Betel-chewing is a deeply-rooted cultural practice throughout south and southeast Asia. 'Kun ja' is an enormously popular stimulant chewed throughout Myanmar. These small parcels of tobacco, areca nuts, slaked lime and optional spices, wrapped in the vivid green leaves of the betel plant comes with a long list of serious health downsides including addiction, deeply stained gums and a high risk of oral cancer. Kun ja patrons suggest that it increases alertness, boosts energy and freshens the breath.
The vivid red splashes of spat out betel on virtually every pavement and wall testify Myanmar's habit. Chewers line up at small kiosks across the city selling the wraps for 200 kyats (around 20 US cents). Hawkers carry them in trays hung around their necks and sell them to people at busy junctions. For sellers, feeding the national habit provides a good living. Myo Myint Tun rises at 3am every morning to sell quids to commuters at a city train station, and earns around $40 daily. This is a good living in a country where the average wage in 2012 was less than $100 a month.
However, doctors have warned that the national appetite for the stimulant is damaging the health in a country with a threadbare medical system. Dr. Dhirendra Narain Sinha, a specialist at the World Health Organization (WHO), said, "Myanmar has one of the highest (number of) users of smokeless tobacco globally, especially among males. My research suggests that just over half of Myanmar's men use the substance, in addition to 16% of its women."
Both tobacco and areca nut are known carcinogens, with mouth-related cancers accounting for a fifth of all of Myanmar's cases of cancer. Dr. Sinha said, "Those who chew betel quids without tobacco have a 250% greater chance of having oral and oropharyngeal cancer than non users. For those who chew tobacco as well the risk jumps 770%."
The latest WHO figures reveal that Myanmar spends the lowest proportion of its GDP on healthcare in the world, just 0.5% in 2013, lower than South Sudan and Haiti. Cigarette packs in Myanmar now carry gory photographic warnings of the health risks, but betel is free of any packaging. Helping Myanmar kick the habit will not be easy.