An unsung surgical pioneer

by Jayantha Senevirathna

MEDICINE: In the wider world, irrespective of riches or social standing, some people lead more interesting lives than others. They are not stuck in dead-end jobs with little prospect of creativity or even a career change. When given the right signal, they start to perform miracles as the need arises.

And so, Hamilton Naki, a teenage black African gardener at Groote Schuur Hospital, Cape Town, South Africa, ended up with an honourary degree in medicine from the University of Cape Town. It was a slow and sustained intellectual achievement that no one could ever be equalled.

Professor Christian Barnard, pioneer in open-heart surgery, publicly accepted that without Hamilton Naki's unusual surgical brilliance, the world's first ever heart transplant would never have happened on December 3rd, 1967.

On that fateful day, Dennis Darvall, while crossing a street in Cape Town to buy a cake, was knocked down by a car.

Her mother died on the spot, but Dennis, unconscious, was admitted to Groote Schuur Hospital. Her head injuries were so severe that she was pronounced brain-dead, but the heart was performing at its best.

Yet it was revealed that she could not stay alive without life support and the resuscitation team suggested to stop supporting her survival and Dennis's father gave his permission to donate her heart to Louis Washkansky, the world's first recipient of a transplanted human heart.

So, Professor Christian Barnard, the young handsome cardiac surgeon, ordered to prepare the theatre for the historical event. As to the complexity of the operation, some elements were not only mission-critical but also time-critical. He well knew Hamilton Naki's uncanny abilities in surgery, and his razor sharp mind in attention to the last detail in demanding circumstances.

Yet the apartheid laws of the land forbade a Black to have dealings with white blood, let alone entering a white operating theatre.

Even for people in the calibre of Hamilton Naki, well appreciated within the medical community, the stringent racial laws of successive governments denied careers deemed for whites.

But Hamilton Naki, gardener turned medical technician, with nimble fingers and dexterous flicks of his wrist, was a master in surgery, and was indispensable. With dogged persistence of the chief transplant surgeon, Professor Christian Barnard, hospital authorities made a rare exception.

They included Hamilton on the historical medical team on a condition that a layman would never have been tolerated. He had been asked to participate, but on the condition of keeping his involvement a secret.

He took it well. An ethical professional of vision, he focused on his duty, rather than salary, perks and name boards that adorn it.

By being a rare intellect race, creed and caste were immaterial to him while it was second nature to some white citizens.

He accepted the opportunity, which led us to admire his prowess as a surgical pioneer in heart transplants some 30 years later.

On that historic day in December, Professor Christian Barnard was busy preparing Louis Washkansky to receive the heart at the main theatre, while Hamilton Naki was deftly plucking the donated heart of Dennis Darvall from another theatre, a few metres away.

For the global media, Louis Washkansky and Dr. Christian Barnard were the focus of attention, and Dennis Darwell was almost a forgotten dead figure.

But Hamilton was totally focused.

He possessed the diverse skills needed in extracting a pumping heart, hosing every trace of blood and, finally, setting the heart pumping again using electrodes before passing on for transplantation, and Dr. Christian Barnard knew that he can rely on Hamilton's skills.

So the black hands extracted the heart from the white corpse, and prepared it for the impending transplantation.

Finally, the heart was passed onto Dr. Christian Barnard's hands and he became a celebrity overnight. The fact that Hamiton's part of extracting Dennis's heart was totally forgotten. It also needed the same technical, precision and mastery Dr. Christine Barnard possessed.

The young, handsome Dr. Christian Barnard who was quite photogenic played host to press quite often.

It is said that he dated famous Hollywood stars of the day like Sophia Lauren quite often. But even on the day of the historic operation, Hamilton Naki, a down-to-earth character, prepared to set off for home early next morning. In some of the post operation photographs Hamilton Naki's ever smiling face was seen without his knowing.

When asked, authorities said that he was just a cleaner. Even though the playing field was uneven, only for him, he played brilliantly. It was enough for him.

Dr. Christian Barnard revealed the real story in 1991 to a television crew about preparing a documentary when South Africa finally emerged from the darkness of apartheid. Hamilton was born to a poor family on June 13, 1926, at Ngcangane village in the Transkei region of Eastern Cape. Like many other Black youngsters at that time, he helped to herd cattle, barefoot, before and after lessons at the village school.

A school dropout at the age of 14, he sensed that cattle herding was not for him. So he went to Cape Town to find work. And found employment as an assistant gardener at Groote Schuur Hospital in the Cape Town University.

Naki was an intelligent worker. So when asked for a man who can assist in handling laboratory animals by medical faculty authorities he was recommended.

Thus an unofficial medical career of a great surgeon had begun. He cleaned, weighed, shaved and injected animals which were to be used by Medical Doctors of the lab in demonstrations to medical students.

Inborn enthusiast of medicine, even without formal education, Hamilton Naki absorbed each and every medical term using his eyes and ears.

Young doctors and medical students were always amazed by his grasp of anatomical terms and his instinctive, analytical mind.

He used to say jokingly: "I steel with my eyes". Later in his life after South Africa's transition to democracy, Dr. Christian Bernard confessed that Hamilton Naki had better technical skills than him. In this new form of government, his achievements became more widely known, and he was recognised with an honourary degree in Medicine from the University of Cape Town.

In December 2002, Hamilton Naki received the highest honour that could be bestowed by the South African state: the National Order of Mapungubwe.

Even after getting such distinguished awards he remained unmoved.

"Those days you had to accept what they said as there was no other way you could go because it was the law of the land." Apartheid!