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  • The History of Blood Transfusion in Sub-Saharan Africaby William H. Schneider
  • Luise White
William H. Schneider. The History of Blood Transfusion in Sub-Saharan Africa. Perspectives on Global Health. Athens: Ohio University Press, 2013. ix + 239 pp. Ill. $32.95 (978-0-8214-2037-9).

This is the first ever continent-wide history of blood transfusion, and as such it has a range of details and stories that I, at least, didn’t know. At the same time it does not have much analysis, so the details and stories tend to dangle. Nevertheless, the details are awesome and the story is a good one. Blood transfusion began on a wide scale only during World War I. The first transfusions in Africa began shortly after that, in the early 1920s. They were a last resort of treatment, to be sure, as they were done without reference to blood groups. Doctors in remote areas transfused [End Page 148]small amounts of blood—from “a healthy, solid European, with no apparent defects” (p. 12)—and waited to see if there were adverse reactions. If there were none, more blood was transfused. By the 1930s, when the well-resourced hospitals of Kampala, Nairobi, and Dakar had facilities to determine blood types, blood transfusion was commonplace enough to be the stuff of anecdotes. Africans hesitated to donate blood, even for relatives, because they feared they would become permanently weakened or that they would “somehow” contract the disease of the person they were helping to cure. By 1960, however, those same hospitals reported that the greatest impediment to transfusion was not the prejudice of Africans but the shortage of trained staff and proper equipment.

The real prize of this book however is its history of blood transfusion between 1945 and the mid-1970s. From the end of World War II until 1960, the urban Belgian Congo and the Copperbelt of Northern Rhodesia had medical services and transfusion technologies at least equal to those in Nairobi and Dakar. Why this was so is not one of the questions Schneider pursues, but the late colonial and early independent era was—almost everywhere but the former Belgian Congo—an era of unprecedented growth in the medical care available in African cities, the development of blood banks, and an involvement of African governments in health policies that is hard to imagine at a time when we think of most medical interventions in Africa as donor-driven. Who knew, for example, that Jomo Kenyatta, Kenya’s first president and easily an iconic nationalist hero, was a huge proponent of blood transfusion and that he designated a week in October for citizens to donate blood? Even with the uneven figures available from different African cities, Schneider shows an increase in blood transfusions in Africa from 1960 to 1972: the numbers trebled in Nairobi, and went up by almost 400 percent in Yaoundé, Cameroon, and more than doubled in Brazzaville, Dar es Salaam, Kampala, and Chad. Schneider does not tell us why certain cities had such a rate of increase—Brazzaville and Yaoundé had Instituts Pasteur—but the numbers are impressive, and put into high relief the decline in health services in Africa after 1972. In another table in another chapter, Schneider shows the percentage of African government expenditures on defense and health between 1972 and 1978. In that period, the only country to spend more on health than on defense was Ghana.

The story of blood transfusion in Africa after 1978 is as sad as any story of government-funded public good in sub-Saharan Africa, but with the exception of an excellent chapter on blood transfusions and the AIDS epidemic, albeit with no mention of structural adjustment programs, he hardly writes about the years after 1980. He spends more pages than are necessary on what is written on blood donation posters. It is in the history and politics of donation of blood that Schneider is at his least analytical. If Africans did not donate blood because of their prejudices, who then donated blood, and how willingly did they donate it? In colonial times, colonial soldiers gave blood, but after independence most blood donors were students in African...

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