Habits that can kill

Prof. (Dr.) Dharmakanta Kumbhakar

(drkdharmakanta1@gmail.com)

The Assamese people have some local addictive habits that have several adverse effects on human health. Due to these local addictive habits, the rate of oral, hypopharynx, and respiratory tract cancer and deaths related to cancer is higher in Assam than in other parts of the country. Almost all communities in Assam have these addictive habits. If we can leave these addictive habits, then most Assamese people will be able to enjoy good health, and the rate of cancer and death related to cancer will decrease in Assam.

The habit of taking betel nuts and leaves is one such type of local addictive habit. The habit of chewing betel nuts and leaves (due to the arecholine contained in betel juice and local irritation on the mucosa), along with tobacco chewing and alcohol consumption, is closely associated with cancer of the mouth, tongue, hypopharynx, and respiratory tract. The betel nut, which is called “Tamol,” is produced in large amounts in the region. The betel leaf, which is called “Paan,” also has a large production in Assam. It is produced from a creeper, which is usually grown around the betel nut tree. Betel nut and leaf have always occupied an important place in Assamese society. It is traditionally used to show honour and respect to guests and important persons in the form of “sarai,” which contains a bunch of betel nuts (Tamol) and leaves (Paan). A traditional Assamese “Bota” containing betel nuts and leaves is a must at all Assamese feasts. A “Bota” with betel nuts and leaves is also used while inviting someone and in many other customary functions. Betel nuts and leaves also hold an important place in the agricultural economy of the region. These ancient ritualistic uses of betel nut and leaf in society have ensured that betel nut chewing habits are very common among the Assamese people. It is taken among all classes of Assamese people, irrespective of age and sex. Betel nut is consumed in Assam mainly in four forms: (1) immature betel nut, (2) mature betel nut, (4) seasoning betel nut (Bura Tamol), and (4) supari. In Assam, the form that is most preferred is seasoned betel nut, or “Bura Tamol”. This is produced by taking raw, mature betel nuts and burying them deep underground between layers of banana leaves for a period of 1 to 3 months. The “tamol” then changes in aroma and texture, and it is then consumed. It is available only during certain seasons. Mature betel nuts without seasoning are also quite commonly consumed. Immature betel nuts are consumed mostly in the district of upper Assam and among the tribal population in the hilly areas of the region near Meghalaya. “Supari” is produced from betel nuts by boiling the natural nut and then allowing it to dry for about 1 month. It is then shredded and taken along with or with betel leaf. This form is not popular in the state and is mostly sold outside of the northern states of India. In Assam, the betel nut is also consumed raw, unlike in other parts of India, where it is consumed in the form of “supari.” Mature but soft leaves of the plant are consumed along with betel nuts.

The commonest way of taking betel nut and leaf in Assam is to take about one quarter or one half of a betel nut and one leaf together and then to masticate this within the mouth for about 5 minutes. The juice is usually swallowed along with the masticated parts of the mixture until the whole of the mixture is consumed. Many people also use additives along with the betel nut and leaf. Most commonly used is lime, which is used in the form of slaked lime, produced by soaking lime with water overnight. A small amount of slaked lime is then added to the mixture. Another additive commonly used is tobacco. Traditionally, a form of tobacco called “dhopat” was used in the mixture, but nowadays, commercially available chewing tobacco is mainly used. A pinch of tobacco is added to the betel nut and leaf and then consumed. The betel nut and leaf are also taken in the form of “Mitha Paan,” in which a special type of betel leaf is used along with the betel nut and a variety of sweetening agents and spices such as cardamom and coconut. Another form is “Jarda Paan,” in which the betel nut and leaf are mixed with “Jarda” (a commercially available mixture of tobacco with various aromatic agents) and other aromatic agents. Commonly used aromatic agents are “Khoya” (Kathaa), a paste-like substance made from the stem of a tree known as “Khairu,” and “Golconda, a sweet jelly-like substance made from various flowers like the rose. Chewing “Paan Masala” is another habit that is seen amongst Assamese. Paan Masala is a commercially available form of supari mixed with sweetening and aromatic agents such as saccharine.

Smoking tobacco is an age-old custom in Assam. It is widely prevalent among Assamese. Previously, the tobacco was taken in a special implement called a “Hooka” in which the tobacco smoke was allowed to pass through a container of water, or in a clay pipe called a “Silim”. However, nowadays, tobacco is mostly smoked in the form of beedis or cigarettes, which are commercially available in packets. Smoking tobacco dramatically increases the risk of developing many diseases. It is responsible for a substantial majority of lung cancer and chronic obstructive pulmonary diseases, and most smokers die either from these respiratory diseases or from ischemic heart disease. Smoking also causes cancer of the upper respiratory and gastrointestinal tracts, pancreas, urinary bladder, and kidney, and increases the risk of peripheral vascular disease, stroke, and peptic ulceration. Maternal smoking is an important cause of foetal growth retardation. Moreover, there is increasing evidence that passive (or “secondhand”) smoking has adverse effects on cardiovascular and respiratory health.

Tobacco chewing is also a widespread local addictive habit among Assamese. The tobacco that is used is commercially available tobacco, a pinch of which is taken in the palm of one hand along with a layer of lime, and the tobacco is then thoroughly mixed and ground with the lime. This mixture is then kept in the mouth between the gums and lips, or the inner aspect of the cheeks, for a period of around ten minutes. After all the juice from the mixture has been swallowed, the quid is spat out of the mouth.

Alcohol consumption is a bad local habit amongst most Assamese people. Alcohol is most commonly consumed in the form of the local brew called “Sulai,” which is made from molasses. Another local brew that is made is rice beer, which comes in several varieties. Among the more affluent classes, alcohol is consumed in the form of Indian-made foreign liquor. Alcohol consumption can cause hepatitis, jaundice, cirrhosis, hepatic carcinoma, cancers of the gastro-intestinal tract, hypertension, psychiatric illness, anaemia, thiamine deficiency, and cardiovascular diseases.