How do the Orang Asli respond when they become ill?

16 November 2023

From 2020 to 2023, Monash University Malaysia's Cultural and Health Lab conducted a series of studies funded by the Ministry of Higher Education (MOHE) under the topic of: "Healthcare utility among Orang Asli in Malaysia: Building a psychosocial model". The study was spearheaded by Associate Professor Rachel Ting Sing Kiat, a clinical psychologist affiliated with the Jeffrey Cheah School of Medicine and Health Sciences. The research team included experts in public health and legal research at Monash University Malaysia. Additionally, this project benefited from the contributions of five research assistants from the field of psychology.

The Cultural and Health Lab conducted structured interviews in Bahasa Malaysia with 201 Orang Asli (70 from rural regions, 131 from suburban regions) in different settlements at Johor, Perak, and Selangor in partnership with local NGOs (e.g. JAKOA, Eko Rimba Hijau, SEACO).

"We were interested in finding out whether Orang Asli from rural regions would differ from the suburban areas in the following domains: What are the common illnesses among Orang Asli? What are the underlying causes of their illnesses? How do they seek help for their illnesses? What are the psychosocial determinants for seeking modern healthcare?”

“From the preliminary analysis, rural and suburban groups reported predominantly physical symptoms when asked about illnesses in the past six months, such as flu, asthma and bowel-related issues, and physical pain or discomfort, like body pain, swelling, and allergies. However, the suburban group showed a higher prevalence of physical symptoms and chronic conditions like diabetes and high blood pressure," shared Lim Yee Lly, one of the research assistants involved in the project.

According to Lim, both groups attributed the mentioned illnesses primarily to "natural explanations," such as ageing and pregnancies. Interestingly, the suburban group displayed a significantly higher inclination toward "lifestyle-related explanations," including factors like smoking and overeating.

Moreover, when it came to seeking medical assistance while unwell, both groups predominantly opted for modern healthcare services like clinics and hospitals, with limited reliance on religious-traditional methods such as spells (jampi), herbs, and religious teachings. Nevertheless, religious-traditional methods were notably more common in the rural group.

Lim added that "personal factors," encompassing aspects like financial preparedness and the perceived severity of the illness, emerged as the most influential psychosocial determinants prompting participants to seek modern healthcare. However, the rural group placed a greater emphasis on what is referred to as "infrastructure-climate factors," including considerations such as road conditions, public transportation, weather, and healthcare-related factors like waiting times and medicine availability. This highlights the distinct priorities and influences shaping healthcare decisions in rural areas.

Dr Ting has put forth several practical recommendations from this study to enhance healthcare for the Orang Asli community. These proposals span different levels of intervention, and their clarity and importance are as follows:

1. Community Level: The study suggests implementing a community-based healthcare model, treating Orang Asli families as a single unit. To overcome the challenges of remoteness, the introduction of mobile clinics is recommended. These mobile clinics can provide vital healthcare services to those with difficulty accessing healthcare facilities. In addition, the study emphasises the need to bolster training for lay health cadres and address issues related to hygiene, water quality, and nutrition, particularly among Orang Asli children.
2. Stakeholder Involvement: Stakeholders are encouraged to improve healthcare accessibility for remote Orang Asli communities. This can be achieved by enhancing public transit options, making it easier for individuals to reach healthcare facilities. Furthermore, optimising human resources in hospitals is essential to reduce waiting times, ensuring a more efficient and accessible healthcare experience.
3. Socio-Governmental Cooperation: The research team advocates for collaborative efforts between federal and state governments to enhance the well-being of the Orang Asli. This collaboration can involve increasing transportation subsidies to make healthcare more affordable and constructing additional healthcare facilities in resettlement areas. These facilities should be equipped to address common illnesses and aim to foster trust among the Orang Asli community in government-provided healthcare services.
4. Cultural Sensitivity: To bridge the gap between traditional beliefs and modern healthcare, healthcare workers or frontliners are urged to integrate elements of religious-traditional healing and health beliefs into healthcare modalities. Additionally, initiatives that protect forest lands and promote traditional herbals should be part of the broader campaign to connect with and serve the Orang Asli community effectively.

"In our lab, we believe that research is to serve the community, extending beyond mere data collection. Therefore, we conducted a debriefing workshop with the Hospital Orang Asli Gombak (HOAG) medical staff on 20 October 2023 to dialogue with them about the implications of our study and invite them for further collaboration. The medical staff confirmed most of our findings based on their years of experience serving the Orang Asli community under KKM's initiative. We are proud of Monash Malaysia's engagement with the Orang Asli community and advocate for a culturally responsive and inclusive healthcare system in Malaysia," Dr Ting stated.