Measles outbreak highlights challenges in caring for Orang Asli

The Orang Asli at Pos Lejang in Lipis, Pahang. Getting to some remote Orang Asli settlements is itself a challenge. (Bernama pic.)

PETALING JAYA: Long journeys into the Orang Asli heartland are common for Dr Madhusudhan Shanmugam, who has been running the Teddy Mobile Clinic since 2015, along with his band of volunteer doctors.

“On one trip, we went deep inside Raub, Pahang to reach an Orang Asli village. There was no proper road and some of the volunteers who were not travelling in four-wheel drives had to get out and trudge through the mud,” he said.

But these aren’t the only challenges medical teams, whether from NGOs or the government, face in delivering medical services to Orang Asli communities.

“There are some who are reluctant to undergo checkups when we go there. Sometimes, we hardly have 10 to 15 patients because they have trust issues with outsiders,” he said.

Madhusudhan, who is in private practice, said he understands the challenges faced by the authorities and acknowledges that building trust takes time.

“To me, the NGOs are the best hope, especially those who work closely with Orang Asli communities on matters like farming or education. They can be a bridge between the Orang Asli and the government.”

These challenges are not uncommon. A think tank says the recent measles outbreak in Kampung Kuala Koh in Gua Musang, Kelantan, highlights the difficulty faced by government services in serving remote and nomadic communities.

Three villagers have officially died of measles, while the cause of deaths of 12 others who were buried before post-mortems could be carried out is still unknown.

The health ministry has revealed that only 61.5% of the villages received their first measles, mumps and rubella (MMR) vaccination jab, while only 30% received their second doses.

This has led to criticism from social media users that the authorities are not doing a good enough job to protect the Orang Asli.

Galen Centre for Health and Social Policy CEO Azrul Mohd Khalib said the low coverage of MMR immunisation is just one of several issues affecting this group of people, with malnutrition being another.

“However, there should not be any finger pointing or blame assigned to any one party.

“It is an extremely tough task, especially for a community that is mobile,” he told FMT.

Azrul said the way forward is to train and embed community health workers among Orang Asli communities.

Ideally, these should be individuals identified and chosen from among the communities and trained to provide basic health care and information on preventive and public health issues.

“It would help identify problems such as future disease outbreaks which would need modern medical care and enable Orang Asli community health workers to alert nearby authorities and seek help,” he said

Alberto Gomes, a professor at Australia’s La Trobe University, said the health issues of the Orang Asli must be looked at holistically.

He said the Orang Asli’s health issues stemmed not from their way of life per se but because they are affected drastically through poverty, displacement and exploitation.

“This is a long-term problem which needs a long-term solution but this is not limited to health issues because their economic, cultural, ecological and social issues also affect their health,” said Gomes, who has spent 40 years studying the Orang Asli.

He said that limited economic opportunities, pollution of water sources and crowded, ill-equipped settlements have contributed to the Orang Asli’s poor health situation.

“Many cannot earn enough. In the past, this was less of a concern because they lived off the land. Now much of their land is gone and forests cleared. When they can’t earn enough, they don’t eat well,” he said.

Gomes said pollution has also led to a drop in water quality and affected their health.

He said long-term solutions like ensuring the Orang Asli had rights to their land, and protecting the forests from loggers and miners and exploitation from businesses were desperately needed.