Hamilton Naki  1st Heart Transplant


Two men transplanted the first human heart. One ended up rich and famous -
the other had to pretend to be a gardener until now.

Rory Carroll on the remarkable story of Hamilton Naki

Friday April 25, 2003
The Guardian

It is one of the iconic images of the 20th century and the handsome surgeon
had every reason to flash his toothy smile. On December 3 1967, Christiaan
Barnard performed the first human-to-human heart transplant and by the following
day Cape Town was thronged with the world's press who had arrived to chronicle
his breakthrough in medical science. It was a decade given breaking new
ground: the race was on to put a man on the moon and to pioneer the transplant
technique that would save, or at least extend, countless thousands of lives. With
as photogenic a celebrity as Barnard the journalists and photographers who
crammed into Groote Schuur hospital had little reason to notice a figure in a
white coat lurking on the fringes. 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 a black man be doing in a research institute in
apartheid South Africa?

Nobody thought to even ask the question and it is only now, almost four
decades later, that 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 who 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
labourer 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 black person 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 neighbours 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 a black 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 underfunded 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 empathised with outcasts.

From cleaning cages Naki progressed to weighing, shaving and injecting the
animals, mostly dogs, rabbits and pigs, and from anaesthetics 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 recognise 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," the Afrikaner said of
Naki decades later.

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 black 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 £70 monthly pension 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 honours and he lined up with former South
African presidents Nelson Mandela and FW De Klerk - "the big giants of the world" -
to collect his medal.

The hands of the forgotten hero clap together at the prospect of a biopic.
"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. "Dr Naki - yes, that would have been nice."

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