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
(c) 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.