Myanmar

Betel Quid Culture in Myanmar

(Credit: Dental Tribute)

If you ever visit Myanmar, you’ll find three main things: Tea houses, Tea leaf salad, and Betel Quids. Usually, people gather in Tea houses for a cup of tea and some tea leaves, while chattering away, they also start chewing on Betel quids. Almost every street corner in Myanmar has a stall selling kun-ya, a traditional sort of stimulating “chewing gum” made with areca nut, betel leaves, dried tobacco leaves, and slaked lime paste that remains very much in fashion despite being carcinogenic and severely damaging the user’s teeth. Kun-ya sellers spread the lime paste (calcium hydroxide) on the betel leaf and sprinkle the tobacco and powdered areca nut on top – sometimes spiced up with cardamom or cloves – before neatly folding the leaf into a square while their customers patiently wait. The term ‘betel quid’ is often used with insufficient attention given to its varied contents and practices in different parts of the world. A ‘betel quid’ (synonymous with ‘pan’ or ‘paan’) generally contains betel leaf, areca nut, and slaked lime, and may contain tobacco. Other substances, particularly spices, including cardamom, saffron, cloves, aniseed, turmeric, mustard, or sweeteners, are added according to local preferences. In addition, some of the main ingredients (tobacco, areca nut) can be used by themselves or in various combinations without the use of betel leaf. Numerous commercially produced mixtures containing some or all of these ingredients are also available in various parts of the world.

In Myanmar, “Be a man! (Yauk gyar mann yin)” is said to urge oneself to do something risky, such as chewing betel quid. A betel quid typically contains betel nut, slaked lime and betel leaf, and sometimes tobacco is added. There are many expectations of what it means to be a man in Myanmar, such as being leaders, protecting their family, community and nation, as well as being resilient, strong and intelligent. These ideas are embedded from an early age and it is thought that ‘real men’ should welcome these challenges. Displaying their masculinity through chewing betel quid provides men with societal power over subordinate men and over women. However, this comes at a cost -chewing betel quid is associated with developing oral cancer. Myanmar has the highest prevalence of betel quid chewing in Southeast Asia. This has led to high rates of oral cancer among men, and the continually higher rate of oral cancer among men compared to women in Myanmar is thought to be due to this practice. Men from Myanmar have been reported to perform multiple risk behaviours, such as smoking tobacco and drinking alcohol, whereas women are more likely to just perform one such behaviour. This is significant, as using tobacco as well as chewing betel quid increase the risk of developing cancer by approximately 10%.

(Credit: UF Health)

 A consensus workshop held in 1996 recommended that the term ‘quid’ should be defined as ‘a substance, or mixture of substances, placed in the mouth, usually containing at least one of the two basic ingredients, tobacco or areca nut, in raw or any manufactured or processed form.’ Many farmers prefer to cultivate betel instead of rice, as it can be grown throughout the entire year. Betel plantations alongside rice fields are a fairly common sight in Myanmar. Economically speaking, the betel plantations and kun-ya stalls represent a burgeoning business for many people in Myanmar. The trouble is, it also wrecks consumers’ health by causing painful medical conditions that can ulcerate their faces or devolve into cancer.

It is recommended that, when the term ‘betel quid’ is used, other ingredients used to make up the quid be specified. A betel quid is often formulated to an individual’s wishes with selected ingredients. In many countries, ready-made, mass-produced packets of the above products are now available as proprietary mixtures known as pan masala or gutka. Betel nuts are rich in tannins and contain a red dye which over time will turn your teeth black and lips red. There’s a number of different species of Areca, and some kinds of nuts are favored in different regions or are only available at certain times of the year. In Guam, the favorite species is a hard, red nut with a grainy texture, known as ugam, whereas in Micronesia, softer, juicier nuts are preferred. The betel nut is split open using a special instrument, and the husk is wrapped in a betel leaf called pupulu. Pupulu has a fresh, peppery taste, but depending on the variety of areca from which it comes it can be very bitter. Seasoned chewers might mix the betelnut with tobacco, or sprinkle the leaf with slaked lime.

Betel chewing is a tradition that dates back thousands of years. Many young citizens of Myanmar – some aged only 16 or even younger – start using it as a pastime with their parents’ consent. The bitter poultice is an acquired taste, and although it’s not clear why the people of the Pacific originally began to chew betel nut, the habit has been passed down through the generations and now provides a cultural link to their past. Chewing betel nut is an everyday activity, but is also a fundamental part of social gatherings and celebrations. It’s often offered to guests as a sign of goodwill and to welcome them into the family home. Medical use of betel nut is limited, while scientific evidence reveals its various health hazards. Research has proved that regular use of betel nut is associated with different types of cancers, systemic illnesses, and various other diseases. In addition, the use of betel nut is also linked to health emergencies, toxicities, and drug interactions. 

Found across Asia, these nuts are harvested from the Areca palm and are chewed for their warming glow and stimulating properties. Such is its effectiveness, that alongside nicotine, alcohol, and caffeine, betel nuts are believed to be one of the most popular mind-altering substances in the world. Although used by women and children, the nuts are especially popular among working-age men, who chew to stay awake through long hours of driving, fishing, or working on construction sites. But the short-lived benefits come at a terrible cost.

The betel nut is a key part of many Asian cultures and can be consumed dried, fresh, or wrapped up in a package known as a quid. Although the exact preparation varies across countries and cultures, the quid is usually a mixture of slaked lime, a betel leaf, and flavorings such as cardamom, cinnamon, and tobacco. Worryingly, the International Agency for Research on Cancer lists each ingredient, with the exception of cardamom and cinnamon, as a known carcinogen – or cancer-causing agent. The slaked lime is seen as a particular problem as it causes hundreds of tiny abrasions to form in the mouth. This is thought to be a possible entry point for many of the cancer-causing chemicals. 

The signs of this popular habit are easy to spot from the roadside stands across the country to the red stains on teeth as well as on streets and sidewalks that stem from betel quid spit. Figures from the World Health Organization show that more than 60% of men in Myanmar chew betel quids and almost 25% of the women do. Aung Thura is 30-years-old and has been chewing betel quids for eight years. Burmese authorities have attempted to limit its consumption with several awareness campaigns in recent years, while the use of kun-ya is banned at government buildings, schools, and hospitals – through these seemingly-ineffective campaigns have had a very underwhelming success rate so far.

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