Jeremy Laurance: Surgeon wanted. No previous experience necessary

Medical Life

He had very good hands" was the phrase Christiaan Barnard used of a colleague, and it is safe to assume he was not complimenting him on his manicure. But given that Barnard is probably the most famous surgeon in the world, who can have deserved such an accolade? And what does it reveal about those who wield the knife?

When Barnard performed the first heart transplant at Groote Schur hospital in Cape Town, South Africa in 1967, it was the medical equivalent of putting a man on the moon. The story went around the globe and came to symbolise medicine's dominion over life and death. The South African surgeon joined the ranks of the jet set, travelling the world until his death aged 78 in 2001.

Now a new documentary has revealed the key role played by an unlikely assistant in one of the most seminal medical events of the last century. Hamilton Naki was a black gardener who tended the tennis courts at Groote Schur, who was called one day by Barnard's predecessor to assist in the laboratory with an experiment on a giraffe.

Although Naki had no formal education, he demonstrated unusual dexterity and exactitude – skills crucial in surgery. He worked his way up to be a principal laboratory technician and instructed more than 3,000 surgeons who made the pilgrimage to Groote Schur following the heart transplant. Although his role in the operation itself is disputed, it is clear that Naki was a key member of the team.

'Hidden Heart', a Swiss-made documentary, reveals how Naki's involvement was effectively wiped from the historical record by the apartheid government – the man himself retired on a gardener's pension of £70 a month in 1991 – while the operation was trumpeted as one of the proudest moments in South African history.

But what is equally fascinating is how a man with no formal education could find himself playing a key role at the centre of one of the most formidable medical teams in the world. Barnard admitted that Naki "had better technical skills, than I did", was a "better craftsman, especially when it came to stitching", and had "very good hands in the theatre".

It is reminiscent of the admission by Sigmund Freud that he was not a particularly good analyst. He may have invented the discipline, but he acknowledged that others, such as his friend, Willhelm Fleiss, were more adept at excavating the human psyche.

No discipline has longer or more intensive training than medicine. Yet years at the operating table cannot trump the contribution of innate skill. When keyhole surgery came in 20 years ago, some surgeons, including those at the top of their game, found they were unable to make the transition.

Now we learn that a gardener was more adept with a scalpel and needle than the world's most famous surgeon.

Are surgical skills less exclusive than we thought? Nurse practitioners and operating department assistants have long stitched and cut. Perhaps the story of Hamilton Naki will finally bring them into the limelight.

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