Up to 75 per cent of oral cancer patients in hospitals disclose that they used betel nuts, paan or gutka.
When the Mughal emperor Akbar’s regular paan maker fell sick Akbar asked the son to prepare paan (betel leaf) for him. The young man put too much chuna (slaked lime) on Akbar’s paan which ‘burnt’ the royal tongue. Furious, Akbar decreed the son must drink a seer of raw lime in punishment. Scared, since he knew chuna’s potential for causing wounds, the young man consulted the wise man Birbal who made him drink a seer of ghee before consuming the lime to offset its harmful effect. The young man did become ill after eating the large quantity of ghee, but he lived to tell the tale.
Paan, is eaten with slaked lime, and katha (catechu, which like the ghee serves to offset the effect of lime), crushed chalia (also known as areca or betel nut), cardamom, and very often tobacco, making the preparation known as betel quid. If a sweet paan is preferred coconut, aniseed and sweet syrup are also added. In India and Pakistan paan is customarily offered at auspicious occasions such as diwali and weddings. It is considered to be a fine way to round off a good meal, and is a successful item of commerce. A childhood memory of paan consists of a shop somewhere in ‘Pindi that sold ‘gudda guddi’ (a paan for children with lots of sweet red syrup), ‘aye bhi woh, gaye bhi woh’ (a soft kapuri paan that melted immediately when placed in the mouth), and ‘falak ki sair’ a paan laden with tobacco as the name suggests that probably made the one who ate it very dizzy.
Paan (betel leaf) goes back a long way across the region. In his writings two hundred years before Akbar, Ibn e Batuta mentioned that paan and chalia were served with barley water after meals at the Mongol court. In the Far East paan has been used for more than four thousand years, and is still an integral part of the food culture of Nepal, the Philipines, Taiwan, Myanmar, Cambodia, Laos, Thailand, Vietnam, Sri Lanka, and Bangladesh. It is eaten not by itself but prepared with katha (katechu), chuna (lime), chalia (areca or betel nut) and tobacco.
Combining all these harmful things, chalia, katha, tobacco and chuna along with sweet or savoury fillings is also ‘gutka’, a highly addictive stimulant also popular in the region. Gutka is ‘stored’ in the cheek and consumed gradually over time.
There are other lesser known ways of eating paan. It makes a refreshing drink by blending the bitter sweet leaves with gulkhand (rose petal preserve) or Rooh Afza as a sweetener, and tukh malanga (chia or basil) seeds. It makes chaat with crisp fried paan, with the chaat ingredients served on the leaves. It can be made into a shake with milk or cream, or ice cream, or into kulfi with full cream milk, sugar, cardamom, pistachios and rose water. It is a pity that these other ways of eating paan are not popular because the prepared paan is implicated in the thousands of cases of oral cancer every year amongst habitual eaters.
Up to 75 per cent of oral cancer patients in hospitals disclose that they used betel nuts, paan or gutka. Prolonged contact of chuna with oral mucosa causes tiny ‘cuts’ on the tongue and cheek when the paan is ‘stored’ in the cheek. The cuts fester and allow harmful chemicals to penetrate the lining of the mouth, causing cancer over time. Katha is similarly harmful. Taiwan, where the practice of chewing paan with fresh betel nuts is very common has one of the highest rates of oral cancer in the world. As for the tobacco, it is dangerous whether inhaled in cigarettes or chewed with paan, because it increases the risk of oral (mouth) and oesophageal (food pipe) cancer. According to a BBC report, chalia is right up there with nicotine, alcohol and caffeine as an addictive substance, and is ‘one of the most popular mind-altering substances in the world.’
Paan is a seasoned traveller. As is so commonly seen in Pakistan, the sidewalks of Chicago, the cobbled streets of Europe and the souks of the Middle East have all been splattered by paan and gutka spittle. As a result in Dubai in 2012 a week long campaign was conducted in several languages, targeting the various paan chewing groups among the population. The import of betel leaf is banned in Dubai and there is a fine of Dh500 for chewing and spitting it in a public place. In England, several local councils have launched education campaigns to combat the habit, and they impose fines on anyone caught spitting paan in a public space. One local authority disclosed that ‘even special teams equipped with high powered water jets are unable to remove the stains from the pavements’, and that it costs them over £20,000 a year to clean the mess.
In September 2013 two young men became the first to be successfully prosecuted by a council in England“http://www.walthamforest.gov.uk/pages/news/council-wins-landmark-case-for-spitting.aspx” for spitting in public, when a Thames magistrates court endorsed Waltham Forest council’s view that spitting was a sub-genre of litter.
The Guardian quotes Ross Goomber, professor of sociology at Plymouth University, who conducted an international spitting survey and spent the summer travelling in Mumbai, Kuala Lumpur, Jakarta, Tokyo, Seoul and Shanghai. Prof Goomber compared the spitting habits of different nations and found it to be a many-faceted thing. He said that “the three most significant spitting nations are India, South Korea and China”. For those interested in the subject, the spitting in Mumbai was mainly connected to the chewing of betel nut, in South Korea it was closely linked to smoking, and in China to an outright distaste for swallowing.
In Europe and Singapore where the penalty for littering is heavy in any case the mind boggles at the penalty red spittle would invoke.
There appears to be a link between smoking and the paan habit. According to a study, 34% of betel chewers smoke, while 3% of non-smokers chew. Many countries have their own anti betel nut and leaf campaigns. Yet there are few public awareness campaigns in Pakistan to point out the danger associated with paan. As with cigarettes it is a common sight to see people in Pakistan with paan tucked into the cheek, their lips, teeth and tongue stained red with betel juice. It is an ugly sight, but a culturally accepted one. And that is what makes it so hard to dislodge.