THE Commonwealth Healthcare Corporation led a two-day Tobacco-Free Recovery Leadership Academy workshop at the Crowne Plaza on Thursday. The goal is to help CHCC develop a plan to “address harmful betel nut and tobacco use among people with behavioral health conditions.”
The participants included officials and staff of CHCC, the Department of Fire and Emergency Medical Services, the Public School System, the Commonwealth Cancer Association, among other agencies and groups.
They were asked to work in small groups and identify ways CHCC could develop and implement an action plan that “reduces tobacco-related health disparities.”
Part of the discussion focused on ways the community could “preserve the traditional use of betel nut chewing” while also reducing its harmful effects on the community.
Local culture
The keynote speaker, Dr. Michael Bevacqua, curator of the Guam Museum, provided the cultural and historical contexts that betel nut or pugua and tobacco occupy in the Mariana Islands.
He said pugua use has been part of the Chamorro culture “since the very beginning.”
“As part of our history in this region almost 4,000 years ago, [ancient Chamorros] bring a number of things from Southeast Asia. They bring plants and crops,” Bevacqua said. “They bring pugua, they bring betel nut. This is something that connects the Chamorros to the Austronesian language and cultural world.”
Bevacqua said pugua is “a crop that makes things possible” — it has social benefits and builds connections between chewers.
“Even as the Spanish [and] the earliest observers noted, when the Chamorro people meet there is pugua. When the Chamorro people pass each other, even in the villages there is pugua. When the Chamorro people enter somebody’s home there is pugua.”
“Pugua is one of those ways that even as the Chamorro people change they still maintain this connection to their ancestral passages,” he said. He said it has been a “social lubricant” across historical periods.
He mentioned weddings as an example of social continuity between the ancient and Hispanicized Chamorros. There were offerings of betel nut at those events, he added.
“Across centuries Chamorro wedding practices changed, but they also remained similar. At the center of it was pugua. When the families came together pugua was shared. When the families were negotiating pugua was shared. Pugua was always there when the families came together.”
He said even when the Spanish established colonial control of these islands, and implemented sweeping changes in diet, clothing, and religion, pugua’s use for social interaction remained important.
As for tobacco, it was a crop introduced by the Spanish, Bevacqua said. People in the Marianas would grow their own tobacco, then process them into cigars. He said during the Spanish era of Marianas history, pugua and tobacco were “both important to the Chamorro people, but they were largely separated. They would smoke cigars, have their own gardens, they might mix some together, but they [tobacco and pugua] also were largely separate vices.”
In the 20th century, Bevacqua said a “huge shift” occurred in the way people in the Marianas used tobacco because of the availability of cigarettes.
“It is a completely different story and has a completely different impact on the 20th century when you go from growing your own tobacco in your home, your grandmother smoking and making her own cigars, to the tobacco being freely available in stores, and millions of cigarettes coming into the Marianas,” he said.
Still cancerous
For her part, Dr. Yvette Paulino, a professor at the University of Guam, said despite the historical and cultural importance of betel nut chewing, it is — even without tobacco — cancerous.
According to data she provided, 78% of oral cancer cases in Oceania are attributed to smokeless tobacco and betel nut.
Her own study, published in 2014, found that in the Marianas there are two general betel nut chewing patterns.
The first one is associated with Guam, where pugua chewers chew mature, red betel nut, add pupulu, or pepper leaf, and swallow the betel quid. They separately also smoke cigarettes, Paulino said.
On Saipan, generally, pugua chewers in her study chewed young pugua and added pupulu, tobacco, and afuk, or slaked lime.
Paulino said 43% of participants in her study who chewed young pugua with its paraphernalia — including tobacco — screened positive for oral precancer signs.
Symptoms
April is Oral Cancer Awareness Month.
The symptoms of oral cancer include white or red sores or patches that do not heal on the gums, tongue, or lining of the mouth; sores on the lips or mouth that bleed easily and do not heal within two weeks; unusual bleeding, numbness, pain, or tenderness in the mouth; difficulty chewing or swallowing, speaking, or moving your jaw or tongue; difficulty opening your mouth.