Dr John Watson-Williams enters the scene
Late in 1986, shortly before the EC became involved, the acting
President of the Uganda Red Cross Society, Edward Mungati, via the American Red
Cross invited Dr. John Watson-Williams, a British haematologist (i.e. an expert
on blood) who had also worked in America, to visit Uganda and advise the URCS
about how to revive the blood transfusion programme which the Red Cross had
previously carried out before civil strife made it impossible. The visit was
made in April 1987, the same month that Dr Lieve Fransen was in Kampala on
behalf of the EC, and Dr Watson-Williams made recommendations on much the same
lines as Dr Fransen, but independently.
Dr John Watson-Williams (right)
He suggested the construction of a blood bank in Kampala, a
national volunteer donor programme, and a blood distribution system to deliver
30,000 units of blood a year. The American Red Cross Society agreed to designate
Dr Watson-Williams as a volunteer delegate to the URCS, and the Carnegie
Corporation of New York provided a $25,000 grant for a feasibility study.
This study was carried out from September 1987 until May 1988.
During that time Dr Watson-Williams worked at the New Mulago Hospital, Kampala,
and at the Virus Research Institute in Entebbe. He was able to report that a
volunteer blood bank programme would probably be successful. He was also able to
evaluate different ways of HIV testing and blood typing, and to select those
which would be most cost-effective in a national programme.
The director of the AIDS Control Programme, Dr Sam Okware, and the
Ministry of Health gave encouragement and invited Dr Watson-Williams to assist
in the planning for the EC-sponsored Nakasero Blood Bank project, so bringing
together the two parties interested simultaneously in much the same contribution
to restoring Uganda's health system. So it came about that in July 1988 Dr.
Watson-Williams was chosen to be the EC's technical assistant for the project,
starting in September 1988.
Dr Watson-Williams came to the Uganda project with strong ideas
about how best to organise blood transfusion services in Africa. He had already
spent time in Nigeria and elsewhere studying the problem, and had already
recognised that an efficient blood transfusion serice in Africa is a quite
different proposition to a transfusion service in, say, Europe. In Europe, blood
is needed for emergency operations, for example for adults after a car crash,
and the electricity supply can be relied on for refrigerating stored blood. In
Africa, both the need and the circumstances are different, with children and
maternity cases being the main recipients, and electricity supplies often
From his previous experience in Africa he had also concluded that
one of the critical deficiencies in patient care was the scarcity of trained
laboratory staff and the resulting low level of diagnostic testing at the
peripheral hospitals where most of the patient care is given. If each hospital
also expected the laboratory staff to recruit, screen and bleed blood donors,
and to test the blood for markers of transmissible diseases, this would further
reduce their ability to provide essential diagnostic testing.
However, if a centralised blood donor recruiting, blood collection
and blood screening and testing service was available, the hospital technician
would be provided with a constant and adequate supply of safe blood and would
only need to perform compatibility testing for each transfusion. The benefits of
this could then be maximised by the development of a high-level centre for
training of blood transfusion staff, both for local programmes and for
programmes in other developing countries, and a demonstration project could be
set up that medical decision-makers from other countries could observe and learn
from. So Uganda became, for Dr Watson-Williams, a chance to demonstrate that his
theory would work in practice.
UBTS Blood Units Collected
Blood units Processed - UBTS 1994 -
Anti-HIV+, Hepatitis+, Inadequate units
HIV Frequency of NBB Blood Donors -
% positive for anti-HIV 1989-1994
HIV Frequency of NBB Blood Donors -
% positive for anti-HIV