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