You may think eating traditional dishes when you go abroad is custom – but you should think twice before doing so in Thailand.
Koi pla, made of raw fish ground with spices and lime, is a favourite feast for parasites responsible for deadly liver cancer, doctors warn.
The pungent meal is quick, cheap and tasty, and is popular in the rural northeast of the country – in the poor remote Isaan region.
But this area of Thailand, deemed the least-visited, has the highest reported cases of cholangiocarcinoma (CCG) bile duct cancer in the world, figures show.
One of the major causes of CCG, which kills 20,000 Thais each year, is a parasitic flatworm native to the Mekong region and found in freshwater fish.
Once eaten, the worms can embed undetected in the bile ducts for years causing inflammation that triggers the deadly disease, the World Health Organization warns.
Narong Khuntikeo, a liver surgeon trying to battle the parasitic scourge, witnessed both of his koh pla-loving parents die from CCG.
He told AFP: ‘It’s a very big health burden around here… it affects families, education and socioeconomic development.
‘But nobody knows about this because they die quietly, like leaves falling from a tree.’
After seeing hundreds of hopeless late-stage cases on the operating table, Narong is now marshalling scientists to attack the ‘silent killer’ at source.
They are fanning out across Isaan provinces to screen villagers for the liver fluke and warn them of the perils of koi pla and other risky fish dishes.
IS THERE HOPE FOR THAI PEOPLE? Narong and his team have developed urine tests to detect the presence of the parasite, which has infected up to 80 per cent of some Isaan communities. They have also spent the past four years trucking ultrasound machines around the region to examine the livers of villagers who live far from public hospitals.The initiative, called CASCAP, started as research at Khon Kaen University but received full government backing last year – putting it on Thailand’s national agenda.Some 500 villagers were recently screened in the Kalasin province as part of the testing, as they all showed high-risk factors.They were all over the age of 40, had a history of eating raw fish and had family members with the cancer, Narong said.A third of them showed abnormal liver symptoms and four were suspected to have cancer.
But changing eating habits is no easy task in a region where love for Isaan’s famously chili-laden cuisine runs deep.
Many villagers are shocked to hear that a beloved dish passed down for generations is a danger rather than a comfort.
Others are wedded to the convenience of a thrifty lunch they can whip up using fish caught in the ponds that border their rice paddies.
Since learning of the cancer link many farmers have started frying the mixture to kill off the parasite – a method doctors recommend.
Yet not everyone is as easily swayed, according to Narong and his team. Many villagers complain that cooking the dish gives it a sour taste.
Others simply shrug off the dangers and say their fate has already been fixed – a common belief in the Buddhist nation where karma can dictate decisions.
Health officials are pinning their hopes on targeting the next generation, showing children cartoons of the risks of eating raw fish.
For the elderly, who are much harder to sway into giving up old tricks, the target is to catch infections before it’s too late, they said.
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