DAVID GREENE, HOST:
Iron deficiency does not just make people sick. The World Bank estimates that these illnesses cost the global economy $70 billion each year. For Cambodia, one of Southeast Asia's poorest countries, a lack of iron takes a particular toll. It's also a country where nothing gets wasted, including scrap metal. So a new company is molding the metal into the shape of little fish and taking on a matter of local and global health. Michael Sullivan tells us how all this got started.
MICHAEL SULLIVAN, BYLINE: It's 2008 and Canadian student Christopher Charles is working in rural Cambodia.
CHRISTOPHER CHARLES: And I was looking at the prevalence of anemia and parasite infection in the region and just sort of began to uncover this huge problem that no one was really doing very much about.
SULLIVAN: That problem, anemia, in this case, associated with low levels of iron in the blood. And almost half of Cambodia's population suffers from iron deficiency largely because of diet. And it's not just Cambodians. That listless tired feeling, you might be iron deficient, too. Professor Imelda Bates is a hematologist at the Liverpool School of Tropical Medicine and she focuses on anemia in low-income countries where she says iron tablets can help.
IMELDA BATES: But people don't like the taste. And they quite commonly give people stomach upsets, constipation...
SULLIVAN: And, let's just say, really nasty stool.
BATES: So there's lots of reasons why people tend not to take iron tablets.
SULLIVAN: So Christopher Charles came up with what he thought was a simple alternative. Give the villagers a little block of iron to drop into their cooking pots. The iron gets released slowly as the water boils and into the food cooked in it. Great idea, right?
CHARLES: I really didn't think that the design - the actual sort of industrial design, if you will - of the ingot itself would be that important. Man, was I wrong.
SULLIVAN: People hated them, thought they were ugly, would damage their pots. But after a few more failures, he figured out that in rural Cambodia, almost everything is about fish. Fish are a big part of Khmer cooking and culture. Even the local currency, the riel, is named after a fish.
CHARLES: I stumbled across this one kind of fish that's called try kantrop. And it's associated with sort of luck in village folklore. That really helps to sell the idea to the Cambodian people I was working with.
SULLIVAN: Fast forward a few years and a few trials later and the Lucky Iron Fish is already in some rural pots. Sot Mot, a 60-year-old grandmother, drops the fish into boiling water as she chops up garlic, ginger and lemongrass for Khmer chicken soup. She's been using the fish for about a year.
SOT MOT: (Through interpreter) Before, I felt tired and lazy and my chest, it hurts when I was tired. But after I used the fish, I feel strong and have energy to work and I sleep well, too.
SULLIVAN: And that's energy she needs taking care of her grandchildren while their parents are off working in the fields or in nearby garment factories. I catch one of the kids on her way to school.
SULLIVAN: Danai is 15.
DANAI: (Through interpreter) Before, when I went to school, I felt tired. Now I do better in math. Before, maybe sixth in the class. But now I'm the first.
SULLIVAN: The Lucky Iron Fish people claim that after just nine months of using the fish every day, they saw a 50 percent decrease in the incidence of clinical iron deficiency anemia. And an increase in users' iron levels. Their third round of trials is now underway. And Professor Bates thinks they seem to be onto something.
BATES: Anything that's simple, that's accepted by the community, that's easy to roll out, that doesn't have too many side effects and that is beneficial, particularly for a condition like this which is of big public health importance, has got to be taken seriously. And I think they're doing the right thing to try and collect good evidence around it.
SULLIVAN: The Lucky Iron Fish Company started rolling out its fish for sale late last year here in Cambodia, abroad and online.
UNIDENTIFIED MAN: (Foreign language spoken). How are you? Fine, thanks. Sorry, a little bit late.
SULLIVAN: In the capital, Phnom Penh, at a little boutique tucked into a side street near the royal palace, the local manager for Lucky Iron Fish has just brought in a haul.
MARIANNE WHEELER: Oh, they look fantastic.
UNIDENTIFIED MAN: It's Cambodian style.
WHEELER: I like these.
SULLIVAN: That's Marianne Wheeler. She runs Trunkh, the only retail outlet for Lucky Iron Fish in Cambodia. And she's having a hard time keeping them in stock. Foreign tourists find the fish irresistible.
WHEELER: They're a beautiful little souvenir of Cambodia and very unusual. But also people have been coming in and buying them because a member of their family or someone close to them is anemic.
SULLIVAN: And if they come in here and they pay retail, then...
WHEELER: With every fish we sell, the Lucky Iron Fish Foundation people donate one to a family in need or recently they have been donating to provincial hospitals.
SULLIVAN: They've sold enough at $25 each, both here and online, that the company is now giving away several thousand to its NGO partners. The socially conscious startup CEO Gavin Armstrong says the goal really is to have a fish in every pot or at least every pot that needs one. For NPR News, I'm Michael Sullivan in Phnom Penh.
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