Wai Htet Aung, age 27, waits for his turn at a crowded betel quid stand in downtown Yangon. Customers have lined up by the table to place their orders. “It’s tasty,” he says. “I have bad breath and I want my mouth to smell better.”
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. “After I chew betel quids my mouth feels better,” says Ko Zaw Naing. “My mind feels relaxed.”
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. “It keeps me awake and keeps me from getting bored when I’m working,” he says.
Betel quids are made from areca nuts that are placed in a betel leaf with slaked lime. In Myanmar it’s usually mixed with tobacco. Health advocates say the nicotine in the tobacco and the arecoline in the areca nuts are a bad combination.
"They are addictive chemicals so by having these two things together people like to chew it more and more,” says Dr. Than Sein, head of the People’s Health Foundation, a health advocacy group in Myanmar that’s trying to educate the public about the risks.
The group’s campaigns have included TV spots with betel quid chewers who are terminally ill. “Betel chewing the first major cause is mouth cancer, oral cancer, then larynx cancer, then lung cancer and also stomach cancer,” says Dr. Than Sein.
Widespread skepticism of dangers
According to the World Health Organization, someone who regularly chews betel quids mixed with tobacco for a long-period of time is more than seven-times more likely to get oral cancer than someone who doesn’t chew it. But many people in Myanmar dismiss the risks.
"Chewing betel quid doesn’t lead to mouth cancer,” says Aung Thura. “The mouth cancer happens if you leave the betel quid in your mouth and sleep all night.” His rejection of the risks was echoed by other people interviewed for this story as well.
Ni Ni Wah, age 54, runs a betel quid stand and is a chewer too. “It’s not like I’m worried about getting mouth cancer,” she says. “The mouth cancer happens to people who keep betel quids in their mouth all night while they sleep.”
But Doctor Than Sein says the risks are clearly there for all betel quid chewers especially anyone who chews it regularly for more than a decade. And he adds that all too often they find out they have cancer when it’s too late to cure.
"Cancer is caused slowly and people do not know it and once they know it they are almost dying,” he says
But in Myanmar, all signs point to betel quid chewing remaining one of the country’s most popular habits.