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<\/figure>\n\n\n\nWiki pic. Making\u00a0Paan<\/a>\u00a0at the shop\u00a0in\u00a0India<\/a><\/p>\n\n\n\n Betel chewing, known in Myanmar as kun-ya<\/em>, is deeply woven into the social and cultural fabric of our society. For centuries it has been a symbol of hospitality, friendship, and tradition. Yet behind this cherished custom lies a serious public health problem that many of us continue to ignore.<\/p>\n\n\n\n As a doctor, I have often wondered whether our attachment to betel chewing is keeping us trapped in a “stone age” of preventable diseases.<\/p>\n\n\n\n Kun-ya has a long and colourful history in Myanmar. Until the 1960s, almost every household kept a beautifully crafted lacquerware betel box known as a kun-it<\/em>. Visitors would be welcomed with betel, cheroots, and green tea.<\/p>\n\n\n\n The ingredients of a traditional quid included betel leaf, areca nut, slaked lime, cutch, and sometimes spices such as cardamom, cloves, and aniseed. Many users also added tobacco.<\/p>\n\n\n\n A famous Burmese saying describes the ideal combination:<\/p>\n\n\n\n “Tada-U for the betel leaves, \u1010\u1036\u1010\u102c\u1038\u1026\u1038 \u1000 \u1000\u103d\u1019\u103a\u1038\u1014\u102f\u101d\u102b\u104a\u1004\u1019\u103c\u102c \u1000 \u1006\u1031\u1038\u104a (Senegalia catechu<\/strong><\/em>, previously known as\u00a0Acacia catechu<\/em>, is a deciduous, thorny tree. The tree’s seeds are a good source of\u00a0protein<\/a>.[7]<\/a><\/sup>\u00a0Kattha (catechu<\/a>), an extract of its heartwood, gives a characteristic flavor and red color to\u00a0paan<\/a>, a traditional Indian and Southeast Asian method for chewing\u00a0betel<\/a>\u00a0leaf (Piper betle<\/em>) with\u00a0areca<\/a>\u00a0nut and slaked lime paste.<\/p>\n\n\n\n Betel was not merely a recreational habit. It played an important role in religious ceremonies, novitiation processions, and social gatherings. Offering betel to monks and elders was once considered a mark of respect.<\/p>\n\n\n\n Even today, the red stains on pavements, walls, and roads throughout Myanmar remain visible reminders of this enduring tradition.<\/p>\n\n\n\n Unfortunately, culture does not grant immunity from science.<\/p>\n\n\n\n Modern medical research has firmly established that areca nut is a carcinogen. When combined with slaked lime and tobacco, the risk becomes even greater.<\/p>\n\n\n\n Long-term betel chewing is associated with:<\/p>\n\n\n\n Medical textbooks often discuss the higher incidence of oral cancers among certain populations, including some Chinese communities. Viral infections such as Human Papilloma Virus (HPV) and Herpes Simplex Virus (HSV) may also act as contributing factors in some cases.<\/p>\n\n\n\n However, in my own medical practice, I have personally seen numerous Myanmar Buddhists, Muslims, and Hindus suffering from cancers of the tongue and oral cavity directly linked to years of betel chewing.<\/p>\n\n\n\n Many of these patients were not smokers or drinkers. Their common risk factor was the habitual chewing of betel.<\/p>\n\n\n\n Anyone with a long history of betel chewing should undergo regular dental and oral examinations. Early detection remains one of the most effective weapons against oral cancer.<\/p>\n\n\n\n My sister, Rita Aung Minn, once recalled our late grandma’s extraordinary attachment to betel:<\/p>\n\n\n\n Even after losing all her teeth, my late grandmother refused to abandon betel chewing. She carried a small brass mortar and pestle wherever she went, pounding the areca nut into chewable fragments. Dentures were made for her, but she rarely wore them. She suffered from chronic wheezing and advancing age, yet the habit remained stronger than discomfort. Looking back, I realise that this was not merely tradition\u2014it was addiction wrapped in culture.<\/p>\n\n\n\n The story is humorous, but it also reflects the powerful addiction associated with betel chewing.<\/p>\n\n\n\n One day I asked a fellow doctor:<\/p>\n\n\n\n “Why are so many people coming to the hospital?”<\/p>\n\n\n\n His answer was simple:<\/p>\n\n\n\n “Kidney stones.”<\/p>\n\n\n\n Although kidney stones have multiple causes, several factors common in Myanmar and other tropical countries contribute to their formation.<\/p>\n\n\n\n These include:<\/p>\n\n\n\n Many people simply do not drink enough water to replace what they lose through perspiration.<\/p>\n\n\n\n The result is a growing burden of urinary stone disease.<\/p>\n\n\n\n Years ago, the Head of Urology at Hospital Kuala Lumpur remarked that urinary stones accounted for a major proportion of their workload. While developed countries have seen reductions in both the number and size of stones due to better prevention, the problem remains stubbornly common in Malaysia and throughout the region.<\/p>\n\n\n\n During my years treating migrants and refugees, I encountered many memorable cases.<\/p>\n\n\n\n One patient came to me with severe ureteric colic. After urine testing and treatment with antibiotics, painkillers, and supportive medication, he disappeared from follow-up.<\/p>\n\n\n\n A year later he returned for an unrelated complaint and happily informed me that my treatment had cured him. He proudly reported passing ten stones.<\/p>\n\n\n\n I corrected him.<\/p>\n\n\n\n “It was not my treatment alone,” I said. “You were fortunate. Many others are not so lucky.”<\/p>\n\n\n\n Another case occurred shortly after the Rohingya genocide.<\/p>\n\n\n\n A Rakhine Buddhist undocumented migrant arrived unable to pass urine for five days. A stone had become trapped beneath severe phimosis. His bladder was distended up to the level of the umbilicus.<\/p>\n\n\n\n After performing a dorsal slit procedure, a torrent of retained urine erupted into the room, soaking everything in its path, including myself. Despite repeated cleaning and disinfecting, the smell lingered for the entire day.<\/p>\n\n\n\n I also remember successfully removing a large stone impacted at the urethral opening of the penis using instruments originally designed for removing foreign bodies from the external ear.<\/p>\n\n\n\n The patient had carried the stone for nearly a month. He had visited several clinics but refused to attend a government hospital because he feared the consequences of being an undocumented refugee.<\/p>\n\n\n\n Even after local anaesthesia, the stone repeatedly fractured as I attempted extraction. Eventually, with a small incision under local anaesthetic, it was removed successfully.<\/p>\n\n\n\n On another occasion, however, even a surgical incision failed to free the stone, and I had no choice but to refer the patient to Hospital Kuala Lumpur.<\/p>\n\n\n\n Such cases remind us that urinary stones are not merely statistics. They cause real suffering, especially among vulnerable migrant populations who often delay treatment until complications arise.<\/p>\n\n\n\n Cultural traditions deserve respect.<\/p>\n\n\n\n Kun-ya is undeniably part of Myanmar’s heritage and identity.<\/p>\n\n\n\n But respecting tradition should not prevent us from acknowledging scientific reality.<\/p>\n\n\n\n When a custom contributes to oral cancer, tooth loss, addiction, and possibly other health problems, we must be willing to discuss it honestly.<\/p>\n\n\n\n Our ancestors inherited betel chewing from previous generations. We are not obliged to pass its harmful consequences to the next generation.<\/p>\n\n\n\n The future of Myanmar depends not only on preserving our culture but also on learning which traditions should be celebrated, which should be modified, and which should be left behind.<\/p>\n\n\n\n Perhaps true progress begins when we have the courage to distinguish between the two.<\/p>\n\n\n\n Four pictures below are taken in my house by Dr. Shyhid, my SIL.<\/p>\n\n\nAn Ancient Tradition<\/h2>\n\n\n\n
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Ngamyagyi for the tobacco,
Taungoo for the areca nuts,
Sagaing for the lime,
Pyay for the cutch.”<\/p>\n<\/blockquote>\n\n\n\n
\u1000\u103d\u1019\u103a\u1038\u101e\u102e\u1038\u1010\u1031\u102c\u1004\u103a\u1004\u1030\u101b\u101a\u103a \u1014\u103e\u1004\u103a\u1037\u104a\u1000\u102d\u102f\u1004\u103a\u1038\u1011\u102f\u1036\u1038\u1016\u103c\u1030
\u1015\u103c\u100a\u103a\u101b\u103e\u102c\u1038\u104a \u101e\u102c\u101d\u102b\u1038\u101c\u102d\u102f\u1037\u1011\u103d\u1031\u1038\u104b<\/p>\n\n\n\nThe Hidden Health Risks<\/h2>\n\n\n\n
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My Sister’s Memory<\/h2>\n\n\n\n
Betel and Kidney Stones<\/h2>\n\n\n\n
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Lessons from Clinical Practice<\/h2>\n\n\n\n
Respect Tradition, Embrace Science<\/h2>\n\n\n\n
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