Liver Fluke – CCA


Wetland ecosystems (rivers, lakes marshes rice fields, coastal areas) are settings that determine human health and well-being through a number of characteristic influences, such as: a source of hydration and safe water; a source of nutrition; sites of exposure to pollution or toxicants; sites of exposure to infectious diseases; settings for mental health and psycho-social well-being; places from which people derive their livelihood; places that enrich people’s lives, enable them to cope and to help others; and sites from which medicinal products can be derived. These influences can either enhance or diminish human health depending on the ecological functioning of wetlands and their capacity to sustainably provide the products and services we derived from them. It follows then that losses of wetland components, and disrup­tions to wetland functions, will have consequences for human health along any or all of these lines (Horwitz et al., 2012). Seen in this way, problems in which the environment is considered to have been implicated in health out­comes cannot be solved by medical approaches to health alone. Rather, broader approaches are needed, drawing on a wider scientific base, including ecologi­cal and social sciences.

Opisthorchis viverrini (Ov), the Southeast Asian liver fluke, is a fish-borne complex life cycle trematode endemic in rice field ecosystems of Thailand, Lao PDR, Cambodia and southern parts of Vietnam where an under-estimate of 10 million people are reported to be at risk of Ov infection. The northeast region of Thailand is known in particular to be a hotspot of Ov transmission which despite nationwide public health prevention campaigns led by the government and private organizations, still present high infection prevalence. The persistence of high infection rates in the region, we argue, is due to 1) its cultural and ecological particularities ­­— where wet rice agrarian habitats; centuries old raw food culture and the parasite complex biology combine to create an ideal transmission arena — and 2) the biomedical-based research and control interventions ill-equipped both conceptually and methodologically to apprehend such complex social-ecological issues and provide sustainable solutions.

This project aimed to investigate elements of a broadened research frame that incorporates ‘ecologic’ perspectives and that provides alternatives to the prevailing scientific interpretations and public narrative. A more balanced and integrative research approach that combines elements of the biomedical model and ecologic models of health is suggested to overcome the limited progress toward the reduction of Liver fluke infection prevalence and CCA incidence in this region.