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Untangling the Complexity of Liver Fluke Infection and Cholangiocarcinoma in NE Thailand Through Transdisciplinary Learning

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Abstract

This study demonstrates how a transdisciplinary learning approach provided new insights for explaining persistent Opisthorchis viverrini infection in northern Thailand, as well as elucidating problems of focusing solely on the parasite as a means of addressing high prevalence of cholangiocarcinoma. Researchers from diverse backgrounds collaborated to design an investigative homestay program for 72 Singaporean and Thai university students in five northeast Thai villages. The students explored how liver fluke infection and potential cholangiocarcinoma development are influenced by local landscape dynamics, aquatic ecology, livelihoods, food culture and health education. Qualitative fieldwork was guided daily by the researchers in a collaborative, co-learning process that led to viewing this health issue as a complex system, influenced by interlinked multidimensional factors. Our transdisciplinary experience has led us to believe that an incomplete understanding of these linkages may reduce the efficacy of interventions. Further, viewing liver fluke infection and cholangiocarcinoma as the same issue is inadvisable. Although O. viverrini infection is an established risk factor for the development of cholangiocarcinoma, multiple factors are known to influence the likelihood of acquiring either. Understanding the importance of the current livelihood transition, landscape modification and the resulting mismatch between local cultures and new socio-ecological settings on cholangiocarcinoma initiation and liver fluke transmission is of critical importance as it may help readjust our view of the respective role of O. viverrini and other socioeconomic risk factors in cholangiocarcinoma etiology and refine intervention strategies. As demonstrated in this study, transdisciplinary approaches have the potential to yield more nuanced perspectives to complex diseases than research that focuses on specific aspects of their epidemiology. They may therefore be valuable when designing effective solutions to context-sensitive diseases such as liver fluke infection and cholangiocarcinoma.

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Acknowledgments

We thank Jennifer Steele for comments on a draft of the manuscript and for design assistance. We are grateful to the following student participants: Aukkarin Kamngam, Chan Jia Hui (Jolene), Chen Meiyi, Choe Tze Yi Charlene, Chua Wan Yun (Ruth), Clare Yong Peck Sie, Dathinee Niwasprakrit, Donovan Leong Jie Xiong, Eber Amanda Joy, Erlin Oktavia, Ethel Tan Yi, Gidapa Tangdologtanakun, Ho Jia Lin Eliza, Indah Nabielah Bte Zulkarnain, James Sng Wei Ming, Joyce Ching Ngai Chi, Kathleen Kwan Ruiyun, Kiew Jia Ying (Felicia), Kodchakorn Laosuwan, Koh Hui Min (Davina), Komin Phoomited, Kwan Ping See, Lai Chong Chao, Lee Jinjia, Lee Min Lin, Leong Mun Kidd, Lim Hong Rui (Roy), Lim Shing Yee (Kelly), Lin Jiaxin, Loh Kai Quan, Loh Min Hui (Pearlene), Loh Zhi Yang, Lok Liang Xun, Loo Wen Bin, Loong Xiu Fen (Shona), Low Woon Kiat (Nicholas), Lucille Annabelle Latiff, Mathieu Tan Hong ‘En, Muhd Herzad Bin Mohd Rahman, Nawarat Pala, Ng Di Sheng (Dickson), Nur Shafwaty Bte Sa’at, Nutsareeya Sitthisuer, Ong Miao Xiang, Paiboon Manorom, Pasagorn Saengsawang, Patnaree Kakarndee, Prakaimat Chapheng, Prowsaeng Poosinghar, Rebecholangiocarcinoma Chou Hui Xin, Sara Cai Weiling, Sasithorn Sangsawang, Shaw Khantichenchart, Shee Siew Ying, Siar Hao Ken Leonard, Sirikamon Tanoi, Soo Xuan, Sunisa Nundee, Surarat Puangjumpa, Tan Kia Hin Crystal, Tan Xiao Yi, Tay May Xuan (Sylvia), Teo Hui En (Diane), Teo Zhi Ning (Dillian), Umaporn Songdaeng, Nutchanat Somkaun, Wang Meirong Gina, Wanitcha Wannasook, Wasin Kanarat, Yap Sin Hou. We also thank Patranun Rattanawongsawat, Beatrice Ho Hui ‘En and Neo Jue Shi Jess for assistance in 2015.

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Authors and Affiliations

  1. Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore

    A. D. Ziegler, Y. T. Lee, C. J. Chuah, C. Grundy-Warr, X. Ong & T. Ismail

  2. Tropical Disease Research Laboratory, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    P. Echaubard, P. Sithithaworn & B. Sripa

  3. Global Health Asia, Faculty of Public Health, Mahidol University, Bangkok, Thailand

    P. Echaubard & B. A. Wilcox

  4. Department of Biology, Laurentian University, Sudbury, ON, Canada

    P. Echaubard

  5. Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    P. Sithithaworn & R. H. Andrews

  6. Liver Fluke and Cholangiocarcinoma Research Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    P. Sithithaworn & R. H. Andrews

  7. Department of Ecology and Parasitology, Karlsruhe Institute of Technology, Kornblumenstrasse 13, Karlsruhe, Germany

    T. N. Petney

  8. Cholangiocarcinoma Screening and Care Program (CASCAP), Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    T. N. Petney, R. H. Andrews & N. Khuntikeo

  9. Office of Prevention and Control 8, Udonthani Province, Thailand

    L. Laithevewat

  10. Department of English Language, Faculty of Humanities and Social Sciences, Khon Kaen University, Khon Kaen, Thailand

    K. Poonpon, P. Tungtang & K. Tuamsuk

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  1. A. D. Ziegler
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  2. P. Echaubard
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  3. Y. T. Lee
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  6. C. Grundy-Warr
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  7. P. Sithithaworn
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  8. T. N. Petney
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  9. L. Laithevewat
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  10. X. Ong
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  11. R. H. Andrews
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  12. T. Ismail
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  13. B. Sripa
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  14. N. Khuntikeo
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  15. K. Poonpon
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  16. P. Tungtang
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  17. K. Tuamsuk
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Correspondence to A. D. Ziegler.

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Ziegler, A.D., Echaubard, P., Lee, Y.T. et al. Untangling the Complexity of Liver Fluke Infection and Cholangiocarcinoma in NE Thailand Through Transdisciplinary Learning. EcoHealth 13, 316–327 (2016). https://doi.org/10.1007/s10393-015-1087-3

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