Hamilton Naki

Surgical assistant to Christiaan Barnard

Hamilton Naki was a former gardener who brilliantly assisted Christiaan Barnard in his surgical research and open-heart surgery and was a key member of the team that carried out the world's first successful heart transplant at Groote Schuur Hospital, Cape Town, in December 1967. But, as a black man in apartheid South Africa, Naki never received the salary or status he deserved, and recognition came only late in life.

Hamilton Naki was a former gardener who brilliantly assisted Christiaan Barnard in his surgical research and open-heart surgery and was a key member of the team that carried out the world's first successful heart transplant at Groote Schuur Hospital, Cape Town, in December 1967. But, as a black man in apartheid South Africa, Naki never received the salary or status he deserved, and recognition came only late in life.

Around 1950, Naki had been tending the garden and rolling the grass tennis courts at the University of Cape Town for 10 years when the head of surgical research, Robert Goetz, asked him to hold a giraffe on which he was operating. Goetz, a Jew who had fled Nazi Germany, perhaps empathised with Naki as a fellow outcast. He was trying to discover why giraffes didn't faint when they lowered their heads to drink. Goetz was so impressed with Naki that he invited him to work in the lab, where he learned to anaesthetise animals, including giraffes.

Naki soon learned a wide range of surgical procedures, and he took over post-operative care of the animals. He could anaesthetise a pig and transplant a liver into it virtually single-handed. He became the laboratory's assistant surgeon and there was little that the surgeons could do that he couldn't. Naki credits Goetz with being his most important teacher.

Goetz eventually went back to Germany, but in 1956 Christiaan Barnard returned from America, where he had learned open-heart and heart-lung bypass surgery, and was eager to continue research and to innovate surgery in South Africa. Barnard used Naki as his anaesthetist and later as his principal surgical assistant, finding he had a remarkable ability to learn anatomical terms and recognise cardiac anomalies.

In the 1950s Naki worked with Barnard while he was developing open-heart surgical techniques, and developed his skills in experimentally transplanting hearts, livers and kidneys in animals while Barnard was treating patients. He had no formal training but was prodigiously intelligent, had a formidable memory, and learned by watching others. When Barnard developed arthritis in his hands, Naki's contribution became even more important.

Because he was black, the nature of his work was kept under wraps. He was promoted to technician and later to senior technician, and paid accordingly. This was the highest the university could take him under the apartheid laws. If any of the whites had described what Naki really did, they would have been prosecuted.

Naki's name does not appear on any of Barnard's research papers. When visitors flocked to see the man who had performed the world's first heart transplant, Naki kept in the shadows, and was obliged to describe himself as gardener and cleaner. Barnard, who vigorously opposed apartheid, spoke in Naki's praise whenever it was safe to do so, and entertained Naki at his home.

Hamilton Naki was born to a poor family in Ngcingane village, in the Transkei region in the Eastern Cape. He received six years of education, which was more than most. Aged 14, he hitched to Cape Town to find work and remained there, sending most of his wages home to his family.

He lived in appalling conditions in a tiny room in quarters for migrant workers in Langa, a black township on the Cape Flats. He would arrive at the lab every morning at 6am, impeccably dressed in a well-pressed suit, shirt and tie, and Homburg hat, carrying an umbrella, a newspaper, and a bible. He worked until 4.30pm, spending his lunch break reading his bible to the derelicts that clustered in the cemetery behind the medical school, and lecturing them on the evils of alcohol and cannabis.

Aspiring heart surgeons who flocked to Cape Town to study with Barnard were, in fact, trained by Naki. He was a fine teacher, gifted with patience, and a strong personality that didn't tolerate slovenliness or laziness. He set high standards and his students knew that he expected them to be met. Naki cherished his role as educator, and taught some 3,000 surgeons.

Naki was a placid man who got on with the notoriously highly-strung and temperamental Barnard. He accepted his lowly status, and appreciated the opportunities he was given. Because of poor record-keeping by the university, when he retired in 1991 there was some question about the duration of his pension contributions. He was given a gardener's pension, amounting to £70 a month.

When he retired Naki arranged for a mobile clinic, converted from a bus, for his home district of Centani, which was 50 miles from the nearest doctor or hospital. He also supported a rural school in the Eastern Cape by collecting regular contributions from doctors he had trained.

In later life he got the recognition he had long deserved, and became one of South Africa's heroes. In 2003 the University of Cape Town awarded him with an honorary master's degree in medicine. In the same year, President Thabo Mbeki presented him with the Order of Mapungubwe, one of the country's most prestigious awards. Two years later, when Mbeki delivered his presidential address to the South Africa parliament, Naki was one of the "senior civil guard of honour" who welcomed him.

Caroline Richmond

Correction

In my obituary of Hamilton Naki [11 June], writes Caroline Richmond, I said that Naki was a key member of Christiaan Barnard's surgical team during the famous first heart transplant in Cape Town. Naki made these claims in interviews towards the end of his life. I have now been assured that he was not present, both by Dr David Dent, Acting Dean of the Faculty of Health Sciences at Cape Town University, and by Barnard's biographer Chris Logan.

"He did not participate in the first heart transplant, nor ever work in Groote Schuur Hospital, nor ever operate on humans," Dr Dent says:

Chris Barnard sequentially performed both historic donor and recipient operations, assisted by four cardiac surgeons. Mr Naki was one of four highly talented technicians in the research laboratory at the medical school. He was a man of great humanity and dignity, with whom I had the pleasure of working at the time of the historic heart transplant. Numerous young surgeons-in-training spent time in the animal laboratory to perform research ­ then transplantation of kidneys, hearts and livers ­ and to obtain higher research degrees. The charming and dextrous Hamilton Naki assisted them.

There was no mention of human surgery when Naki received his honorary MMed degree from Cape Town University in 2003. The citation said, "Mr Naki assisted with the experimental work that preceded. . . the historic first heart transplant."

A source close to him at the time is said to have reported that Naki first heard about the transplant operation on the radio. If this is true, it seems that, in old age, he changed his story, perhaps in response to pressure from those around him.

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