Following the Red Cross model in British colonies, blood was usually expected to be donated voluntarily during this period from the Second World War to independence, but French colonies generally followed the metropole model, where the government set a price to compensate for the effort to make a blood donation.16 There were pressures, however, that produced a mixture of paid and voluntary donation everywhere. In some of the British colonies, for example, there were hospitals that did not rely entirely on Red Cross voluntary donors; thus there was already a mixed approach before independence.17 Likewise, both the Red Cross volunteer system of collection and the Dakar center recruited unpaid donors from the Westernized African classes and workforces: army personnel, civil servants, and factory workers, but above all older schoolchildren and prisoners. The practice in Senegal was that if donors came to give blood at the transfusion center, they were paid for their trouble and fed, but donors at mobile units on-site were not. The question of who donated and who used blood will be examined in greater detail in chapters 4 and 5. Both groups grew significantly during this time period. The most important categories of patients receiving transfusions were general medicine (including accidents and emergencies) and surgery, along with maternity services and pediatrics if these specialties were available.
After independence, the organization of transfusion services entered a new phase, with most countries accelerating expansion by building provincial hospitals to serve regional needs better. This was also in response to the higher cost and slowness of transport that occurred in the centralized model. Other countries, which had never been able to centralize, such as Nigeria and Congo/Zaire, left it to the local hospitals to arrange for their own transfusion services, sometimes with the assistance of the Red Cross, sometimes with a paid service, and sometimes both. Thus, after independence there was a general swing away from centralization and its high costs, toward a middle position of mixed organization with limited regional services at best, and hospital-based means to supplement or complement blood collection and testing. In general, this move was driven by the continued increase in the use of transfusion and the corresponding need for more donors, which had accelerated in the last ten to twenty years of colonial rule.
Transfusions in French African Colonies after the Second World War
In most African colonies, the Second World War diverted resources elsewhere and reduced the practice of blood transfusion. The major exception to this, as mentioned above, was Senegal, where shortly after the Allied invasion of North Africa planning began for the Pasteur Institute in Dakar to collect and ship blood to the front. This development had significant repercussions for the organization of transfusion services, not just in Senegal but all of French West Africa.
In September 1943 the Dakar Pasteur Institute was instructed to prepare test sera for blood group determination of European and African troops stationed in Dakar and the Senegal-Mauretania colonies. In addition, the Pasteur Institute was to ship test sera to all colonies in French West Africa. By the end of 1943 over six thousand vials were prepared and 449 Africans and 166 Europeans had been tested.18 In 1944, Gaston Ouary, a surgeon in the colonial medical service at the African hospital in Dakar, was sent for training to the blood transfusion center established in Algiers by Edmond Benhamou.19 After Ouary’s return, he and two other colonial medical officers, Yann Goez and Jacques Linhard, secured the equipment necessary to set up a service at Dakar, including writing a manual for training personnel to draw blood and perform transfusions. In February 1945 these personnel, under the direction of the Pasteur Institute, began their transfusion service in an American army barracks on the outskirts of Dakar. By the end of the war enough blood was collected to provide over 225 liters for transfusion, mostly in the form of plasma but also some whole blood that was shipped to troops in Italy.
This wartime development also had an immediate impact on civilian blood transfusion, because once a source of blood was available, it was also used by the main civilian hospital in Dakar and the military Hôpital principal.20 In fact, French colonial authorities were quite aware of these extended benefits from the start. Thus, when Ouary returned from his training in Algiers, the transfusion manual he wrote with Goez and Linhard in November 1944 was not just for wartime use.21 As the head of the French colonial health service, Marcel Vaucel, stated in his introduction, the authors of the book had a double purpose: “to describe the new technique for their distant comrades, [and] to expand the uses of blood transfusion in tropical locales.” Benhamou repeated this in the conclusion to his preface: “We are sure that blood transfusion in all its forms (fresh whole noncitrated blood, stored whole blood, blood products) has a large future in our colonies, and that the notes so brilliantly edited and perfectly illustrated by Médecins-Commandants Ouary and Goez, and Médecin-Capitaine Linhard, will significantly aid in the diffusion and expansion of this heroic therapy, in war as in peacetime.”22 And, as the authors themselves put it, “We thought it useful to make these [scientific and technical developments] known to our comrades in the empire, who work without access to publications and who find it impossible to follow the medical progress achieved during this war.”23
The report that Ouary wrote to his superiors upon his return indicated the implications for infrastructure that predicted some of the subsequent developments of transfusion services in most African colonies and independent countries. “Today those who must care for the wounded demand larger and larger quantities of blood. Such an increase in transfusion has necessitated the creation of a new organization.” He pointed out that the Algiers center included:
• a laboratory to prepare the different types of blood, furnished by its own collection sources, mobile teams both lightly and fully equipped, and secondary fixed centers
• a warehouse to provide equipment and biochemical supplies
• a training center for reanimation-transfusion teams24
Following the plan of the Colonial Health Department, the Pasteur Institute continued the blood collection service in Dakar after the war; and although the amount of blood collected dropped to less than thirty liters in 1946, donations steadily grew thereafter.25 In 1949 the two large Dakar hospitals (Hôpital le Dantec and Hôpital principal) had organized transfusion services, the one in le Dantec being housed in a new surgery wing completed that year, with twenty-four beds dedicated to “reanimation.” Louise Navaranne, a doctor who accompanied her husband, Paul, to Dakar when he was assigned to the surgery service of le Dantec, directed the reanimation center. In 1950 she reported almost four hundred transfusions with whole blood and plasma supplied by the transfusion service.26
At this same time, credits were voted to establish a federal transfusion service that opened in 1951 to serve all colonies in French West Africa.27 In a letter to the governor general of French West Africa, the director of public health for the federation, Léon Le Rouzic, gave four reasons for the creation of the federal transfusion center, some of which proved to have clear foresight, combined with others that never saw the light of day. They were:
1. The important increase in the number of serious accidents occurring each day in Dakar and its environs.
2. The capital of AOF [l’Afrique Occidentale Française] has an airport that has become a crossroads of international airlines, and health facilities must possess a maximum of resources in case of an airline accident. It is noticeable that foreigners are concerned about the means at our disposal in this regard.
3. This facility will become part of the health facilities of greater Dakar.
4. The transfusion center will be a federal facility, with blood and plasma capable of being sent at any time to facilities in the interior by regular airlines or planes (military or civil) required for this.28
Linhard, who had trained in obstetrics at Bordeaux a few years following Ouary in the 1930s and was coauthor with him of the transfusion manual for use in the colonies, became the first director of the transfusion service in Dakar. The reports of the service quickly showed that sufficient donors were found that met the greatly increased demands for