Fulbright + National Geographic Research in Taiwan


My TEDx Talk and Research in Taiwan—Going Beyond Betel Nut to Minority Health

hello again world! It’s been three months since I’ve written to you.

a film shot of the art in my lab at the national taiwan university chemistry department, 35 mm.

two months of living in Taipei—a metropolitan city—and being immersed in stacks of academic papers, health policy reviews, public datasets. two months of meetings with the Taiwanese Ministry of Health’s cancer control branch, bioethicists, anthropologists, clinicians, filmmakers, public health experts, and epidemiologists. 

attending a traditional amis tribe wedding.

then, one month of living with an Amis indigenous tribe in Dulan—a rural village—and focusing on visceral knowledge gained through traversing the mountains and seaside, ancestral knowledge, oral histories preserved through storytelling, and sensory knowledge that comes from colors, music, laughter, and dance. 

three collective months of simply absorbing everything, allowing my subconscious to process new experiences and ways of thinking. 

i am going to post informal pieces more often—attempts at consciously processing what I’ve learned thus far, what my opinions are, what questions I still have, what ideologies I need to reexamine, and what answers I need to continue searching for

but before I dive into that, the purpose of this post is to clarify why/what/how/when/where of my project in accessible terms. it’s evolved in several ways since I began my work!

why am I researching betel nut chewing in Taiwan?

a basket of betel nuts at an amis pre-wedding ceremony.

betel nut is a carcinogenic and addictive stimulant chewed by about 10% of the world. taiwan’s population has the highest daily quantity of betel nut usage and the highest incidence (number of new cases per population) of betel nut linked oral cancer in the world. in Taiwan, the two most significant groups of betel nut chewers are working class laborers, who often use betel quid as a stimulant to keep them up during long labor hours or as an agent of socialization (similar to drinking or eating together with friends), and certain indigenous tribes, who use the betel quid in a variety of cultural practices (approximately 46% of indigenous Taiwanese people chew betel quid in Taiwan overall). national betel quid policies and awareness campaigns have not made significant improvement in curbing betel nut consumption in Taiwan—for example, in indigenous Taiwanese populations, the betel nut chewing quit rate is at just 7.6%. furthermore, it turns out that even though taiwan has a national oral cancer screening program, indigenous peoples and laborers have the lowest screening rates due to a combination of lacking community awareness of betel nut’s health impacts, less resources for hospitals/clinics to conduct these screenings, cultural stigma against betel nut chewing in taiwan, and time/economic difficulties that inhibit people in lower socioeconomic statuses from being able to visit the hospital. 

overall, oral cancer caused by betel nut chewing in indigenous and rural populations carries many characteristics of other socioeconomically driven health disparities, but culture and controversy seems to play a bigger role in influencing this phenomenon than other such health disparities (like cultural foods and their link to diabetes/obesity).

anika, why are you personally interested in betel nut? and how did you even come up with the idea for this project?

actually, I have a tedx talk answering this question (note: my project methods and focus changed a bit since I gave that talk, but the reasons are still the same)!

what am I doing here in Taiwan and how am I doing it? my overall aim is to find healthier and culturally compatible strategies for lessening betel nut linked oral cancer health disparity in taiwan. because I see and understand issues through systems, I’m taking the following multidisciplinary approach that spans science, policy, visual arts, community activism, and clinical engagement.

a summary of the nine objectives I'm working to meet by the end of my time in taiwan!

generally, I’m trying to....

1. find and validate healthier/natural ways to prepare betel nut [by understanding how existing different cultural betel nut preparations/chewing methods (such as eating a dried vs fresh betel nut, changing the additives used, swallowing the juices, etc) impact how cancerous each version of betel nut is], then share this information with healthcare institutions and relevant communities

2. [long term, my master’s work] see if it’s feasible and ethical to create a completely noncancerous genetically engineered betel nut by knocking out the gene that leads to production of the cancerous compounds in betel nut

3. improve the oral cancer screening rates and community health education in rural/indigenous communities by designing culturally appropriate media campaigns, organizing free community screening/education events and working with physicians, policymakers, and health officials to see how we can improve the system from the policy side

4. tackle the controversial perceptions of betel nut chewing in taiwan (those who don’t chew it think it’s a backwards tradition, those who chew it often view it as an important cultural symbol) through documentary filmmaking of cultural practices involving betel nut, multimedia storytelling to humanize the issue, and writing a bioethics/medical humanities paper on the ethics of regulating betel nut chewing

5. use betel nut as a case study for seeing how minority health disparities operate and manifest throughout the entire system of healthcare—from the individual person to local health institutions/healthcare providers/public health officials to federal health policies—and through media, cultural stigma, and science

what's your timeline for accomplishing this?

I spent my first two months in Taipei, Taiwan working with the Taiwan Ministry of Health’s Health Promotion Administration and a lab at National Taiwan University understanding the health care system in taiwan, history of federal betel nut regulation policies and oral cancer prevention programs, current pressing health issues, creating my research survey, learning about/choosing which tribes I’ll be working with, and setting up my scientific protocol for quantifying how cancerous various existing methods of betel nut preparation throughout taiwan are. 

these next 6 months I’ll be living with three different tribes who have different cultural identities, betel nut preparation practices, and cultural uses of betel nut doing fieldwork, filming, sample collection, and community education. I’ll also be working on the clinical and local health policy side (oral cancer screening program/health awareness) with the Taitung County government/hospital and include laborers in my study. then one month with betel nut farmers in the southern pingtung county (this part is more important for investigating the feasibility of a noncancerous genetically engineering betel nut) and laborers, and finally returning to taipei/different communities to present and share my work. 

throughout the year, I’ll be making trips back to taipei to process my betel nut samples and attend federal cancer policy meetings at the Ministry of Health and Executive Yuan (taiwan’s congress). 

future posts

ok whew! finally made it through. that was a lot of typing. anyways, if anyone made it this far I hope this will help give some context for my next few posts (which will be less formal than this one, likely more short stories, stream of consciousness stuff, a periodic research update post, film photos)....

here's some upcoming posts I have planned:

  • my national geographic grant (what it supports) and the link between preservation of indigenous language and government funding/environmental/political rights

  • reflecting on recent crispr gene editing controversies, monsanto/agribusiness/neoliberal control of genetically modified crops, and how we can re-envision the future of genetic engineering as a tool for addressing health/environmental issues in developing countries or disadvantaged populations

  • film photos/prose on a mystical experience I had on an uninhabited island with my amis friend

  • western vs non western knowledge, generational storytelling/oral history as resistance, the ethics of public health intervention, and conceptions of health in indigenous/rural communities

  • environmental justice on indigenous land in taiwan—nuclear waste on orchid island and luxury resorts built along the taitung coast

  • an audio recording of an interview with a paiwan elder about betel nut as a symbol of protection for paiwan women

  • sharing some preliminary scientific data and research on producing a genetically engineering noncancerous betel nut

thanks for reading! feel free to comment below (things you're interested in reading about in my next posts, questions, comments, anything) and i’ll get back to you :)

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Field notes and documentation from my Fulbright year in Taiwan.

This is not an official Department of State website or blog, and the views and information presented are my own and do not represent the Fulbright Program of the U.S. Department of State.