Born and raised in the northeastern province of Ubon Ratchathani, Saitarn Ponchan is more than familiar with uncooked fish salad and other raw and undercooked meat dishes. Yet she has never eaten any of them.
ILLUSTRATION: JAKKRIT UTTAYANANON
Those dishes, especially the spicy uncooked fish salad or koy pla, are her parents' favourite choices on the menu _ like several other Isan people.
"My parents still eat uncooked fish but they always make it well-cooked just for me," said the 10-year-old schoolgirl, adding her parents are worried that she may contact diseases from the traditionally-prepared Isan dishes.
Uncooked fish salad which is linked to liver cancer is a major health concern in the Northeast _ a region where eating raw fish is common.
"There are two types of liver cancer _ hepatocellular carcinoma (HCC) and cholangiocarcinoma. The HCC begins in the hepatocytes, the main type of liver cell. It is the most common form of liver cancer that is found in the world, except in Thailand, especially, in the Northeast," Dr Thiravut Khuhaprema, chairman of the National Cancer Institute Foundation, explained.
Children playing an educational game during a campaign to fight liver cancer in the Northeast.
The other type, cholangiocarcinoma, starts in the small tubes in liver called bile ducts, so it can be called as bile ducts cancer, he said, adding this cancer is mainly caused by opisthorchiasis, a parasitic disease associated with eating raw or under-cooked freshwater fish, and nitrosamines, a chemical basically compound used in food preservation.
According to the doctor, there is no treatment for this type of cancer as bile ducts cannot be taken out of the liver.
"Although it cannot be cured, it can be prevented by avoiding its two causes," said Dr Thiravut.
In the northeastern part of Thailand, nearly six million people are infected with opisthorchiasis. The figure makes Thailand the country with the highest number of cholangiocarcinoma patients in the world. There are 80 patients per 100,000 population in Thailand compared to one per 100,000 in the West.
Liver cancer ranks No.7 cause of death in Thailand with two patients dying from the disease every hour. There are 23,000 new cases each year and 87% of them are in advanced stage.
In a bid to fight against the lethal disease, youth volunteers in Si Sa Ket and Ubon Ratchathani recently launched a campaign to promote healthy eating habit, or to avoid uncooked fish, among local kindergarten kids and elementary students. The activity was part of the Liver Cancer Prevention project in partnership with the National Cancer Institute Foundation and Bayer Thai Co Ltd that was launched last year.
The project encourages local people to learn about the causes of cholangiocarcinoma and aims to enhance the quality of life of people in the Northeast where eating raw fish is a common habit.
"My grandfather died from cholangiocarcinoma at the age of 57. And now elders in my village are dying one by one," Kittiya Silawong, from the Faculty of Public Health Sciences, Chalermkarnchana College, said.
"Grandpa had eaten spicy raw fish salad since he was young. Although I told him it was not good for his health, he refused to give up. He claimed that lime juice or some red ants he put in the salad and drinking rice whisky would kill any germ in raw fish. That's not true, but he, like so many people of his generation, strongly held that false belief and ignored my warning.
"Adults usually come up with many reasons to keep eating raw fish, their favourite food. For example, 'If I am going to die because of eating under-cooked fish, I would have died many years ago' or 'It doesn't matter if I stop eating raw fish right now because I had had it since I was a kid'," said Kittiya.
"Actually, the more they eat that inappropriate food, the more they are at risk to opisthorchiasis and cholangiocarcinoma."
As for the most effective result in preventing opisthorchiasis, they should not even have a bite of raw fish. Therefore, kindergarten kids and primary school students are principal targets to be informed.
To communicate with kids, the youth volunteers of Chalermkanchana College, Si Sa Ket province, emphasised on using new communication media. They produced and presented cartoon videos, illustrations, music, game and short theatrival plays about the cancer. All these were designed to help younger children commit the message to memory, creating awareness about avoiding the risks of eating raw or under-cooked food and thus contracting liver cancer. The target group included more than 100 students from the college, elementary students from eight schools and parents of the participating children.
"Kids have to know the danger of eating uncooked fish," said Kanokwan Khan-nguen, a volunteer from the Faculty of Public Health Sciences, Chalermkarnchana College.
She said it is hoped that the children will pass on the information to their parents and relatives.
"Whenever we have a chance, we alert adults, too. Our presentations involved not only young children, but also their parents, reinforcing the call for change in attitude towards food. While admitting that it's very hard for them to change their eating habit, they promised not to allow their kids to eat like them. And that is enough for us."
Ubon Ratchathani Rajabhat University also held a similar "kids-first" educational campaign, with a role-play act, Jao Wai Rai Pla Dip or Evil Raw Fish, and games. It targets some 300 kindergarten and primary school students.
The campaign aims to make it easier for the young audience to get the message. There was also a performance of modern northeastern-style music by a mor lam sing folk band as well as fun-filled activities.
"It's maybe too late for the adults as they are hooked on the taste of raw fish, but for children, they will be our spokesmen, model, a new generation with no more high incidence of cholangiocarcinoma," said Tinnagon Samanya, a volunteer from the university's Faculty of Public Health Sciences.
The young volunteer knows well that it's a lot easier said than done. "Eating habits will not easily change. However, it's worth trying."