The remarkable Hamilton Naki
History cleansing couldn't hide the truth Reported April 27, 2003

On December 3, 1967, Christiaan Barnard performed the first human-to-human heart transplant and by the following day Cape Town, South Africa.

The journalists and photographers, who crammed into Groote Schuur hospital, had little reason to notice a figure in a white coat that was forced to stand in the shadows. Had they asked, they would have been told that Hamilton Naki was a cleaner and gardener who washed floors and swept leaves.

What else, after all, would an African man be doing in a research institute in apartheid South Africa? Apartheid-era laws forced Mr. Naki to pretend that he was a gardener. In reality, he was the surgeon that Barnard sought out as his right-hand man during the historic operation because of his extraordinary surgical skills. Nobody thought to even ask the question and it is only now, almost four decades later, which the truth has emerged. Hamilton Naki was not a gardener. The employment records which described him thus for 50 years were a lie, a fiction to fit the edicts of a racist state. Naki was a surgeon - a pioneering surgeon considered by colleagues to be the most technically gifted of the hospital's medical team. Without him the transplant might never have happened. Yet this was someone with no formal education beyond the age of 14, someone who was regularly harassed and arrested by police officers that regarded him as a "kaffir", a sub-human. His was one of those stories that exposed white superiority as a myth so the state hushed it up. In Stalin's Russia an existence might be erased altogether but in South Africa, to be classified as a manual laborer was enough to make you invisible, a non-person. Barred from training as a doctor, from the whites-only operating theatre and from slicing white flesh, Naki was an aberration. "Nobody was to say what I was doing. A person of African descent was not supposed to be doing such things. That was the law of the land," he says now. Stroll among the shacks of Langa township outside Cape Town and you will spot him: a 78-year-old man struggling to survive on a gardener's pension, his past as unknown to neighbors as to the outside world. That is likely to change. Fame is knocking on the door of the house he shares with his 10 children and grandchildren. The film company Ad Astera is making a television documentary, Hands of a Forgotten Hero, to be followed, funding permitting, by a feature film. It was the late Barnard himself who tipped off his friend, the film producer Dirk de Villiers, about his collaboration with Naki. "A lot of stories have been told about Chris, but this is one that hasn't been told," says De Villiers. Naki was born in 1926 in Ngcingane, a small village in the Eastern Cape. As a child he wore sheepskins when it was cold and always went without shoes but, unusually for an African boy at that time, made it past primary school before hitchhiking to Cape Town at the age of 14 to seek work. The University of Cape Town hired him as a gardener and for the next decade he maintained the tennis lawns. Punctual, diligent and dapper in a shirt, tie and hat, Naki was chosen by the foreman in 1954 when a doctor in the under funded medical faculty, Robert Goetz, said he needed help with the laboratory animals. Still trim and fit, Naki becomes animated at the memory: "Ooh, yes. At that time there was no one else you see, no one else willing to do that sort of work." Another explanation for this career leap could be that the Jewish doctor who had fled Nazi Germany may have empathized with outcasts. From cleaning cages Naki progressed to weighing, shaving and injecting the animals, mostly dogs, rabbits and pigs, and from an aesthetics to machines which pumped air into lungs, allowing Goetz to operate on organs for the benefit of watching medical students. "It was difficult work but I wanted to learn," says Naki. By the early 1960s, he was slicing, stitching and using drips. "We learned a lot from the dogs. We put two livers in one, two hearts in another; then, when we got a donated organ, we would throw away the two we put in and put in the proper one." He also helped to operate on a giraffe, dissecting the jugular venous valves to find out why creatures with such long necks do not faint when bending to drink. As Naki notched up surgical hours, colleagues admired his steady hand. "You must not cut the vessels and must hold the forceps correctly and know where to stitch," he says. Rosemary Hickman was one of many surgeons who trained at Cape Town and learned from Naki. "Despite his limited conventional education, he had an amazing ability to learn anatomical names and recognize anomalies. Hamilton arrived at work at 6am come rain, shine, or strike and no matter how far he had to travel he almost never missed a day." This was no mean feat for a man with no running water, no electricity, no car and often no bus because of strikes. Despite the discrimination Naki faced in the outside world every day, he was the obvious assistant to choose when Barnard, an ambitious cardiac surgeon, returned from the US to introduce new open-heart surgery techniques to South Africa. "He probably had more technical skill than I had," Barnard said of Mr. Naki, after conceding that his African assistant was able to perform liver, lung and heart transplants on animals, on his own, which no other doctor in the world was capable of carrying out," Barnard said of Naki decades later. Surgeons from across South Africa, and all over the world, came to learn and develop their skills under Mr. Naki's guidance. Indeed, it has been estimated that Mr. Naki passed the knowledge he acquired during his countless operations on animals to more than 3,000 doctors worldwide. By 1967, kidneys and livers had been transplanted but not yet the organ in which love and compassion were said to reside. Amid mounting suspense, surgical teams around the world vied to be first to transplant a human heart. Cape Town's Groote Schuur hospital had a volunteer recipient. Louis Washkansky was a 55-year-old diabetic with incurable heart disease. For a dying man it was an easy decision, noted Barnard. "If a lion chases you to the bank of a river filled with crocodiles, you will leap into the water convinced you have a chance to swim to the other side. But you would never accept such odds if there were no lion." The donor was Denise Darvall, a 25-year-old who stopped to buy a cake, was hit by a car and was pronounced brain dead by the doctors. With the permission of her father, 60 seconds after the respirator was turned off, a team led by Naki went to work, a 48-hour marathon. "Your hands get tired. We were exhausted. You must wash out the blood from the heart and put in the recipient's blood." When electrodes were applied it resumed beating and a second team led by Barnard placed the organ inside Washkansky. The heart beat strongly and, even though he died of pneumonia 18 days later, the operation was hailed as a success. "On Saturday, I was a surgeon in South Africa, very little known. On Monday, I was world-renowned," Barnard, recalled. Not so his African colleague. "I was called one of the backroom boys. They put the white people out front. If people published pictures of me they would have gone to jail." Is it a bitter memory? Not at all, says Naki. "It was the way things were. They pretended I was a cleaner." Religious, Naki trusted in God and accepted his status. He was friendly with Barnard who invited him round to his house for drinks. In the documentary, Naki embarrasses the film crew by addressing them as "Baas", an apartheid-era deferential term. Maintaining the fiction that he was a menial worker, the state allowed him to operate and give lectures to medical professors until his retirement in 1991. His £90 monthly pension (about 143.00 in US dollars) is the main source of income for the 11-strong, unemployed household but Naki says money does not matter, though he confesses a desire for cable television. He is puzzled and pleased by the belated recognition. Last December the government included him in national honors and he lined up with former South African presidents Nelson Mandela and FW De Klerk to collect his medal. The hands of the forgotten hero clap together at the prospect of a biographical movie of his life. "Oooooh, it's exciting, isn't it?" One thing does rankle; by the time the apartheid regime fell, he was too old to study for a degree and officially he remains a retired gardener. "I can be happy now that everything is out. The light is lit and the darkness has gone," he said. "Dr. Naki, yes, that would have been nice."