Thai doctor fights against carcinogenic raw fish dish that killed his... https://www.theguardian.com/world/2017/jun/28/thai-doctor-fight...

Thai doctor fights against carcinogenic raw

fish dish that killed his parents
Koi pla, raw fish ground with spices and lime, is thought to kill up to 20,000 people in
Thailand every year

Freshly caught sh in the Thai province of Khon Kaen. Millions of Thais across the rural north-east regularly eat the raw sh
dish koi pla. Photograph: Lillian Suwanrumpha/AFP/Getty Images

Oliver Holmes and Agence France-Presse

Wednesday 28 June 2017 13.03BST

A doctor in Thailand whose parents died from liver cancer after eating a much-loved raw
sh dish is travelling the countrys rural north-east to warn people o the recipe.

Koi pla, a cheap plate of raw sh ground with spices and lime, is eaten by millions of
Thais, especially in one of the nations poorest provinces, Isaan.

But the meal often contains parasites that cause a type of liver cancer believed to be
killing up to 20,000 Thais per year. Isaan has the highest reported instance of
cholangiocarcinoma, or bile duct cancer, in the world.

The aggressive cancer is often caused by a parasitic atworm or liver uke native to
fresh water sh in the Mekong region.

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Its a very big health burden around here, Narong Khuntikeo, who went on to become a
liver surgeon after he lost his parents, told Agence France-Presse.

But nobody knows about this because they die quietly, like leaves falling from a tree.

Without surgery, the disease has one of the lowest survival rates of all cancers, according
to cholangiocarcinoma charities.

Narong has brought together scientists, doctors and anthropologists in his ght against
the silent killer.

His team has spent four years driving ultrasound machines and urine testing kits around
the Isaan region, testing villagers for the parasite. Up to 80% of the inhabitants of some
communities were found to have ingested the parasite. At a recent testing visited by
AFP, a third of villagers showed abnormal liver symptoms and four were suspected to
have cancer.

Ive never been checked before, so I think I will probably have it because Ive been
eating [koi pla] since I was little, said Thanin Wongseeda, a 48-year-old queueing up for
the screening in Kalasin province.

Thanins test came back negative, but he said he would stay away from the uncooked
sh salad from now on.

Narong is encouraging others to do the same but it is proving dicult, especially in a

country famed for and proud of its treasured local dishes, their recipes passed down
across generations.

Local health ocials have introduced a school curriculum of colourful cartoons that
aims to teach children about the risks of raw foods.

But older generations are harder to convince, says Narong.

Theyll say: Oh well, there are many ways to die, he said. But I cannot accept this
answer.

Doctors recommend frying the mixture of chopped sh but many villagers say cooking
the pink esh gives it a sour avour.

I used to come here and just catch the sh in the pond, said Boonliang Konghakot, a
farmer from Khon Kaen province. Its so easy to eat raw.

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Topics
Thailand
Food safety
Seafood
Cancer
Fish
Asia Pacic
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