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 doctors decided that transfusion was appropriate for African patients, there were not enough Europeans to serve as donors to meet the rapid rise in demand as Africans agreed to take advantage of the treatment. European patients might insist on a European blood donor, but this quickly became a marginal part of the blood transfusion service compared to the large African population in the colonies that needed and donated blood for transfusion.
In British colonies there was a scattered record of blood group testing before 1945, according to annual laboratory reports that indicate widespread but probably infrequent use of transfusion. The lack of published articles by British authors between the wars suggests no sustained attempts at treatment or service like there were in the Belgian Congo. A Red Cross chapter could organize a panel of donors on a small scale for occasional use by a local hospital, which was the case in Kenya as early as the 1930s. The Southern Rhodesia Red Cross had larger ambitions when it launched the National Blood Transfusion Service in 1939, but the plan was cut short by the outbreak of the Second World War.42
The introduction of transfusions on a regular basis in most British African colonies came after the war. Table 2.4 summarizes the record, drawn often from government and Red Cross reports.43
TABLE 2.4. Blood transfusions reported in British colonies, 1947–62
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
| Kenya | 1947 |
| Nyasaland | 1948 |
| Tanganyika | 1948 |