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June 20, 2005

BehindTheMedspeak: Hamilton Naki — The surgeon who never was

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On December 3, 1967, the body of a brain–dead young woman was brought to Groote Schuur Hospital in Cape Town, South Africa.

Her still–beating heart was removed by Hamilton Naki (above).

50 feet away, on the other side of a glass panel within the same operating suite, Dr. Christiaan Barnard removed the damaged heart of Louis Washkansky.

Barnard placed the heart of the young woman within Washkansky's chest cavity and it began to pump Washkansky's blood through his arteries.

Overnight, Barnard became the most celebrated doctor in the world.

Naki, as usual, caught the bus home to his one–room shack, without electricity or running water, in the black township of Langa.

In some of the post–operation photographs Naki inadvertently appeared at Barnard's side; he was a cleaner, or a gardener, the hospital explained.

Naki's obituary, describing the astounding life of an extraordinary man whom Barnard admitted was probably a better surgeon that he was, appeared in the June 9 Economist; it follows.

    Hamilton Naki, An Unrecognised Surgical Pioneer, Died on May 29th, Aged 78

    On December 3rd, 1967, the body of a young woman was brought to Hamilton Naki for dissection.

    She had been knocked down by a car as she went to buy a cake on a street in Cape Town, in South Africa.

    Her head injuries were so severe that she had been pronounced brain-dead at the hospital, but her heart, uninjured, had gone on furiously pumping.

    Mr Naki was not meant to touch this body.

    The young woman, Denise Darvall, was white, and he was black.

    The rules of the hospital, and indeed the apartheid laws of the land, forbade him to enter a white operating theatre, cut white flesh, or have dealings with white blood.

    For Mr Naki, however, the Groote Schuur hospital had made a secret exception.

    This black man, with his steady, dexterous hands and razor-sharp mind, was simply too good at the delicate, bloody work of organ transplantation.

    The chief transplant surgeon, the young, handsome, famously temperamental Christiaan Barnard, had asked to have him on his team.

    So the hospital had agreed, saying, as Mr Naki remembered, "Look, we are allowing you to do this, but you must know that you are black and that's the blood of the white. Nobody must know what you are doing."

    Nobody, indeed, knew.

    On that December day, in one part of the operating suite, Barnard in a blaze of publicity prepared Louis Washkansky, the world's first recipient of a transplanted human heart.

    Fifteen metres away, behind a glass panel, Mr Naki's skilled black hands plucked the white heart from the white corpse and, for hours, hosed every trace of blood from it, replacing it with Washkansky's.

    The heart, set pumping again with electrodes, was passed to the other side of the screen, and Mr Barnard became, overnight, the most celebrated doctor in the world.

    In some of the post-operation photographs Mr Naki inadvertently appeared, smiling broadly in his white coat, at Barnard's side.

    He was a cleaner, the hospital explained, or a gardener.

    Hospital records listed him that way, though his pay, a few hundred dollars a month, was actually that of a senior lab technician.

    It was the most they could give, officials later explained, to someone who had no diploma.

    There had never been any question of diplomas.

    Mr Naki, born in the village of Ngcangane in the windswept Eastern Cape, had been pulled out of school at 14, when his family could no longer afford it.

    His life seemed likely to be cattle-herding, barefoot and in sheepskins, like many of his contemporaries.

    Instead, he hitch-hiked to Cape Town to find work, and managed to land a job tending lawns and rolling tennis courts at the University of Cape Town Medical School.

    A black—even one as clever as he was, and as immaculately dressed, in a clean shirt, tie and Homburg hat even to work in the gardens—could not expect to get much further.

    But a lucky break came when, in 1954, the head of the animal research lab at the Medical School asked him for help.

    Robert Goetz needed a strong young man to hold down a giraffe while he dissected its neck to see why giraffes did not faint when they drank.

    Mr Naki coped admirably, and was taken on: at first to clean cages, then to hold and anaesthetise the animals, then to operate on them.

    The lab was busy, with constant transplant operations on pigs and dogs to train doctors, eventually, for work on humans. Mr Naki never learned the techniques formally; as he put it, "I stole with my eyes".

    But he became an expert at liver transplants, far trickier than heart transplants, and was soon teaching others.

    Over 40 years he instructed several thousand trainee surgeons, several of whom moved on to become heads of departments.

    Barnard admitted—though not until 2001, just before he died—that Mr Naki was probably technically better than he was, and certainly defter at stitching up afterwards.

    Unsung, though not unappreciated, Mr Naki continued to work at the Medical School until 1991.

    When he retired, he drew a gardener's pension: 760 rand, or about $275, a month.

    He exploited his medical contacts to raise funds for a rural school and a mobile clinic in the Eastern Cape, but never thought of money for himself.

    As a result, he could pay for only one of his five children to stay to the end of high school.

    Recognition, with the National Order of Mapungubwe and an honorary degree in medicine from the University of Cape Town, came only a few years before his death, and long after South Africa's return to black rule.

    He took it well.

    Bitterness was not in his nature, and he had had years of training to accept his life as apartheid had made it.

    On that December day in 1967, for example, as Barnard played host to the world's adoring press, Mr Naki, as usual, caught the bus home.

    Strikes, riots and road blocks often delayed it in those days.

    When it came, it carried him—in his carefully pressed suit, with his well-shined shoes—to his one-room shack in the township of Langa.

    Because he was sending most of his pay to his wife and family, left behind in Transkei, he could not afford electricity or running water.

    But he would always buy a daily newspaper; and there, the next day, he could read in banner headlines of what he had done, secretly, with his black hands, with a white heart.

June 20, 2005 at 10:01 AM | Permalink


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Please note the following correction to this story, which turned out not to be true. This is an extract from the British Medical Journal from last week.

Correction
Hamilton Naki

Our obituary of Hamilton Naki (BMJ 2005;330:1511) claimed that Mr Naki, a former gardener, had directly assisted Christiaan Barnard in the world's first heart transplant, and that he was the unsung hero of this pioneering work, who was denied due recognition at the time because of South Africa's apartheid system. The obituary was based on secondary sources, including obituaries that had already appeared in other publications, such as the Economist and the New York Times (both 11 June 2005), and including two interviews with Mr Naki, one in the careers section of the BMJ ( BMJ Career Focus 2004;328: 98[Free Full Text]), and one with BBC online (http://news.bbc.co.uk/1/hi/world/africa/3011105.stm).

Since publication the BMJ has learnt that some of our claims about Mr Naki were false (see Letters, p 517); although he did learn how to perform transplants on animals in the laboratory, he was never involved in surgery on human subjects, and did not remove the heart of Denise Darvall before Barnard transplanted it into Louis Washkansky. The Economist has also since expressed its regret at being caught up in this misapprehension (www.economist.com/people/displayStory.cfm?story_id=4174683).

Chris Logan, the author of a biography of Christiaan Barnard (Celebrity Surgeon: Christiaan Barnard—A Life), told the BMJ, "Naki was a truly remarkable figure who learnt how to perform liver transplants on animals in the laboratories...he was a highly valued member of Barnard's research team. Against the backdrop of apartheid South Africa, for an uneducated black man to achieve this was indeed astonishing in itself.

"But he did not at any stage assist in the first or subsequent human heart transplant operations, nor could he have done under the apartheid laws at the time."

Posted by: Nicola | Sep 11, 2005 8:21:06 AM

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