In the villages of Kandal province, instead of bright, bouncing
children, Dr Charles found many were small and weak with slow mental
development.
Women
were suffering from tiredness and headaches, and were unable to work.
Pregnant
women faced serious health complications before and after childbirth, such as
haemorrhaging.
Ever
since, Dr Charles has been obsessed with iron.
Anaemia is the most common nutritional problem in the world,
mainly affecting women of child-bearing age, teenagers and young children.
In
developing countries, such as Cambodia, the condition is particularly
widespread with almost 50% of women and children suffering from the condition,
which is mainly caused by iron deficiency.
The
standard solution - iron supplements or tablets to increase iron intake - isn't
working.
The
tablets are neither affordable nor widely available, and because of the
side-effects people don't like taking them.
Lump of iron
Dr
Charles had a novel idea. Inspired by previous research which showed that
cooking in cast iron pots increased the iron content of food, he decided to put
a lump of iron into the cooking pot, made from melted-down metal.
The iron fish is modelled on a species commonly eaten in Cambodia
His invention, shaped like a fish, which is a symbol of luck in
Cambodian culture, was designed to release iron at the right concentration to
provide the nutrients that so many women and children in the country were
lacking.
The
recipe is simple, Dr Charles says.
"Boil
up water or soup with the iron fish for at least 10 minutes.
"That
enhances the iron which leaches from it.
"You
can then take it out. Now add a little lemon juice which is important for the
absorption of the iron."
If
the iron fish is used every day in the correct way, Dr Charles says it should
provide 75% of an adult's daily recommended intake of iron - and even more of a
child's.
Trials on several hundred villagers in one province in Cambodia
showed that nearly half of those who took part were no longer anaemic after 12
months.
'Better than tablets'
Prof
Imelda Bates, head of the international public health department at Liverpool
School of Tropical Medicine, says the iron fish is a welcome development.
"These
sort of approaches are so much better than iron tablets, which are really
horrible.
"If
it's something that is culturally acceptable and not too costly, then any
improvement to anaemia levels would be of great benefit."
Around
2,500 families in Cambodia are now using the iron fish and the Lucky Iron Fish company has distributed nearly 9,000
fish to hospitals and non-governmental organisations in the country.
What
pleases Dr Charles most is the fact that villagers appear to have accepted the
smiling iron fish, which is 3in (7.6 cm) long and weighs about 200g (7.1 oz).
Cambodian villagers are encouraged to boil up water with the 3in iron fish in the pot
One woman and her daughter, who are part of a current trial in
Preah Vihear Province, told the BBC they would use it during cooking.
"I'm
happy, the blood test results show that I have the iron deficiency problem, so
I hope will be cured and will be healthy soon.
"I
think all the people in Sekeroung village will like the fish, because fish is
our everyday food."
Scale of anaemia
The
World Health Organization estimates that two billion people - over 30% of the
world's population - are anaemic, mostly due to iron deficiency.
It
says stopping iron deficiency is a priority - for individuals and countries.
"The
benefits are substantial. Timely treatment can restore personal health and
raise national productivity levels by as much as 20%," it has said.
And
it emphasises that it is the poorest and most vulnerable who stand to gain the
most from its reduction.
But there are other forms of anaemia. It can also be caused by
vitamin B12 and A deficiencies, parasitic infections, such as malaria, and
other infectious diseases.
That
is when it gets complicated, says Prof Bates.
"Anaemia
is a multi-factorial problem. It's the end product of many different health
issues.
"And
measuring whether people have enough iron or not in their bodies is very
difficult in developing countries," she said.
As
a result, she says, knowing how many people really are iron deficient isn't
easy to work out.
Rice diet
In
those with iron-deficiency anaemia, the cause is often poor diet. And that's
the case in Cambodia, Dr Charles says.
"They
have a really poor diet - a big plate of white rice and maybe a small cut of
fish.
"That's their two meals a day. And it's just not meeting
their nutritional requirements."
What's
missing from their diet are iron-rich foods, particularly red meat. Green leafy
vegetables, such as spinach, are not as rich in iron and mustn't be overcooked
if they are to offer any benefit at all.
The
Lucky Iron Fish project has a plan to get fish to every part of the world that
needs them, including countries like Canada, the US and Europe.
So
should everyone be putting recycled metal car parts in their soup?
According
to the experts, there is no reason not to - although levels of anaemia are far
lower in developed countries, and there is easier access to iron-rich foods
which can make all the difference to pregnant women and vegans, for example.
We
could all eat iron filings instead, of course, but they wouldn't taste half as
nice.
What does iron
deficiency do to the body?
Iron
deficiency anaemia is a condition where a lack of iron in the body leads to a
reduction in the number of red blood cells.
Iron
is used to produce red blood cells, which help store and carry oxygen in the
blood.
If
there are fewer red blood cells than normal, your organs and tissues will not
get as much oxygen as they usually would.
This
means you can suffer from tiredness, shortness of breath, heart palpitations
and a pale complexion.
If
left untreated it can make people more susceptible to illness and infection.
Pregnant
women and children are particularly vulnerable. Anaemia is thought to
contribute to 20% of all deaths during pregnancy.
Source: World Health
Organization
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