of transfusions in surgery services of hospitals in the French Congo in 1933 and 1934.62 Another example of an exception that demonstrates the case in point, comes from Sierra Leone, a fairly small British colony (1931 census of 1,768,480), with few Europeans, and not particularly noted for significant investment in health or other Western development. Yet in 1936 the annual report of the pathology laboratory of Connaught Hospital in Freetown mentioned grouping seven blood donors (six African), a figure that rose to thirty-six (twenty-five African) in two years. Similar scattered examples show the widespread ability, even if limited in practice, to do blood transfusion in sub-Saharan Africa before the Second World War.63
In Uganda, for example, blood grouping was first reported by the Kampala Medical Laboratory in 1931. There were similar reports from Tanganyika in 1932 and the Gold Coast in 1935.64 The 1939 annual health service report for French West Africa stated there were 140 blood group tests by hospital laboratories (24 for Africans), a figure that rose to 891 the following year (813 for Africans).65 In the Belgian Congo, similar sources reported 18 blood group tests in 1929 in Katanga, rising to 46 (22 for Africans) in 1939. Similarly, the bacteriology laboratory in Léopoldville reported 75 blood group tests (27 for Africans) in 1937.66 Figures from these reports are, therefore, undoubtedly a low estimate of transfusions done, since they could be and certainly were also done using blood donated by a relative or member of a hospital staff, without assistance of donor panels, and without being reported.
TABLE 1.1. Transfusions reported (more than 10 annually) in African colonies by World War II
| Colony | Date and notes |
| Belgian Congo | 1924 Haut Katanga, 300 patients; 2 other locations by 1940 |
| Uganda | 1931 first blood-grouping reports from Kampala |
| Kenya | 1932 Nairobi, 24 donors |
| Tanganyika | 1932 first blood-grouping reports |
| French Congo | 1933 Brazzaville |
| Ethiopia | 1935 first report of transfusion service in Addis Ababa |
| Gold Coast | 1935 first blood-grouping reports |
| Sierra Leone | 1936 first reports, 38 in 1938 |
| Rhodesia | 1939 report of 903 donors |
| Senegal | 1940 report of 813 blood groupings, French West Africa |
| French Soudan | 1941 300 blood-grouping reports |
| Sources: D. Spedener, “Le traitement des pneumonies des noirs par transfusion de sang des convalescents,” Bulletin médical du Katanga 1 (1924): 234–38; Germond, “Statistiques des cas de pneumonie traités par transfusion de sang de convalescents,” Bulletin médical du Katanga 1 (1924): 243; Uganda Protectorate, Annual Medical and Sanitary Report, 1931, 49; Kenya Colony and Protectorate, Medical Research Laboratory Annual Report, 1933; Tanganyika Territory, Annual Medical and Sanitary Report, 1932, 67; Inspection générale du Service de santé, AEF Colonie du Moyen-Congo, “Rapport annuel,” 1933, 111, and 1934, 124, box 117, IMTSSA; R. Ghose, “History of Blood Transfusion in Ethiopia,” Ethiopian Medical Journal 31, no. 4 (April 1963): 208; Gold Coast Colony, Departmental Reports, 1935–1936, 44; Sierra Leone, Annual Report of the Medical and Sanitary Department, 1936, 51; Report of the British Red Cross Society for 1939, 92, 95; AOF, Service de santé, Rapport annuel, 1940, 79; AOF, “Inspection générale des services sanitaires et médicaux, Rapport annuel 1941,” 115, box 4, IMTSSA. |
The records between the wars, therefore, show that all conditions existed in sub-Saharan Africa that were necessary for blood transfusions to take place: availability of donors, willing patients, and technical ability to do transfusions. They also suggest that the numbers were limited, primarily by the availability of Western medical doctors and facilities to do transfusions. There is also a hint of how innovation took place, usually through connections to knowledge and resources outside the established colonial medical structures (e.g., Red Cross, universities, mining). With this overview of the interwar period as a base of reference, the changes can be better appreciated that took place during and after the Second World War that dramatically spread and increased the use of blood transfusion in Africa.
2 BLOOD TRANSFUSION FROM 1945 TO INDEPENDENCE
There was sufficient Western medical infrastructure to make blood transfusions possible in Africa between the world wars, but this did not immediately lead to large numbers of transfusions. The rapid increase came after the Second World War, for a number of reasons. The explanation of how this rapid growth happened in most colonies is best understood by the changes in general conditions that increased the number of hospitals and brought more doctors to Africa who were able to use transfusions.
The period after 1945 in the history of modern health care in Africa is usually subsumed together with the rest of colonial rule and contrasted with the dramatic growth of health facilities after independence. Compared to the interwar colonial period, however, there was a sharp increase in hospital construction and training of medical personnel after 1945. Construction of new and modern hospital facilities after the Second World War was not only the most visible evidence of these investments but also the one with the greatest direct impact on transfusions. In French West Africa, for example, thanks in part to the FIDES (Fonds d’investissements pour le développement économique et social), created in 1946, the number of “general hospitals” rose from two in 1938 (both in Dakar) to twelve in 1952, with a corresponding rise in the number of hospital beds from 1,630 to 3,810. In Belgium the Van Hoof–Duren Plan of the 1940s called for the creation of a medical-surgical center with 100 to 150 beds in each of the 120 administrative sectors of the colony.1 Similar projects were supported by the Colonial Development and Welfare Acts of 1940 and 1945 in Britain, such as a ten-year plan in 1946 for health in Nigeria that established a medical school and university hospital at the University of Ibadan in 1948.2
The growth of health facilities after the war created more places where transfusions took place, while at the same time changes in techniques during the war made it even easier to practice them. Among the most important innovations was the ability to store whole blood as well as to separate and freeze-dry plasma. Although the latter technique was never widely used in Africa, in those places where electricity and refrigeration came to hospitals, it was feasible to have “blood banks” (in the sense at least of being able to store blood). The latter by no means replaced the practice of drawing blood from a donor at the time of transfusion in many parts of Africa, but the overall result of changes in transfusion practice during the Second World War was to make its use in treatment of patients much more routine. This was reinforced by changes in training and practices in Europe that made doctors who came to Africa after 1945 much more familiar with transfusion.
Conditions in Africa during and after the Second World War
With one important exception, the immediate effect of the Second World War was to hinder the use of transfusion in African colonies because resources were diverted elsewhere. In addition, there was almost no fighting in sub-Saharan colonies that might have prompted the need for transfusion, and generally the region was too remote to be a source of blood for troops fighting elsewhere. Kenya reported limited blood donations for military and civilian patients during the war, but there were no programs in British Africa, such as were instituted in India or Australia, whereby large-scale blood collection services were established to support the fighting
