Try and picture a situation where a whole community, a whole country, a whole continent and several generations wrongly believe in a traditional practice devoid of any scientific studies to determine its efficacy and contraindications. That is what seems to be the curse that struck the people of Asia, especially the south eastern part which comprises of countries such as India, Bangladesh, Nepal, Thailand, Myanmar and Vietnam among others.
If at all betel nut – also known as Areca nut had any commercial or nutritional benefits then it has failed its growers and consumers big time, with devastating effects to the latter. The adverse effects that betel quid comprising of betel nut, slaked lime and tobacco, all wrapped in betel leaves has had on the lives of the people of Myanmar and South East Asia in general leaves more questions than answers.
In my motherland Kenya, authorities have been struggling to bring the cultivation and consumption of a mild stimulant called miraa (khat) under control, albeit under pressure from Britain and other European countries that were once the biggest export markets for the green gold from Meru highlands. Miraa is now classified as a drug in most European countries. And that’s when one starts wondering why the governments of this region aren't seeing the dangers directly associated with chewing of betel quid. The people of Myanmar call it guam and they are among the highest consumers of the harmful stuff; sickening not just because of the unpleasant public chewing, or the discolouration and carcinogenic effects on the consumers' dental facilities and oral cavity but equally disgusting is the rampant unhygienic spitting of red spatter all over, a practice that defies gender boundaries.
Unlike the East African miraa menace which is mainly a nocturnal social activity, guam is chewed at any time, day or night. 4 rolls of guam cost slightly under 1 € and each roll can be chewed for about 10-15 minutes depending on the strength of the user’s mandibles. From interactions with my Myanmar friends, I'm disturbed to learn that an average user chews about 40 rolls daily but there are those who do more than 100 rolls in a day. A very expensive pastime activity, people chewing away 25 € daily!
Guam thue (betel blood) covers most of the ground, roads, urinals, sinks and pedestrian walkways – you see it all over Myanmar, you see it all over South East Asian cities and towns. The spitting habit is so bad that bus operators in Yangon Myanmar provide their commuters with disposable plastic papers to deter them from spitting freely from bus windows onto the streets. A taxi driver in Yangon told me he once had guam thue splashed on his windscreen as he tried to overtake a bus in downtown Yangon. Hotels in Yangon and the larger Myanmar also have "spitting bins" in their restaurants, corridors and lobbies, just like you would provide ashtrays for smokers.
But why chew betel quid?
The people of South East Asia love meat, chicken and an assortment of sea food, all of which leave consumers with a foul smelling breath. Motivated by the desire for fresh breath, the answer was found in betel nut which immediately spread across South Eastern Asia like bushfire. The people had found a natural cure to halitosis, and it was so cheap that everybody could easily afford it. People chewed and chewed, their natural mouthwash soon became an addiction, perhaps due to the nicotine in the tobacco. Users then discovered that betel quid was also a stimulant and could keep sleep at bay, making the user to work long hours without snoozing off. It soon became popular among drivers, especially long distance drivers who said it helped them maintain concentration on the road.
Perhaps the original intention as a mouthwash explains how the use of betel quid transgressed across genders, generations and social status. Literally everybody uses guam, and that's where the problem starts.
The mouthwash has turned out to be a source of untold misery and suffering. Very few users will dare smile in public because guam has been busy discolouring and nibbling people's teeth at an alarming rate, just like miraa has done to many people in North Eastern Kenya. Worse still, some users have ended up with oral and throat cancers.
The World Health Organization (WHO) Expert Group for Research on Cancer reported in 2004 that the percentage of oral cancer among all cancers diagnosed in hospitals in Asia has always been much higher than that usually found in western countries, where the habit of chewing betel quid, with or without tobacco, is virtually unknown. In many descriptive studies, investigators have obtained histories of chewing betel quid with tobacco from series of patients with oral cancer; and in all these studies the percentage of patients who practice betel quid chewing was found to be extremely large. In addition to oral cancer, significant increases were seen among chewers for cancer of the oesophagus, liver, pancreas, larynx, lung, and all cancer. Chewing and smoking, as combined by most betel chewers, interacted synergistically and was responsible for half of all cancer deaths in this group. Chewing betel leaf quid and smoking, the scientists claim shortened the life span by nearly 6 years. Scientists in Taiwan have also found that chewing betel quid increases the risk of cardiovascular disease and mortality. A Lancet Oncology publication also claims that betel leaf quid may cause tumours in different parts of the body and not just the oral cavity as previously thought. (Excerpts from Geneva: World Health Organization. 2008, Lancet Oncology and BMJ)
Scientific teams from Taiwan, Malaysia and Papua New Guinea have reported that expectant mothers who chew betel quid during pregnancy, significantly increase adverse outcomes for the baby. The effects of betel quid and areca nut were similar to those reported
for mothers who consume alcohol or tobacco during pregnancy. Lower birth weights, reduced birth length and early term were found to be significantly higher (WHO reports and publications on Betel Quid)
Ignorance, shortage of oncologists, plus high cost of medicare has not helped the suffering consumers a single bit. Lack of government policy and or commitment further compounds the problem as the authorities appear to be indifferent over the matter. Perhaps they haven't realized the magnitude of the problem yet. Aren't governments supposed to protect their citizens from all forms of harmful substances and practices? Where will the nation get a healthy working population if majority of the citizens within the productive age are under the spell of guam? And if majority of the population cannot work, where will the government harvest taxes from? Some problems require radical actions to deal with – if you are not ready to provide free treatment and palliative care for patients with oral/throat cancer and you are not ready to fit everyone with dentures then you must consider declaring guam illegal. And where is big brother USA and his European cousins to help avert this unfolding health crisis? Or are they keeping away because it ain't their problem? The betel quid problem qualifies to be declared an oral disaster of global proportions. Developed countries must do something to contain this problem, and it has to be more something more than just creating nice TV commercials advertising European or American toothpastes. There is need to sponsor public awareness campaigns, support with treatment of those already diagnosed with various forms of cancers and also push for the establishment of rehabilitation centres to help people kick the habit.
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