SARAWAK’s modern midwifery history began perhaps with small steps during the arrival of the Brookes.
This noble profession of delivering babies safely into the world was only minimally recorded in the state just before the Second World War.
Until that time, midwifery was carried out by hands-on husbands, mothers-in-law, mothers, sisters and the traditional kampung midwives — and perhaps also through some of the most primitive methods imaginable.
In my own family, we had many tragic tales of childbirth deaths.
My paternal grandmother Chong Jin Soon passed away at 38 during childbirth in 1938 in Sibu. An aunt had an epileptic fit and died with the unborn baby in her womb. A distant relative had a breeched baby and both died during the long painful delivery.
And yet women have continued to bear children to this day, risking their lives, unceasingly continuing to carry out their role of perpetuating the human population.
And so on and on, we can tell many such stories when we can get women together.
According to Ningkan, a middle-aged Iban from Long Lapok, his grandparents had many children in the 1920s and 1930s.
He could definitely say his grandmother delivered her own children — beranak sendiri or self-delivery.
Hii Kah Ang from Miri, a former teacher in Marudi, now in his 70s, had this to share: “In the 1940s in Sarawak, there was no midwifery or hospital service to speak of. All the women in the rural areas would have given birth the “old ways” or by adat lama.
“In the towns, there were local bidan or Chinese barefoot midwives but usually it was another woman, or even just the husband, who would help with birth.
“Many stories of unsuccessful self-deliveries were told in those day. The infant and maternal mortality rates were high.”
In the Baram, according to another retired teacher, as recent as 50 years ago, 50 per cent of Kenyah and Kayan mothers and their babies died at childbirth.
The ulu midwives
Hence, as late as the mid-1950s, the genteel British governor, Sir Anthony Abell, personally went around the Baram to collect a few “bright and able young Kenyah, Kelabit and Kayan girls to study in Kuching to become ulu midwives”.
I met up with Asung Lenjau in Miri through her daughter Diana, who spoke about her mother being a midwife when we went to Marudi on a social welfare project.
This is her amazing story. And let it be known there was a batch of midwives trained in the mid-1950s to serve the rural women but have they been forgotten?
According to Asung Lenjau, the daughter of a Kenyah headman at Long Jeeh in the Baram, she and another Kenyah girl, Baun Balang from Lio Mato, were selected and encouraged by the last British governor to train as midwives in Kuching.
They took a government boat to Kuching alongside others — two Kelabits, Bungan and Sigan, and a Kayan, Salalang.
In Kuching, they were joined by Hajijah, Jovida, Lily and two Iban sisters, Rose and Catherine Nanang.
Asung was the first Kenyah girl to be picked for a two-year midwifery course in Kuching in 1956 to 1957. She was then only 16.
In the morning, she and her friends worked at the Kuching hospital to orientate themselves with the working environment. In the afternoon, they studied under the Sisters who instructed in English and Malay.
One of Asung’s first experiences was a caesarian birth done by Dr Chong Chung Hian (later Professor Chong and medical director of Health Services, Sarawak), the first local medical doctor in the state.
When Asung was asked to bundle up the baby who was stillborn, she broke down.
“When I held the small dead body I could not accept his death so easily,” she recalled.
The doctor was busy, trying his best to save the mother. The caesarian was successful in a way but the baby could not be saved. After the mother was wheeled away, the doctor came over to calm young Asung.
“Don’t cry. This is a difficult case and both of them could have died. But we have managed to save the mother and she could have another child. Drink some tea and you will be all right.”
Asung said it was an honour to be comforted by a doctor who was able to save lives! And she was so touched by this incident that she vowed she to do the same — save as many lives as possible on her return to the Baram.
The two years went by quickly and the trained ulu midwives returned to their homes or villages to help rural women in childbirth and provide some childcare.
The study instructions were simple and by watching deliveries, Asung and her friends learned quickly.
It’s difficult to source documents or records for this course as only oral history of the Baram gives us an idea of how these first ulu midwives returned to serve in the Baram — at Long Jeeh, Long Moh, Lio Mato, Long San, Long Silat and some other remote areas accessible only on foot.
Asung was sent back to Long Jeeh where she started her midwifery service until 1969. After the formation of Malaysia, these rural midwives were to become the forgotten nurses of the ulu Sarawak as the medical service was being revamped and then came under the federal government.
Asung remembers she had to keep records of births and deaths in an exercise book. She used the records to collect her pay (10 dollars for delivery and an extra two dollars for birth certificate) from Marudi but the journey was too far away by boat and she often provided free services in the name of God and country.
Although Long Jeeh had its government clinic by the mid-1960s, Asung was neither given a proper pay nor placed under the government payroll, probably because the officers did not know about her or how to place her in the right category.
Soon, family life and other cares took over, and she too was put aside — like her other five friends. And in time, they were completely out of the loop.
Today, she has her stories to tell about her work in Ulu Baram — how she walked to longhouses and travelled by her own little longboat from Long Jeeh to outlying areas to help bring babies into the world. The government did not pay her any allowance for transportation or food.
Like her other sister midwives, she was dedicated to her work. She wore her original government-issued uniform until it could no longer be worn.
The government-issued shoes were worn out but not discarded even though her feet grew a size bigger after the birth of her children.
She became well-known throughout the Baram for smooth deliveries and child-and-mother healthcare.
“For as long as the pregnant mothers came to see me for help, I would give instructions on how the child should be delivered — where and when,” she said.
“I was able to tell whether it was going to be a difficult birth or not. The nearest clinic in Ulu Baram was at Long San where missionary nurses served the Upper Baram — and occasionally, doctors would come.
“But again many men could not afford to bring their pregnant wives for emergency deliveries and so many mothers died because of lack of financial support.”
Better ways, better lives
Asung also received help from Tuan Sapu.
She said it was through Christianity that many Kenyahs, Kayans, Kelabits and also Penans gave up their old ways, adding that this indirectly helped mothers and children stay alive – better ways meant better and healthier lives.
“The minds of our people were opened and they were able to accept the new truths about health, childbirth and pregnancy,” Asung explained with a smile.
Tuan Sapu was Charles Hudson Southwell, who spread Christianity in the Baram. He and his fellow missionaries helped change the mindsets of many Kenyahs, Kayans and Kelabits.
In those very significant years, it was also the new religion which opened the minds of the Baram people and many women were saved from deaths.
“The Southwells continued to minister in the Highlands until the 1980s, working among the Kelabits, Kayans and Kenyahs.
“Hudson developed a Kayan-English dictionary to preserve this indigenous language and established a Community Development Project far up the Baram River at Long Lama that provided technical training to improve local living conditions,” ‘With Pythons & Head-Hunters in Borneo’ (2009) by Brian Row McNamee (Xlibris).
Asung, herself a very strong SIB church member, wakes up early in the morning to read the Bible and sing songs of praise in Bahasa Malaysia.
She showed me her well worn Buk Kudus, placed in the centre of her simple living room in Miri. Her Bible is her good companion.
Once she was called to Long Silat to help a Penan father whose wife had already given birth.
Asung asked the Penan father how she gave birth and he said he used “a flat stone to force the baby out of the stomach”.
Fortunately, the baby survived and Asung managed to clean up the Penan mother and advised her on what to do.
She also cut the umbilical cord and dressed the baby with the clothes she brought.
Old adat – a big obstacle
One of the biggest obstacles Asung faced is old adat or the old way of giving birth.
Most of the Kenyahs would follow the old ways. In one instance, a Kenyah father who adhered to the old adat, did not allow anyone to help. Also, no one would offer to help.
The superstitious belief that the dead mother would turn into an avenging spirit frightened a lot of the people during those days. So when a difficult birth was predicted, Asung would ask the expectant mother to go to Long San for help.
Most would be saved if they listened to her. But there was one case where a mother refused to go to Long San, preferring to let her own husband deliver the baby.
After several days, the father came to ask Asung for help. But it was too late. The mother and child had already died.
And being fatalistic, the father accepted the situation as ‘normal’ and quietly went away while Asung felt very distressed that she could not help a fellow mother.
Another case was totally out of this world to those who heard Asung relate it.
A mother had already given birth. The father called Asung for help because the mother couldn’t stop bleeding but when checking the baby, Asung saw the baby still had an uncut umbilical cord. Under the clothes, she also discovered the mother’s uterus “was half out” – and she had been bleeding for three days.
Asung used her hands to slowly push the uterus back into the mother’s body and cut the umbilical cord. Today, both mother and baby are still alive!
Lost a child
Asung married Tony Ngau in 1969 and they have four children but lost one child who had a high fever. Tragically, their home was too far from Marudi and they could not reach the government hospital in time. She was not assigned to any government clinic after she had children. This was after Malaysia was formed.
Perhaps, it was too difficult for the officers in Marudi to make arrangements for this ulu midwife to be recognised. Moreover, it was too difficult (and too expensive) for her to travel from Long Jeeh to Marudi in those days.
In the end, she gave up her work and concentrated on raising her family. She had served her people for 10 years. However if she could, she would still provide service to her people without payment. Forty-five years on, septuagenarian Asung is still ever ready to help expectant mothers.
“Although I’m already 77 years old now, I believe I can still help women deliver their babies in the most ulu of places and in the lost extreme conditions with my hands and with the wisdom given by God,” she said teary-eyed.
Presently, Asung lives in a wooden house by herself in one of the kampungs in Miri while Tony tends the farm in Long Jeeh.
Asung gets only RM300 from BR1M, which she shares with her husband. The rest of the financial support comes from their three children.
Asung wants to be near her children and Miri Hospital. She said if she lived in Long Jeeh, her transport to Miri would be about RM160 per trip.
“I pray to God every day for He knows what I have done and I put my mind at rest on His lap,” she said.