John Charles Hargrave AO, MBE, MD, DSc(Hon), MBBS, FRACS, DTMH
Plastic and Reconstructive Surgeon
26 March 1931 - 6 August 2020

John Charles Hargrave was a remarkable man who led an exceptional life. He enhanced the lives of all he treated, those with whom he worked and those he befriended. He was innovative and influential in the fields of public health, leprosy, reconstructive surgery, microsurgery, Aboriginal health, empowerment and education, global health and international relations. He is an adornment to this College.

John was born in Perth and grew up in Western Australia. He attended Medical School at the University of Adelaide, Western Australia having no medical school at that time. It was during a student placement in the north that John became aware of the existence of leprosy amongst Aboriginal people in the Kimberley. After internship in 1955, he was appointed as a Survey Medical Officer in the Northern Territory. The next 40 years of his life were spent working in the challenging and unique physical, sociological, and medical environment that is the Northern Territory of Australia, and to the islands north of Australia.

The duties of a Survey Medical Officer at that time involved travelling throughout the remote parts of the Territory, meeting, examining and documenting health and illness, providing onsite treatment and planning further treatment or monitoring. Notably, John was the medical officer with the 1957 Lake McKay expedition which contacted some of the last remaining groups of the nomadic Pintubi people of the Western Desert who had no previous contact with colonists. John noted their robust good health and advised against any relocation or interference. Medical services outside the few main towns were disorganised and split between government clinics, mission clinics and basic first aid posts with no single overall source of funding or accountability.

During these early surveys, John noted the significant prevalence of leprosy. Leprosy had entered the NT in the 1880s via indentured labourers and gold miners and spread slowly but extensively, particularly amongst Aboriginal people. A lack of understanding of the aetiology, along with no effective treatment, stigmatised leprosy patients, who were forcibly removed from their families and communities. Under powerful public health laws, they were incarcerated on an inhospitable island in Darwin Harbour, usually for the remainder of their life. Immediately prior to John Hargrave’s arrival in the NT, the Leprosarium was transferred to a more pleasant spot on the mainland and treatment was now a possibility. However, the practice of forced isolation was continued in the NT, against world trends favouring outpatient treatment. Given the history and the prevailing authoritarian approach at the time, there was understandably continuing fear amongst Aboriginal people. This resulted in symptoms and signs being hidden, and a mistrust of treatment programs.

John Hargrave brought a new, enduring approach. All his life he had an easy, respectful, engaging manner with all he interacted with regardless of race, status, or language. He dedicated himself to learning common phrases of all the languages of all the people he worked with, both in the NT, and later in Indonesia and Timor. He rapidly gained the trust of his patients and they and their families began to accept treatment and dislocation to the leprosarium when indicated.

The government East Arm Leprosarium, staffed by Catholic Sisters from the order of Daughters of the Sacred Heart and under the superintendence of John Hargrave, became associated with healing, recovery, peace, and lifelong warm relationships. Behind the scenes there were significant tensions with a reactionary Commonwealth medical hierarchy who clung to the older models of lifelong forced incarceration, but these battles were eventually won by evidence, argument, and sheer tenacity.

John was a compulsive teacher, mentor, collaborator, and encourager. Throughout his life he identified persons of promise, ability and goodwill and freely shared his knowledge and skills with no regard to hierarchy. He thus developed a cadre of Aboriginal health workers in the NT who could diagnose, treat, perform physiotherapy, operate, suture (including microsurgery), and dress wounds. He started the first formal training programs for Aboriginal health workers. Nurses equally were empowered to adopt high level skills and functioned as equals on the team.

From his base at the East Arm Leprosarium, John continued to travel throughout the NT diagnosing, teaching, supporting, and following up his patients. John learnt to fly to facilitate his movement around the Territory. He developed an innovative computer-assisted register and a sophisticated public health approach which fed into his MD thesis on Leprosy in the NT, awarded in 1976.

John realised the need for a comprehensive program which would cater for all aspects of leprosy including education, medical treatment, surgical treatment, and rehabilitation. The latter two were not available to Territory patients and, indeed, were not represented in most major Australian centres. During a series of sabbaticals and with a WHO scholarship, John visited leprosy centres throughout South East Asia, studying and learning techniques and management. In 1962 he spent some months with Dr Paul Brand in Vellore, southern India. Paul Brand was the doyen of leprosy management and the father of reconstructive surgery for deformities resulting from nerve damage. On his return to Darwin, with no other surgical training and in the face of administrative opposition, John established a reconstructive surgical program at the leprosarium from scratch. He later enticed a physiotherapist from India to continue the development of the necessary accompanying rehabilitation program.

John was constantly looking to provide the best, world-class treatment for his patients. He noted the rise of microsurgery in the 1970s and immediately saw the potential for its application in both nerve repair and reconstructive surgery including free flaps. Together with the Sisters at the Leprosarium, key Aboriginal health workers and Dr Jon Wardill, then a new young surgeon in Darwin, he converted the operating room at the leprosarium into a laboratory and in 1975 began a disciplined, structured program of learning micro vascular anastomosis using a rabbit ear artery model.

In 1981, just six years after the first microvascular groin-to-foot free flap had been described in the western literature by Dr Ian Taylor in Melbourne, John Hargrave, Dr Jon Wardill and Sister Jo Kenny performed their first free flap procedure at the Darwin Hospital, a groin flap to the destroyed forefoot of a young woman. Reimplantation of the first amputated digit soon followed and a composite fibular free flap to a femoral defect occurred the next year. This team continued to hone their skills in the laboratory and mortuary. John and a young research colleague, Dr Jai Raman, who would later become a leading cardiothoracic surgeon, undertook a microsurgical study tour to the Shanghai 9th People’s Hospital in 1986. John’s leadership and initiative resulted in a sophisticated microvascular, reconstructive and hand service to the people of the Territory for many years. In recognition of his exceptional surgical expertise and service John was granted a Fellowship of this College (FRACS in plastic and reconstructive surgery) in 1987.

By 1982, under John’s leadership, leprosy was in marked decline in the Territory and the East Arm Leprosarium was closed. While continuing in Leprosy control, John was appointed as the inaugural NT Director of Aboriginal Health, and later started the incipient Communicable Disease Unit. Simultaneously, he was also appointed as a specialist hand surgeon to the Darwin Hospital and provided the electro-neuro and myographic services to the NT.

His fertile mind continued to seek new ways to improve outcomes for his patients and in collaboration with colleagues in Sydney in 1970 he developed a research program in nerve grafting. He collaborated with several bright young colleagues including Jai Raman in 1986 and Douglas When in 1990, investigating freeze-dried micro-arterial and micro-neural autografts in a rabbit model. This project sought to establish the feasibility of using “off the shelf” grafts for patients with nerve and vascular defects. John’s contribution was important in eventually showing that this approach was not a viable option.

In the late 1980s, a nursing colleague brought his attention to the suffering caused by untreated deformities among people of the islands of Eastern Indonesia, a one-hour flight to the north of Darwin. John undertook several survey trips and then, using the same gently persuasive, person-centred and collaborative approach that conquered leprosy in the NT, developed a locally supported, sustainable reconstructive surgical program in Timor and Flores. This preceded and straddled the time of the violent independence struggle of East Timor. He again identified and mentored local clinicians of ability and promise, sought out and established working relationships, functional health services, collaborated with locally based organisations, and learnt local languages. To support this work, a small funding and logistics team under the banner of a Darwin based Not-for-Profit organisation, Australian and South East Asia Rehabilitation Foundation (ASEA Rehab) was established. He also interacted extensively with Dr Rowan Nicks, who encouraged his collaborations and humanitarian efforts in South East Asia.

His trips to and focus on Indonesia and Timor Leste grew in the 1990s and continued after his retirement from the NT Health Service in 1995. Surprising many, John built a beautiful house overlooking the Derwent estuary in Tasmania, and after more than 40 years in the tropics, moved to Tasmania in the late 1990s, by flying down in his twin-engine plane. He continued trips to the north, introducing and mentoring other surgeons and clinicians including Darwin surgeons Dr Stephen Baddeley and Dr Peter Riddell into the role of reconstructive surgery in Eastern Indonesia and the newly independent Timor Leste. Dr Mark Moore, a talented reconstructive and craniofacial surgeon based in Adelaide who was already collaborating and supporting the development and delivery of plastic and reconstructive services to the Northern Territory, was inducted into the leadership of ASEA Rehabin 2000. He transferred oversight of the work to the new, Adelaide based, Overseas Specialist Surgeons Association (OSSAA). Mark continues to lead teams providing a valued, bespoke, and appropriate program of reconstructive surgery, mentoring and skill transfer to those same communities. Mark and Peter found that mentioning John Hargrave’s name facilitated open doors throughout eastern Indonesia and Timor.

John quietly and graciously received multiple honours throughout his life including an AO in 1995 which supplemented an earlier MBE from 1967, and an honorary Doctorate from the Charles Darwin University. He was later appointed as a Professorial Fellow by Flinders University. He was bestowed the ANZAC Peace Prize in 1996 and from this College, in addition to the FRACS, he was recognised with the ESR Hughes award in 1999 for distinguished contributions to surgery and the RACS International Medal in 2007. Always a modest man, he was reluctant to talk about or promote himself and would skilfully divert conversations to the welfare and lives of others.

John did not marry and had no children. He was diagnosed with bi-polar disorder in his 40s and his fortitude and productivity through the highs and lows of this challenging condition are both remarkable and inspirational. After moving to Tasmania, he enjoyed ongoing contact with loyal friends and continued writing and organising his thoughts and work in the peaceful surrounds of his chosen retirement location. He took up playing the oboe late in life, the choice of this difficult instrument not surprising for a man who thrived on challenges. His later years were impacted by illness which he bore bravely. He died peacefully in Hobart on 6 August 2020 with plastic and reconstructive surgeon Peter Riddell, one of his many grateful friends and protégés, close by.

John Hargrave’s unique character, skills and dedication saw the virtual eradication of leprosy in Northern Australia. His humanity and generosity of spirit attracted gratitude and loyalty from his many patients, colleagues, and friends across all walks of life. His innovation and persistence saw a remote disadvantaged population having access to the most modern and sophisticated reconstructive surgical techniques. His collaboration and inspiration mean his work continues via others.

Truly, a remarkable life.

This obituary was prepared by Phillip Carson FRACS in collaboration with many of John’s friends and colleagues, October 2020.