Académie royale de Médecine de Belgique

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Eloge de feu le Pr Michel Lechat, membre honoraire

par Mme le Professeur Debarati GUHA-SAPIR, membre associé, et Ian DAVIS, collaborateur.

Michel Lechat, a pioneering figure in disaster management, died on  28 February 2014.   He was  born  in  Belgium  and grew up in Brussels. As a highly independent (and opinionated) teenager, he was educated in boarding schools and then studied medicine at the University of Louvain.

At medical school, Michel met Frans Hemerijckx, an eminent tropical disease doctor who had pioneered changes in the treatment of leprosy. He promoted the use of sulphone and insisted that the isolated patients in leprosaria be allowed to live with their families. These were days when young doctors were packed off to unknown places and Michel, aged 27 years old with a wife and two small children, was sent to a leprosarium run by Belgian nuns and priests outside the village of Iyonda, deep in the Belgian Congo.

When Michel took over in Iyonda as the ‘médecindirecteur’ treatment was moving from Promin, a sulphone drug administered in a series of painful injections, to Dapsone, a drug pioneered by Robert Cochrane in the leprosarium at Carville, Louisiana. These were both lifelong treatments because they kept the bacilli load down without eliminating it, guaranteeing the existence of leprosaria and their residents into the future. Some strains of leprosy also began to show resistance to Dapsone.

It was in Iyonda that the novelist Graham Greene came to live with the Lechat family for a few months to research his book A Burnt-Out Case (a term used for patients cured of leprosy). It was a remarkable study dealing with issues of self-love and selflessness, belief and disbelief, and the leprosy patient’s choice between amputation, which relieves pain but leads to a loss of ‘wholeness’, or no amputation, which entails continuing pain but a feeling of being whole. Michel must have been a worthy intellectual foil for Greene, who questioned basic tenets underlying the motivations and drivers of medical care in the tropics. In the foreword to the book Greene wrote a personal letter to Michel, referring to him as 'Dr Colin’, a character in the book.

Michel greatly cherished his encounter with Greene and, later in life, took enormous pleasure in attending gatherings of the Graham Greene Birthplace Trust, a group of Greene enthusiasts that meets annually to celebrate his life and writings.

In the 1970s, having undertaken doctoral studies at Johns Hopkins University and a five-year research assignment with the World Health Organization (WHO)/Pan-American Health Organization (PAHO), Michel returned to Brussels. By this time the treatment of leprosy had radically changed and multi-drug therapy had been introduced that would cure patients in as little as six months. He promptly set up the Centre for Research on Epidemiology of Leprosy, the first of three innovative research centres. Michel published widely on the epidemiology of leprosy - the subject closest to his heart - and was actively engaged in developing new forms of treatment. He was at the forefront of efforts to replace traditional mono-drug therapy, which kept patients in leprosaria throughout their lives, with multi-drug therapy (endorsed by WHO in the early 1970s), which permanently cured leprosy patients and allowed them to return to normal society.

In 1973, Michel set up the Centre for Research on the Epidemiology of Disasters (CRED) in Brussels - well before the study of disasters and conflicts became an accepted area of study. His co-founders were John Seaman, then medical director of Save the Children Fund, and Claude de Ville de Goyet, then director of Emergency Programmes at PAHO. While preparing the legal documents to set up the centre they discovered - late one night - that a fourth constituent member was required.

Michel, never easily daunted, rushed out into the corridor and found a Turkish cleaning lady, who was pressed into service to add her signature. Through CRED Michel undertook some of the earliest studies on risk factors of mortality in earthquakes and the centre now houses global databases on disasters (EMDAT) and conflicts (CEDAT).

Through his friendship with John Seaman Michel was introduced to the London Technical Group (LTG), a group of doctors and scientists united in a concern to develop disaster research. The subject was in its infancy in Europe at that time, although well established in the social sciences in the United States. In 1976, Michel, John Seaman and Ian Davis were invited to take part in a study of the role of the US Government’s Office of Foreign Disaster Assistance (OFDA). This involved regular visits to Washington where Michel’s sharp humour and rich insights enlivened the committee’s deliberations.

In 1992, Michel reflected on these formative experiences in the opening speech of a conference on ‘Disasters and the Small Dwelling’ in Oxford:

I cannot resist here the temptation to recall some old memories common to many of us all.Not only the Oxford Conference on Disasters and the Small Dwelling of 1978, but also the London Technical Group in the early 1970s and the prominent figure of our late friend, John Rivers; The National Academy of Science Committee on Disaster Assistance,Washington, 1976–78, under the chairmanship of Russell Dynes, a pioneer in the field;the ongoing collaboration of the Oxford Polytechnic Disaster Management Centre to our courses in Brussels; the adventurous launching of a most successful scientific journal, Disasters,by John Seaman (Lechat, quoted in Aysan and Davis, 1992, p. 6).

Michel became a mentor to promising young scientists undertaking pioneering work in the epidemiology of disasters. These included Eric Noji (then at Johns Hopkins University) and Roger Glass (then at the US Centre for Disease Control), who went on to make remarkable contributions in this area, with major publications in The Lancet.

Finally, Michel co-founded the European Surveillance of Congenital Anomalies (EUROCAT) with Josephine Weatherall, a network of population-based congenital anomaly registries across Europe. The goal was to strengthen registration and surveillance systems for birth defects and thereby influence global policy. In 2010 the World Health Assembly adopted a resolution calling on all member states to promote primary prevention and the health of children with congenital anomalies by developing and strengthening registration and surveillance systems.

John Seaman has described Michel as a ‘one-off ’, and his many friends valued him as a maverick with a deep hatred of cant and a dislike of bureaucratic pretensions. Ian Davis recalls his frustration with ‘the system’ when attending various UN gatherings.

Michel was often invited to sit on a platform at these events along with the great and the good, especially after he was made a Baron by the king of Belgium. At one end of the platform someone would be speaking at the rostrum, while the other members of the platform party would be politely taking notes and occasionally nodding agreement. Michel, however, never one to suffer fools, would provide a continuous non-verbal commentary that could relieve the tedium of any presentation of empty rhetoric, yet he seemed totally oblivious to the fact that his expressive mannerisms were watched by the entire audience. He contorted his face (resembling Jacques Tati) in scowls to register disagreement with the speaker’s sentiments, rolled his eyes and even raised his hands in disbelief when some platitude was trotted out that he considered thoroughly incorrect or unacceptable !

Michel’s frustrations, passions, insights, and radicalism, which came through so clearly in his 1992 conference speech in Oxford, remain as relevant today as ever (particularly with the advent in 2015 of a new HFA2 Risk Reduction Framework).

In this speech, Michel described what was needed in the forthcoming International Decade for Natural Disaster Reduction (IDNDR):

Large-scale marketing [of IDNDR . . . ] has its dangers. Institutionalisation is not the least of these. New stereotypes, looking at visibility more than at achievements, trading in words rather than facts. This is a normal trend in the bureaucratic ecology.

Here is one crucial role the academics and the universities could and should play, through conferences like this one [. . .] bringing together people for trying out new ideas, experimenting outside of the tracks, following risky ways rather than safe procedures, exploring innovative avenues of research and not marching according to rituals, being concerned more with products than processes, keeping serendipity alive—all these are the responsibilities of informal scientific groups […] [to attract] new and young people to the field [and] prepare them to ever reinvent disaster management (Lechat, quoted in Aysan and Davis, 1992, p. 7).

Michel Lechat was a rare person who resisted integrating himself fully into the establishment of medical, social, or disaster management bodies. Undoubtedly a pioneer in the development of international disaster management, he was an imaginative man capable of seeing poetry in science while never compromising his scientific rigour. His human warmth was combined with acute medical skills and a profoundly rational approach. He leaves behind him a network of researchers working in disaster epidemiology, leprosy and congenital anomaly who owe him a great deal for his many ground-breaking ideas that are now taken for granted. He also leaves behind his wife Edith, a gifted botanical artist, and their three children, Marie, Laurent, and Sylvie.