This dish could be behind a serious public health issue, causing up to 20,000 deaths each year.
Health experts, especially Dr. Narong Khuntikeo, a liver surgeon whose parents both died from liver cancer related to this dish, are urgently addressing the situation.
As reported by the Guardian, Dr. Khuntikeo is on a mission to inform people about the health dangers of koi pla, a traditional dish that carries significant risks.
His effort aims to alert villagers about the danger of bile duct cancer, or cholangiocarcinoma, which can result from parasites found in this dish.
The dish consists of raw fish chopped up with spices, herbs, and lime and is a popular choice in Isaan, which is one of the poorest areas in Thailand.
While this meal is cherished and widely eaten, the raw fish frequently contains parasitic flatworms called liver flukes.
These parasites, found in freshwater fish from the Mekong region, are directly associated with cholangiocarcinoma.
Survival rates for those diagnosed with this cancer are quite low unless they receive surgery, and the frequent consumption of this dish has made Isaan one of the areas with the highest bile duct cancer rates globally.
Dr. Khuntikeo's efforts have highlighted a health danger that has been largely ignored.
He works alongside a team of scientists, doctors, and anthropologists who have spent years visiting isolated villages in Isaan equipped with ultrasound machines and urine testing kits.
Their testing has uncovered a shocking level of parasite exposure: in some villages, up to 80% of residents have consumed liver flukes.
"It's a very big health burden around here," Dr. Khuntikeo shared with Agence France-Presse, emphasizing the silent nature of the illness and how victims often 'die quietly, like leaves falling from a tree.'
Recent testing efforts have revealed concerning health information.
In one village screening, about one-third of the individuals who were tested showed liver issues, with some even diagnosed with early-stage cancer.
Discovering these risks was a real eye-opener for residents like Thanin Wongseeda, a 48-year-old villager from Kalasin province.
Although his tests did not indicate any signs of cancer, he acknowledged that he had been eating a dish called koi pla since he was a child.
Recognizing the growing awareness, Thanin stated that he plans to stop consuming koi pla, but this change in mindset is still not common among many.
While Dr. Khuntikeo's initiatives are making headway with some, there is still resistance.
Koi pla is a significant part of the local culture, and the tradition of eating raw fish has been passed down through generations.
Cooking the dish is a potential solution since heat can eliminate the liver flukes, but many locals reject this idea because cooking alters the taste.
"I used to come here and just catch the fish in the pond. It's so easy to eat raw," said Boonliang Konghakot, a farmer from Khon Kaen province, adding that cooking the fish makes it taste sour.
To combat this culinary tradition, local health officials have started educational programs in schools, aiming to raise awareness among younger generations about the dangers of consuming raw foods like koi pla.
Cartoon illustrations are now used to teach children about these risks, but persuading the older generation has proven to be more difficult.
Dr. Khuntikeo often recalls the common reactions from older villagers who dismiss his warnings, responding with phrases like, "Oh well, there are many ways to die."
This resigned perspective highlights the significant challenge he faces in changing cultural practices and saving lives.
The struggle against the koi pla tradition highlights the sensitive balance between maintaining cultural heritage and ensuring public health.
Dr. Khuntikeo's personal experiences drive his commitment to preventing a tragedy that has impacted families throughout Isaan.
While he recognizes the cultural importance of koi pla, he hopes that individuals will prioritize their health and that of future generations.
For now, his goal is straightforward: to convince as many people as possible to avoid a dish that, as he has witnessed, can come with a fatal price.
