Michel Lechat - Curriculum vitae#

Congo 1953#

I am often asked why I choosed to go working in the Congo. The answer is quite simple : just by chance. In my last year of medical school at Louvain University, I was offered a fellowship to spend six months in the Congo to work in the field of tropical medicine. At my interview I Was asked: "And in the future, what would you like to do in our nice Colony, my young fellow ?" I naively answered: "Psychiatry, Mr.Directeur Général". I think the Directeur almost felt from his chair. Finally, he offered me leprosy : a couple of months residency in the leprosy settlement of Dr.Hemerijckx, at Tshumbe Ste Marie, in the bush of Kasaï. Fifteen thousand patients , a large variety of diagnostic problems, great human misery, and on top the fantastic enthusiasm of Hemerijckx.

The following year, having obtained my diploma, I returned with my wife to the Congo as medical-director of the Yonda leprosarium, which was supposed (at least in my mind !) to be remodeled as the prototype institution adapted to the new availability of efficient antileprosy drugs, rehabilitation of the patients, research, etc… Then came six years of intensive work, difficulties but also successes (1953-59).

I dedicated the time left to the study of leprosy deformities and bone lesions under sulfone therapy. The results were published as a book, obtained an award, and led to the degree of "agrégé de l'enseignement supérieur" (Ph.D.)at Louvain University.

Johns Hopkins, Baltimore #

While we were on home leave in Belgium in1960 the Congo got its independence. We could not return to Yonda. A US epidemiologist, James Doull, who had followed my publications, suggested me to apply for a job at the Johns Hopkins School of Hygiene and Public Health in Baltimore. Hopkins, one of my wildest phantasms !. We packed, and left to America on an immigrant visa with the youngest of our three children, aged three weeks. I was appointes instructor, a sort of lab technician, in the Unit of John Hanks (the father of the Hanks solution for tissue cultures) Being a poor laboratory man, I spent most of my time hanging around various departments sitting on courses and attending seminars, -operational research, biostatistics, genetics, -with the blessing of my bosses. Sickle-cell anemia and malaria, Rous sarcoma and chickens, Konrad Lorenz with his geese, the genetic code, the amyotrophic sclerosis in the Chamorros of Guam, and of course the world famous 1932 air pollution episode in the Meuse Valley of which I had never heard before.

This experience was very mind-opening. It greatly served me later in my teaching as well as for setting up research programs .After two years, I was given a fellowship from the NIH (National Institutes of Heath) to proceed with a regular curriculum leading to the Master (MPH) and Doctoral (Dr. PH) degrees in Public Health.

P.A.H.O(Pan American Health Organization)
#

We left the US at the end of 1964, the education of our three children being the main reason. I was appointed as PAHO/WHO zone epidemiologist for Mexico, Cuba, the Dominican Republic and Haïti. It was a great change, financially of course, but also culturally. Working in Cuba was by a most impressing experience. A few years "despues el triunfo de la Revolucion" the country was shaken by an incredible momentum forward, especially in education and public health. The adults were competing for the "quinto grado", the fifth degree of primary school. Primary health care and health education were absolute priorities for the fidelist government.

In Haïti, it was a different, sorrowful, story. I was supervising the yaws eradication surveillance, discovering the biases and pitfalls of surveys and health statistics in poor countries, criss-crossing the hills on horseback, surrounded by two "tonton-macoutes". Harvesting examples for my future courses of epidemiology at the university, apart of acquiring a vivid experience of insuperable human misery.

Returning home#

Soon afterwards, I received a letter from my Alma Mater, Louvain University. They were building a School of Public Heath in Brussels, and proposed me to become the Director. Everything to be started from scratch. This is an offer that you do not reject. We accepted and we went back, the whole family, at the end of 1966. As for being the Director of this new school, they unearthed somebody else. I was appointed deputy, and had to wait 17 years to become the director. That was my chance. A complete freedom. Indeed, my good fortune all along my life has often been to transform drawbacks into opportunities.

Apart from new teaching programs, I undertook a number of research projects. Namely, three are worth mentioning : 1. leprosy ; 2. surveillance of congenital anomalies; 3.health in natural disasters. The roots of the initiatives are to be found in my years at Hopkins

Leprosy research#

From Tshumbe Sainte Mariee where I had worked as a medical students in 1951, Dr.Hemerijckx went to India where he started a large program of detection and ambulatory treatment of leprosy patients ( clinics under the trees ) in Polambakkam, South India, under the auspices of a new Foundation. They were in charge of 35,000 patients in the villages of the area. I proposed to Hemerijckx's successor, Dr.Claire Vellut, my classmate at the university, to try developing a mathematical model of the transmission of leprosy based on the excellent statistical data of this project. It was a huge enterprise, with retrieval of the individual data representing some 400,000 person-years of observation, transfer to punched cards, conceptualization of the model, writing special softwars, and forthcoming simulation of epidemiological indices, incidence and prevalence, according to operational variables such are delay for detection, segregation of the patients, vaccination (virtual since non existing), compliance to treatment. I got precious help from my research assistant, C.Misson, and his husband, an operation research specialist. The simulations' results were utilized to guide the research efforts, discuss actual data of the leprosy control campaigns, recommend allocation of resources.

In the 70ies, in the context of increasing world-wide leprosy control activities, it became indispensable to improve and standardize statistics on the registration of leprosy patients. As Collaborative Center of WHO for the Epidemiology of Leprosy, my department at the University was suggested by WHO to develop such a system. Under the appellation of OMSLEP Recording and Reporting System, it was translated into French, Spanish, Portuguese, Arabic, Chinese, tested in a number of countries, and accepted by many, We started then to regularly publish statistics, an activity taken thereafter by WHO

Teaching#

I organized or participated in teaching in Bolivia, Argentina, Cuba, Ethiopia, Spain, The Netherland, China, Papua-New Guinea.

CONGENITAL ANOMALIES : EUROCAT#

On my return to Europe I had started prospecting around for some interesting research projects in epidemiology. A first attempt at measuring the impact of domestic accidents in schoolchildren had led nowhere. The survey questionnaires were apparently stirring some feeling of culpability in the parents. A subsequent well-planned case-control study of congenital anomalies in newborns had prompted a warning by the veterinary services to leave apart any question evoking a link between pigeon-breeding at home and pregnancy turning amiss, for it could be detrimental to the fancy of pigeon-racing, a national sport in Belgium.

At the time, in its early days, what was then known as the EEC (Economic European Community), had no provision to deal with health matters With the exception of the health of coal miners(European Coal and Steel Community) and the protection from ionizing radiations (Euratom) its founding text, the Treaty of Rome, was silent on the subject of health. Then, in 1974, I was approached by the Committee of Medical Research of the then European Commission who informally requested me to imagine and design some kind of activity which could make up for this vacuum and open the doors for the possible future development of European health programs. This exercise could get some minor financing. Thus, let us grasp this well-timed opportunity and select some health problem, important and interesting, that at the same time would be palatable for the grantors.

I invited to Brussels 16 of the best known epidemiologists of Europe together with 4 medical experts from WHO and the EEC for two days discussions. As convener of the meeting I stated the objectives in the following terms: "The long-term aim will be to promote new attitudes toward epidemiological studies in the countries of the EEC, in the governments, in the public, and in the medical profession. The goal is to have something which brings the public in, has a great health importance, is not controversial, and has great opportunities for the future."

After having seriously review the pros and cons of a number of research topics, the participants agreed on the theme of "Epidemiological Monitoring of Congenital Malformations in the Countries of the European Community" .The tragedy of thalidomide was still in the mind of everybody. Together with the late Geoffrey Dean, from the medico-social board in Dublin, we undertook a number of visits to identify places, designated as "Registries" which could participate in a multicentric study. It soon appeared that to prevent political interference the choice should not be "top to bottom" but rather "bottom to top", that is, it should be a cooperative endeavor of regions, rather than countries, according to criteria such as interest, initiative, expertise, and especially previous experience, or at least attempts at developing some epidemiological surveillance system.

The Project was approved. It received funding from the European Union, as the first concerted action of the Public Health Program of the European Commission.

The late Josephine Weatherall (1922-2006) of OPCS (Office of Population Censuses and Surveys) in London was detached part-time to manage the project at the Epidemiology Department of the Louvain University in Brussels. In view of establishing the program on solid basis, she accomplished a remarkable work regarding a number of crucial issues, namely definition of population covered, definition and coding of diagnoses, coverage of fetal deaths, registration of induced abortions after prenatal diagnosis, precision of diagnostic information, registration of late diagnosed cases, conflict between quality, quantity, and rapidity , active data collection and motivations, confidentiality, data analysis, Training sessions were organized for registry workers, guides were published. J.Weatherall (1922-2006) was later assisted by a full-time young epidemiologist, Helen Dolk.

EUROCAT is recognized as a WHO Collaborating Center for the Epidemiological Surveillance of Congenital Anomalies. Started in 1979 as a cooperative project between a few centers, among them Charleroi and Antwerp in Belgium, Paris, Strasbourg, Groningen , Umbria in Italy, the network had grown over the years and in 2004 it included 35 registries in 19 countries, members of the E.U. or non-members (Croatia, Norway and Switzerland) with a total of close to 5 million births covered.

The Central Registry has now been transferred to Belfast, under the leadership of Helen Dolk, who in the mean time had been appointed Professor at the University of Ulster.

References (see also List of Publications ): #

• "The Beginnings of Eurocat" Cabay edit. Louvain la Neuve, 1985

• Lechat, M. F. "European Surveillance of Congenital Anomalies. 30 years of development ".' Premiers Pas' "Liber Amicorum voor Leo P. ten Kate, (2005) 85-87

• Dolk, H. "European Surveillance of Congenital Anomalies. 30 years of development." 'And EUROCAT develops and constantly looks to its future' ""Liber Amicorum voor Leo P. ten Kate (2005) 89-95

• Lechat MF, Dolk H.: Registries of Congenital Anomalies./ Environmental Health Perspectives Supplements 101 (1993)153-157

• Dolk H. " EUROCAT. 25 years of European surveillance of congenital anomalies" Arch. Diseases Children, Neonatal Death (2005).90.335-358

• http://www.eurocat-network.eu

NATURAL DISATERS AND HEALTH #

Being in Washington in 1971, I happened to meet Steve Tripp "Mr.Catastrophe" , the Disaster Relief Coordinator at USAID, later to be appointed as the first director of OFDA, the Office of Foreign Disasters Assistance. He was what one may term a terrific man, with in the latest decade the direct experience of innumerable calamities, cyclones, floods, earthquakes, drought, etc... He was also a men attentive and listening to others. We went to speak of the recent 1971 cyclone in Bengladesh (then West Pakistan), some 300.000 deaths. About what could be done. He told me "This type of problem has not been properly studied. As for professional guidance, there is none. You, in the universities, should carry out research on the effects of natural disasters on populations. That is epidemiology !"

Thus, back in Brussels, I decided to organize a small brainstorming meeting on the issue.The University gave me 3.000 $ to cover the travel expenses. I had the fanciful idea to title the meeting "Seminar on the Ecology of Natural Disasters". At a time when the word ecology was not on everybody lips, it had an intriguing and attractive flavor. Hence, I got another three thousand ! I invited a dozen persons. Over 70 signed on.

Then, after the meeting, the interest somewhat exploded. It was a great success. WHO Director General, Dr. H. Mahler, offered me a one-year fellowship to train an epidemiologist in that field. I recruited Dr. Claude de Ville de Goyet. We undertook surveys of the effects of earthquakes in Guatemala and Italy. Together we established a special structure in my Department of Epidemiology at the School of Public Health of UCL in Brussels, the Center for Research on the Epidemiology of Disasters (CRED). A few years later Dr. de Ville became Chief of the Emergency Preparedness and Disaster Relief Coordination Program at the Pan American Health Organization, regional office for the Americas of the World Health Organization.

The United Nations then declared the decade 1990-1999 International Decade for Natural Disasters Reduction (IDNDR). I had to play a role in the Committee of Experts set up for preparing the Decade. It greatly boostered the activities in disaster prevention and preparedness world-wide. As soon as 1983, Dr..Debarati Guha Sapir joined me as assistant in research as well as in the management of the CRED. She was promoted to professor and succeeded me as the director of the Center when I became emeritus in 1992. Since then, she has considerably expanded the international activities in research as well as in training and services.

Significant people I met #

As president of the International Leprosy Association, among the many people of all sorts and venues, Presidents, Majesties, Holy Fathers, Ministers and the like I had to meet, the one who impressed me most was Mrs.Indira Gandhi, in the course of the preparation of the 12th International Congress of Leprosy to be held in Delhi in 1984. I had asked how it comes that she he was so interested in leprosy that she had proclaimed that disease as one of the three major health problems in India. The answer was straightforward. Jailed together with her father the Pandit Nehru, the only reading material she had found in the prison was a missionary booklet describing the horrors of leprosy. It had marked her for life. Since then I always wondered how often historical decisions may have been taken by important leaders on the basis of casual facts having occurred during their childhood, or just through some minor events mentioned by the schoolteacher and reported by the children on their return to the presidential palaces!

Another remarkable person was Dr. N. R. Sen, a professor emeritus at the Calcutta's Institute of Tropical Medicine. On his retirment, he was working for Mother Theresa, treating at dawn the leprosy patients gathered at street corners. Not the clinics under the trees, but the clinics on the pavement. One morning that I had joined him, after we had completed the treatment round, Dr. Sen proposed that I accompany him at a nearby temple. He told me :"Do you know why I am going to pray? I want to thank Siva for having sent Jesus who suggested Mother Teresa to offer me the opportunity to do something useful in the last years of my life

The most interesting post I held#

The most rewarding function I carried out was undoubtedly having served for 17 years (1978-1985) as member and afterwards as the president of the Selection Committee of the King Baudouin International Development Prize. I was like diving in an universe of theories, trials, experiments, projects , successes, failures, initiatives and commitments of all sorts. Fueled by charity, enthusiasm, solidarity. Among the most recent laureates: the Kagiso Trust, in South Africa, fighting apartheid by social actions; the Grameen Bank in Bengladesh ; TASO,(the Aids Support Organization) a model of solidarity given by patients in Uganda; Fair Trade, promoting equitable trade in developing countries. Reviewing about 1,000 projects over all these years, and visiting a couple of them, was an enlightening (and highly instructive) experience.

Qualifications

• Docteur en médecine, Catholic University of Leuven, 1952
• Diplôme en Médecine Tropicale, Institut de Médecine Tropicale Prince Léopold, Anvers, 1953
• Agrégé de l'Enseignement Supérieur, Université de Louvain, 1960
• Master of Public Health, The Johns Hopkins School of Hygiene and Public Health, Baltimore, USA, 1963
• Doctor of Public Health, (Docteur en Santé Publique), The Johns Hopkins School of Public Health, Baltimore, MD, USA, 1966

• Professor Emeritus, UCL, since 1992
• Médecin-Directeur de la Léproserie de Iyonda, Mbandaka, Belgian Congo(1953-59)
• Instructor, Department of Pathobiology, The Johns Hopkins University, Baltimore, USA, 1960-62
• Consultant des National Institutes of Health (NIH), USA, 1963-64
• Fellow in Epidemiology, National Institutes of Health, USA, 1962-65
• Epidémiologiste Régional, Organisation Mondiale de la Santé et Organisation Panaméricaine de la Santé, Mexico, 1965-66 (Mexico, Cuba, Haïti, Dominican Republic)
• Professeur Extraordinaire à l'Institut de Médecine Tropicale, Anvers (1972-81)
• Professor, Cours International pour la Promotion de la Santé, Amsterdam and Anvers (1967-80)
• Professeur d'Ecologie Humaine, Faculté des Sciences Appliquées, UCL-Louvain-la-Neuve (1971-88)
• Professeur Ordinaire, Faculté de Médecine, Catholic University of Leuven (1972-92)
• President of the Département d'Epidémiologie et de Médecine Préventive (1969-92)
• Directeur, Center for Research on the Epidemiology of Disasters (CRED), Centre Collaborateur de l'OMS, UCL (1978-92)
• President of the Ecole de Santé Publique, Catholic University of Leuven (UCL), Bruxelles (1983-92)

• Consultant ou conseiller temporaire (évaluation de programmes et projets, études de faisabilité, environnement, enseignement): Ethiopie (1960), Togo (1962), Sénégal, Côte d'Ivoire, Cameroun, R.D.C., Republic of Congo (1971), Romania (1974), Venezuela (1977), Guatemala (1978), Nigeria (1980), Cuba (1980, 1984), Japan (1982), People's Republic of China (1983), Marocco (1985), Costa-Rica (1986), India (1986, 1987, 1988), Vietnam (1994), Thailand (1996), Côte d'Ivoire (1997), Micronésie (1999)
• Divers: rapporteur général, Conférence Européenne de la Planification Sanitaire, Bucarest, 1974; rapporteur, Comité International d'experts enSciences Médicales et Santé Publique sur les Effets de la Guerre Nucléaire sur la Santé et les Services de Santé, Genève, 1982
• President of the Comité Consultatif du Programme Global d'Elimination de la Lèpre, LEAG (1994-99)
• Member, Comité de Monitoring et d'Evaluation du Programme Global Lèpre, MEEG (1995-99)
• Member, Comité de Groupe de Travail sur les Projets Spéciaux contre la Lèpre, SAPEL (1994-99)

• Evaluation des risques de santé et faisabilité de projets - barrages, développement rural, relocation de population: Burkina Faso (1972), Mauritanie (1973), Sénégal (1975), Ghana (1976)
• Membre du Groupe Technique d'experts Banque Mondiale sur la Politique de Santé en Afrique, 1989

• Membre de la Délégation belge (1972 à 1990); rapporteur des discussions techniques Habitat et Santé, 1973

• Member of the Groupe d'experts auprès du Secrétaire Général des Nations-Unies pour la préparation de la Décennie Internationale de la Prévention des Catastrophes Naturelles (IDNDR), 1989-90
• Member of the Comité Technique et Scientifique de la Décennie IDNDR, 1990-1995
• Vice-Président de la Conférence Internationale des Nations-Unies sur la Prévention des Catastrophes Naturelles, Yokohama, 1994

• Etude sur "Impact of Research and Technology on the Efficiency of Primary Health Care in Tropical Regions", Programme STD, 1986
• Enquête au Guatemala, Honduras, Salvador, Nicaragua, Costa Rica, Panama sur "Diagnostico sobre Recursos Humanos e Infrastructura en Cienca y Tecnologia en Centroamericana y la Cooperacion con la Communidad Europea: Sector Salud" IRELA, 1992
• Member of the Comité d’Evaluation du Programme BIOMED 2-DGXII (1997-2000)
• National Academy of Sciences, National Science Foundation, Committee for International Disasters Assistance, Washington DC: expert (1976-1978)

• Union Sud-Africaine (1990), Brésil (1992)

• Gouvernement belge, AGCD (enseignement, programme de recherches, évaluation de programmes): Zaire (1969, 1970, 1971), Algérie (1977); Bolivie (1977, 1978)
• Swedish International Development Agency: Ethiopie (1973)
• USAID: Indonésie (1987), Zaire (1988)
• Conseil Africain et Malgache pour l'Education Supérieur, CAMES, Côte d'Ivoire (1988)

• Enseignement, recherches, évaluation de programmes, enquête de faisabilité: Guinée Bissau, Myanmar, Indonésie, Ethiopie, Vietnam, Inde, Népal, Papouasi Nouvelle-Guinée, Egypte, Turquie, Portugal, Malaisie, Nicaragua, République Dominicaine, Cap Vert, Brésil, Mozambique, Micronésie.
• Sasakawa Memorial Health Foundation (Japon). Member of the Comité de Gestion du Sasakawa Leprosy Elimination Fund (1994-99).
• Président, FOMETRO (Fonds Médical Tropical) 1998-

• Member of the Académie Royale de Médecine de Belgique (hors-cadre);
• Membre honoraire de l'Académie Royale des Sciences d'Outre-Mer de Belgique;
• Conseil Supérieur de l'Hygiène, Ministère de la Santé Publique (membre invité) (1972-1993);
• Member of the Conseil d'Administration, Institut de Médecine Tropicale, Anvers (1983-1993).
• Member of the Commission d'Epidémiologie et de Psychiatrie, Fonds de la Recherche Scientifique Médicale (1973-1992).
• Membre du Comité de sélection, Prix International Roi Baudouin pour le Développement (1979-1995). Président (1973-1995);
• Member of the Conseil Consultatif de Médecine Préventive du Haut Exécutif de la Communauté Française de Belgique (….-1990);
• Member of the Conseil d'Administration, Fondation Damien (Amis du Père Damien) (1970-1985)(1991- ). Vice-Président 1975-1985 / Président 1985
• Member of the Conseil d'Administration, FOPERDA

• President of the Commission Médicale de l'LEP (Fédération Internationale des Associations de Lutte contre la Lèpre) (1974-1978); member 1969-1987
• President, Association Internationale Contre la Lèpre (ILA) (1978-1988); Président Emeritus 1993 -
• Expert de l'OMS (Lèpre) (1969-2004); Président du 7e Comité d'Expert, 1986
• Délégué de la Belgique, Groupe de Travail sur l'Epidémiologie, Comité de la Recherche Médicale et en Santé Publique, Commission des Communautés Européennes (CEE) (1972-1988)
• President, International Leprosy Union (ILU) (1988-2001)
• Member of the Academia Europaea
• Chef de Projet, Action Concertée sur la Surveillance des Anomalies Congénitales (EUROCAT), Commission des Communautés Européennes, DGXII, DG V (1983-1996)
• Président du Comité de Gestion du Fonds Alphonse et Jean Forton, Fondation Roi Baudouin (1996-)
• Membre du Conseil Scientifique de l’Institut Scientifique de la Santé Publique, Louis Pasteur (2001-)