A while back I recall sitting in a clinic waiting for my friend to be sewn up after a climbing accident. We were in an aboriginal district and the population in the area is about 90% aboriginal. While I waited, I listened to a group of doctors sent by the government from Taipei and Taitung promote health and hygene. The thrust of the campaign was to teach the aborigines about the dangers of smoking and chewing betel nut. The doctors spent a lot of time and energy trying to convince the tribe members to stop chewing betel for better oral hygene and to help reduce the number of oral cancers among aborigines.
One way to look at this is a government effort to better the lives of aboriginal peoples through health education and supply them with the information they need to make an informed choice regarding their health and well being. Aboriginal districts do not have the same access to health information and resources other districts have and the price of poor health can be severe in poorer areas.
Another way to look at this campaign is as a paternalistic effort by outsiders to push their own cultural mores on others without regard for the cultural impact of their work.
The second idea seems over sensitive at first glance, but consider the significance betel nut plays in Taiwanâs austronesian culture and Taiwanese culture as a whole.
Betelnut has been used by austronesian people for thousands of years for pain relief, hunger suppresion, religious rites and recreation. Betelnut is still an extremely important part of Taiwanâs aboriginal culture for its use in forming bonds of friendship and making offerings to the ancestors. Betel was a symbol of peace between people and was usually carried by people to welcome strangers.
Betelnut use is one of the most prevalant austronesian influences in modern Taiwanese culture and is still used as a peace offering between friends and strangers, like a handshake.
Is the campaign to irradicate betel nut use also a campaign to inadvertantly eradicate an important cultural ritual of austronesian Taiwan? Should outsiders be the ones to carry out the campaign or should it be directed by the communities to balance health care with a sense of cultural and social responsibility?
Funny topicâŚI know, but mull it around for a while.
Maybe I have been chewing too much betel?
While I mull your question, consider this - tobacco had the same function as betel nuts to native americans. So should world governments be trying to stamp out it use. Yes, I know it as evolved into something else but then so has betel nut use, or hasnât it?
Whatâs the dilemma here? Doctors are saving lives by warning people that long-term use of betelnut can lead to oral cancer. Betelnut chewers have a substantially increased risk of developing this horribly disfiguring and often fatal disease. Those odds increase up to 20-fold when other factors like smoking and alcohol use are considered.
It would be a problem if the government was doing nothing to reduce rates of oral cancer among aboriginals.
Are you sure? I thought it was introduced. In one book I was reading the author said she was unable to find a reference to it before the 1771 century. Maybe I misinterpreted and she meant âin that particular localeâ or something.
Anyway, Iâm with the other posters. The health issue is more important. Actually, Iâm curious about the social and health effects of nut aside from the oral cancer. Does it affect daily functioning at all. Most of the adult males where I live are not fulltime employed and they all chew all day. I donât suppose that the latter is a cause of the former, but I am a little curious how a big binlang habit affects daily life etc.
I would say modern medicine is unware of many things like culture. It has been for at least hunderds of years, at least since a modernization of knowledge after the enlightenment. We lost much as science began specialization and disiplines were invented. Weâre only now beginning our long march as science becomes multi-disciplinary.
The damage to one chewerâs mouth can cost up to a million NT$ to fix. Itâs unfair to ask the health insurance system to pay for a problem knowingly caused by the âvictimâ. How can educating people be incorrect? Cigarettes are also a kind of currency in Taiwanese culture, should the health ministry just keep quiet about lung cancer out of cultural concerns? Take the warnings off the packs? All of the chewers I know personally are well aware of the risk, but it doesnât stop them chewing. Only the loss of all their teeth will stop them chewing. Should the rest of us subsidize their behaviour?
OTOH, the red mouth has to be less attractive to the opposite sex. Hopefully this would inhibit population growth among the chewing classes.
Any mixing or commonization of cultures will destroy something. And Iâm speaking of other rituals and practices besides Betel nut. Itâs too bad in time there probably wonât be much left of the Aboriginals.
These are difficult questions which do not have a âbestâ solution, particularly by reducing issues to pecuniary concerns.
Interesting topic though⌠Although something may be bad for health, it plays a strong cultural role. What happens if betel chewing is exterminated. I guess the thrust of this thread is the similarity between a modern campaign to eradicate an âunhealthyâ custom and similar cases in the past where customs were deemed by an outsider to be âbadâ and thus the culture was altered by outsiders. I see a parallel with the various campaigns waged by the Japanese to eliminate cultural beliefs to âtame the savagesâ. Practices such as headhunting, house burials, tattooing, eye teeth extraction etc were all eliminated in the name of assimilating people who were deemed by another people as âsavageâ.
During the early part of the 20th century the Japanese demanded many of the traditions of the Seediq and Truku halted under threat of punitive military action. For the Seediq and Truku, when a person died they were to be buried beneath his/her dwelling. The personâs Utux (spirit) would reach the Rainbow Bridge and hold up his/her hand to the Utux on the other side. The manâs hand would be stained red from the blood of heads taken and the womanâs would be stained from the dye sewn into cloth, both attributes marking a member of the tribe who had fulfilled the responsibilities of the society and thus allowed to pass. When the Japanese disrupted the practices of burial and headhunting, the Seediq and Truku worried what would happen at death and if they would be allowed to cross the bridge.
This is an extreme example of how the cultural mores of one people may impinge on the cultural mores of another. Maybe the change should not be pushed by the government, but instead by the tribes. The Bunun in the 1920âs replaced human heads with animals and woven balls.
Most surgery for oral cancer in Taiwan doesnât cure the patient anyway - itâs mostly palliative surgery. In other words, the cancer was caught at a late stage and surgery was recommended, not as a cure (itâs too late), but to extend life for a few months, a year at best.
More education is needed to tell people to seek treatment early on if they have symptoms. My student is the head of ENT at the largest hospital here in Taichung. He says that people try all sorts of herbal remedies before theyâll even consider trying âWesternâ medicine, but by that time the cancer is so far developed itâs too late to do anything except perform palliative surgery to extend life.
How can this be unfair? Are we only to be covered by health insurance for accidents? What about soaring rate of obesity in Taiwan?
Are there any published facts concerning betel nut use? Spack mentioned combining betel nut use with smoking and alcohol the incident of cancer goes up 20 timesâŚwhere did this figure come from? How many people die from betel nut use yearly in Taiwan?
Vannyel - there are plenty of data on this topic but unfortunately I donât have time to dig them up. I got the 20-fold stat from a professor of public health whose papers I used to edit.
The professor I just mentioned has a colleague who did a PhD at London University. His thesis was basically about betelnuts in Taiwan. I borrowed it for a day and made some notes because it made such interesting reading. Unfortunately I didnât make a note of the relevant references so youâll just have to trust me or do your own research.
These are some of the notes I made.
[quote]
You are 28 times more likely to develop oral cancer if you
Spack: I didnât say anything about cancer. The lime paste they put in, and whatever else is in the red paste, eats away teeth, the lining of the mouth, the gums⌠Let that go on for long enough and cancer or no cancer itâs a lot of damage to repair.
Vannyel: Letâs try this example. We both live in a country with a national health insurance scheme to which you must contribute. My recreational drug of choice is cocaine (which damages body tissue). I use cocaine knowing full well it will destroy first the lining of my nostrils, and then the cartilage and so on and so on. When that happens I present myself to the local hospital and ask them to do an expensive rebuild on my nose because Iâm having a hard time without it⌠Rinse and repeat. Are you okay with that coming out of your contributions?
As with many habits (like cigarettes, alcohol, and online porno), the amount of âviceâ consumed is important in determining its impact on health and welfare. Obviously, modern chewers have access to a vast supply of nuts produced by a politically powerful farming lobby determined to further its business interests despite health warnings, and have the time and money to consume in large quantities.
On the other hand, the traditional aboriginal betel nut culture grew around a hunter-gatherer lifestyle where a fella was constantly on the go looking for food (and sometimes heads), leaving little time to chew outside of ritual functions. I guess Iâm curious about the amount of betel nut the average aborigine chewed âback in the dayâ before its modern reinvention among the local Han culture as a mass-produced âTaiwanese bubble-gum.â Was betel nut use as harmful to aborigines (and their immediate sinicized descendants in Taiwan) as it is to modern Taiwanese recreational users?
Iâm not expecting detailed Dutch records of oral cancer rates among the Ping-pu aborigines in the southwest core area or anything, but something that would illustrate different usage habits between mountain-dwelling aborigines pre-WW II and the gob-spitting mass-consumers of today. If such data exists at all, perhaps it could lead to a consensus as to what is considered âharmful consumptionâ and what can be considered âtraditional consuptionâ (again, assuming thereâs any difference at all).
Of course, this again leads to the question of whether one culture should have the right to regulate anotherâs traditions⌠:s
The cultural anthropologist Levi-Strauss wrote 4 volumes about myth. He also studied many tribal cultures. Maybe thereâs something in there about rituals of other aboriginals.
a large part of this thread is related to the monetary costs of betel nut, but whoâs cultural value is that? are we inserting our own cultural values into otherâs lives while evaluating this topic?
Maowang, this is Taiwan where money is everything. If you want to talk about cultural values then let us remind ourselves that Chinese people see âmaking a fortuneâ and being rich as a virtue. Itâs all about making a buck. What motivates farmers to plant betelnut trees in the first place? You guessed it - big, juicy profits.
So, money is not just an important consideration, itâs the very root of the problem.
[quote=âhsiadogahâ]Spack: I didnât say anything about cancer. The lime paste they put in, and whatever else is in the red paste, eats away teeth, the lining of the mouth, the gums⌠Let that go on for long enough and cancer or no cancer itâs a lot of damage to repair.
Vannyel: Letâs try this example. We both live in a country with a national health insurance scheme to which you must contribute. My recreational drug of choice is cocaine (which damages body tissue). I use cocaine knowing full well it will destroy first the lining of my nostrils, and then the cartilage and so on and so on. When that happens I present myself to the local hospital and ask them to do an expensive rebuild on my nose because Iâm having a hard time without it⌠Rinse and repeat. Are you okay with that coming out of your contributions?[/quote]
Doesnât this happen already in every country that has a national health insurance schemeâŚwhether itâs alcohol, smoking, or OBESITYâŚmy contribution pays to treat your over-indulgence or dependency.
