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

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СКАЧАТЬ the organizing of blood collection

      (d) the responsibility for equipment

      (e) liaison between the various major hospitals

      “She” the report went on, specifying the secretary’s gender, “should be responsible to a joint committee appointed by the BMA.”⁵¹

      The Red Cross branch in Kampala was so enthusiastic in its desire to cooperate that it hired the wife of a physiologist at Mulago to be a part-time secretary and installed her in an office with telephone, stationery, and index cards, even though it did not yet have the resources for the other equipment. For that, the Uganda branch sent a request to London for funds, specifically to Joan Whittington, the director of the British Red Cross overseas branches, who had visited Uganda earlier in the year. While awaiting approval, the Uganda branch began publicity and lectures to educate and motivate potential donors.⁵² London quickly approved the request for £750 to purchase a refrigerator, a van, donor sets, needle-sharpening equipment, bottles, and other supplies and equipment.

      Some features of the new blood transfusion service, such as recruiting donors at schools, colleges, and missions, set a pattern that was followed not just in Uganda but most African colonies and countries. Other early practices, such as typing all potential donors but contacting only those with blood type O, were abandoned as soon as demand required more donors. In the first year of activity, 456 potential donors were recruited at ten schools, colleges, and the police training academy, with 228 found to be “universal donors.” The initial goal was to have a supply that permitted transfusion of ten pints per week, although first reports were that the average was only six per week by January 1949. In addition to stepping up recruitment of donors, the service adopted a policy for stored blood that also gave an indication of use. The policy stated that stored blood would be used “for emergency cases only, until the day the bleeding team replenishes the [blood] bank with a fresh supply, after which the previous week’s supply is made available for non-emergency transfusions such as anemia cases.” To dramatize the importance of storage, the president of the Uganda Red Cross branch reported that fifty of the first eighty-one transfusions “have undoubtedly proved to be life-saving in accident cases and where cases have been suffering from post-operative shock.”⁵³

      The demand for the transfusion service grew quickly at Mengo and Mulago Hospitals. The 1949–50 annual report for the Red Cross branch in Uganda quoted one surgeon as saying, “The field of surgery has been greatly widened by the Blood Transfusion Service and surgeons have been able to perform operations which were hitherto too dangerous or else entirely impossible.”⁵⁴ The target of ten transfusions per week was met and doubled in 1949 but remained steady at around seven hundred transfusions per year until the mid-1950s, when the annual total surpassed one thousand per year. The expansion was possible because of more persuasive and extensive recruiting, including the making of a film that was dubbed into the local language and later exported to other African colonies and countries (see chapter 5).

      The hospitals, meanwhile, intensified their efforts to persuade friends and relatives of patients to donate blood, not just before but after transfusion. As a 1956 Uganda Blood Transfusion Service report described it, “The Red Cross Blood Transfusion worker at Mulago Hospital, Mr. Emmanuel Muwonge, goes round the wards regularly and speaks to relatives and friends of patients needing blood transfusions. He explains the need and the technique to them, and, if they are willing to give blood he makes the necessary arrangements and assists the doctor.”⁵⁵ The result, it went on, was that one patient who received three pints of blood, thus saving his life, had relatives and friends who donated a total of nine pints to the service. For the whole year of 1956, Mulago Hospital received 339 pints of blood in this manner out of a total of 1,407 pints collected for the entire protectorate.⁵⁶ That same 1956 report announced the intent of Jinja Hospital to organize another transfusion center for Busoga Province, in the east, and an Asian subcommittee was created to establish an Asian blood bank in Kampala.

      The generally good records of the Uganda Red Cross document the expansion of transfusion before independence that reflected even further growth of services at provincial hospitals. By 1958 there were transfusion services at Mbale and Gulu, as well as Kampala and Jinja. In 1962 the last report of the transfusion service before independence indicated that nine thousand pints of blood were collected, still mostly in and around Kampala. By this time the majority of blood processed at the Nakasero Hill transfusion center was drawn by mobile units at numerous locations including colleges, high schools, training centers, prisons, a convent, and the airport at Entebbe. The list of provincial collections was equally impressive, based on statistics for selected years between 1957 and 1965.⁵⁷

      TABLE 2.6. Blood donations reported, Uganda, selected years, 1957–65 (pints)

       *Total for 1963 from separate source.

      In 1948 when the Uganda Red Cross branch responded to the call for a transfusion service, its president observed that her organization’s reputation “carries considerable weight” that might help the project succeed. “It was felt therefore that if this blood transfusion service were started under the auspices of the Red Cross, it would win the confidence of the African far more than a Government-sponsored project.”⁵⁸ Whether true or not, already by 1952 the newly appointed governor of Uganda, Sir Andrew Cohen, attended the annual meeting of the Red Cross branch and made special note of the success of the blood transfusion service. His speech paid tribute and also made the following prophetic observation:

      If the Red Cross and other voluntary bodies can start new services, this may become so popular and may come to be regarded as so necessary and essential that eventually they will become part of the fabric of the Government, and Government, whether willingly or unwillingly, will be forced to take over those services and run them themselves. That is how public affairs go. We have an excellent example of this, if I am not wrong, in the Blood Transfusion service, which is a fine service which you are now running and which eventually no doubt will become the responsibility either of local government or of Central Government.⁵⁹

      As the use of transfusion expanded both in Kampala and Jinja, as well as at up-country hospitals in other parts of the protectorate, the government (both of the colony and subsequently of the independent country) took a more enlightened approach, giving the Uganda Red Cross Society a subsidy to continue its part in the transfusion service, rather than taking it over completely as a government service. By the time of independence, however, tensions were growing between the two parties because of increasing costs and the inability of the Red Cross or government to meet them. Sue Maltby, a British Red Cross worker in Uganda, stated in a report at the end of 1959 that the blood transfusion service, “continues to expand at an alarming rate,” with the result that it was always short of money. When the Red Cross asked for an increase in government subvention, it was refused. Members responded with letters written “to the minister from Lady Crawford [wife of the governor of Uganda],” followed by meetings, revised estimates, and more meetings. Only after all that, Maltby reported, was the Red Cross promised an extra £500 for 1959. And for the next year they agreed to an increase from £750 to £2,500 (current value of $60,000), “but not before we held the biggest pistol possible to their heads,” she concluded.⁶⁰

      When the women in the Red Cross were the wives of the doctors using the transfusion services, these matters could be worked out “within the family.” With the increasing use of transfusion and more turnover in Red Cross volunteers, however, the delicate balance between those using the blood that was provided by those doing recruiting, bleeding, testing, and storing was upset and disagreements resulted. Although the Red Cross had been offered government resources to help with the costs of its responsibilities, the Red Cross complained that the funding did not cover their rapidly rising costs. This was СКАЧАТЬ