Good News (Part 2)


When I visited Cambodia I went to Kompong Phluk, a village where all the houses are on stilts, and everyone knows how to swim. The villagers raise fish in the Tonlé Sap, which is the largest freshwater lake in southeast Asia. During the dry season, from November to May, this lake drains into the Mekong River near Phnom Penh. But during the monsoons, water flows back from the Mekong into the lake, and it grows six-fold in area! We took a boat ride down this muddy river into the Tonlé Sap and saw the fish farms.

In 2008, a Canadian student named Christopher Charles was working in rural Cambodia. He was living in a house on stilts. He had no electricity or running water, but lots time to sit around and think.

He started thinking about anemia.

Anemia is often caused by an iron deficiency. It makes you tired and weak. You have trouble thinking clearly. Almost half of Cambodia’s population suffers from this disease! In fact, over 3.5 billion people on our planet have anemia, and the World Bank estimates that it’s a $50 billion drain on the global GDP.

You can cure anemia with iron supplements—but they taste bad, and they often cause stomach pains, constipation, and even more disgusting problems.

So Charles had another idea: give villagers little blocks of iron to drop into their cooking pots. The iron gets released slowly as the water boils.

But at first, people hated them. They thought the iron blocks where ugly. They thought the iron blocks would scratch their pots. So they turned them into doorstops.

He kept trying. He needed a second idea: one that could make the first idea work.

He realized that in rural Cambodia almost everything revolves around fish. Fish from the Tonlé Sap provide Cambodians with 60% of their protein intake. People earn lots of their money fishing, they’re important in Khmer folklore. Even their currency—the riel—is named after a fish!

So, he made iron into “lucky fish” , shown here:

Now people are happy to put one into the pot when cooking.

One of those who has been using the fish is Sot Mot, a 60-year-old grandmother who lives just outside Phnom Penh. She drops the fish into boiling water as she chops up garlic, ginger and lemongrass for Khmer chicken soup. “Before, I felt tired and lazy and my chest shook when I was tired,” she says. “But after I use the fish, I have strength and energy to work and I sleep well, too.”

One of her grand-daughters seems to be improving, too. “Before, when I went to school I felt tired, and I didn’t do well at math, maybe the sixth in the class,” says 15-year-old Danai. “Now,” she says proudly, “I’m No. 1.”

Of course, this idea needs to be tested with scientific studies. And here’s one such study:

• Christopher V. Charles et al, Iron-deficiency anaemia in rural Cambodia: community trial of a novel iron supplementation technique, The European Journal of Public Health, 28 January 2010.

More studies are coming up.

No matter what the result finally is, it shows that paying attention to local culture can work wonders when trying to help people.

Large parts of this story are paraphrased from the following radio show, which is definitely worth listening to:

• Michael Sullivan, In Cambodia, ‘lucky’ iron fish in the pot could help fight anemia, Morning Edition, National Public Radio, 25 December 2015.

5 Responses to Good News (Part 2)

  1. Karl says:

    What a wonderfully good idea… I wish more people (including me) could think of easy solutions like this!

    • John Baez says:

      Actually I believe the main lesson of this story is the virtue of persistent cleverness.

      The idea of putting a lump of iron in a pot was simple and clever… but it didn’t work in practice. So then Christopher Charles needed a second clever idea—one that required a good knowledge of Cambodian culture. And if you listen to the news story on National Public Radio, you’ll see he also had some other good ideas: for example, ways to fund his organization.

      I’ve read that the key to ‘enterpreneurship’ is the ability to stay interested in a problem long enough to have all the bright ideas required to bring a dream into reality. This is very different from math, where as soon as you know how to solve a problem ‘in principle’, it’s solved.

      • Karl says:

        Yes, indeed, persistence is very much required, but also the willingness to try new ideas and look into different aspects of a problem, like culture, with an open mind. In medicine, like in other fields, I presume, one tends only to look down the well-trodden paths, in this case vitamin supplements (or generally pharmacological solutions). Oftentimes that’s also the most convenient, because there are already prepared logistics and cut-out schemes for preparing and distributing the product, thus indirectly also for making profits. Carving out an unorthodox solution is not so easy, and therefore finding the idea in the first place is only the beginning. For the rest persistence, as you say, is required.

        Thanks for the reply, btw, and many interesting posts.

        • John Baez says:

          You’re welcome! You’re right, if one looks down the well-trodden paths one will miss ways to ‘cut the Gordian knot’ and solve problems more cheaply and effectively.

  2. John Baez says:

    We’re having a good discussion on this subject over on G+, so I urge folks to go there and read it. For example, Nila Jones asked:

    What I am wondering is why all these Cambodians are anemic. They eat a lot of greens, right? Do they have gut parasites?

    That made me read a study about this question:

    • C. V. Charles, A. J. Summerlee and C. E. Dewey, Anemia in Cambodia: prevalence, etiology and research needs, Asia Pac. J. Clin. Nutr. 21 (2012) 171–181.

    Here are some excerpts:

    i) Iron deficiency anemia

    Iron deficiency anemia may result from a single, or any combination of four major factors: i) inadequate daily iron intake and/or iron bioavailability; ii) increased iron needs at various stages of life, including pregnant women, children and adolescents; iii) chronic iron loss due to menstruation, ulcers or parasitic infection; and, iv) impaired iron utilization after absorption as a result of repeated infection and/or concomitant micronutrient deficiencies.

    In Cambodia, In Cambodia, data are scant on the prevalence of iron deficiency anemia and inference from surveys on the prevalence of general anemia must be used.

    In 2009, Schumann et al. conducted a study on the efficacy of iron supplements in 250 rural children. At baseline, iron deficiency was estimated to be present in 44.0% of children aged 6-24, even when controlling for inflammation.

    ii) Vitamin A and other micronutrient deficiencies

    Deficiencies of several key micronutrients may also lead indirectly to anemia, typically by influencing hemoglobin metabolism. These include vitamin A, folate, vitamin B-12, vitamin C, protein, and copper. Vitamin A deficiency, in particular, is a well-established contributor to anemia and is also common in the developing world where dietary diversity is limited. Vitamin A is essential for hematopoiesis, and it is thought that this vitamin is required for the mobilization of iron for hemoglobin synthesis.

    Data on the prevalence of vitamin A deficiency can be taken from the Demographic and Health Surveys. In 2000, 22% of rural children aged 6-59 months had severe vitamin A deficiency as assessed by serum retinol levels.

    iii) Helminths

    Helminths are a division of eukaryotic parasites that live inside their host, commonly in the intestinal tract. The organisms can disrupt nutrient absorption leading to weakness and disease and may contribute to anemia by causing blood loss and depletion of iron stores and/or by inhibiting vitamin A absorption; diarrhoea and chronic inflammation are also common side effects. In Cambodia, helminths constitute a major health problem. A survey of intestinal parasite infection in 251 primary school children in Kompong Cham Province was conducted in 2002 and reported an infection prevalence of 57% in males and 51% in females. In a similar survey of 623 schoolchildren in Battambang province, 25.7% individuals were infected.

    iv) Malaria

    The world over, malaria is an important cause of anemia as the parasitic infection ultimately leads to hemolysis of red blood cells and a decrease in hemoglobin production. Since 1991, the Cambodia National Malaria Centre is responsible for monitoring the prevalence of malaria in the country.Though malaria was once considered a significant cause of morbidity and mortality in Cambodia, a high level of deforestation has occurred over the past two decades (29% of primary tropical forest between 2000 and 2005) and this has dramatically decreased the size of suitable habitat for malaria-infected mosquitoes. In turn, the Cambodian Ministry of Health report that the prevalence of malaria has dropped significantly.

    In 2009, approximately 64,000 confirmed cases of malaria were reported, with the majority caused by the Plasmodium falciparum species of the malaria parasite. Cases appear to be concentrated in rural areas, with a particular clustering along the western border of the country. Though malaria may be a contributing factor, the relatively low prevalence and marked clustering in isolated areas of the country suggest that malaria is not a significant cause of anemia in Cambodia.

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