I only add this brief post because I know many of my readers have family in Isaan, the north east region of Thailand, and this article could be of interest to them and their Thai families. Traditions die hard here as anywhere but maybe if the eating of raw fish applies to the people we care about we can have some influence on their behaviour. Thankfully my Isaan family don’t eat raw fish but you might have a different scenario.
UPDATED 6 AUG 2017: A BBC YouTube video on this subject has now been included at the bottom of this post. My thanks to Rudy for the link.
I would firstly like to thank both Jim, a reader who sent me the original information, and MSM Lifestyle HERE for the article (although there are many other copies on the internet), which is reproduced in this post as follows:
It wasn’t until he got to medical school that Narong Khuntikeo finally discovered what caused the liver cancer that took both of his parents’ lives: their lunch. Like millions of Thais across the rural northeast, his family regularly ate koi pla — a local dish made of raw fish ground with spices and lime. The pungent meal is quick, cheap and tasty, but the fish is also a favourite feast for parasites that can cause a lethal liver cancer killing up to 20,000 Thais annually.
Most hail from northeast, a large, poor region known as Isaan (Tony added – not so poor these days – Isaan is booming) that has dined on koi pla for generations and now has the highest reported instance of the Cholangiocarcinoma (CCA) — bile duct cancer — in the world. One of the major causes of CCA is a parasitic flatworm — or fluke — which is native to the Mekong region and found in many freshwater fish. Once eaten, the worms can embed undetected in the bile ducts for years causing inflammation that can, over time, trigger the aggressive cancer, according to the World Health Organization.
“It’s a very big health burden around here… it affects families, education and socioeconomic development,” said Narong, who went on to become a liver surgeon to battle the scourge. “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, doctors and anthropologists 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 fermented fish dishes. But changing eating habits is no easy task in a region where love for Isaan’s famously chili-laden cuisine runs deep.
– Karma and convenience –
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.
“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, licking his lips as he sprinkled seasonings into a bowl of the finely-chopped fish’s pink flesh.
Since learning of the cancer link he has 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.
“They’ll say: ‘Oh well, there are many ways to die,'” lamented Narong. “But I cannot accept this answer.”
– Catch it early –
When it comes to changing eating habits, health officials are pinning their hopes on the next generation, targeting children with a new school curriculum that use cartoons to teach the risks of eating raw.
For the elderly, the target is to catch infections before it’s too late. Narong and his team have developed urine tests to detect the presence of the parasite, which has infected up to 80 percent 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 (Cholangiocarcinoma Screening and Care Program), started as research at Khon Kaen university but received full government backing last year — putting it on Thailand’s national agenda.
“I’ve never been checked before, so I think I will probably have it because I’ve been eating (koi pla) since I was little,” said 48-year-old Thanin Wongseeda, one of 500 villagers lining up for a recent screening in Kalasin province.
The group ticked off a series of high-risk factors: they were over the age of 40, had a history of eating raw fish and had family members with the cancer. A third of them showed abnormal liver symptoms and four were suspected to have cancer.
Thanin was one of the lucky ones, emerging from his ultrasound with a look of relief.
“I don’t think I will eat (koi pla) raw anymore,” he told AFP with resolve. As for his neighbours? “They will not quit it easily.”
I would like to thank Rudy, who has left a comment below, for a link to a great YouTube video on this topic below:
If only there was a Thai version.
Hi Tony,
Thanks for the heads up mate, I was staying at my partners family village in Chaiyaphum Christmas before last and my first meal there was Koi Pla. Definitely not my cup of tea, especially with red ants crawling out of it but I had to finish it for them as they were so proud to serve it to me. I will be showing this article to my partner tonight and trying to educate her family as they are lovely people and I don’t want to see this happen to them.
Also, I have just bought your e-book and can’t wait to start reading it. I plan to purchase land in Chaiyaphum next year and looking forward to building a house… I feel a lot more confident now I have your book.
Great work Tony, keep it up!
Cheers,
Graeme
I am so pleased you found that story useful. Thanks for buying the book. If you have any questions please let me know. I have a very active and useful Facebook group based on buulding in Thailand, which if you haven’t found already is here: https://www.facebook.com/groups/416779518982533 Good luck.
G’day Tony,
It’s been a while since catching up – apologies mate. Work & stuff…no excuse.
Great read as always – many thanks for sharing. It is all the more topical given the recent heavy rain in Surin prompting a surge in fish caught by locals around Yuri’s village. We discussed the way they cook the fish – fortunately they do always cook theirs albeit not so the small shrimp in Som Tum.
Heading over to Thailand in a couple of weeks. Wish we had time to visit but will only be there for six days. Will be staying in Yuri’s moo baan and BKK. And yes, we will be stocking up on Tong’s wonderful coffee.
Keep posting please Tony – it always gives Yuri and I plenty to talk about and helps us shape our plans in so many ways. And don’t forget the next book!
Cheers…Greg
PS . 12 degrees in BNE this morning – that’s 4 degrees higher than Canberra’s max. Another week of mid-20’s ahead. Winter was all of 3 days this year.
G’day Tony
A few weeks ago I found your site on the web and have been avidly reading it ever since. Having just finished reading all of your blogs, what can I say other than, it is amazing, incredible and an invaluable insight to living in Thailand from an expat’s point of view.
I am particularly impressed by how you have committed to being an inclusive part of the Thai culture, both in your immediate family and in the greater Thai community, well done mate.
My wife of 4 years is Thai and we currently live here in Perth WA, however as I am 5 years from retirement age, we are making plans to relocate to Thailand to retire.
Pao my wife is from Sakon Nakhon, not so far from your home and on our next visit to Thailand my wife and I would really like to meet you Gaun and Peng, if this request is convenient for you.
I like yourself have a deep level of respect for the Thai culture and have committed to adopt the traditional Thai way of life. Whenever I visit Thailand I live and eat as the locals do and enjoy every minute of it. I became a Buddhist 17 years ago, therefore I am empathetic with the way “you” are living in your moo baan.
Do keep up your fantastic stories of living in Thailand, I am an enthusiastic photographer too and particularly enjoy your excellent photographs, they are both high in quality and particularly creative.
Best wishes to Peng, Gaun and yourself.
Kind regards
Chris and Pao
In Perth WA
p.s. I would very much appreciate communicating with you directly on some aspects of retiring in Thailand, will you please contact me via my personal email address when you have a moment 🙂
Hello Chris and Pao.
I so enjoyed reading your comment. Thank you very much for posting such a positive review of the blog. I sometimes get a bit disheartened by the lack of feedback from the many people who visit the site but never make the effort to leave a comment on what they have read. People like yourself Chris give me the motivation to keep on writing and taking those photos.
I won’t write more here as I will contact you directly via email.
Thank you again.
Tony
Hi Tony
Yes liver cancer is rife in the North East of Thailand. My wife’s brother in law passed away from liver cancer two years ago. He was 52 years of age and lived only one month after being diagnosed. I did some research at the time and found this video put out by Khonkaen University. https://www.youtube.com/watch?v=KQy5n8G-maM
Rudy thank you so much for that video link. I will add it to the main body of the blog post. I am sorry to hear that you have been directly touched by this problem. So sad to lose someone that young. Unfortunately attending funerals for people who should have lived for many more years seems to be part of life in the village for a variety of reasons.
Many thanks for your contribution.
Tony
Hi Tony
Good news that your family doesn’t eat this dish. A geat pity that deadly connection had not been made sooner…
Are you happy to eat cooked fish in Isan/Thailand?
Cheers
Pippa
Yes. I was pleased to hear that was the case with the family.
I do eat local fish but in most cases they are the ones bought in the market (alive and shortly after dead) and well cooked by Gaun at home. In the villager’s case I am surprised anything survives their intake of chilli and lao khao, which is a deadly strong Isaan rice whisky. We also take worming medication every six months or so (sorry to get so personal) just in case.