Is a river more important than Orang Asli children?

I often wonder if our nation wants to hear the truth, or if we are just covering up reality. I also wonder if we will ever get serious about important issues facing marginalised communities that have no voice.

The recent uproar over children in inner Kuala Lumpur being malnourished is good, but there is a disproportionate silence over the long-standing malnutrition of our Orang Asli children. We hope, with the birth of a New Malaysia and a government that focuses on the needs of the people, that truth and reality can be shared about our Orang Asli sisters and brothers.

1. The vast majority of Orang Asli children are malnourished, and this is worsening

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

A recent study we did on Orang Asli children in Perak (1,329 children in the state under two years of age) showed that 40% were malnourished by the age of two (Clinical Research Centre Perak 2016). The actual figure is much higher as many had poorly plotted growth charts that could not be evaluated.

Perak, under the health ministry, has the best re-feeding nutrition programme for Orang Asli children, yet we cannot halt this crisis of malnutrition.

2. The mortality rate for Orang Asli children is six to eight times higher than for other Malaysians

The actual mortality rate for Orang Asli children is not easy to determine as we are unable to document all who live in the interior. But available data suggests that the death rate among these children is six to eight times that of the national average.

This means that for every one Malay, Chinese or Indian child that dies, six to eight Orang Asli children will die. The actual difference is probably higher.

I have been involved with this community for more than three decades, and have observed a deterioration in their health and economic status over the last 30 to 40 years. In the past, we rarely saw malnutrition among the children, who would die predominantly of malaria. But in the past 20 years, the vast majority of Orang Asli children die as a result of underlying nutrition problems. They are not able to cope with even a simple diarrhoea or pneumonia infection due to chronic malnutrition.

The primary reasons for such poor health and the high prevalence of malnutrition are the external social factors affecting the community, including resettlement schemes, logging and river silt pollution, all of which result in a loss of traditional protein sources.

3. The death trap of government resettlement schemes and extensive logging around Orang Asli villages

Government resettlement programmes for the Orang Asli are a death trap for many. They worsen malnutrition by removing food security. And despite a new government, we continue to see extensive logging activities around Orang Asli villages, often resulting in the complete deforestation of the area.

NGOs working to uplift the Orang Asli people share how there has been no change and possibly even a worsening of logging activities in the past year. This results in the Orang Asli people losing their natural protein sources (the forest and rivers) to logging and pollution. This simple diagram shows the factors that have affected this community for years, and which are the major causes of poverty and malnutrition.

4. The Department of Orang Asli Development (Jakoa) is ineffective and not trusted by some Orang Asli people

The Orang Asli are seldom consulted or involved in decision-making about the programmes affecting them. They are not in control of Jakoa. This is an uncomfortable reality.

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

Jakoa seems always short of funds and is unable to fund even basic transportation for children with chronic illnesses to hospital for checks by paediatricians. It would be good to audit the development and financial budgets given to Jakoa, and see where the money has been spent (the socio-economic development budget given to Jakoa in 2016 was close to RM200 million).

5. What works, and suggestions for the support of Orang Asli children

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

1. Some years ago, a few of us advocated for the healthcare needs of the Orang Asli to be moved from Jakoa to the health ministry so that we can support these children. The transfer of health responsibilities to the ministry has allowed us to make meaningful inroads on the well-being of these children.

2. Written protocols on the resuscitation of malnourished Orang Asli children are vital as malnourished children respond differently to treatment. This requires the support of paediatricians.

3. Acute re-feeding protocol on malnourished children – we have to be careful how we feed decompensated, malnourished children. This is best done in regional centres with the necessary expertise.

4. Proactively identifying children with severe malnutrition and rescuing them before they become ill. We cannot wait for children with severe malnutrition to become ill. We need to boost their nutrition before it happens.

5. Establishing re-feeding centres in larger villages, and health facilities in the interior. This is the most important stop-gap measure through which 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 them. The key is to give Orang Asli children under the age of five one protein-energy meal every day.

Suggestions to improve their outcome in the long term include:

1. The total revamp of Jakoa. It should be placed under the Prime Minister’s Department (currently an “orphan department”) and be staffed predominantly by Orang Asli.

2. The Orang Asli need meaningful socioeconomic development that is sustainable and culturally acceptable. Development plans must be discussed with and involve the Orang Asli. We cannot import our ways but must listen to their suggestions and ideas. Remember, for the Orang Asli it is vital that 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, communities and health needs.

3. Halt all logging activities around Orang Asli villages and stop any resettlement programmes.

4. The government should work with major NGOs supporting the Orang Asli as they are often better equipped to understand the community and carry out successful initiatives.

5. Significantly increase funding for health and development programmes involving Orang Asli children and communities, especially community-based feeding programmes.

For the sake of comparison, from 2012 to 2017, the government spent RM2.3 billion on the River of Life project in Kuala Lumpur. However, it is not willing to spend RM15 million on an annual basis to feed Orang Asli children below the age of five. What an indictment of our humanity: a river is more important than an entire people group and the lives of children.

Close to one year ago, on May 28, 2018, I made a plea to the new government to save these children. Now, a year later, the situation has worsened.

I understand from colleagues and NGOs on the ground that the vital lifeline, the community-based feeding programmes for Orang Asli children, are again plagued with interruptions in funding. I cannot understand why we cannot get our priorities right as a government and a people. Saving lives is far, far more important than putting up more buildings or having mega projects. We elected the government to save the people, not enrich capitalists.

Can I suggest that instead of expensive overseas “learning trips” for our politicians and senior civil servants this year, they spend a month at an Orang Asli village in the interior, experiencing 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 plans tomorrow. Today is their day, or we will lose more of them.

Dr Amar-Singh HSS is a senior consultant paediatrician. - FMT