Health in the Borneo Highlands: the Bario Kelabit.

Introduction

Unlike many areas in Borneo, Bario is cool, quiet, and sequestered. From a health perspective, the Kelabits are better off than many Borneo farmers. They still have a usable environment for subsistence. Bario has a clinic and flying-doctor service, but public information about health is patchy and treatment tactics can be erroneous. Problems such as scabies, intestinal worms, dental decay, and a fatalistic outlook on depopulation plague them. The lure of city life for the many educated Kelabits continues to depopulate Bario and to weaken Kelabit identity.

Food Sufficiency in Bario

After I had studied rural villagers in Sarawak, Malaysia, who were trying to cope with poor soils, land encroachments, and agrobusiness pressures, I longed to see a contrasting area. That's why I went to Bario.

As I found out, Bario also has poor soils but no land encroachments or any threat of large plantations being put there. It is also food-sufficient, unlike many other areas. Bario paddy fields produce ample "Bario rice," which is widely esteemed. While rice thrives on these peaty fields, they are not as favorable for vegetable growing. (1)

Where, then, do Bario people get their vegetables? Bario is a flat valley in the highlands surrounded by forested mountains. (2) Many wild vegetables and medicinal plants are thus available to foragers (Christensen 1997, 2000; Noweg et al. 1998). Other vegetables are grown on the plateau, such as kangkong, spring onions, cabbages, cassava, changkok manis, and taro. But flourishing vegetable gardens are rare, except for those "on contract" to the local schools. (3) Since the only easy way in and out of Bario is by the daily (Twin Otter) plane from the urban world, and since most school children are boarders from outlying longhouses, local vegetables for them are a necessity. These contract gardens meet this need.

A few fruits grow at Bario's 1200 meter elevation, including mango, rambutan, guava, and pineapple. The banana trees look rather forlorn, their leaves shredded by the winds. Durian trees and coconut palms are rare. On Bario's southern outskirts, fruit trees are more common.

Fishing and hunting are variable. When I was in Bario in August, 2001, stream levels were low and it was not "the season" for wild pig. Bario has no proper river, unlike most communities in the Upper Baram area. Small fish can be caught from creeks nearby, but the larger and tastier ones, such as luang pelian (semah), live in rivers that are an hour away by motorbike. (4) Except for the pigs, few game animals survived in the highlands once guns became available. Even these few are sporadically hunted. For the rest of the animal-protein supply, there are quite a few chickens and even a few ducks around, the latter introduced by the Agriculture Department. The ducks don't count for much since their meat is unpopular and many have died of duck disease. One man said he had seven ducks left, all males. (5)

There seem to be no goats in Bario, but there are water buffalo. They were first acquired, early in the 20th century, from Kalimantan. In pre-buffalo times, the plentiful sambar deer were the main meat source (Talla 1979). The water buffalo are used to eat the old rice stubble, trample the rice-field mud before planting, and fertilize the field at the same time. (6) And one farmer said he raises sheep. The buffalo are eaten on occasion, especially during name-changing feasts, but I'm not sure about the sheep. The school boarders have chicken flown in for their meat supply, but not in adequate amounts.

All these resources add up to food sufficiency for the Bario Kelabits and, with supplementation, for the children boarding at the schools. If so, one might expect that undernutrition would not exist there, even though it exists elsewhere in Sarawak. Indeed, according to Bario clinic records, no pre-school Kelabit children were undernourished in 2000. Three, however, were overweight.

Urban Influences vs. Health

People in Bario hanker after urban amenities. Motorbikes are handy for getting around on the dirt road that meanders around the valley. Air-borne trucks, the one farm tractor, and the like, arrive piecemeal and are reassembled on the spot. Although most Kelabits are staunch Christians, even cigarettes and beer come in by air, as do sweets, new influences, trekking tourists, petrol, and electric generators. (7)

Tourists arrive thinking Bario is electrified when they see the miles of power lines and concrete poles. Evidently the mini-hydro project installed in the 1990s was poorly planned. It worked for one Christmas Eve and has been inert ever since. Houses have generators, often used for watching evening TV. The rice cookers and other gadgets once bought in anticipation of mini-hydro electricity have quietly been forgotten. People cook with firewood.

Meanwhile, urban health problems are creeping into Bario. As people now generally live longer than did earlier generations and as more snack foods are now available, diabetes, poor teeth, and especially high blood pressure (HBP) are not uncommon in adults (Lim et al. 2000). HBP is easily determined at the local clinic, so the HBP "epidemic" may be largely an artifact of ascertainment. That is, HBP may have also been common in the past but seldom looked for. At any rate, people seem to be over-anxious about it, possibly because it's rather a novelty to them and because it may lead to mortal events. (8)

Teeth are a health problem in Bario. To fly to a dentist in town can cost more than a month's supply of cash. Such flights are hardly routine since most Kelabit are cash-poor farmers. While a government dentist visits at times, he only does extractions. On a lifelong basis, this is a disservice. Many older people have lost teeth and now cannot masticate food well. (9) Also, some elders have gold-capped teeth, due to the fashion introduced by the Chinese long ago. (10) Gold-capping leads to rot as it is impossible to brush out bacteria lurking under the caps. Fortunately, there is hope for the teeth of the Bario children, thanks to the efforts of a school principal to obtain restorative dental equipment and thanks to the offer of an urban dentist, also Kelabit, to visit at times to do the work.

Bario has had piped water since 1968 (Saging, 1976/77), but today the water pressure is low in the dry season. Everyone boils their drinking water for fear of gastritis. Even then the water is acidic and suspected of causing upsets. Also, there are no filters on the pipes from the mountains. If working filters equipped with chlorine and fluoride were in place, both stomach ills and dental caries might wane.

Other Local Considerations

Other aspects of nutrition, besides food and teeth, include micronutrients such as iodine and the question of intestinal parasites. Unlike many inland people in Sarawak, the Kelabits have probably never been "bothered" with goiter and its attendant harm to thyroid function--which is especially important for neurological development in utero. There are no cretins in Bario. The reason is that Kelabits have long exploited salt springs, as have their neighbors, the Penan. Kelabits make their own mineral salt at the hot springs. Harrisson (1959:6) said it was "stinking of iodine," but the batch I saw had no smell. Since this ash salt is iodine-rich and has long been traded among highland people, a large territory traditionally was goiter-free (Chen 1990). The salt, however, is not salty enough to be a preservative for "salting down" meat or fish to save for lean times (Harrisson, 1954).

Intestinal parasites are a different matter. Based on a recent study (Nor Aza Ahmad et al. 1998), most of the school children in Bario are parasitized. About 14% had hookworm, one cause of anemia, and 16% had roundworms (Ascaris). Since other parasites were also present, over 60% of the students studied had at least one kind. Many had two kinds. While the primary students are dewormed semi-annually, the secondary students have not received this attention so far. Their principal is trying to remedy this.

While nutrition and its related topics of teeth, goiter, and intestinal problems are basic health concerns, they are not the whole story. However, because little research has been done on the Kelabit, the presence of viral infections, congenital and genetic disorders, typhus, and other conditions cannot be assessed. (11)

People say there are few mosquitoes in Bario, which suggests that filariasis, dengue, malaria, and other vector-borne diseases are rare there. Yet a research team looking for mosquitoes in Bario in 1995 found species that transmit malaria, viral encephalitis, and dengue (Chang et al. 1998). Malaria cases have occurred among Kelabits in the south of Bario, perhaps related to their contact with Penans there; Penan school boarders in Bario have also been ill with malaria (Talla 1979). Another consideration about infectious diseases is that twice a year Indonesians arrive in Bario to plant out rice seedlings (in August) and to help in the harvest (January-February). Up to 80% of Kelabit households hired Indonesian farm laborers in 1995 (Hew and Sharifah 1998). The Indonesians come over the mountains from the border, a six-hour walk away. Since Kalimantan does not have health services as good as Malaysia's, these laborers may bring infections in with them. This has not been studied, although malaria cases have been recorded among Indonesians at the Bario clinic.

On the plus side, it appears that Bario has almost no alcoholism or cirrhosis and not much lung cancer. The reason is the pervasive church condemnation of alcohol and cigarettes there. (12) Another plus is that Bario's clinic is staffed by a medical assistant (paramedic) and a commtmity nurse, although adding another nurse would be extremely useful (as Bario's "mayor," or penghulu, confirmed). (13)

The Scabies Story

Lots of soap and water for hand washing and bathing would benefit Bario children. Since many intestinal parasites are transmitted by the fecal-oral route, soaping up would lessen the worm load. It might also alleviate another problem rampant in Bario children when I was there: scabies (kudis buta). The scabies epidemic started in the primary school and spread to the secondary school next door. Adults I talked to didn't understand that it was caused by a skin parasite, a mite, or how it could best be treated. (14) Some thought it was simply an allergy.

The topic of scabies brings up issues about the effectiveness of health service in this remote community, as well as the level of knowledge about health in Bario and in the outlying longhouses that furnish most of the school boarders. The Bario clinic does not stock many supplies for epidemics of any kind, relying instead on the "flying doctor service" and air-cargo shipments for other than basic needs.

Perhaps because scabies is not life-threatening, it has received little action. But scabies is certainly curable. Besides treating individual cases with 5% permethrin lotion put on from the neck down and left on overnight, the usual advice is to boil all clothes, towels, hair combs, slippers, and bedding. This is easier said than done, especially for 7-year-old school boarders who have no "house mother" to do it for them. Also, boarders often journey home to their longhouses on weekends, and the people there may know little about scabies treatment. Re-infections easily occur.

Scabies, therefore, is a problem with social, medical-service, educational, and government-policy dimensions. Coping with it will require unusual luck or unusual cooperation from all sectors. While scabies is endemic to many areas, it waxes and wanes. Luck might be needed for it to wane in Bario.

The Past and the Future

The Kelabits are distinctive in several ways. They are more oriented to land than to rivers. They raise water buffalo, unlike most other indigenous groups in Sarawak. And they have grown irrigated rice on their plateau for centuries, with their rice farming techniques differing from those of other Borneo groups. (15) Yet many Kelabit valleys once used for paddy farming were vacated long before World War II (Christensen 1997). (16) Despite their flair for growing rice, the Kelabit population has experienced a long decline, at least in the highlands. More recently, the confrontation period in the 1960s between Malaysia and Sukamo's Indonesia led to the evacuation of many near-border Kelabits to Bario, while at the same time people in Bario were flowing to the cities on the coastal plain. (17)

Bario people today seem resigned to the further depopulation of their highlands, a sort of mental fog which is only forgotten temporarily when they go vacationing to see their urban relatives (cf., Labang 1979). Large families are a thing of the past. Family planning is popular, with 111 women on "the Pill" in 2001, according to clinic records. With continual out-marriage in the towns, many Kelabit children have lost their language and traditional culture, a process accelerated by the "national language" and "national culture" taught in government schools. (18)

Perhaps in coming years ecotourists may notice the bleak look of the Bario Valley, despite traces of old bunded fields and irrigation channels there. Where, they might ask, are the 44 varieties of rice once cultivated in the area? Where are the people who can remember the past?

Acknowledgments

I thank the people of Bario, Poline Bala, Andrew Kiyu, and Otto Steinmayer for their cheerful and vital assistance. This work was undertaken while I was a Fulhright fellow at the University of Malaysia Sarawak in 2001.

(1) Rice mills were started in the 1960s but rice husks were fed to pigs at least in the 1970s in some areas (Talla 1979). Burned rice husks from the mills are sometimes spread on the fields, one source of organic fertilizer.

(2) Bario Valley is less than three miles long by one mile wide, but the Kelabit Highlands is some 40 miles long by 20 miles wide.

(3) According to Talla (1979), before paddies flowered or bore grain, vegetables were planted on the bunds, but this seems to be rare now. The bunds were mowed with modern grass trimmers when I was there, even though they are built up of fertile muck from the paddies and could support an edible landscape.

(4) Carp once imported by the Agriculture Department for fish-farming in bunded fields escaped to rivers when bunds washed out during heavy rains (Talla 1979).

(5) Tom Harrisson and others introduced ducks to the Kelabit Highlands just after World War II. By 1948 there were evidently hundreds of ducks there, spread all over by individuals doing cluck trading. But by 1954, few were left (Harrisson 1954).

(6) In the 1960s, government-funded canals were dug to drain the previously water-logged valley. Drainage of the swamp turned the peat into clay soil (Talla 1979).

(7) As a result of this new religion, "many of their age-old practical values have unwittingly been abandoned" (Labang 1979:12).

(8) For reliable and plentiful information on HBP, hypertension, hookworm, and scabies (see later sections), and other health issues, a good internet source is the National Institutes of Health in the United States. Its home page (http://www.nih.gov/health/) has a subheading "MEDLINEplus." Turning to that page, and then to the attached "health topics" page, lets one focus in on HBP and, separately, on scabies. Under the "health topics" page, its subtopic of "parasitic diseases" leads one to a fact sheet on parasitic roundworm diseases, including hookworm. There are also two articles on HBP under the heading "blood pressure" provided under the "Full-text Consumer Health Publications" subheading on the home page.

(9) While Harrisson (1959:14) reported that young girls used to have their top two front teeth knocked out, he didn't mention if this was considered beautifying.

(10) According to Harrisson (1959, p. 14), men gave up blackening their teeth and switched to gold-plating when they began frequenting the coast, if they had "enough gum or bezoar stone or other jungle produce to pay...the price." Further, he wrote (p. 209), "The Kelabits and other inland peoples had never heard of gold as money. They valued it highly, for one reason only. The habit of chewing betel nut, which spread into the interior in comparatively recent times, damages the teeth eventually. In the interior there are of course no dentists [and] the methods of cooking and many items of diet require strong teeth. So, since the interior came into regular ... contact with the coast, far and away the most important reason for collecting jungle produce and carrying it out, with enormous labour, has been the urge to protect these front teeth with gold caps. As well as this, the show of gold in the mouth is regarded as attractive ... A set of gold caps, prepared and placed by a Chinese 'dentist' at Marudi ... cost about 10 [pound sterling] before the war--a big sum, involving saving and much effort ..."

(11) Mental retardates, who never marry, were mentioned by Talla (1979). Whether they were the victims of genetic conditions, congenital iodine deficiency, or some other problem is unknown.

(12) Other health advantages of Christianity have been lauded by various Kelabit writers, such as fostering longhouse cleanliness.

(13) Interestingly, the Kelabit pemancha, senior to the penghulu, was the first Kelabit to receive paramedic training; he then served as a dresser at a dispensary built in the highlands (Talla, 1979).

(14) Later, some parents were said to be applying a weedkiller, Roundup, to affected areas of the skin (P. Bala, personal communication).

(15) The Kelabits evidently once polycultured rice, planting different varieties together in the same field (Harrisson 1954). Long ago, one Kelabit noticed a tall rice plant in his field that had produced well. He saved the seed and used it in a monoculture plot, to avoid wind pollination by the old varieties. The husk, or pericarp, of this new variety was not adhesive to the rice grain. It came off easily during de-husking, unlike that of the old varieties that could only be partially "polished" with the traditional mortar and pestle. The problem that ensued when this new polished rice became popular was beriberi, caused by a deficiency of vitamin B1 (thiamine). This vitamin had been readily available in the semi-polished rice of the old varieties. However, the beriberi threat was mitigated by the continued use of the old varieties in making the local rice wine, which was drunk in large quantities at that time.

(16) According to Talla (1979), introduced diseases such as cholera, smallpox, and influenza were the major cause of population decline from the 19th century up to 1940, when the population stabilized. Infant mortality was quite high prior to World War II. After 1945 modern medicine started to become available. According to Harrisson (1959, p. 61), venereal diseases and attendant sterility were not involved in this decline since upland people were well aware of "certain unpleasant illnesses in the lowlands arising from sexual intercourse [and] that these illnesses have, so far, escaped Bario and the surrounding longhouses, an oasis in the venereal populations of Asia."

(17) Yet according to Saging (1976/77), the entire Kelabit population grew from 1,358 in 1949 to 2,541 in 1970. While there may be 5,000 Kelabit in all today, only a minority still live in the highlands on a permanent basis. Town life lures them away.

(18) And inter-group marriages seem to be increasing. They were already occurring in the 1970s, mostly with Chinese (Talla 1979).

Literature

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Saging, R. L.

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A. Baer

Department of Zoology

Oregon State University 

Corvallis, OR 97331

[e-mail]