A review of Malay Responses to the Promotion of Western Medicine, with Particular Reference to Women and Child Healthcare in the Federated Malay States, 1920-1939, by Wan Faizah Wan Yusoff.
As far as the rhetoric of the British colonial administrations of the Federated Malay States was concerned, medicine was a tool of empire and an unusually effective way to win the hearts and minds of the indigenous population. In practice, however, medical provisions for the Malay were extremely modest and ineffective, if they were provided at all. In her dissertation, Yusoff effectively illustrates the rather ambivalent attitudes of the British colonial administration towards health initiatives for the Malay. In the nineteenth century, as is outlined in Chapters 1 and 2, medical care was only offered to soldiers, sailors, and other Europeans involved in colonial administration. In the first part of the twentieth century, it was extended to include indigenous bureaucrats and plantation works, and finally, but only to a very modest degree, were attempts made to provide care in the countryside to the indigenous Malay. Public health activities were limited to epidemics and other diseases that could interfere with commerce and the health of the white colonial elite and the indigenous elites closely associated with them. Health measures were undertaken sparingly and, if they were, they were driven by economic rationales.
The work of Michel Foucault on medicine and health has influenced many historians of colonial medicine. Foucault analyzed how public health measures and medical interventions are one of the most far-reaching means for the state to insert itself in the most intimate details of individual lives and one of the best ways to transform individuals and populations. Foucault is present in this thesis, and undoubtedly similar ideas were present in the minds of the most idealistic colonial physicians in the Malay Federated states. Even though he envisaged modern ways for how power could be exercised, colonial administrators never really tried to implement anything as grandiose and comprehensive. Initiatives in colonial medicine generally were extremely modest and only had negligible effects.
Yusoff describes how British colonial rule, in particular in the Malay Federates states, was guided by the principle of non-interference with the customs and traditions of the indigenous population in order not to provoke undue hostility. Matters of health and disease and, even more, matters of pregnancy and birth were, not surprisingly, regulated by religious beliefs and customary practice (adat). Bomoh (indigenous healers) and bidan (indigenous midwives) took care of most health matters. Indigenous medical practices were preserved until the end of the colonial period. British physicians would frequently decry the superstition ideas and irrationality of these practices, but this only served to buttress an image of superiority for Western medicine and to justify why health initiatives were only undertaken sparingly. The colonial authorities often blamed the poor health of Malaysians on their faith in traditional healers and their antipathy towards modern medicine, even though Western medical services were hardly available (and poverty the most common source of ill-health).
In Chapter 3, Yusoff describes the religion of the Malay as highly syncretic. Islam was (almost) universally adopted or, as it is more accurate to say, older beliefs and religious practices were incorporated, resulting in an unusually interesting syncretic form of religion. Similarly, medical practices from the British colonizers were selectively received and adopted when they fit existing beliefs and practices. Injections to cure yaws have always been in high demand, partially because they were unusually effective, and partially because yaws was seen as a type of disorder that could be cured by this type of medical intervention. This was not the case for convulsions, for example, which were thought to be caused by the intervention of spirits. A western medical approach simply appeared out of place here. One of the innovations of this thesis is the analysis of indigenous Malay views on health and disease, which makes Malay responses to British health initiatives appear entirely reasonable. In other words: there is much more to the alleged resistance of the Malay against Western medical interventions. The great strength of this thesis is in subverting this age old colonial medical doctrine by investigating which initiatives were successful and why, and which ones failed to evoke a response.
One of the problems in providing medical care to the Malay was that hospitals and health services tended to be concentrated in urban areas while most Malay lived in their kampongs “at the end of the road”. Most Malay could simply not afford to travel to urban clinics (which had little to do with superstition or prejudice). How strong was the resistance against Western medicine among the Malay? Yusoff relates how the Malay refused to receive treatment in hospitals — which is no surprise if one considers the unhygienic and primitive conditions of the few beds that were made available to them. Malay Muslims greatly distrusted health services offered by missionaries. Religious convictions and cultural convictions made Malay women highly resistant to investigation and treatment by male physicians during pregnancy and childbirth — which caused considerable but also predictable problems in organizing maternal health care (the topic of Chapter 4). When female physicians were hired, this resistance was reduced significantly (Chapter 5). Interest in western medicine increased greatly when efforts were made to travel to indigenous villages with a traveling clinic and to provide public health education (Chapter 6). When health services were provided by fellow Malay, this resistance was reduced even further (Chapter 7).
This dissertation leans heavily on secondary sources on British colonial medicine in India (and, to a lesser extent, Burma), which is a fruitful strategy because the number of studies on the history of medicine in the Malay colonies is very limited (the path-breaking work of Lenore Manderson, who is cited extensively, is a welcome exception — see Lenore Manderson, Sickness and the State: Health and Illness in Colonial Malaya, 1870-1940. Cambridge: Cambridge University Press, 2002).
Unit for History and Philosophy of Science
University of Sydney
Arkib Negara Malaysia, Kuala Lumpur (Administrative files, annual reports, health reports)
National Archives of Singapore
National Archives (Public Record Office), United Kingdom (Files related to the Federated Malay States)
School of Oriental and African Studies, University of London. 2010. 275 pp. Primary Advisor: William Gervase Clarence-Smith.
Image: Detail of a map of Malaya (British Malaya) by the Surveyor General of the Federated Malay States and Straits Settlements, showing Singapore (part of the Straits Settlements) shaded in red and Johor (one of the Unfederated Malay States) in orange. The island of Pedra Branca appears on the right of the map marked “Pedra Branca Horsburgh”. Case Concerning Sovereignty over Pedra Branca/Pulau Batu Puteh, Middle Rocks and South Ledge (Malaysia/Singapore): Memorial of Malaysia, vol. 1, p. 143, para. 314. Wikimedia Commons.