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

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СКАЧАТЬ reports have not been found about where shipments went from the federal transfusion service in Dakar, and it was only in 1955 that an official category was created for blood transfusion in the annual French colonial medical reports. Nonetheless, based on intermittent reports, it is clear that transfusion was widely used, and in some places regularly established, in French West and French Equatorial African colonies by 1956.³⁷

      Given the widespread ability to do transfusions, it follows that the main initial effect of the Dakar service, as far as West African and Cameroon colonies are concerned, was to expand the practice. In other words, this was likely an unusual case of increased supply stimulating demand. Then by the late 1950s, as demand in the colonies began to exceed the ability of Dakar to supply blood and blood products, especially at a reasonable price, the hospitals in the other colonies developed their own local sources. Sometimes this was done publicly and openly, as in 1957, when the Ivory Coast officially voted to create its own blood transfusion service. The minutes of the territorial assembly reported the health minister’s testimony: “A blood bank is indispensable to the colony at this time because of the increase in patients who can benefit from whole blood and whose needs are always urgent in nature. The center in Dakar, he said, has prices that are too high. He has been forced on several occasions to order blood directly from France.”³⁸ Other colonies, such as Togo, did not require such dramatic action. A hospital might simply ask a patient’s family to find a donor, or develop a more systematic way of insuring blood for transfusion quickly and affordably. In any case, the trend was clearly toward a decentralization of blood collection that foreshadowed the pattern for the period of independence.

      TABLE 2.3. Transfusions reported with whole blood and plasma, French African colonies, 1955–56

Colony	1955	1956
French West Africa
Ivory Coast	79	695
Dahomey	—	286
Guinea	164	—
Upper Volta	25	40
Niger	148	182
Senegal	—	—
Dakar Hospitals	577	867
Other	1,054	293
Togo	—	180
French Equatorial Africa
Ubangi-Shari	37	33
Congo	55	116
Gabon	63	22
Cameroon	—	273
Source: Annual medical reports for each colony, 1955, 1956, IMTSSA.

      The evidence about blood transfusions in former French African colonies is very broad but unfortunately also very shallow. It provides a fairly complete account of when and where and how many transfusions were done over a large part of West and Central Africa, but there is less evidence about who gave blood and for what purposes. One particularly intriguing feature is that the population of the Dakar region was essentially donating blood for all of West Africa during most of the 1950s. Moreover, the blood donation rate (for example, 14,181 donations in 1957 for a population of 234,500) was 6,047 per hundred thousand, easily the highest found anywhere in Africa and well in excess of the two-to-four-thousand per hundred thousand rate that became the standard for donations in Europe and North America. The reason why so much blood was donated is only partly explained by tradition and military troops stationed in Dakar. It was likely also the result of the French policy of a 500-franc (CFA) payment for a donor’s time, plus refreshments (a sandwich and a drink).³⁹

      More will be said later about who donated, but overall these French records emphasize the colonial administrative part of the story. Of note here is that with only a few exceptions, the doctors and administrators remained largely anonymous, thanks to the centralized bureaucratic system of French reporting. Fortunately there is much richer evidence about the history of blood transfusion in the British and Belgian colonies, because of the participation of the Red Cross societies. Although their records are also biased toward documenting the work of Europeans involved, their detail permits a better indication of the Africans who were the patients, donors, and part of those who organized and administered the transfusions.

       Transfusions in the British African Colonies after the Second World War

      Blood transfusion in the British African colonies, as in the French colonies, ultimately depended on a doctor’s decision to use the procedure for patients. That decision, however, was strongly influenced by the state of local health facilities, including the existence of a hospital and a readily available blood supply. After the 1920s any doctor in Africa who was intent on doing so could give a blood transfusion to a patient in a Western hospital by finding a donor from the hospital staff, the patient’s family, or like Lambillon, even from convalescing patients. This search could require some effort, and it stands to reason that if a supply of blood were available, doctors would be more inclined to give transfusions to patients. In this scenario the doctor would be the bottleneck limiting blood transfusions. If patients were in need of transfusion, a service organized for recruiting donors and processing blood might persuade a reluctant doctor to give transfusions. In British African colonies, local Red Cross branches frequently served that purpose in facilitating transfusions.

      When the government of French West Africa, for example, took steps to continue a blood supply after the Second World War, it stimulated the use of transfusions in hospitals, not just in Dakar and Senegal, but elsewhere in West Africa. This approach, however, differed significantly from what happened in the British African colonies. For, unlike the French colonies where the government took the lead, it was the local Red Cross branches who took the initiative in the British colonies, either to respond to a request by a hospital or medical service to find blood donors or to initiate the idea by approaching the medical authorities with an offer to find volunteers to donate blood. As Percy Oliver pointed out at the British Empire Red Cross Conference in 1930, blood donation was “a very fine form of service for Red Cross members.”⁴⁰

      Records show that Europeans in Africa began the process, and in some settler colonies such as Kenya and Southern Rhodesia, all parties (patients and donors, as well as doctors) operated in a segregated system, at least for a while.⁴¹ But that did not remain the case for long. In places like Tanganyika and Uganda, let alone Nigeria or the Gold Coast, there simply were not enough Europeans to operate a separate transfusion system. And even in the settler colonies the increased government expenditures on health services after the Second World War meant that transfusions and other medical treatments had to be extended to African patients. The ethos, not to mention practical politics at the time, would not allow such blatant racism. Once СКАЧАТЬ