Development of the Red Cross Blood Transfusion Service in PNG: Nick Booth

Peter Bernard Booth was born in England on 30 October 1918. He did well at school and gained a scholarship to Cambridge University, where he studied Medicine. He graduated LRCP MRCS in 1943, and was immediately commissioned into the Royal Army Medical Corps. The RAMC sent him to do a course in Blood Transfusion, which shaped the rest of his life.

After completing the course, he was sent to Poona, India, in preparation for the mass casualties expected as the Japanese pushed through Burma into India. In fact, this never occurred and he spent his time running a Blood Transfusion Service that catered mainly for the Indians of Poona, and organising Army concert parties. This may explain why he so enjoyed the 1980s television comedy It ain’t ‘arf hot, Mum, about a wartime British Army concert party in India.

Before going to India, Peter married his first cousin, Pauline James. A son, Nicholas Peter (Nick) was born in January 1945, and did not see his father until he was two and talking.

On his demobilisation, Peter obtained the position of Deputy Director of the North London Blood Transfusion Centre, at that time located in a building in Barnet erected as a gas decontamination centre early in the war. Around 1950, this was relocated into quite grand purpose-built accommodation next to the Edgware Hospital, and renamed the North-West London Blood Transfusion Service.

Around the same time, Pauline died after a long and difficult struggle with tuberculosis, for which there was no cure at the time. Not all that long after, Peter was visited at work by Kathleen (Kitty) Staynes, who has also been in the RAMC in Poona. The friendship was renewed, but she went off to do research in San Francisco. He wooed her by letter and in 1952 she came back to England and married him. A daughter, Susan Averil, was born in April 1953.

The Director of the NW London BTS was a large and jovial Welshman named Jimmy James, who was usually to be found at the receiving end of a large Scotch whisky. He did not like filling out forms for the British National Health Service, and so passed them all on to his Deputy. Peter did not enjoy the forms either, but did not have anyone he could pass them on to.

In 1962, Peter saw an advertisement in the British Medical Journal for the new position of Director of the Red Cross Blood Transfusion Service in Papua New Guinea. He applied and, perhaps rather to his surprise, was offered the position. When he told his children about the move, there was an immediate dive for our World Atlas (dating from about 1900) to find out where “Port Moresby” was.

The trip out to Australia, paid for by the Red Cross, was on the P&O liner Orcades, stopping at many places on the way. After meeting Red Cross Blood Bank staff in all the Australian capital cities, the family finally arrived in Port Moresby in October 1962, to find that nobody seemed to be expecting them. There was no house available, so they were put into a bungalow in the grounds of Government House. It was rather bizarre living in these idyllic surroundings, listening to the ABC news about the Cuban Missile Crisis and expecting the start of WW3. Before long, the wheels of the Administration moved a bit, and they were allocated a three-bedroom Admin house next to Boroko oval and conveniently close to Taurama Hospital.

There was already the skeleton of a Blood Transfusion Service in existence, responsible (at least in theory) to the Queensland Red Cross BTS. There were two nursing sisters in Port Moresby (Bernadette Beebe and Barbara Gimpel), one in Lae, and one in Rabaul (Kath Tweedy); together with various national orderlies, drivers, etc. It goes without saying that these sisters were remarkable women, used to running their own little domains, who were not entirely sure about this newly-appointed Pommie who might try to tell them what to do. It took some diplomacy to get them on side.

The Public Works Department had arranged for the erection of a new Blood Transfusion Centre at Taurama Hospital, conveniently placed between what were then called the European and Native Wings. It was pretty much an empty shell, so Peter’s first task was to order and install the equipment needed to make it functional. In a remarkable demonstration of public service intelligence, the new building had an insulated cool room for the storage of blood, but there was no refrigeration equipment.

Within a few months, the equipment was in place, the cool room was working, and a routine had been established in Port Moresby. At intervals of around two weeks, loads of equipment would be put into the BTS Holden station wagon, and almost the entire staff would head off to do a “mobile bleed”. In theory, blood donations were always voluntary. This was true in practice when the mobile bleed was at an office in Konedubu; but perhaps not when it was at the Army or Police barracks, while the prisoners at Bomana Jail had no choice.

When a blood donation is taken, the donated blood goes into a plastic bag, but there are also small samples taken for testing. One test is to check the blood group of the donated blood: is it A or B or O; is it Rhesus positive or negative? These tests require expensive reagents. It was soon found that all Papuans and New Guineans are Rhesus positive, so Peter stopped testing for the Rhesus factor.

In one way, the absence of Rhesus negative was a good thing, as grave problems can arise when a Rhesus negative woman carries a Rhesus positive child. On the other hand, Rhesus negative people cannot receive a Rhesus positive blood transfusion, so Peter’s nightmare was that an airplane might crash, laden with Rhesus negative Australians, and there would not be enough Rhesus negative blood for them. Fortunately, this never happened; but there was one car accident on Three Mile Hill that involved five drunk, Rhesus negative Australians and greatly taxed the supply of negative blood.

The Health Department fairly quickly worked out that, while the Red Cross had Peter as a Serologist, they could have Kitty as a Haematologist. She was rapidly offered a position as Specialist Pathologist at Moresby Hospital.

The mid-1960s were a time of great expansion of the PNG Public Health system. As new Base Hospitals were set up in places such as Wewak and Mt Hagen, a proper Pathology laboratory was provided and hospital staff were able to take blood donations. However, there was a limited supply of donors, particularly of Rhesus negative blood, and so there could be a shortage if a patient required a significant quantity of blood.

On the other hand, the Port Moresby Blood Bank had something of an over-supply of blood. Once a blood donation has been taken, there is a limited time within which it can be used for a transfusion. After that time, it had to be sent to the Commonwealth Serum Laboratories for processing into useful blood by-products.

Peter therefore thought that it should be possible to provide an emergency blood supply to remote areas by air from Port Moresby. Some experiments were undertaken with a five-gallon can lined with thermal insulation and it was found that these cans, if kept in the shade, would keep blood quite well for six hours or more.

The Red Cross therefore got hold of several five-gallon cans, lined them with thermal insulation, and painted the outside white with a Red Cross logo and wording: “URGENT! HUMAN BLOOD”. To guard against possible problems, Peter went and spoke with the freight managers of both TAA and Ansett-MAL, and was assured that any consignment of blood would be treated with special care.

Came the time that Wewak Hospital requested some blood. Two bags of suitable blood were selected and placed in one of the cans, which was taken to the airport and placed in the tender care of one of the airlines. A job well done. Except that, in the afternoon, there was a message from Wewak: the plane had arrived, but there was no blood on board. Investigations followed, and it became obvious that, in transhipping freight from one plane to another in Lae, the can of blood had been forgotten and had been left on the tarmac, in full sun, for at least six hours. The airline’s offer to get the can onto the next plane from Lae to Wewak did little to diminish Peter’s displeasure, although fortunately the patient managed to survive.

Even if the records were available, it would be tedious to list each advance in providing blood transfusion facilities. It is enough to say that, within ten years, the Red Cross and the Public Health Department had co-operated to ensure that was a functioning national blood transfusion service. All the base hospitals had a blood bank and a pathology laboratory, and there were arrangements to supply blood to the smaller hospitals.

As Independence drew closer, the location of the house next to Bomana Oval became something of a problem. Various people had always used the garden as a shortcut, but some of them decided that they would break into the house on the way through. The position of Director of the Blood Transfusion Service in Christchurch was advertised. Peter applied, and this time was not surprised when he was appointed.

However, a few years later, his successor in Port Moresby resigned. The PNG Government had a Papuan in mind to be the Director of the Blood Transfusion Service, but felt that he had not yet had enough experience. Peter was approached to act as Director for a year, during which he would mentor the prospective Papuan appointee. He obtained approval from the Christchurch Blood Bank, and returned to Port Moresby.

At the end of his secondment, he returned to Christchurch to find that, as he said, somebody had moved into his office and they did not seem very pleased to see him. As he had a standing invitation from the University of PNG to teach there, he went back to Port Moresby as a Visiting Professor in the Medical School. As a bonus, the University also got Kitty to teach haematology to the unsuspecting students.

After a year or so, Peter was approached by the Australian Government to undertake an Australian foreign aid project of setting up a blood transfusion service in Nepal. He accepted, and spent three interesting years in Nepal.

Officially this was a half-time appointment. His interpretation of this was that he worked full-time for three months, organising what needed to be done. Then he and Kitty would hire a Land Rover and a driver, and set off for three months touring around the Himalayas. On returning to Kathmandu, he would find that not much had been achieved in his absence and so would take up where he left off.

By the end of his time there, a blood bank had been built and had been officially opened by Nepalese Royalty. How efficiently it now operates is anybody’s guess.

After this, Peter and Kitty retired; initially to their house in Sumner, Christchurch, with its view up the coast to Kaikoura. The steep slopes there became too much for them, and they moved to a small town house in Motueka, near where their daughter Susie lived. Peter passed away in February 1990, and Kitty followed in January 1993. Because of their wartime service, the NZ Army provided memorial plaques which are displayed in the Motueka cemetery with a view behind them up the river and into the mountains.

 

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