Vivien Hamilton: surgeon-janitor

Creation: Spring & Easter
Sense make before book. (Grenada, Tobago)













A sister-author‘s comment on yesterday’s post led me to Vivien Thomas. She wrote, “Hamilton Naki is the Vivien Thomas of South Africa. Wow!!! When will we get our just due?”

When, indeed.

Like Naki, Thomas assisted a white surgeon, Alfred Blalock, in animal research. Like Naki, in a time or place without segregation Thomas would have been recognized everywhere for his medical research and his surgical skills. With no little education and no formal medical training, both men performed operations, did post-doctoral research, and trained student surgeons while holding menial positions: Naki as a gardener and Thomas as a janitor.

Thomas and Blalock worked together to disprove the theory that medical shock resulted form toxins in the blood. Their research into the causes of shock saved lives of thousands of soldiers in battle. At the same time, Blalock and Thomas worked on experiments that were to revolutionize heart surgery.

When Blalock became Chief of Surgery at Johns Hopkins in 1941, he asked for Thomas join his team. Thomas then became the only Black employee (except for janitors) at Johns Hopkins. The appearance of this Black man in a white lab coat created as much confusion as his surgical skills without a medical degree.

When a paediatric heart surgeon sought a cure for blue baby syndrome Thomas had the answer. He created the blue baby condition in a dog, and then corrected the condition through surgery. Thomas worked on the process for about two years, operating on 200 dogs. Blalock performed the surgery only once, as Thomas’ assistant. Thomas therefore needed to direct Blalock step by step when the surgeon used the procedure for the first time on a child. At Blalock’s insistence, Thomas stood at his right shoulder for his first 100 operations on blue babies.

The medical world hailed the blue baby surgery as a breakthrough, and neither Blalock nor Johns Hopkins acknowledged Thomas’ contribution. Indeed, Johns Hopkins did not accept its first Black surgical students for another thirty years. Thomas continued to be so poorly paid that he sometimes worked as a bartender, often at Blalock’s parties. Lines between the two men may have been blurred in the lab, but the distinctions were reinforced in the medical school (low pay, separate bathrooms and entrances) and on social occasions. Johns Hopkins raised Thomas' salary and appointed him senior lab technician only when, in 1946, Thomas threatened to resign to return to carpentry.

Thomas (August 29, 1910 – November 26, 1985), grandson of a slave, was born in Louisiana and grew up in Tennessee. He wanted to become a doctor, and tried to earn money for his education by working as a carpenter and an orderly. The 1930s depression wiped out his savings and ended his dream. Thomas had difficulty finding permanent work of any kind, and was a janitor when Blalock hired him as laboratory assistant at Vanderbilt medical school. Within three days of his employment, Thomas was performing surgery on dogs. He tried to enter college again in 1950, but gave up on medical studies when his years of experience could not go to his credit.

Thomas’ partnership with Blalock lasted 34 years, and his work in surgical research continued for 15 years after Blalock's death. One of the many surgeons Thomas trained said of him, “Even if you'd never seen surgery before, you could do it because Vivien made it look so simple.”

In 1971, Thomas’s former medical students commissioned a painting of Thomas to be hung next to Blalock’s painting at Johns Hopkins. In 1976, Johns Hopkins presented Thomas with an honorary Doctor of Laws (not Doctor of Medicine), and in 1977 Thomas became an official member of the Johns Hopkins medical school faculty.

Thomas' story inspired the PBS documentary, "Partners of The Heart" and the HBO film, "Something The Lord Made."

Naki – South African surgeon gardener

Creation- Spring & Easter
Knowledge is like a garden: if it is not cultivated, it cannot be harvested. (Guinea)









Hamilton Naki’s work helped to bring about the world’s first heart transplant. Contrary to myth, he was not present when Professor Christian Barnard carried out the operation, because Black men were not allowed in white hospital rooms in apartheid South Africa. However, Naki’s skills in animal research paved the way for heart transplants on human beings.

In the late 1950s, Barnard’s hospital employed Naki to maintain the grounds and tennis courts. He was later sent to work at the medical school, cleaning the animals’ cages – work people avoided because it is so messy. One day, a professor of surgery asked Naki to help hold a giraffe on the operation table; as a result of the competence he showed, researchers gradually allowed Naki to do more serious work.

Naki proved to be a skilled surgeon and anesthetist. In particular, he had surgeon’s fingers and did open heart surgery, pulmonary bypass, and heart and liver transplants on dogs. He was skilled in the post-operative care of animals, and he was able to do almost all the work of a qualified surgeon. Indeed, Barnard thought Naki did a better job of stitching than surgeons including Barnard himself. Naki taught transplant techniques to about three thousand young surgeons who studied under Barnard.

Naki gained his surgical skills because of his intelligence, memory, and capacity to learn by observing and practice in secret. The hospital promoted Naki to the highest position possible for him under apartheid law – senior lab technician. Nonetheless, when he retired he received a gardener’s pension.

Barnard acknowledged Naki’s work only after apartheid ended, when he referred to Naki as. “one of the great researchers of all time in the field of heart transplants.” Naki’s work as Barnard’s principal assistant was particularly important when Barnard developed arthritis in his hands.

Naki (26 June 1926 – 29 May 2005) was born in rural South Africa and migrated to
Cape Town when left school at 14. He had only sixth grade education, and could not have received medical training under the apartheid system. While he worked with Barnard, he lived in a Black township where he had no electricity or running water. Most of his wages went back to his village to support his extended family.

During his retirement, Naki organized a mobile clinic for his rural community that was 50 miles from the nearest doctor or hospital. In addition, he organized support for schools with funds collected from doctors he had trained.

In 2002, Naki received one of South Africa’s highest honors – the presidential award of the Order of the Mapungubwe. In 2003, the University of Cape Town awarded him an honorary medical degree.