Dr C M Vellut, ‘An autobiographical sketch’, The Indian Leprologists Look Back. Bombay, 1990, pp. 133-40.

I was born at Brussels the capital of Belgium in October 29, 1926, the last one of 6 children. About my childhood, I had a happy childhood. My brothers and sisters soon married and I had nephews and nieces when I was only 8! It is a united family whom I meet very often, as all my brothers and sisters have settled in Brussels.

I was finishing High School at the end of the War. Studies were greatly disturbed, but normal life went on inspite of all the trouble of bombing and refugees and others. Soon after I joined an international society, a Christian Society which sent professional women to the developing countries. I joined the medical college in 1945 in the Catholic University of Louvain in Belgium. I was the first of my family to enter the medical field….in good health who don’t think much of the medical field! My choice was really a surprise for my family. I graduated in 1952 having specialised in histopathology and cancer. I wished to go to India where I would like to work, make my career and give my services. I knew a few Indians in Belgium and I suppose that influenced me. I went to England for one year to follow the courses of Tropical Medicine and Hygiene and at the same time to learn English. I never learnt English in school so it was a bit difficult but anyway somehow at the end of the year I was ready to leave. I was the first of the family to leave Belgium, but after me several of my nephews and nieces have gone to other parts of the world.

So from what I knew, I wanted to work in rural India where the real life and future of India remains and there the needs of medical service were greater. The question of the visa was a big problem already at that time it was very difficult for foreigners to get a resident visa in India. After some time I met Rajkumari Amrit Kaur, who was at that time Minister for Health in the Government of India. Because of my histopathology background I was given a post in the Vallabhbhai Patel Chest Institute, where I worked for one year. In fact I worked with Dr. A. Paintal who is now the Director General of the Indian Council of Medical Research. He welcomed me in his family and I was quite [at] ease in India. Soon after, two nurses joined me and we were all working in Delhi but with the idea that we would like to work in the rural area was yet to materialise.

At the end of 1954 Dr Hemerijckx was sent from Belgium to India to establish a Leprosy Control Centre. The idea of a leprosy control centre was proposed by some people in Belgium to thank India for the help she gave at the time Belgium was in trouble after the flood in 1953. A very large quantify of jute bags were needed and India sent it at once. So some friends met to find out a way how we could really help the people of India. So Dr. Hemerijekx was sent. He was looking for a team to work with him, and for a place to establish a Centre. When he met us in Delhi, three of us were most happy to leave Delhi and to go to the rural areas. This is how I actually entered the field of leprosy. I never had in my mind to do leprosy work before.... For me leprosy was a disease out of the blue. I had been is working with cancer patients and cancer patients were much more difficult, because in the cancer institute in those years you knew that many of them would be dying in the very near future. I am always surprised when people asked me “How did you choose leprosy….how can you work with leprosy patients?”…. I came into the field just by chance by working with Dr. Hemerijckx, and I really don’t see anything particular in working in the leprosy field….I like to work with chronic patients because we can create a link. In that sense I was quite happy. A leprosy patient for me is like any other patient.

After discussing with Rajkumari Amrit Kaur and others in the Ministry Dr. Hemerijkx chose Polambakkam as the place for establishing the Belgian Leprosy Centre. In fact Polambakkam had a long history already because Dr. R. Cochrane started there epidemiological work in 1933-35 when he received quite a large piece of land. At that time, there was not yet any treatment for leprosy but the idea of asking the patients to sleep separately was very much in the air. So he started here a so-called night segregation centre and at the same time an epidemiological centre to see leprosy in the context of the village, and to study conditions of the transmission of the disease.

Up to that time Dr. R. Cochrane had been working in a Leprosarium where patients are out of their natural milieu. When Dr. Hemerijckx saw the Centre that Dr. Cochrane had established he said that he immediately fell in love with the place.

The people who donated land to Dr Cochrane were still very much active in the village, are still active today and have always helped us. In every situation we knew we could rely on Mr. P. K. Muthumala and his children and on Mr. T. Kumarappa for help. They welcomed us when we came to Polambakkam in June 1955.

This was really how I joined leprosy work: My wish to serve in India was also fulfilled.

So with Dr. Hemerijckx was team leader and friend, we started work here. First he asked us to get some training because he would be much too busy to train us. So he sent me to Dr. K. Ramanujam in Saidapet. From that time I always consider Dr. K. Ramanujam as my guru in leprosy. I really learned quite a lot in one month’s time examining the patients in the full sun so that you can see very nicely the lesions. It was really good to be with such a wonderful clinician for one month, without any other responsibility except looking, seeing and listening. My friends, the two nurses, were also for a month with Dr. H. Paul in Chingleput. We learned leprosy and were also able to learn many other things in the one month. Dr. Ramanujam and Dr. H. Paul remain our close friends from that time.

People and circumstances that stimulated me to work in leprosy?

From that time, there were quite a lot of people I met. I have already given the names of Dr. Hemerijckx, Dr. K. Ramanujam Dr. H. Paul, Prof. Jagadisan was at the Railway Station when we reached Madras in 1955 and he has always remained very close. Dr. Dharmendra and Dr. R. Cochrane came many times to Polambakkam. I was also stimulated by attending the Biennial meeting of Indian Association of Leprologists/Workers meeting. I had the privilege to attend the International Conference at Tokyo in 1958, where I read a paper on leprosy reaction. That was really an entry into the leprosy world.

I met many people in Tokyo with whom I have been in contact since then, my old classmate Michel Lechat, who had gone through 7 years of Medicine with me in Louvain. He was already involved in leprosy in his last year of Medical College, he had been talking of leprosy before finishing college! I did not visualise that I would be in the same field. When we met in Tokyo, we were very happy to be together again, and since that time we have had many ventures together in leprosy, in India, and out of India. As a Professor of Epidemiology at the Public Health School at Louvain, he has stimulated me to do some studies. This is a friendship from the medical college through leprosy which continues to this day.

My main contributions….

I think it is really the study of leprosy at the grass roots. The operational questions of control, the clinical features of early leprosy, the study of reactions, neuritis, prevention of deformity. As a team, we studied together at Polambakkam many patients and we have presented some papers on this subject. I was also interested by the fact that I could really follow up the patient at a very long range. For some of them, it is nearly 33 years of followup specially the lepromatous patients.

Because as we did not discharge any lepromatous patients till 1982, they are still around us. The non-lepromatous patients have gone far.

We studied also the question of relapses together with colleagues. Dr. V. Kandaswami, Dr. N. Bhaktareddy, Dr. F. P. Vaidyanathan, Dr. M. Rangaraju, Dr. E. Rajamanickam. All of them have continued in the leprosy field whether in India or somewhere else. Later on Dr. H. Maroof joined us also. The training in leprosy work that has awakened the interest of many of my young colleagues can be considered as one of my contributions.

Like Dr. Hemerijckx I found that the leprosy workers specially in the Control Programmes in the rural areas are the pivot of the control work. They are really the important people because they are the link between the patients and the medical profession; the regularity of the treatment, the motivation of the patients is really in the hands of the field workers. They are called non-medical assistants, leprosy inspectors, para-medical workers and really play a very important role. I am really happy that for the last 20 years, even 25 years I have been involved in training field workers.

This is really something important. I heard, on several occasions, that they have been good in their work. The control units were happy to receive staff trained at Polambakkam. The success of the training is due to the fact that we were a team of motivated workers, who have been trained, right from the beginning together, by Dr. Hemerijckx. After all, when I came to Polambakkam with my two friends, Simone and Helene we did not know anything about leprosy. Only two staff who knew about leprosy, one was the lab technician, Mr. S. Albert who had been working with Dr. Cochrane in Tirumani, the other Mr. L. Alex who had been trained in the Gandhi Memorial Leprosy Foundation. These two with Dr. Hemerijckx trained us. I knew I could rely on them. It is important that young men coming for a “job” have a good orientation right from the beginning.

The other field where I contributed at Polambakkam is in the study of an epidemiometric model in collaboration with the School of Public Health of Louvain University and Professor M. Lechat. When looking retrospectively about 55000 patients have passed through this centre and for whom the details about treatment are known. Sometimes the minimum of details since there was a flood of patients at the beginning. In fact the first time we counted the number of patients after 4 months we had received already 6000. So the notes on admission were not always very elaborate, because we were pressurised by the number of new cases. Dr. Hemerijckx used to say, “You work, you treat, you cure, and then you count!” We started the work with the minimum of buildings, with the minimum of facilities, because he said “We will establish the work and then build bricks around.”

In 1960 as per our agreement with the Belgian Government the Centre was handed over “stock and barrel” and staff was absorbed in the Government service. The Government asked me if I would be willing to continue the work for another 5 years. The 5 years continued for much longer and I continued to work here with the team.

I have been there for such a long time that people would tell me that I would never be able to work anywhere else, but, in 1978, I was asked by the Government of India and WHO to take up short-term consultancy for evaluation of the National Leprosy Control Programme in several states. I visited at that time Andhra Pradesh, West Bengal, Orissa, Karnataka.... later on Bihar, Uttar Pradesh and Maharashtra. I more involved at the national level

In 1980, I left Polambakkam but remained very much in touch for a special programme of study of therapeutic trials of the new regimen of MDT, two different regimens under THELEP which is a branch of Tropical disease research (TDR) under WHO. I was acting as the Principal Investigator. So I came back occasionally to Polambakkam but it was Government Medical Officers who took responsibility of work at Polambakkam level.

In between I was a member of the Study Group of WHO who established the first MDT regimen to be applied on a mass scale (1981, at Geneva). It was very interesting. We were a small group, some field workers and some scientists discussing the rationale of the different aspects at the operational level as well as the experimental. We came to the conclusion that the actual WHO MDT regimen was the best treatment to be used on a mass scale, for the moment.

When I came back to India in 1981, I was asked to participate in the Swaminathan Committee in 1982-83. I was mainly committed with the Damien Foundation, first as a Consultant and then as a Secretary. The Damien Foundation is one of the organisations of Belgium which have many connections in India. Dr. Hemerijckx was the founder of the group. The first Secretary for India was Dr. V. Ekambaram. Jaques Vellut my brother’s son was one of the Directors. I requested the Damien Foundation to specially pay attention to North India where there is less leprosy control work done in a systematic way but where the number of’ patients is quite high. The Damien Foundation had centres in Bihar up, and Rajasthan (Deeg, in collaboration with JALMA), in Orissa, Gujarat in a tribal area, I was specially attached to the Kanpur Unit. With the help of very good field workers we were able to cover completely two blocks and to have a very good referral unit for Kanpur and for the surrounding districts.

In 1985 there was a cry of distress from Polambakkam where there was a very serious difficulty in administration. Somehow I came back in 1986 for 2 years. It was good to be back at the grass roots. I really appreciated to be back with the patients I knew and mainly with the staff. Many of the staff are still the same that started with me in 1955. It was also good to apply and to see the difficulty of applying what I had been advising the others to do as Consultant. So this is where I am now. By July 1989 I will probably continue some connection with THELEP which is supposed to continue till 1994.

There is another project of THELEP with paucibacillary so I will keep in touch. I want to go back and do serious work in North India in 1990 (Uttar Pradesh, Bihar).

In brief, I am fundamentally a field worker and I am never happier than when I am at clinics, examining patients with colleagues and staff. The dream of Dr. Hemerijckx was to eradicate leprosy in a unique way. We failed to do it, economic conditions remaining poor.

I come to the question of the future of leprosy in India for the next 25 years….

I am in fact very optimistic about the individual result of MDT at the condition that the treatment is regular and is well monitored clinically. Reversal reactions are more common than with Dapsone. With reversal reactions we always have the risk of neuritis, new paralysis and deformity developing. So we have to be extremely careful. In fact we face more problems with paucibacillary who may make reaction before, during and after good therapy, hence the very big important role of physiotherapists and of regular detailed assessments at the beginning, during treatment, and after treatment. I am probably less optimistic about the control work. For the moment there is a kind of fascination for statistics, figures, attendance. There is a temptation to forget the patients who we cannot reach for one reason or another….the patients who refuse therapy, who have reaction, who have complications, or new palsy, who are dissatisfied, who are drop outs for one reason or another. There is a tendency to forget about them and to give the impression that really all the patients are under therapy.

There is a difference between the voluntary organisations and the Government. First the Voluntary Organisations deal with a much smaller area compared to the Government. They have usually a Referral Hospital where patients are admitted when they have complications and where specialists are available. For many of the Governments who cover a much larger area with medical officers and field workers who are not always ready to take extra duties the monitoring of MDT special programmes is not always up to the mark. Actually this monitoring has to be done in the field, the clinics, in the villages more than on paper as it is done too often. It is a very demanding task and it is not always done. So often the difficulties are neither diagnosed nor expressed. So that the persons who are clinically responsible for this campaign do not realise their part of responsibility. In this special programme the key role is with the District Leprosy Officers who are in direct control and have full power of planning and monitoring. Where the District Leprosy Officer has good experience in a Leprosy Control the chances of success are certainly higher. Perhaps the Consultants are also important, but there is a lot of limitation, because they are repeatedly told the administrative problems are not under their purview, and often the programme is handicapped because of administrative reasons.

We realise also that we shall not reach eradication of leprosy unless there is a definite improvement in the quality of life (economy, social conditions, education). Then only a situation will exist when all communicable diseases will be eliminated.

Now I would like to go on to the next question about my remembrance about famous people.

Famous people: The persons who really inspired and influenced me are the people I am working with….the team of leprosy workers, physiotherapists, of doctors. Among the workers, there have been some ex-patients, like Mr. Sadagopan, Mr. Jayaraman, Mr. Arumugham. They have very much inspired and influenced me to continue when it was difficult. I call them “famous.”

Polambakkam became a “famous” place because of Dr. Hemerijckx’s formidable energy and popularity, because of the Polambakkam team’s high spirit. We welcomed many famous guests, some friendly visits, some official visits….King Baudouin and Queen Fabiola from Belgium; King Leopold and his family; Mr. and Mrs. Raoul Follereau; Mother Teresa; Governors and Ministers from the Government of India and the Tamil Nadu Government; Michel and Edith Lechat; Vanderweid....our Visitors’ Book is very lively with all kinds of comments, jokes, drawings, lots of people, all “famous” in a way or another.

About my interests

My main problem was, and still is, the problem of languages and communication with people. I understand some languages, but when I speak only a few initiated people can understand what I mean….

In India there are so many different languages.

Except for this problem it has been a joy to live in India, living in a village, in a zone of peace and understanding, receiving visitors from all over the world and. introducing them to the real India, the India of the villages of the people working here.

Of course, my religious spiritual fulfilment, ultimately the cause and inspiration of my being here has a very deep warmth and has sustained me all these years.

My interests are really very varied….in national and international politics, … in the fight for liberation. For instance the fight of the Palestinians, the fight in Nicaragua, the fight of the minorities in India. I really am very much involved, unfortunately more in thoughts and prayers than in facts. These are really some of the points on which I feel very strongly. I am reading a lot. I like to relax with some music. Of course the life is slightly different from one I visualised in my youth. There are many, many other projects which I would have liked to implement but deeply I am grateful to the Lord for all that he has given to me.

The tape received on November 11, 1988.

Treatment Used/Researched:
MDT