The History of Blood Transfusion in Sub-Saharan Africa. William H. Schneider

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СКАЧАТЬ Linhard, will significantly aid in the diffusion and expansion of this heroic therapy, in war as in peacetime.”²² And, as the authors themselves put it, “We thought it useful to make these [scientific and technical developments] known to our comrades in the empire, who work without access to publications and who find it impossible to follow the medical progress achieved during this war.”²³

      The report that Ouary wrote to his superiors upon his return indicated the implications for infrastructure that predicted some of the subsequent developments of transfusion services in most African colonies and independent countries. “Today those who must care for the wounded demand larger and larger quantities of blood. Such an increase in transfusion has necessitated the creation of a new organization.” He pointed out that the Algiers center included:

      • a laboratory to prepare the different types of blood, furnished by its own collection sources, mobile teams both lightly and fully equipped, and secondary fixed centers

      • a warehouse to provide equipment and biochemical supplies

      • a training center for reanimation-transfusion teams²⁴

      Following the plan of the Colonial Health Department, the Pasteur Institute continued the blood collection service in Dakar after the war; and although the amount of blood collected dropped to less than thirty liters in 1946, donations steadily grew thereafter.²⁵ In 1949 the two large Dakar hospitals (Hôpital le Dantec and Hôpital principal) had organized transfusion services, the one in le Dantec being housed in a new surgery wing completed that year, with twenty-four beds dedicated to “reanimation.” Louise Navaranne, a doctor who accompanied her husband, Paul, to Dakar when he was assigned to the surgery service of le Dantec, directed the reanimation center. In 1950 she reported almost four hundred transfusions with whole blood and plasma supplied by the transfusion service.²⁶

      At this same time, credits were voted to establish a federal transfusion service that opened in 1951 to serve all colonies in French West Africa.²⁷ In a letter to the governor general of French West Africa, the director of public health for the federation, Léon Le Rouzic, gave four reasons for the creation of the federal transfusion center, some of which proved to have clear foresight, combined with others that never saw the light of day. They were:

      1. The important increase in the number of serious accidents occurring each day in Dakar and its environs.

      2. The capital of AOF [l’Afrique Occidentale Française] has an airport that has become a crossroads of international airlines, and health facilities must possess a maximum of resources in case of an airline accident. It is noticeable that foreigners are concerned about the means at our disposal in this regard.

      3. This facility will become part of the health facilities of greater Dakar.

      4. The transfusion center will be a federal facility, with blood and plasma capable of being sent at any time to facilities in the interior by regular airlines or planes (military or civil) required for this.²⁸

      Linhard, who had trained in obstetrics at Bordeaux a few years following Ouary in the 1930s and was coauthor with him of the transfusion manual for use in the colonies, became the first director of the transfusion service in Dakar. The reports of the service quickly showed that sufficient donors were found that met the greatly increased demands for transfusion. After six months of operation, the Dakar center reported 3,508 donations of 300 to 350 cc each from almost two thousand donors. Of these 1,384 were Africans, mostly civil servants (the Europeans were military), and none were women. Within three years, according to the center’s 1954 report, it drew blood from over twelve thousand donors, all but five hundred of whom were Africans.²⁹ Significantly, and uniquely for sub-Saharan Africa, the Dakar transfusion service had facilities for freeze-drying plasma, which was useful for shipments to the other colonies.³⁰ The increased supply of blood and plasma made it possible for le Dantec Hospital to increase its blood transfusions dramatically, according to the use of blood products at the hospital before and after the opening of the new transfusion center.³¹

      Most of the blood and plasma were distributed by train to Senegal and the French Sudan, and by air to the major cities of French colonies throughout West Africa: Bamako, Conakry, Abidjan, Niamey, Ouagadougou, Lomé, and Cotonou, as well as Douala, Cameroun (a UN protectorate administered by France). This regional approach, and the possibilities it implied for centralized services and quality control, proved to be exceptional and temporary. For reasons of cost, increased demand, and the growing political-independence movements, separate transfusion services were soon created in each colony.

      TABLE 2.1. Blood and plasma use, le Dantec Hospital, Dakar, 1950–52

Year	Whole blood (250 cc units)	Plasma (350 cc units)
1950	180	207
1951	384	286
1952	1,146	675
Source: “Rapport annuel, Hôpital Central Africain,” 1950–52, box 32, IMTSSA.

      Before the establishment of the blood collection service in Dakar, there were reports of transfusions in the French Congo as early as 1933 and 1934. Additional evidence shows transfusions there in the late 1940s as well.³² Likewise, there is indirect evidence of transfusions from lab reports of blood group testing in French West Africa in 1939, most likely from the Dakar hospitals but also in the French Sudan between 1940 and 1945. Gabon reported blood group tests in 1950 and 1951, and, along with Togo and the French Congo, it established agreements in 1950 on the price paid for blood given by local donors, in accordance with the national agreement negotiated in 1949 between the Ministry of Health and the Fédération nationale des donneurs de sang de France et d’Outre-mer.³³

      These accounts suggest a pattern outside Dakar that followed the interwar record in Belgian and British colonies, where the individual interest of doctors or other circumstances determined the use of transfusions. And colonial health services moved doctors around fairly regularly. Thus, for example, the transfusions done in the French Congo in 1950 followed the appointment of Ouary as surgeon at Brazzaville Hôpital général after he left Dakar. In 1955 he was chief of the surgery service in Tananarive, Madagascar.³⁴ Likewise, when Togo completed construction of a new hospital in Lomé in 1954, Amen Lawson headed the bacteriology department, and unilaterally started a paid blood donor service, because it was much cheaper and more responsive to immediate needs than service from Dakar.³⁵

      TABLE 2.2. Total blood units supplied, Centre fédéral de transfusion (Dakar), 1950–58

      Note: Units are either 250 cc whole blood or 350 cc plasma. Three blood products were produced at the center: Whole blood, liquid plasma, and dried plasma.

      Source: Unclassified records, CNTS Dakar.

      The reports of overall blood and plasma production through 1958 give an indication of the number of transfusions in French West African colonies for which the blood was supplied.³⁶ Of note was the rapid growth but quick leveling off of donations and units produced, likely due to costs, plus the very high rate of blood donation by the local population. African donors made up the vast majority from the start, and there was a steady growth of whole-blood collection. Plasma remained a significant portion of production but leveled СКАЧАТЬ