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

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СКАЧАТЬ of Lejeune, plus the direct and indirect evidence in published articles and unpublished reports, it appears that the first transfusions were done in Africa at the beginning of the 1920s. This means that the conditions necessary for a transfusion—a patient in need, a donor, and a doctor with knowledge and means—existed at a relatively early time, even compared to the first transfusions in the world in the modern era, which began only in the decade before the First World War. The record also shows, however, that only after the Second World War were transfusions done widely and in large numbers in Africa. Understanding this timing requires further examination of questions about the setting in which the introduction of this lifesaving Western medical technique took place.

      Blood Donation and the Uses of Transfusion in Africa

      There were three broad conditions required for transfusions to take place in Africa or anywhere else: patients in need, a source of blood, and facilities with someone knowledgeable of a method to transfuse the blood. The first two of these conditions depended on Africans’ attitudes toward Western medicine, and more specifically whether they understood the need for transfusion and were willing to do something as unusual as donate and receive blood. Surprisingly, these were not the biggest hindrances or limiting influences on when blood transfusion began. To be sure, there was a natural reluctance to do something as unusual as allow blood to be taken from or introduced into one’s body; and there are numerous anecdotal examples and a few systematic studies of resistance to, as well as persistent racist observations about, the inability of Africans to understand Western medicine. For example, Meghan Vaughan has described the resistance of Africans in northern Nyasaland to smallpox eradication efforts in the 1930s. In addition to compulsory infliction of some pain, the measures also entailed, “the curtailment of movement, the segregation of villages, the banning of funerals and the burning of victims’ huts.”¹⁵

      These examples were exceptions to the general and relatively quick acceptance by Africans when Western medicine became available. There was not only little resistance but Africans also eagerly responded when its effectiveness was demonstrated. An early example was the rapid success of the Anglican doctor Albert Cook, who came to Uganda in 1897. In fact, his fellow missionaries already there were afraid the Africans’ acceptance would distract them from religious conversion. Shortly thereafter a Church Missionary Society dispensary in the colony attracted over two hundred patients a day within months of opening.¹⁶

      A later example was the speed, surprising to some Western observers, with which Africans generally accepted injections and other Western medicines. This was frequently noted by outsiders who feared overuse by patients demanding injections or medicines, no matter the condition. One medical officer who served in Uganda beginning in the late 1930s reported cases where blood donors thought that the act of donating blood had the curative power of an injection because a needle was used.¹⁷

      Blood transfusion required even more explanation, especially for donors, but it was one of the Western medical techniques whose value was immediately and obviously demonstrable, in Africa as elsewhere. When Grace Crile, wife of the American surgeon George Crile, described the results of his first transfusion on a human, which she assisted as a nurse in 1906, she recalled, “I stood at the foot of the operating table and witnessed the miracle of resurrection.”¹⁸ Thus, in large measure, because it worked so well, transfusion became a part of modern medicine throughout the Western world soon after a safe way was found to transfer the blood from donor to patient, at the beginning of the twentieth century. The experience of the First World War helped resolve some initial problems, and in the 1920s transfusion shifted from wartime use for injuries sustained in battle to its more common civilian uses to replace blood loss from various accidents and diseases, as well as in childbirth. All these conditions existed in Africa, as well as another endemic to the region, severe anemia.

      Many expressed doubt that Africans would allow their blood to be taken or subject themselves to such a radical procedure as introducing the blood of another into their bodies. For example, early reports of transfusion in the Belgian Congo relied on recovering patients in hospitals as the source of blood, people with little power to decline.¹⁹ Likewise, a similar approach was used to persuade African troops in Kenya to donate blood during the Second World War, but there was so much resistance that a special study was done to learn why.²⁰ In Senegal, one of the early practitioners of transfusion, Gaston Ouary, expressed strong doubts about Africans donating blood for fear of becoming weak from blood loss or somehow contracting the disease of the patient receiving blood.²¹

      These fears and occasional reluctance to donate blood proved not, however, to be the obstacle that some Western observers feared. In the end, the obvious benefit that a transfusion produced was coupled with adaptation and persuasion to obtain the necessary blood donors. Writing in 1960, at a critical juncture on the eve of independence in many African countries. H. C. Trowell, a British physician at Mulago Hospital in Kampala, Uganda, quickly dismissed the potential problem of finding blood donors. In “Transfusion,” a section in his Non-infective Disease in Africa, he stated, “It is not proposed to discuss the social prejudices against blood transfusion in Africa, as within a few years these are usually overcome, and then it is usually the shortage of staff and apparatus, rather than the shortage of donors, which is the limiting factor.”²²

      In fact, the overall pattern was not so different from that in the West, where a variety of methods and motivations, from patriotism to payment, have been used to secure adequate blood for transfusion. Yet according to most studies, less than 9 percent of the U.S. population (of donor age 18–65 years) donates blood in a given year. In Africa a combination of voluntary donation, appeals to obligations from family and friends, and payment have historically been used to secure an adequate blood supply.

      The Development of Transfusion Technology to 1950

      Of all the things that determined when and how blood transfusion came to Africa, in shortest supply were the facilities and someone knowledgeable about the procedure. Doctors were simply not available in large enough numbers in Africa to introduce blood transfusion on a wide scale until after the Second World War. The techniques they used were adaptations of those worked out in Europe and America in the first half of the twentieth century. These methods strongly influenced when, where, and how transfusion was practiced in Africa, hence it is worth reviewing them, because in the end, transfusions were given in Africa essentially as elsewhere: in hospitals, by doctors or their assistants. Thus, even more than other procedures of Western medicine, such as drug prescriptions or injections, the history of blood transfusion in Africa was linked directly to the two most important institutions of Western medicine: hospitals and doctors.

      Patients and healers have long thought blood had curative and restorative power, but the effective medical use of blood transfusions is a relatively modern innovation. It was only after Harvey’s discovery of the circulation of the blood, in the seventeenth century, that there was demonstrable proof of the potential benefit of transfusion, and not until the beginning of the twentieth century that effective blood transfusions entered the realm of scientifically based medical practice.

      Surgeons took the lead in developing the effective techniques of blood transfusions at the beginning of the twentieth century; hence patients were treated in a hospital setting with sterile conditions, with anesthesia if necessary, and careful monitoring. These conditions were indispensable for the first effective transfer of blood from a healthy donor to a patient; in fact the initial transfusions were done by connecting the artery of a donor to the vein of a patient. This lifesaving, although long and delicate, procedure was repeated by surgeons in a number of locations who quickly added such basic refinements as measuring the amount of blood donated and preventing clotting. The discovery that sodium citrate delayed coagulation meant the end of so-called direct transfusion, where blood drawn from a donor was immediately given to the patient, usually in the same room. Now, the drawing of donors’ blood into a syringe or tube could be separated from the procedure of giving it to the patient. The result immediately made transfusion easier, but the procedure remained under the supervision of a doctor. СКАЧАТЬ