Since Independence, gained in 1957, major changes have occurred in the rural areas of Malaysia not least amongst which has been the provision of maternal and child care services to hitherto neglected areas. In the first part of this paper, the demographic and disease patterns are described. The second part outlines the general development efforts and describes in greater detail the rural health services that have been organized in Malaysia. In the concluding section, changes in mortality and morbidity are examined.
Malaysia has a large variety of traditional medical systems that are a direct reflection of the wide ethnic diversity of its population. These can be grouped into four basic varieties, namely, traditional "native," traditional Chinese, traditional Indian and modern medicine, examples of which are described. In spite of the great inroads made by modern medicine, the traditional systems are firmly established. Patients move from one system to another or use several systems simultaneously. The integration of the traditional Malay birth attendant into the health team is described. The forces influencing the development, acceptance and integration of the medical systems is discussed.
Unlike much of Peninsular Malaysia, the Baram District of Sarawak remains sparsely populated and underserved, one of the most underserved peoples being the nomadic and semi-nomadic Penans of the Baram. Until quite recently these Penans lived as small nomadic bands of hunter-gatherers. More recently, they have begun to settle in longhouses. However, lacking the necessary skills to live a settled mode of life, these Penans suffer a great deal of hunger, malnutrition, disease and death. Primary health care with its emphasis on the seven essential elements, including food production and nutrition, environmental sanitation, good maternal and child health, knowledge of disease and how it can be prevented as well as the treatment and control of locally endemic diseases, is of critical value in the survival of the semi-nomadic Penans. The specially designed primary health care programme for the Penans of the Baram is outlined briefly in this paper.
Keyword: Baram, Penans, Primary Health Care, Sarawak, Village Health Promoter.
The permainan puteri (usually abbreviated to main puteri) is an indigenous Kelantanese healing ceremony in which the bomoh (traditional medicine-man), the sick individual and other participants become spirit-medium through whom puteri (spirits) are able to enact a permainan ('play'). It has been successfully used as a psychotherapy for depression. The bomoh assisted by his minduk (master of spirits) and a troupe of musicians, is able to provide a conceptual framework around which the sick individual can organize his vague, mysterious and chaotic symptoms so that they become comprehensible and orderly. At the same time the bomoh is able to draw the sick individual out of his state of morbid self-absorption and heighten his feelings of self-worth. The involvement of his family, relatives and friends tends to enhance group solidarity and reintegrate the sick individual into his immediate social group.
Three indigenous Malay surgical procedures, namely circumcision by the mudim, bone-setting by the bomoh patah and cupping, are described. It is noted that complications are associated with both circumcision and bone-setting, and suggestions are made of possible health measures to cope with the situation.
On the basis of a questionnaire on smoking behaviour, knowledge and attitudes administered to medical students in the University of Malaya in July 1987, the prevalence of smoking was found to be low (10%) among medical students. Smokers and non-smokers were equally well informed about common smoking complications. Most students, irrespective of smoking status, felt that they would as future doctors, often advise sick smokers against smoking. In contrast, less than half would do so for healthy smokers who do not themselves raise the question of smoking. The students' personal smoking behaviour also influenced their view of their professional role. Appropriate values, attitudes and a preventive approach towards smoking need to be further developed in the medical students' thinking and behaviour.