A doctor in Thailand has started a new campaign to try and prevent people from eating a local dish that can kill them. Spurred on by the deaths of his parents, he is trying to educate people as to the dangers of eating the much-loved delicacy that contains raw fish.
The dish is something known as koi pla, a cheap meal made by mincing raw fish with herbs, spices, and lemon juice, and is particularly popular in one of Thailand’s poorest regions, Isaan. Eaten by millions of people, the dish is also known to have a deadly side effect: It can cause those who eat it to develop fatal liver cancer.
It is not actually the fish that are the causative agent, but rather the liver flukes – parasitic flatworms – that often live inside them. These flukes are so prevalent and the dish so popular that the level of liver cancer in Isaan province is bizarrely high. In fact, it is thought that the disease accounts for more than 50 percent of cancers diagnosed in men in this region, compared to just 10 percent globally.
It was after both of Narong Khuntikeo’s parents died from the bile duct cancer known officially as cholangiocarcinoma that he went on to train as a liver surgeon. Now he is on a mission to educate people as to the danger that koi pla poses. He has been organizing a group of doctors, scientists, and researchers to take ultrasound machines and urine tests around Isaan to test villagers for the disease.
The fish used to make the dish are caught in Mekong, where the liver fluke is widespread. Since the fish is eaten raw, it means that over time locals build up a high parasite load that can then lead to the development of liver cancer. In his mission to teach people about the threat of the fluke, Narong has encountered many people who have been eating the local dish since they were young, but who have never been tested.
Many don’t know of the hazard of eating koi pla, as when people die from it, they are often older and do so quietly at home. This is why Narong is trying to reach as many locals as possible.
It has not, however, been easy to persuade people to take the tests. The dish, despite its clandestine danger, is a delicacy in the region and people have been eating it for decades. The locals, particularly the older folk, are resistant to change and feel that cooking the fish, which is the best way to kill the parasite, ruins the taste.