Narong Khuntikeo lost both of his parents to a deadly cancer called cholangiocarcinoma. He went on to become a liver surgeon, and in the process, he found out what made his parents sick. Now he’s traveling the countryside, trying to prevent more tragedies like the one that befell his mom and dad. The culprit? A raw fish salad called koi pla, eaten frequently in the cash-strapped Thai province of Isaan (also: Isan). Koi pla is an affordable dinner made of ground raw fish, spices, and lime juice. But it also has one secret ingredient, and it’s the one that so often proves deadly: liver flukes.
What are liver flukes, you ask? Liver flukes are tiny parasitic worms that attach themselves to the walls of the liver.
When they really start thriving, they can cause terrible damage to their host organism. Eventually, liver fluke infestation can lead to liver cancer and cancer of the bile duct, which was what took Khuntikeo’s parents. Unfortunately, countless others remain at risk. The dish is so popular in Isaan, and liver flukes are so widespread, that liver cancer makes up more than 50 percent of the cancer cases discovered in that province. Everywhere else in the world, liver cancer makes up just 10 percent of all cases. Up to 20,000 Thai residents die of liver cancer every year, and Isaan has more cases of bile duct cancer than anywhere else in the world. “It’s a very big health burden around here,” Khuntikeo told The Guardian. “But nobody knows about this because [victims] die quietly, like leaves falling from a tree.”
Khuntikeo intends to spread this important message throughout Isaan and beyond.
For the past four years, he has traveled around the province testing locals for the presence of liver flukes. In some areas, a staggering 80 percent of the population was infected. The government has heard Khuntikeo’s message, and local schools have begun to teach kids about the dangers of consuming raw fish, even in a beloved dish like koi pla. The older generations aren’t absorbing this news, however. “They’ll say, ‘Oh well, there are many ways to die,'” Khuntikeo said. “But I cannot accept that answer.”
There is a simple solution.
Cooking fish kills the parasite before it can latch onto the diner’s liver. If chefs prepared a version of koi pla with cooked fish, cancer rates in Isaan might plummet with time. There’s just one problem with that suggestion: People prefer their koi pla raw. “I used to come here and just catch the fish in the pond,” Khon Kaen resident Boonliang Konghakot told The Guardian. “It’s so easy to eat raw.” Other fans of koi pla say that cooking the fish ruins the flavor. That may be, but isn’t it worth a minor sacrifice of flavor to avoid liver cancer? If Khuntikeo’s mission succeeds, people in Isaan (and around the world) will stop consuming koi pla. Until that happens, though, people still continue to make and serve the dish. If you’re ever in Thailand and someone offers you a bowl of koi pla, be ready with your excuse; this dish could be deadly in the end.