In Thailand, Love of Food Carries Deadly Risks

It can be a fatal attraction, medical researchers say. The raw fish that is so avidly consumed in the stilt houses that sit among rice paddies and wetlands of the country’s northern provinces contain parasites that can accumulate in the liver and lead to a deadly cancer. Known as bile duct cancer, it is relatively uncommon in most parts of the world but represents the majority of the 70 liver cancer deaths a day in Thailand, according to Dr. Banchob Sripa, the head of the tropical disease research laboratory at nearby Khon Kaen University.

“It’s the most deadly and persistent cancer in the region,” Dr. Banchob said.

For the past three decades, he has led an unsuccessful campaign against the parasite, known as a liver fluke and which is also endemic in Cambodia, Laos, Vietnam, parts of China, the Korean Peninsula and Siberia.

Dr. Peter Hotez, the president of the Sabin Vaccine Institute, a nonprofit organization in the United States that researches neglected tropical diseases, describes liver flukes as one of “the most important infectious causes of cancer that no one has ever heard of.”

Cooking the fish would eliminate the risk of infection. But the battle against liver flukes is being undermined in Thailand by a deeply ingrained love of the sour and smoky-tasting fermented dishes that generations of villagers have relished.

Some villagers just cannot break the habit, said Nutcharin Yanarangsri, a volunteer at a government health clinic in the village here who spends her days walking from house to house with a singular message: “Say no to raw fish!”

“We tell them, ‘If you really want to eat it, you’d better boil it or cook it,”’ Ms. Nutcharin said during one of her rounds through the village. “But they tell me, ‘Eating it raw is so delicious. I can’t stop. I love it!”’

Whether it is a green papaya salad with just the right mix of sweet and sour or a duck curry swimming in spices, the cuisine of Thailand is a national passion. The country’s 65 million people seem to spend their waking hours either talking about food or consuming it.

But the Thai love of food has a masochistic side. It is not uncommon for office workers to lunch on searingly hot chili-laced dishes only to rush to the bathroom a few hours later with a bad case of Bangkok belly.

The love of fermented foods, especially in northeastern Thailand, is the extreme version of this gourmand obsession — and that love is often heedless of the consequences.

One popular dish in northeast Thailand is called pla som, or sour fish, which is made by mixing raw fish, garlic, salt, steamed rice and a pinch of seasoning powder. The mixture is shaped into egg-size portions, put into plastic bags and left to sit in the tropical heat for three days. That is not nearly long enough to kill the parasites, which die only after at least six months of fermentation.

Liver flukes are present only in fresh water, but they are not found everywhere. The rate of infection in Bangkok, a five-hour drive away, is close to zero.

Transmitted through feces, the parasites thrive in rural areas without proper sanitation, and they rely on snails, fish, cats and humans as hosts. Yet villagers do not see fermented fish as a dangerous thrill.

This is not analogous to the tradition in Japan of eating fugu, the puffer fish that is potentially toxic when prepared the wrong way.

The deadly effects of eating parasite-infected raw fish accumulate over decades, in the same way that drinking large amounts of alcohol over a lifetime can damage one’s liver. (Heavy drinking increases the chance of bile duct cancer for those infected with the parasite, Dr. Banchob said.)

Somewhere between 1 percent and 5 percent of people infected with the parasites contract liver cancer.

Laos, Vietnam and Cambodia also have high rates of liver cancer, according to statistics from the United Nations. Dr. Banchob estimates that about 10 percent of the population in Laos is infected with liver flukes.

Dr. Hotez of the Sabin Institute said that the parasite is similar to other worms and ailments that get less attention because they rarely afflict wealthy urban populations. “Even though Thailand is a middle-class country, there are still pockets of intense poverty — and with that poverty come high rates of neglected tropical diseases,” Dr. Hotez said. “We’ve got the technology to make vaccines. But we don’t have the funding.”

Dr. Cherdchai Tontisirin, a surgeon in Khon Kaen who has operated on liver cancer patients, blames the Thai government for the persistence of the disease. More could be done to make sure villagers stop eating raw fish, he said.

“The government has never taken this seriously,” Dr. Cherdchai said. “This is a disease that affects only the north and the northeast, and these are regions that have been

Thailand and Cambodia Clash Again in Border Dispute

BANGKOK — Thai and Cambodian troops clashed for a third day on Sunday in the first major territorial encounter since an informal cease-fire that followed four days of fighting in February. At least 10 people were killed and thousands of residents were evacuated from border areas, according to reports from both sides.

The United Nations called on the countries to settle the conflict peacefully, with an effective and verifiable cease-fire. The exact cause of the latest clash, which began early Friday, was unclear, with the two sides accusing each other of making the first move in what was mostly a long-range artillery duel.

The fighting was reported at border areas 100 miles west of Preah Vihear, an 11th-century temple that has been the focus of armed tensions since it was listed in 2008 by the United Nations as a World Heritage site under Cambodian administration.

Both nations claim ownership of a strategic area of 1.8 square miles near Preah Vihear. Two other ancient Hindu temples in the border area are the focus of the latest eruption of fighting.

In his weekly television address, the prime minister of Thailand, Abhisit Vejjajiva, accused Cambodia of starting the fighting. “When there is firing into Thailand, we must fire back,” he said.

Mr. Abhisit added: “We must not fall into Cambodia’s trap in trying to spread a picture of conflict, or say the conflict is unsolvable through bilateral talks.”

A sticking point in efforts at negotiations is Thailand’s resistance to Cambodia’s demand for mediation by international bodies. In the past, outside judgments have favored Cambodia. In 1962, the World Court ruled that Preah Vihear, which stands on a border bluff overlooking the Cambodian countryside, belonged to Cambodia.

The disputes involve border demarcations between the two countries made by former French colonial administrators and include references to competing maps and interpretations of maps.

The conflicting claims are a rallying cry for nationalists on both sides. In Thailand, they have become a focus of the antigovernment “yellow shirt” protests in recent months.

In February, the United Nations forwarded a Cambodian request for mediation to the Association of Southeast Asian Nations in which both sides agreed to allow unarmed military observers to be posted along the border.

But the Thai military resisted that plan, and the country’s foreign minister, Kasit Piromya, said that his government was trying to secure the cooperation of the armed forces to find a peaceful settlement.

Cambodia accused Thailand over the weekend of firing artillery shells “loaded with poisonous gas” and of flying jet fighter sorties over Cambodian territory. Thailand rejected the accusations as groundless.

 

Cambodia and Thailand Extend Battle

PHNOM PENH, Cambodia (Reuters) — A second day of fighting between Thai and Cambodian troops on Saturday killed at least four soldiers, bringing the two-day death toll to 11, the worst bloodshed since the United Nations called for a cease-fire in February.

Thousands of villagers have been evacuated from the disputed border area in jungles near the Ta Moan and Ta Krabey temples, about 90 miles west of the 900-year-old Preah Vihear temple, the site of a deadly four-day standoff in February.

Lt. Gen. Thawatchai Samutsakorn of the Thai Army said one of his soldiers had been killed. A local hospital said 13 were wounded.

Suos Sothea, deputy commander of Cambodia’s artillery unit in the area, said three Cambodian soldiers had been killed and 11 wounded, bringing the two-day toll of wounded on both sides to at least 43.

The Cambodia Defense Ministry condemned “these repeated deliberate acts of aggression” and called on Thailand to cease “hostilities.” It accused Thailand of firing cluster munitions — weapons banned by many countries — as well as shells “loaded with poisonous gas.”

The Thai foreign affairs minister, Kasit Piromya, denied those accusations as “groundless.”

Sovereignty over the ancient, stone-walled Hindu temples — Preah Vihear, Ta Moan and Ta Krabey — and the jungle of the Dangrek Mountains surrounding them has been in dispute since the withdrawal of the French from Cambodia in the 1950s.

Ta Moan and Ta Krabey, perched on an escarpment about seven miles apart in terrain riddled by land mines, were built in the 12th century when the Khmer empire stretched across parts of Thailand and Vietnam before shrinking to present-day Cambodia.

Thailand says that according to a 1947 map, the two temples are in its Surin Province. Cambodia rejects that claim and says they are in its Oddar Meanchey Province. Before Friday, the two countries jointly patrolled the area largely without incident.