang Asli. In this context, the health-care system that had been developed with paternal care has retained its original structure but not its substance or spirit. In the hands of a highly ethnicised, post-colonial state with a narrow Malay nationalist agenda, the paternal structures, of which the health care services is one, have worked against the interests of the Orang Asli.

Orang Asli concept of health and illness
Traditionally in Orang Asli settings, when a person suffered an illness that was serious enough to warrant some action, it became a concern of the whole community. Other ailments, such as skin diseases, evoked no general concern as they were considered to be harmless, since the victims could still function normally. Like most traditional communities, the Orang Asli have long perceived disease as being the result of a spirit attack, or of the patient’s soul being detached and lost somewhere in this world or in the supernatural world (Gianno 1986: 6). The Orang Asli also believe that both their individual and communal health are linked to environmental and social health. If there is too much pollution, for example, or too much blood spilt, and taboos governing correct behaviour have not been followed, then disease and even death will strike (Endicott 1979, Howell 1984). The Orang Asli believe that such illnesses are better treated by incantations and ritual, rather than by modern medical practices. Treatment is usually given through healing ceremonies, coordinated by one or more shamans, and invariably involving the whole community.

Thus, as opposed to the biological concept of disease, the Orang Asli concept of illness is culture-specific (Kleinman 1973). Healing is often a community effort. The shaman or healer (who may also be the midwife in some communities) is an important anchor in the traditional Orang Asli health system. As Wolff (1965) noted, the intimate ties created between patient and healer in a traditional framework reinforce a strong sense of socio-medical reciprocity that government officials or western-trained doctors are rarely able to replicate. It is not surprising therefore that the Orang Asli have an intense desire for healing to be integrated within their local socio-cultural context. Traditional healers and their methods are thus unlikely to disappear easily from Orang Asli culture.

Furthermore, rather than being a mish-mash of mumbo-jumbo, the Orang Asli’s traditional medical system is an ordered and coherent body of ideas, values and practices embedded in a given cultural and ecological context. Infused in all this is the presumption that health is a communal or kinship responsibility, that taboos and all other practices related to maintaining health and preventing illness are necessary, and that any breach by one individual will have repercussion on others. The Orang Asli are also very clear about the link between maintaining their environment and maintaining their health and sustenance.

Orang Asli health and health care in colonial times
During the British period, most Orang Asli diets were nutritionally satisfactory (Bolton 1972: 799). Noone (1936) contended that Temiar who have less contact with outside society were generally healthier than those with more contact. As Jeyakumar (1999) and Kuchikura (1988) have observed, when Orang Asli traditional territories are left intact, undiminished and un-appropriated, they provide adequate protein and a healthy variety of fruits and green vegetables.

This does not mean that Orang Asli living in the past were devoid of health problems. On the contrary, in the 1930s, for example, the Temiar were known to have malaria and other fevers, bronchitis, boils, scabies, wounds, neuralgia, dental caries, intestinal worms, and yaws [1]  (Baer 1999). At that time, modern health care was largely unknown. A few Orang Asli who happened to live near a friendly tin mine or rubber estate did receive basic medical assistance from the company’s first-aid provider. Also, some European explorers, game hunters, railroad surveyors, and even colonial officials, in a humanitarian spirit, provided medical supplies to some Orang Asli communities that they visited.

Moreover, during this time, the encroaching outsiders brought new pathogens to Orang Asli areas. Smallpox, cholera, typhoid, flu, syphilis, and other life-threatening maladies became all too common (Baer 1999: 156, note 57). These diseases, against which the Orang Asli had no immunity, killed many Orang Asli, even wiping out whole villages, and contributed to the long-standing Orang Asli fear and distrust of strangers. The Batek, for example, reported that before 1942, their population was much larger than it is now and that many had died in disease epidemics brought into their lands by encroaching Malays (Endicott 1997).

However, most Orang Asli did not see any medical personnel until after the onset of the Emergency in 1948, when British troops invaded interior areas to combat Communist insurgents operating from there. As we shall see below, this was the impetus for the authorities to act in a positive manner to the Orang Asli.  In particular, Orang Asli health and health care, which until then had received no attention from the colonial government, began to attract official concern.

The impact of the emergency and the establishment
of Gombak Hospital

Soon after the British reoccupied Malaya at the end of World War II, they regained control of the towns and settled areas, and as they harried the Communist insurgents, the Malayan Communist Party withdrew its followers to camps in the forests. These road-less, inland areas offered both concealment and the opportunity to sway the forest Orang Asli to the insurgents’ cause, whether on the basis of intimidation, or past friendship, or by misinforming them about the political situation. Orang Asli were enlisted as messengers, informers, and growers of farm produce to feed the camps.

To ‘protect’ the Orang Asli from this situation and thereby weaken Orang Asli aid to the insurgents, the British herded Orang Asli into hastily-built resettlement camps during the early years of the Emergency (1948-60). As many as 7,000 Orang Asli died in these squalid camps from disease, malnutrition and depression (Polunin 1953; Carey 1975). When it became obvious that this tactic was a failure, the British began to build forts and associated amenities for the Orang Asli in the forest. These amenities were meant to win their loyalty, but while most forts had a functional medical post staffed by a medical orderly, only two medical doctors were available to pay regular visits to the many Orang Asli villages located near these forts or further afield (Bolton 1968).

With the Communist insurgency widespread and on-going, the medical posts at the forts had little effect on the overall health of the Orang Asli. For this reason, the government built a special hospital for Orang Asli in 1957 [2].  This was a significant historical development for Orang Asli health services. Run by the Department of Aborigines (Jabatan Orang Asli, or JOA), its first medical director Dr. J. Malcolm Bolton planned to provide a hospital where the family of an ill person could accompany him or her. It was thought that this would encourage Orang Asli to seek treatment at the hospital, as it was believed that their primary fear was leaving their familiar forest surroundings and their family (Bolton 1973a, b; Harrison 2001). There were two main advantages to this plan: first, it made the patient more comfortable at the hospital and second, accompanying family members could be given medical examinations, especially for tuberculosis (Bolton 1973a). The idea was to create a hospital that integrated into Orang Asli life.

Bolton recognised that western medicine and traditional medicine occupied different niches in the healing spectrum and so had the potential to be complementary rather than contradictory. He realised that the Orang Asli did not tolerate or accept long-term hospitalisation as a necessary means to regain health. Such hospitalisation not only cut off the patients from their forest environment and their community but also from access to their traditional healers and treatments (Bolton 1973a).

However, one of the key reasons for the success of this programme to encourage Orang Asli to stay in the Gombak hospital was the fact that patients there usually had a ‘relative’ on the staff who spoke their language, understood their wishes and fears, and could explain to them the origin of their disease and the purpose of the treatment given (Bolton 1968). The original staff at the hospital had no medical training, but they were provided with ‘practical training’ in government hospitals (Bolton 1973a). By 1963, 143 of the 161 medical staff at Gombak were Orang Asli [3].

By 1972, there were 139 inland medical posts for Orang Asli, all staffed by trained Orang Asli personnel (Bolton 1973b). ‘Flying’ doctors and nurses periodically visited many interior areas, sometimes travelling onward by boat or foot (Kinzie et al. 1966; Sjafiroeddin 1968). Emergency helicopter evacuation to hospital was also provided, as was iodized salt to goitre-prone areas.  Furthermore, since neonatal and infant death rates – as well as maternal death rates – were still high in the 1960s, prenatal and obstetric care at Gombak was given great attention (McLeod 1971). Mothers were tested and treated for anaemia, malaria and intestinal helminths. Iron, folate and vitamin supplements plus a good diet were provided. X-rays were screened for tuberculosis. Accompanying family members were also tested, treated, housed, and fed. Iron and vitamin tablets were provided for newborns. Moreover, in the 1970s, Gombak Hospital was training midwives for in-village deliveries.

In retrospect, while this era in Orang Asli health-care delivery was motivated by the desire of the government to win the hearts and minds of the Orang Asli (and so deprive the Communist insurgents of valuable help and information), it was the dedication and empathy of individual medical practitioners, notably Dr. Bolton and his teams of volunteer doctors and nurses under the programmes of organisations such as CUSO (Canadian University Services Overseas) and CARE (Cooperative for Assistance and Relief Everywhere), that resulted in significant improvements in Orang Asli health services, as well as an increasing willingness of the Orang Asli to accept modern medicine alongside traditional healing. The introduction of western medicine was, after all, the main thrust of the health programme then (Polunin, 1953). The Orang Asli’s rights to their culture and traditions were respected by Bolton’s staff, in order that the health programme would not be jeopardised.

Post-colonial decline
The Emergency ended in 1960 with the retreat of the Communist forces, and the nation gained independence from Britain in 1957. Although the Orang Asli health-care services was largely continued, by the late 1970s there were signs that it was in decline [4].  This prompted Khoo (1979), an officer working in the JOA, to publish a plan to improve the JOA medical services for Orang Asli as it became more Malaysianized. His first priority was community education [5].   Second was maternal and child health, given the existing high mortality and high under-nutrition, as well as “maternal depletion”  [6] among Orang Asli mothers. Third was control of diseases such as malaria and tuberculosis, fourth, improvement in curative services, and last, the gathering of information on health problems – that is, research.

Unfortunately, these proposals were not put into effect. By the 1980s, several reports were published asserting that the medical services for Orang Asli under the JHEOA (Jabatan Hal-Ehwal Orang Asli, or the Department of Orang Asli Affairs, the new name for the JOA) were inadequate. Veeman (1986/87), for example, wrote about the attitude of the government and the scarcity of medical personnel. She noted that maternal and infant death rates were still high and that Gombak still had no facilities for handling birth complications. Among other problems, primary health care was still not available to all Orang Asli and travelling medical teams were lax in making their scheduled rounds. Lambros and co-workers (1989: 6) also reported that anti-malarial prophylaxis:

… is infrequent if not nonexistent. Fansidar and chloroquine have not been freely available to the Orang Asli. Medication is only available when they become so sick that they must leave their forest dwellings and travel long distances to seek medical care at a clinic or hospital.

These reports correctly identified the gradual slackening in the medical and health care of the Orang Asli in the 1980s. Unfortunately, the situation did not improve in the 1990s. By then, it was reported that only 67 of 774 villages (9 per cent) of Orang Asli villages had clinics (Lim 1997), compared to 139 medical posts active in the early 1970s (Bolton 1973b).

Orang Asli health today
Direct and indirect health effects on the Orang Asli were recently reviewed (Baer 1999). Among the findings, the crude death rate for Orang Asli is twice that for all of West Malaysia (Ng et al. 1992).  In terms of women’s health, sex ratios for Orang Asli today, as in the past, favour men; that is, the women die off at earlier ages (Department of Statistics 1997). Indeed, the maternal death rate for Orang Asli in 1995 was much higher than for other Malaysians. The Orang Asli suffered 4.8 per cent of these deaths, although they made up less than 0.6 per cent of the population at that time [7].  As Hema Apparau reported in 2002, Orang Asli women have the highest recorded rates of postpartum hemorrhage and puerperal sepsis, far above the rates for other groups.

In terms of infectious diseases, Orang Asli children in Perak have three times the incidence of tuberculosis as the state average, and Orang Asli of all ages have 5.5 times the state average (Jeyakumar 1999). Despite their very small population size, Orang Asli had 51.5 per cent of the malaria cases recorded in Peninsular Malaysia in 2001 (JHEOA 2005: 22). In 2003, this proportion had increased to 53.6 per cent (JHEOA Gombak Hospital 2004). For 1994, the leprosy rate for Orang Asli was 23 times higher than for others in West Malaysia (Fadzillah 1997). The incidence of leprosy is also on the increase among the Orang Asli, from 8.74 reported cases per 100,000 of the population in 1998 to 19.63 in 2002 (JHEOA Gombak Hospital 2004). Also, the ‘old’ diseases and infections that have plagued Orang Asli for as long as they can remember still plague them today. These include skin infections such as scabies, worm infestation, diarrhoea (sometimes resulting in fatality), and goitre. In fact, although goitre is easy and cheap to prevent, up to a third of Orang Asli adults are goiterous today, which is about the same proportion that had goitre 50 years ago (Baer 1999). A ‘new’ disease, HIV/AIDS, has also been found among the Orang Asli. Data from the JHEOA hospital in Gombak in 2004 revealed that there were 31 cases of HIV/AIDS among the Orang Asli in 2003.

Orang Asli women and children are especially vulnerable to nutritional deficits and attendant intestinal parasitism. Lim and Chee (1998) found that the nutritional status of the 34 Orang Asli women they examined in Pahang was generally not satisfactory.   Their mean nutrient intake levels (except for Vitamin C) were below the required minimum, while their mean iron intakes were about one-quarter to one-third of the required level. In Pahang, 35 per cent of the Semai women studied by Osman and Zaleha (1995) had protein-energy malnutrition and 64 per cent were goiterous; even 35 per cent of the men had goitres [8].  In Perak, 73 per cent of the Temiar women and 48 per cent of the Temiar men studied had intestinal worms (Karim et al. 1995). Moreover, the vast majority of Orang Asli children are underweight and stunted (Zalilah and Tham 2002). This supports the findings of Osman and Zaleha (1995) who found that 80 per cent of Orang Asli children studied were undernourished and stunted. Many of the children also had intestinal worms and protozoa, anaemia, dental caries, and vitamin A deficiency (Kasim et al. 1995; Ariff et al. 1997; Norhayati et al. 1995, 1998; Rahmah et al. 1997).

It is well to emphasize here that most Orang Asli lack food security (Zalilah and Tham 2002). With the majority of them living below the poverty line, their narrow margin of survival makes the Orang Asli’s health situation precarious. They are also vulnerable to natural hazards and the whims of ecosystem destruction by others.

State ideology and policies, and the JHEOA
The British established the Department of Aborigines (JOA) in 1950 during the Emergency period, to ‘protect’ the Orang Asli. This department, now the Department of Orang Asli Affairs (JHEOA), controls the Orang Asli through Act 134: Aboriginal Peoples Act, 1954 (Revised, 1974). Under this Act, the JHEOA is empowered to create and regulate Orang Asli settlements, appoint and remove headmen, control entry into Orang Asli abodes, control the crops Orang Asli grow and the usage of their lands – among other arbitrary powers. Since the provisions of the Act effectively destroy the autonomy of the Orang Asli, they directly contradict the concept of indigenous rights (Nicholas 2000). Notably, this is the only piece of legislation that is directed at a particular ethnic community.

There is an obvious fissure between the actual situation of Orang Asli health today and JHEOA goals, stated in the following verbatim extract from their website:

… To create an individual, family and community of Orang Asli who are healthy and productive by a health system that is fair, easily accessible, disciplined and adaptive to change in response to environment and customer's expectation with every stratum besides encouraging individual responsibility and social participation towards improving the quality of life [9]. 

This fissure is an outcome of state ideology and the way the Orang Asli and the Orang Asli ‘problem’ are perceived and administered. The Orang Asli are regarded as ‘wards of the state’ and the JHEOA, their godparent.  That the relationship is conceptualised as one of parent and child is reflected in various ways.  For example, Jimin Idris, JHEOA Director-General from 1986 to 1992, frequently asserts that he had to care for 70,000 ‘children’, “from the womb to the grave”. That the Orang Asli are to be treated as children is not something new. In a matter involving an application for land by some Orang Asli towards the end of the nineteenth century, the British Resident wrote that, “They must be provisionally treated as children and protected accordingly, until they are capable of taking care of themselves” (Selangor Secretariat/2853/1895). McLellan (1986: 91) further maintains that the JHEOA “has continued the British paternalistic and the Malay feudal patronage role toward the Orang Asli, so it settles claims and decides policy without actively involving or even consulting those concerned.”  The Orang Asli, therefore, are not recognised as a people, but rather as individual subjects requiring large doses of governmental support in order to assimilate them into mainstream society.  This underlying attitude extends well beyond legal and land matters, and into the realm of health policy and healthcare for the Orang Asli as well.

The underlying assumption in state policies is that Orang Asli backwardness is a result of their way of life and remote location. Government policy therefore is to introduce strategies and programmes to ‘integrate them into the mainstream’. What exactly this ‘mainstream’ refers to, is not clearly spelt out. But from early policy proclamations and current development programmes, it is apparent that this four-decades-old objective of the JHEOA is basically about moulding all of today’s Orang Asli into mainstream Malay society. Such an objective has ramifications for the Orang Asli, even in aspects of health-care delivery and their general health situation, as this chapter argues. Primarily, however, as discussed by Nicholas (2000), it sets the ideological and political basis for subjugating a people.

When Malaya was granted political independence by the British colonialists upon the defeat of the Communists, the Malay-based political party, United Malays National Organization (UMNO), rode to political power on the crest of Malay nationalism. Subsequent nation building was based on the historical pact that accorded special privileges to the Malays in exchange for citizenship rights for the non-Malay immigrant population. The special position of the majority Malay population was premised on the notion of their indigenous status. As such, the historical precedence of the Orang Asli was difficult to acknowledge. Eventually, the way in which the state tried to resolve this incongruity was by policies that attempted to assimilate the Orang Asli into the Malay population. The Orang Asli were treated differently and separately but never fully recognised as an indigenous people with all the rights that are conventionally accorded to indigenous peoples by international custom. These rights include recognition as an autonomous people, recognition of the right to traditionally-occupied lands, recognition of the right to practice, maintain and develop their culture, language and religion, and recognition of their traditional knowledge and indigenous systems and the right to protect and promote these.

The non-recognition of these rights has directly brought about the fate of the Orang Asli, in terms of their poor socio-economic status and political inconsequence and, as we argue here, the abysmal state of their health.

Dominance, authority and control
The paternalistic institutions inherited from the British accorded to the Orang Asli [10]  a unique position that allowed them to be treated differently from other sectors of Malaysian society. In the absence of a willingness to recognise the Orang Asli as an indigenous people with inalienable rights, and in the context of a particular ethnicised politics, the state translated this difference into dominance and authority over the Orang Asli. As will be seen from the examples given below, this dominance and authority was often manifested in discrimination against, and control over, the Orang Asli. Unfortunately this has been as true for Orang Asli health care as for other aspects of Orang Asli living.

Blaming the victim instead of oneself appears to be quite commonplace in administrative dealings with Orang Asli, especially in matters about health. For example, in October 1985, when 23 FELDA [11] settlers in Trolak, Perak, came down with jaundice, the health authorities were quick to blame the nearby Semai village and to call for its resettlement. This call was made on the ‘possibility’ and ‘feelings’ that the Semai were contaminating the water supply by their unhygienic practices. Although another 1,057 people in the district had come down with jaundice in the preceding month, no drastic action like resettlement was suggested for non-Orang Asli communities. As it turned out, the cause of the outbreak was insufficient chlorination at the treatment plant (The Star 18 February 1985, 2 December 1985).

In February 1997, when two Jah Hut children in Kuala Krau, Pahang died from an overdose of anti-malarials irresponsibly dispensed by a health department team, the authorities denied it was their fault and suggested that the deaths were due to the parents’ negligence. A coroner’s inquiry, however, ruled that the cause of death was in fact an overdose of anti-malarials (Toh 2000, Nicholas 1997, Baer 1999). Notably, this was the fourth fatal incident arising out of the anti-malaria programme in the same state!

Recently, in April 2004, when four Semai children died within five days with symptoms of vomiting and diarrhoea, the authorities were quick to attribute the tragedy to salmonella poisoning – and, consequently, the poor hygiene of the Orang Asli (Husairy Othman 2004). The government reiterated that it could only provide proper health facilities and infrastructure if the Orang Asli were resettled. The Health Minister who made this comment did not realise that RPS Terisu in Cameron Highlands, where the tragic deaths occurred, was a resettlement scheme and had been so for many years! [12] The cause of the deaths was eventually found to be a rota-virus infection.

Even more recently, in July 2004, when a university study found high levels of Escherichia coli in Tasik Chini lake that caused rashes and diarrhoea in some Orang Asli living in their five lakeshore villages, the Minister in charge of Orang Asli affairs immediately suggested that the Orang Asli be resettled into one place “so that they can attain proper amenities”. However, as the village batins there pointed out, the problem only started when the authorities dammed the Chini River to prevent the lake water from flowing into the Pahang River. Moreover, the university study plainly said the contamination was due to improper sewage disposal by a local resort and by the Tasik Chini national service camp at the lakeside! (The Star, 26 July 2004, 27 July 2004, 29 July 2004).

Such blame-shifting on health problems reveal the underclass status of the Orang Asli. No dominant social group would accept such allegations without a counter-challenge, and no politician would dare to pit himself against a group that could jeopardise his own position. Such attitudes about Orang Asli also clearly show how those responsible for promoting Orang Asli welfare and health are themselves ill-informed or ignorant of the issues involved. Worse, they wield their authority and dominance by backing measures that would further marginalise the Orang Asli.

The official stance of authority and dominance, coupled with ignorance of Orang Asli culture, is sometimes reflected in an insensitive technocratic way of handling problems.  For example, in 1996, when the President of the Malaysian Association of Maternal and Neonatal Health revealed that 60 per cent of the 42 mothers who died during home births in 1994 were Orang Asli (Sunday Star, 29 September 1996), the Minister responsible for Orang Asli Affairs immediately ordered that the seven existing Orang Asli health-transit centres be turned into Alternative Birthing Centres (ABCs) (John 1997, 2004).

This official order may appear to be decisive and prompt, but on the ground, it had drastic repercussions. For one, Orang Asli mothers-to-be were ‘warded’ for about a month before the delivery date to ‘wait out’ their time. Not only was this psychologically stressful for the women, it also placed a heavy burden on the rest of the family, especially for those families living near subsistence. Home births were discouraged and in some cases forbidden by local health staff [13].

Orang Asli mothers still prefer home delivery because institutional delivery not only creates problems for the rest of the family, it is also culturally ‘unfriendly’.  It may be true that by encouraging institutional deliveries, maternal death rates will decline, but a more sensitive way of implementing this policy would be to create conditions that allow Orang Asli mothers to feel more secure and comfortable, as well as mitigate the problems faced by families.  Another way to reduce Orang Asli maternal mortality is to train resident midwives and make available telephone and transport services.

The myth of development and resettlement: Inability to see traditional resources as necessary to health

Development planners and policy makers commonly assume that Orang Asli health will improve if the Orang Asli accept development programmes designed for them or accede to resettlement elsewhere (usually with cash-crops as the main means of subsistence). The reality is far from this, based on the known regroupment failures, such as at Busut Baru, RPS Banun, Bekok, RPS Kedaik, Kuala Koh and, RPS Terisu [14].

The poor nutritional status of Orang Asli children living in regroupment schemes shows that the scheme’s social objectives are not being met. Khor (1994: 123) wrote that:

Some 15 years after relocation, the nutritional status of Orang Asli children in regroupment schemes can be described as poor with a moderate to high prevalence of underweight, acute, and chronic malnutrition. Their dietary intakes are deficient in calories and several major nutrients. … There exists an over-simplified assumption that introduction to cash-cropping will lead to increased income, which will provide more money for food, and in turn result in improvement in nutritional status. ... In reality, relocation entails cultural uprooting and lifestyle changes which may not be overcome by the provision of physical facilities and economic incentives only.

Such lamentable conditions in these myriad schemes is due to the narrow subsistence base and psychological disenfranchisement caused by uprooting Orang Asli from their traditional territories. While the authorities argue that Orang Asli regroupment does not necessary entail relocation, the reality is that the local resource base declines because it must be shared with others who have been moved in from their own homelands.  This is a major cause of poor nutrition among the Orang Asli.

In reality, resettlement is often not for the purpose of improving Orang Asli health or lifestyles, but for other reasons such as security (resettling Orang Asli during the Emergency), making way for public projects (the Kuala Lumpur International Airport, the Universiti Kebangsaan Malaysia campus, highways, dams),or even making way for private projects (housing developments, golf courses, resorts, other settlers).  It is made possible because there is no legislation protecting the Orang Asli as an indigenous people with inherent rights to their traditional territories.

The state of Orang Asli health care today
The Orang Asli health care services is now made up of 125 treatment centres (designated locations where a mobile clinic visits periodically), 20 transit centres (centres where patients and accompanying persons are housed while waiting to be transferred to a hospital for treatment), and 10 health clinics (JHEOA 2005).  There is an understanding between the Ministry of Health (MOH) and the JHEOA’s Department of Health and Medicine, whereby the MOH provides services to the areas that are accessible by land transportation, leaving the interior villages, numbering 323 villages out of a total of 869, to the JHEOA.

Nevertheless, there are major shortfalls in health service provision to the Orang Asli.  The JHEOA itself, in its Orang Asli Community Health Action Plan (JHEOA 2005), points to the lack of comprehensive health services in the interior villages [15].   The same document attributes the falling admissions rate in Gombak Hospital, now a 166-bed hospital, to the shunting of Orang Asli patients to MOH facilities.  There are, however, other organizational problems that may be related to this.

Since the early 1990s, there has been no governmental recruitment of Orang Asli paramedics or health providers. This is diametrically opposite to the policy adopted by Dr. Bolton and his team in the 1960s. There has been no official reason for this but some past officers of JHEOA have attributed this state of affairs to the prejudices of certain JHEOA decision-makers, while the JHEOA on its part contends that there were no qualified applicants from the Orang Asli for these roles.

This time period was also marked by a high level of corruption in the JHEOA as acknowledged by a former senior officer of the JHEOA (Mohd. Tap 1990: 84, 104). Newspapers even reported that hospital staff had turned parts of the Gombak hospital premises into daylight gambling dens (Bertita Harian, 3 March 1984, 10 March 1984). There were also cases of Orang Asli girls (accompanying their sick relatives) being abused or asked to engage in prostitution; as well as cases of ambulance drivers asking for monetary incentives in order to send recovered patients back to their village [16].

Orang Asli were often treated condescendingly or berated when some minor error or omission occurred. As such, many Orang Asli said that they did want to go to the hospital because the employees did not treat them with respect (cf. Gianno 2004: 64) or because they were insensitive, discriminatory, and unfriendly (Harrison 2001).

This is not to suggest that there are no instances of exemplary dedication and sensitive dispensation of healthcare to the Orang Asli today. We acknowledge that particular individual healthcare providers – be they doctors, nurses or paramedics – have displayed the same genuine concern and responsibility so admirably exhibited by the early volunteer doctors and nurses under the still-remembered supervision of Dr. Bolton in the 1960s and 1970s.

However, these individuals are the exception and are more likely to be attached to medical centers of the Ministry of Health rather than the JHEOA medical service. It is not uncommon to hear JHEOA doctors attributing their “sacrifice” to serve the Orang Asli to their “pity” for the people. Also, it is no longer a priority in the Orang Asli medical service to have first-line Orang Asli health workers who can support and clarify technical matters for their hospitalised ‘relatives’. The introduction of a programme to train village-level Orang Asli Health Volunteers (Sukarelawan Kesihatan), although an excellent idea, has unfortunately yet to achieve its desired goals.

Orang Asli health care has indeed taken a beating in the past two decades, not for lack of resources or knowledge of what needs to be done, but primarily because the political and ideological basis of the Orang Asli ‘problem’ has not been corrected (or even acknowledged). The Orang Asli have been treated as not-so-deserving beneficiaries of government largesse, rather than the other way round. This situation is further worsened by discrimination and the formal denial of Orang Asli inherent rights, such as their rights to their traditional lands and resources. Those responsible for Orang Asli health (or for that matter, their overall well-being and advancement) could not or did not want to see the link between Orang Asli wellbeing and good health on the one hand, and their need to be in control over their traditional lands and resources on the other.

With increasing pressures to privatise healthcare in Malaysia, and the unwillingness of the state to accord the political and social recognition that is due to the Orang Asli as the first peoples on this land, it is difficult to see how Orang Asli healthcare will improve through the initiative of the state and its functionaries. It remains a major project, therefore, for the Orang Asli to assert the recognition of their rights as a people, and with it, the delivery of a more sensitive and effective healthcare system.



1.  Although these earlier studies did not mention goitre, it should be noted that lack of goitre was unusual among inland groups.

2.  This was first sited in Kuala Lipis, Pahang, and later moved to a forested area in Gombak, Selangor. Thereafter, it has been called the Gombak Hospital.  See the JHEOA website, (accessed 16 September 2005).

3.  It should be noted that the daily cost for a patient at Gombak Hospital was only 28 per cent that of other government hospitals (Bolton and Snelling 1975). This low cost probably reflected the fact that the budgeted expenditure per patient was far less, rather than that the hospital had found ways to run its services more efficiently.

4.  Yet the Commisioner for Orang Asli Affairs then, Iskandar Carey, maintained that the government’s aim was to raise the standards of health and hygiene for the Orang Asli, an aim he thought had already been fulfilled (Carey 1976). He also wrote that 120 Orang Asli were paid a monthly allowance to distribute medicines in villages. This was a laudable practice but was far from comprehensive since these 120 people could not serve all the 629 Orang Asli villages in the country (1969 census data).

5.  The problem with traditional aetiology was that Orang Asli did not easily accept the need for preventive medicine: “If the spirit causing malaria had departed, why continue taking tablets?” (Bolton 1973a: 1122). But they were willing to accept anti-malarial tablets (quinine) as it was thought that the bitter taste they gave to the blood kept the evil spirits away.

6.  The physiological ill effects of having many pregnancies.

7.  Personal communication between Adela Baer and Ravindran Jegasothy, of the Department of Obstetrics and Gynaecology, Seremban Hospital, 2002, and author of ‘Sudden maternal deaths in Malaysia, a case report’, J. Obst. Gynaecol. Res. 28 (4): 186-193, 2002, which reported that MOH records were analyzed by a national committe of six obstetricians and gynaecologists, a physician, an anaesthetist, an health administration personnel and a nursing matron.  After reading this paper, Adela Baer corresponded with Ravindran Jegasothy about the situation for indigenous women.

8.  In stark contrast to the 35 per cent Semai rate, only 7.5 per cent of rural Malay women studied had this malnutrition (Osman and Zaleha, 1995).  In related work, Osman and coworkers (1993) found that the food intake of Semai adults resettled at Betau in Pahang averaged only 1143 kcal/day.

9. (accessed 9 May, 2005)

10.  No other ethnic group in the country has a government department assigned specifically to oversee its protection, wellbeing and advancement, or an act of parliament to legislate every aspect of its society.

11. Federal Land Development Authority schemes.

12. RPS stands for Rancangan Perkumpulan Semula, or ‘regroupment scheme’.

13. Threats of refusing to register the birth, of refusing aid in the event of a difficult birth, and of laying criminal charges in the event of a tragedy, have been used.  One anecdote of the experience of a Mah Meri woman may be used to reflect the insensitivy with which Orang Asli women are often treated (personal communication with Reita Rahim, April 2004).  On the day when the community celebrated their Hari Moyang (Ancestors’ Remembrance Day) in February 2004, a nurse from the district hospital, about 15 kilometres away, came to her house and took her away to the ABC without informing any family member. After a frantic search, the family found her, but was only able to bring her home after much insistence and promises to ensure that she complies with the medication prescribed.  The nurses said that they were ‘following instructions’, and they needed to ward her due to her low iron and red blood cell levels.  Be that as it may, the way she was removed was highly questionable.

14. In the 1960s, half of the Semaq Beri in a resettlement centre died from cholera (Morris 1997).

15. In this document, the lack of comprehensive health services in the interior villages was singled out as the reason for the high tuberculosis infection rates.

16. Personal conversations between Colin Nicholas and Orang Asli hospital assistants based in Gombak Hospital, 1993-1994.


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