Cambodian people know a lot about minimising waste. When a meal is cooked at one of the street stalls, over small charcoal burners, practically every part of the animal goes into the meal. The market stalls offer a selection of chickens’ feet, cow intestine, frogs, congealed pig’s blood, embryonic eggs found in the chicken’s womb, fish heads and grasshoppers. I have long since given up trying to guess what is in tonight’s bowl of steaming food – it is always delicious, and since few people speak English I tend to just point at a pot and get given a bowl of something or other. The smell of fermented fish sauce hangs in the air. This is made out of any remaining parts of fish once the edible flesh has been removed, fermented in strong brine for up to a year until it reaches the requisite level of pungency.
When meals are eaten there are rarely any leftovers. At the Night Market in the North East of the city, barefooted children scurry around the mats on which many people sit and eat together in the evenings. The children are looking for leftover food; they slurp the remainder from plastic cups and scrape rice grains from plastic trays.
Once the leftovers have been scavenged, staff at the market dispose of the rubbish in piles on the streets. These are collected by municipal refuse collectors although this is sporadic. While the piles of rubbish await collection, they are often picked through by local children.
The approach to medications used by the DSF is to dispense precisely the number of tablets required before the next scheduled visit. This is effective in two additional ways – firstly, non-attendance at clinic is very rare as it would mean people would run out of medicines. Secondly it enables accurate review of exactly what has been taken – tablets are removed from packs by the nurse and put into small plastic bags labelled in Khmer with instructions. The monthly medicines budget is around $3000 and there are approximately 50 patients on their books at any one time.
It has been estimated that in the UK over £2 billion a year is spent on unnecessary, expensive or inappropriate treatment. Furthermore, it is thought that around £300 million is spend by the NHS on wasted medications, as often happens when a person’s medication regime is changed and medicines get stockpiled at home, or when repeat prescriptions are issued without review. To put this in perspective, the Gross Domestic Product for the whole of Cambodia last year was around $50 billion (approx £37 million). One of the main ways in which waste can be reduced is through adequate support at the point of prescribing. It is also essential that the effectiveness of medicines, and any adverse effects, are closely monitored, as people may decide to stop their medicines if unsupported.
In the UK we would do well to learn from Cambodia about making the best use of resources – not just medicines and food, but time – perhaps our most precious of all resources, and often under-appreciated until we realise our moments here are finite.