Remembering Hamilton Naki – a South African hero who started off tending gardens of a hospital, and was eventually awarded an honorary Master of Medicine degree for his contributions to medical science.
Western Cape, South Africa (06 October 2020) – Hamilton Naki was a laboratory assistant to cardiac surgeon Christiaan Barnard in South Africa. He was recognised for his surgical skills and for his ability to teach medical students and physicians such skills despite not having received a formal medical education and took a leading role in organ transplant research on animals.
Naki was born on 26 June 1926 in Centane in the Eastern Cape and only progressed to Standard 6 (currently Grade 8) at school. His first job at the University of Cape Town was a gardener before he was noticed by Dr Robert Goetz, who had a defining influence in Naki’s life. Goetz taught him how to dissect animals and operate on them.
Professor Rosemary Hickman, a renowned and skilled surgeon who knew Naki well, wrote that “Naki had an amazing ability to learn anatomical names and recognise anomalies. His skills ranged from assisting to operating and he frequently prepared the donor animal (sometimes single-handedly) while another team worked on the recipient.”
It was in his role as laboratory assistant that Naki much later crossed paths with the Barnard brothers. Dr Christiaan Barnard had returned to South Africa in 1958 after studies abroad and began mastering the techniques of organ transplants, conducting South Africa’s first human kidney transplant in September 1964.
By 1967, Christiaan’s brother Marius had also returned from the United States. He started preparing for the first human heart transplant by working on dogs in the laboratory.
A 2014 overview article in The Bulletin of the Royal College of Surgeons of England described Naki’s role: “Naki anaesthetised the dogs for the earlier work in heart surgery in the laboratory, which was on the establishment of the open-heart bypass, using an external heart pump. This was a finger pump that circulated blood through heat exchangers that were warmed or cooled by huge steel tanks of water. Such pumps were difficult to maintain and often broke down unexpectedly.”
In his first interview in 30 years in 2011, Dr Marius Barnard told me that Naki was “asleep in his bed during the first heart transplant”. He said it would have been illegal and unethical to allow anyone to operate on another human without the necessary medical qualifications.
Although Naki did learn how to perform transplants on animals in the laboratory, he was never involved in surgery on human subjects. Under Apartheid Hamilton was disadvantaged because he was barred from working in the Whites-only operating theatre, and his contributions in the laboratory were largely unpublicized at the time.
In an interview with the BBC, Hamilton reflects: “Those days you had to accept what they said as there was no other way you could go because it was the law of the land.”
Publishing his story
But after the country’s first democratic elections in 1994, Naki’s contribution to open-heart surgery came to the fore, allowing for his remarkable story to be told.
Four decades after the first heart transplant took place at the Groote Schuur hospital in Cape Town, stories began to surface about the role that Naki played in the procedure. Chris Barnard apparently hinted at Naki’s involvement shortly before his death in 2001, and Naki himself claimed, at one stage, to have been involved more directly in the groundbreaking procedure.
A source close to Mr Naki once asked him where he was when he first heard about the transplant. He replied that he had heard of it on the radio. Later, he apparently changed his story.
He changed it, it seems, not simply because of the confusion of old age, but because of pressure from those around him. Mr Naki was already a hero, as a black man of scant education who had trained himself to carry out extremely difficult transplants on animals. Christiaan Barnard admitted that “given the opportunity”, Mr Naki would have been “a better surgeon than me”.
Various credible publications began publishing Mr Naki’s ‘untold’ story of his involvement at Groote Schuur. Some of these publications included The Economist and the New York Times (both 11 June 2005), and two interviews with Mr Naki, one in the careers section of the British Medical Journal (BMJ Career Focus 2004), and one with BBC online.
The majority of these publications have since expressed their regrets at being caught up in a misapprehension, as surgeons at Groote Schuur, the hospital where the transplant was performed, have assured researchers and the media that Mr Naki was nowhere near the operating theatre when the transplant was performed. As a Black person during Apartheid, and as a person with no formal medical qualifications, he was not allowed to be. The surgeons who removed the donor’s heart were Marius Barnard, Christiaan Barnard’s brother, and Terry O’Donovan.
Making a difference
Although he lived in a tiny room in Langa, an impoverished township in the underprivileged area known as the Cape Flats, with no electricity or running water, Naki would set out to work every morning in a hat, suit, tie and polished shoes.
Even after his retirement, Naki continued to make a difference by raising money for a mobile clinic in his rural hometown in the Eastern Cape. He also called on surgeons – who were once his trainees – to donate money for a school in his home province.
Recognition and Awards
With that said, Hamilton Naki was a South African hero and in 2002 then president of South Africa Thabo Mbeki gave Naki the country’s highest order, the National Order of Mapungubwe, for his years of service.
The following year Graça Machel, UCT’s vice-chancellor and wife of former president Nelson Mandela, gave Naki an honorary degree in medicine in recognition of his work in the field of surgery.
On 29 May 2005 Naki died of a heart attack but his life and work, alongside the achievements of Barnard, have been captured in a documentary, Hidden Heart, which can be found on many streaming services. The Swiss, German and South African production, from directors Cristina Karrer and Werner Schweizer, gives an intimate look at the relationship between the two medical pioneers and finally gives due credit to one of South Africa’s most unlikely “surgical fathers”.