It’s 8 am and the rented four-wheel drive is already packed with food, cooking utensils and anthropometric measuring equipment.
These tools – weighing scales, height measures – will help nutritionist Nicholas Alvin George and his team of nurses later on in the day when they visit the Penan communities in Long Urun.
For now, having a heavy breakfast is a must since they will have no time to lunch later in the afternoon.
Ironically, they are going to a place where they will be cooking but the food is not for them.
Nicholas and his team are part of Community Feeding Programme under the Malaysian Government Transformation Programme, GTP 2.0.
It is a plan to improve the nutritional status of Orang Asli children aged 6 months to below 6 years of age in rural Perak, Pahang, Kelantan and the Penan community in Sarawak.
The programme became one of the Ministerial Key Performance Indicators (MKPI) for Ministry of Health in 2013.
“They don’t have the same conveniences we have,” Nicholas said of the remote Penan communities they will be visiting. “We have food to cook at home but they depend on nature and their environment.”
The Penans are known as a nomadic indigenous people in Sarawak but over time most of them have settled in longhouses. They still prefer hunting and gathering jungle produce as means of survival.
“It is easy to say that these ‘nomads’ can survive since they live in the forest,” said Nicholas. But these days the forests they are living have become ‘sawit’ or oil palm forests.
“One of the elders told me, ‘We never had problems like this before. When I was young we had more than enough (to eat).'”
The journey to the Belaga interior
The journey from Sungai Asap Clinic, where Nicholas and his team are attached to is one to two hours away from Long Urun, Belaga.
“The length of the journey depends on the weather. If it is raining, the road will be slippery so we need to take our time.”
The road to Long Urun is bumpy and untarred as it is a logging road. Nicholas described the journey like getting a ride on a massage chair except the ‘massage session’ resulted in muscle ache.
The Community Feeding Programme in Long Urun currently covers six longhouses – Rumah Ating, Rumah Adih, Rumah Besi, Rumah Dang, Rumah Labang and Rumah Pait.
There are 83 children registered with this programme. This number includes those who are malnourished and those who are of normal weight.
This is to ensure the children with normal weight are still being monitored and do not fall into the malnourished category.
They also have Penan volunteers helping in the programme, preparing food for the children from Mondays to Fridays around 7 to 8am.
Instilling healthy eating among the Penan communities
Nicholas and his team usually visit the centre every month for five days.
“During the visit, we send one month’s food ration stored in a room which has been agreed upon by the longhouse chief to be used for this programme.
“We will measure the registered children’s anthropometry with a measuring mat for babies, a stadiometer (to measure height) and weighing scale. This is important for us to see the nutritional status of the child and the effectiveness of this programme.”
They then plot the children’s growth rate against the World Health Organisation growth chart for infants 0 – 5 years old and children 5 to 10 years old.
The team also has to check for head lice and cut their fingernails if necessary as well as check for any visible signs of health issues.
Once they’ve completed the health checks, they cook for them.
Nicholas said they designed the menu to provide them with the right amount of calories and nutrients. Some of the menu items they introduced are porridge with eggs and green vegetables, ‘linut’ (a kind of sago paste) with fried eggs and fern.
“For them, it is luxury food. Usually the food I prepare for them are high-calorie and high-protein food but most importantly a balanced diet.”
According to Nicholas, there is a small-scale sundry shop in the area which could take them 20 minutes to reach by foot, but essential foods like eggs, meat, fish and chicken won’t be available all the time as it is a small family business.
“Being a nutritionist, it won’t be enough just to provide them with the right food to eat,” he said as educating and raising awareness of healthy eating are the most important parts of their job.
He also observed that the remnants of their hunter-gatherer lifestyle means that they don’t eat a balanced diet and that they tend to skip meals.
Healthy eating in a challenging environment
Nicholas found communication easy with the Penans as they understand and converse well in Malay.
But getting them to practice healthy eating is difficult in the interior when they live a low-income, subsistence lifestyle.
“For them eating is simply just eating—nothing more than that and as long as they eat,” he said.
Without the programme, the villagers may typically eat ‘linut’ or tapioca leaves.
“They will usually hunt for animals but its not like going to a grocery shop where you just pick up what you want and that’s it. It may take them awhile to hunt – the fastest would be a day but it may take days and up to a week,” Nicholas explained.
He added that once they’ve returned with the spoils of their hunt which could include wild boar, they divide it up among themselves and eat it that same day as they have no refrigerators.
Hygiene is another concern for Nicholas and his team as the children can be spotted playing with mud or dirt on their hands. Plus, it is normal for them to see the children running around without slippers, another concern as it can lead to worm infection, one of the causes of malnourishment in children.
Nicholas noted that educating the parents is not a ‘one-time thing’.
“We can’t tell them everything at a time. It has to be gradual and done repeatedly,” he said. “This may take time but it is necessary for them to understand.”