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

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      Sources: Published annual reports of colonial government medical departments, and Red Cross reports, 1947–62, BRC London.

      The early and significant use of transfusion in Uganda is clearly shown by table 2.4, as is the late start in the West African colonies of Nigeria and the Gold Coast. It does not follow, however, that lack of data means that transfusions stopped, especially after the first reports. It was much more likely that reports were simply not filed. Table 2.4 shows that by 1953 all these British colonies except one reported transfusions whose numbers were at least in the hundreds and grew at an accelerated rate during the 1950s to ten thousand or more annually in a few colonies by 1960.

      The increase in transfusions in settler colonies of East and southern Africa after 1945 occurred because black Africans were included, and the Red Cross branches in these colonies were very much involved in the process. In Southern Rhodesia the Red Cross branch at first attempted to supply all blood needs, including the needs of African hospitals, by using white donors, according to the head of the British Red Cross overseas branches who visited there in 1948. By 1950, however, a separate African blood bank was established in Bulawayo.⁴⁴ The Kenya Red Cross branch reported the establishment of a blood transfusion service in 1947 at King George VI Hospital, the main hospital in Nairobi (now called Kenyatta National Hospital), with 248 blood donations reported that year. In the second half of 1948 the pathology laboratory of the Nairobi European Hospital (now the Nairobi Hospital) reported that 191 Africans were typed as blood donors for family and friends.⁴⁵ In Northern Rhodesia the Red Cross branch was asked to establish a blood transfusion service in the colony, beginning in 1950 at the African hospital at Lusaka, while in West Africa, the Red Cross involvement came a few years later and depended on relations between the local branches and hospitals.⁴⁶ To summarize, by 1953 all major British colonies in Africa had organized blood transfusion services.⁴⁷

      TABLE 2.5. Beginning dates of Red Cross Branch Blood Collection Service in British African colonies after World War II

      It is impossible in this study to provide a detailed history of blood transfusion in each colony, but closer examination of the records in Uganda and the Belgian Congo provides examples of the complexities not revealed in the broader survey of developments.

      Transfusions in British African Colonies: The Case of Uganda

      One of the most interesting and successful efforts at establishing a transfusion service was in Uganda, where local health authorities asked the Red Cross branch to establish a blood transfusion service in 1948. The response surprised everyone, as Uganda developed the first colonywide blood transfusion service in a sub-Saharan African state. Because of the extent of activity, Uganda also provided an early indication of who donated blood, even if the record of who received transfusions is still not very well documented.⁴⁸ The details are worth examining, not because they were typical but because they illustrate the possibilities.

      On May 4, 1948, a meeting of the self-styled Sub-committee of the British Medical Association in Uganda called for “setting up a Blood Transfusion service to meet the demands for blood transfusion for all races in the vicinity of Kampala and in exceptional circumstances, in any part of the Protectorate.”⁴⁹ Several features of the three-page report were telling. First, there were only four members present, although they represented the surgical staff and pathology laboratory of Mulago Hospital, the biggest and most important government hospital in the protectorate. Included was Ian MacAdam, a recently arrived surgeon who remained in Uganda until 1972 and helped build the hospital’s reputation with doctors that he attracted, including subsequent Nobel laureate Denis Burkitt. Second, it is clear from the document that transfusions were already being practiced both at Mulago Hospital and Mengo Hospital, the first Western hospital established in 1897 by missionary Albert Cook in Kampala. Part of the justification for setting up the service, as the report pointed out, was that the necessary staff were already at Mulago Hospital for such things as lab work and sterilizing equipment. “For several years,” reported the president of the Uganda branch of the Red Cross in 1949, Mengo Hospital “had obtained blood, in cases of dire necessity, from dressers [doctors’ assistants] and students.”⁵⁰

      To establish a more reliable blood supply for more frequent transfusions, the subcommittee pointed out, what was needed—in addition to refrigeration, transport, and identification of adequate donors—was an “organizing secretary.” This was an overt appeal to the British Red Cross in London to supply the equipment and personnel. The May 4 request spelled out quite clearly what the duties of the secretary should be:

      (a) the propaganda for Blood Transfusion

      (b) accurate records of donors