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Beyond the euphoria: PNG has world’s highest rate of oral cancer

Buai chewerKATHLEEN PRIOR | BBC News | Extracts

Read the full story, with its graphic images, here

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."


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Philip Kai Morre

Betel nut is one of the most addictive nuts which develop physical and psychological dependency. Craving is real and the chewer becomes a slave and dependant on it. Betel nut also creates more rubbish and our towns are polluted.

Betel nut is conquering the highlands provinces and travels to the remotest areas. It is an economic means for the informal sector and solves cash flow problems. But while it has positive benefit, health risk is a bigger problem.

Don Albertson

I don't think chewing buai is the most disgusting habit, but it certainly ranks high in the list.

My current gorge-riser is tobacco/snuff chewing in meetings where the chewer spits into a clear plastic cup. Far worse than red lips and teeth.

I wonder of buai is more carcinogenic than oral tobacco or if they're neck and neck. I remember meeting a man who had the entire left side of his lower jaw removed - that was the side he kept his chaw in.

Philip Fitzpatrick

That photograph ruined my breakfast.

Betel nut chewing has to be one of the most disgusting habits in the world.

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