PORT MORESBY - In Papua New Guinea, the popularity of the psychoactive betel nut is on the rise. With mouth cancer rates soaring, the nation is struggling to control its growing addiction.
Once reserved for sacred events, now almost half of Papua New Guineans chew betel nut.
It is common for children as young as six to chew it, and addicts admit using the drug every day from morning to night.
The chewing of betel nut, the seed of the Areca palm, is common across Asia and the Pacific.
In PNG, where it is known locally as buai, it is consumed with a mustard stick dipped in slaked lime powder.
The sale of betel nut is a lucrative business
Chewed then spat out, it creates a sense of euphoria and alertness.
At an annual cultural festival in East New Britain Province, the tell-tale signs of betel nut chewing are ubiquitous. Spittle and shells litter the ground, as men, women and older children laugh and chatter with lips stained bright red.
A clan from the Baining mountains are performing, and Philomena has travelled with them alongside her five children aged eight to 18 years. They are all chewing betel nut.
As Philomena chews her eyes widen and she begins to sweat.
"It is a stimulant, it gives you a high feeling and keeps you going when you are becoming bored." Then a jet of red spit shoots from her mouth.
Gesturing with her hands, she speaks louder, "Now I am chewing it energises me. I have been psyched up."
Betel nut's active ingredient, arecoline, acts on the same receptor proteins in the brain as nicotine. It is highly addictive and also a carcinogen.
Papua New Guinea has the highest rate of oral cancers in the world. According to the World Health Organisation, nearly one in every 500 new cases of mouth and oropharynx cancer is in PNG and it is the nation's biggest cancer killer.
Last year the inaugural No Betel Nut Day was held to educate citizens on the risks and early symptoms. This year it was postponed because of a date clash with elections - the minister of health lost his seat.
For doctors delivering devastating terminal diagnoses, it's too little, too late.
"We lack the public awareness aspect of preventive health...Betel nut is now a part of everyone's life, and it's disturbing to see parents give it to their young children," Dr Sapuri says.
"It's become a norm and so it is very difficult to fight it."