Health Tips For Hajj

Health Tips For Hajj

Medical Research on the Health of Pilgrims during Hajj

Hajj is a unique Islamic season where more than two million Muslims from all over the world gather in one place for weeks. There is no question that Hajj forces certain demands on the one who performs it. There are the hardships of travel, walking while performing religious rites, fluctuations of the weather in Makkah and Madina during summer, and so on.

It is not surprising that many pilgrims feel exhausted due to the changing conditions, which may over load the heart, chest and kidney functions of those who suffer from chronic diseases.
Since all the rituals of Hajj are performed at a specified time, and despite the fact that free health services for pilgrims are offered by the Government of Saudi Arabia, many pilgrims do not seek medical help. Plus, many of them do not spend the approximate time in hospitals out of excitement not to miss any of the rituals of Hajj.

Thankfully, a number of medical studies have been recently published in some medical journals, discussing this topic. Some of these studies deal with the topic of heat strokes which afflict pilgrims; others discuss other medical and surgical problems in general, kidney problems and others.
Gastroenteritis the most coommon disease during Hajj. A study by Dr. Hasan Ghaznawi of King Abdul Aziz University (KAU) in Jeddah published in 1988 by the Saudi Medical Journal, included a survey of a number of pilgrims and showed that gastroenteritis the most common disease among the pilgrims, especially those from Egypt and Syria. The elderly were more vulnerable to infection. The second most common disease was pneumonia, which accounted for a high proportion of deaths among those over fifty years of age.
Heatstroke was found to be the main cause of death among most of the pilgrims, which claimed the lives of 28 percent of the deceased pilgrims. The elderly and women were more likely to die because of suffocation due to overcrowding at the time of throwing the pebbles.

Heart diseases among pilgrims:

There is no doubt that there are many heart patients who come to Hajj every year. Dr. Muhammad Yusuf of King Abdulazeez University Hospital in Madina conducted a study in the Hajj season in 1413 A.H. During that season, 754 pilgrims were admitted to hospitals with internal medical problems. The proportion of people with chest diseases was 73%. Meanwhile, the proportion of people with heart diseases was 61%. One-fourth of the heart patients were suffering from diseases in the coronary arteries. The last fourth was afflicted with high blood pressure.
The proportion of those who suffered myocardial infarction (heart attack) was 16 % of total cases. Unfortunately, most of the patients suffered from more than one disease. 57 pilgrims died during this period, and myocardial infarction was the main cause behind the death of half of them.
During the meeting of the Heart Association in 1995, the researcher asserted that patients’ negligence of medicine brought many of them to hospitals. One of the problems that doctors face in the treatment of pilgrims is the difficulty of communicating with patients due to the barrier of language and the absence of medical reports for patients indicating their health condition before coming to Hajj.

Heatstroke among pilgrims:

Heatstroke is an ambulatory medical condition with symptoms of high body temperature exceeding 40 degrees, lack of sweating, disorders of the nervous system ranging between mental disturbance and loss of consciousness (coma). In Saudi Arabia, where the heat during the summer reaches more than 48 degrees, few cases of heatstroke occur among people living there because they are used to the high temperature. Anyways, heatstroke is more likely to happen during the Hajj season, particularly when it corresponds with summer.
Cases of heatstroke usually occur during the first two weeks of the month of Thul-Hijjah on the road from Makkah to ‘Arafaat to Mina to Makkah again due to overcrowding, hot weather and several other causes. The government of the Custodian of the Two Holy Mosques has made special arrangements for the prevention and treatment of heatstroke in specialized centers in Makkah, Mina and ‘Arafah. These centers have special units to cool the body named (Makkah Body Cooling Units).
The Saudi Medical Journal published a study in 1986 where a comparison was made between two methods of cooling:
First: the rapid cooling by the Makkah Body Cooling Units.
Second: the simple traditional method for cooling by covering the patient’s body with rolls of moist gauze with normal water spray at room temperature while allowing airflow from all directions through electric fans. There was no significant difference in the time of cooling or the final results between the two methods. This suggests that the first normal and traditional method is still effective in treating these cases.

Researchers attribute the high incidence of heatstroke among pilgrims to several causes, including:

1. High temperature and humidity during the night when the Hajj season is in summer.
2. Overcrowding of pilgrims which causes lack of air movement.
3. Not being used to the hot weather.
4. Difficult acts performed by pilgrims such as walking, especially in the middle of the day, as well as the persistence of some pilgrims to climb Mount Ar-Rahmah on the Day of ‘Arafah and walking several kilometers.
5. Traffic jams and lack of air conditioners in many cars and buses.
6. Many pilgrims already suffer from diseases, such as diabetes and heart disease.
7. Obesity.
8. Drought.
9. Old age.

Cardiovascular changes due to heatstroke:
In 1994, the Journal of Saudi Heart Association published several studies submitted by researchers during the Heart Diseases Conference, held in the city of Dammam in January 1994. Dr. Leith Memish of the King Faisal Specialist Hospital in Riyadh, along with his colleagues, studied changes that occur in the Electrocardiography (ECG) of 28 patients suffering from heat exhaustion and 34 patients suffering from heatstroke. They found out that the ECG was abnormal in 29 out of 34 patients.
Sinus Tachycardia was common among many patients. There were also alterations in the ECG suggesting a state of myocardial ischemia.
Prof. Dr. Muhammad Nooh of King Khalid University Hospital in Riyadh, presented a study which included 51 pilgrims suffering from heatstroke and he used the ECG with ultrasound. He discovered that 17% of the patients suffered from topical disorder in the functioning of the heart muscle. Also, one-fourth of the patients developed pericardial effusion (the membrane enveloping the heart muscle).

Parasitic diseases in Hajj:

Dr. Sirwat of Al Noor Hospital in Makkah conducted a study published in the Journal J. Egypt Soc. Parasitology in 1993 about developing parasitic diseases by pilgrims. Diarrhea was the most common disease due infection with the Giardia parasite. The disease is common in developing countries, and it can be easily identified by stool examination. It can be easily treated by a drug called (Flagyl) metronidazole. There were also some cases of malaria and Schistosomiasis. Researchers stressed that urine and stool examination is still very effective in diagnosing diseases.
Before coming to Hajj, the pilgrim is recommended to visit his doctor and obtain a medical report of his condition. He is also recommended to have a sufficient quantity of the drugs he uses.

General tips for pilgrims:

1. Taking care of the cleanliness of food and drink, and carefully washing vegetables and fruits.
2. Avoiding exposure to the sun for long periods, and staying away from crowded places as much as possible.
3. Getting enough rest and sleep.
4. Wearing light cotton clothes which are loose and light colored.
5. Having plenty of fluids on hot days, especially on the Day of ‘Arafah.
6. Reducing physical exertion by avoiding activities like walking in the market, especially during the times of intense heat.
7. Consulting a doctor as soon as one feels any discomfort or illness.

Safety: A Miraculous Aspect of Hajj

The topic of Hajj safety is an inspiring and soul-stirring subject. Why would it not be when it addresses one of the great signs: The House of Allah. It is a perpetual miracle which calls people to reflect and thus find their way to the Truth and firmly believe that Muhammad  , was truly sent by Allah The Almighty as a messenger.

Imaam Al-Qurtubi  said, “Makkah continues to be a sacred place which is safe and protected against earthquakes and other disasters that afflict other places. Allah made people glorify it and fear to commit evil in it to the extent that it became known and famous for its safety”

Allah The Almighty Says (what means):
· “Have we not established for them a safe sanctuary to which are brought the fruits of all things as provision from Us? But most of them do not know.”[Qur'an 28:57]
· “And [mention] when We made the House a place of return for the people and [a place of] security.”[Qur'an 2:125]
· “By the fig and the olive. And [by] Mount Sinai. And [by] this secure city [Makkah]“[Qur'an 95:1-3]
· “Have they not seen that We made [Makkah] a safe sanctuary, while people are being taken away all around them?”[Qur'an 29:67]
These verse and others prove that the safety and security of Makkah was and continues to be from Allah The Almighty, and it is indeed a sign from Allah The Almighty to all people to ponder upon and reflect.

Your diet during Hajj

Moderation in consuming food during Hajj season ‎is one of the issues to which every pilgrim should pay special attention. This issue is a principle of healthy nutrition in addition to being a Prophetic recommendation. The Prophet, , said:“No man fills a container worse than his stomach. A few morsels that keep his back upright (i.e. adequate him for the needed energy) are sufficient for him. However, if he has to (eat more), then he should keep one-third for food, one-third for drink and one-third for breathing.” [Ahmad and At-Tirmithi]

In addition to moderation in consuming food, the pilgrim should make sure that his food is healthy and free from any microbes, bacteria, or parasites. The pilgrim also needs various types of food that fulfills his body’s needs, whether of calories, proteins or vitamins during his moving from one place to another while performing the rites of Hajj.
An ideal nutrition plan to be followed during Hajj is as follows:
- Proteins are a vital factor of the daily diet of the pilgrim. Proteins are found in meat, eggs, fish and milk. The pilgrim needs about 100 gm of proteins a day.
- It is also important to consume foods that are rich in vitamins. The best sources of vitamins are liver, fresh fruits, corn and wheat.
Similarly, fats are an important source of thermal energy and its sources include fatty foods such as cream, butter, shortening and oils.
With regard to the diet of the ill pilgrims, such pilgrims need a special diet during Hajj. For example, the patients who suffer kidney problems must have a diet low in proteins and phosphorus, in addition to consuming little salt. They also need to have plenty water, juice, vegetables and fruits, besides avoiding consuming fat. The same applies to pilgrims who suffer liver problems, diabetes and gout patients.
Therefore, those pilgrims should visit the medical clinic to review their diet to ensure that it is suitable for the circumstances of Hajj. Such pilgrims, particularly the diabetes patients, also should consult a nutritionist before traveling to Hajj.
Here are some important health tips to ensure a balanced diet during Hajj:
1-Avoid eating exposed food and check the expiry date on canned food.
2-Moderation in consuming food is recommended in order not to overburden the stomach. The foods that cause indigestion and gases such as fatty foods should be avoided.
3-Wash fresh vegetables and fruits thoroughly.
4-Cook meat well.
5-Consume fluids that contain an adequate amount of minerals to replenish the body.
6-Take care of personal hygiene by washing one’s hands before eating, and using odorless soap.
Food safety during Hajj is a vital factor in keeping healthy and preventing diseases.

Safety and Security Guidelines

Pilgrims should follow some guidelines that would help them maintain their health and avoid some of the expected health hazards during the Hajj season.

Dear pilgrim, the following are the most important instructions that you should follow to preserve your safety and health:
1 Perform the required rituals easily and moderately as Allah The Almighty never Charges a soul except with that which is within its capacity.
2 Avoid annoying others during Tawaaf, Sa‘y between the Safa and Marwah and casting the pebbles.
3 Maintain personal cleanliness, which is an important factor in disease prevention.
4 Pilgrims should use an umbrella and avoid making Tawaaf or Sa‘y in case of very hot weather.
5 Refrain from eating uncovered foods that are exposed to flies and dust and use packed or preserved foodstuffs after verifying their expiry date.
6 It is preferred to consume fruits, vegetables and boiled foods that benefit the body and do not irritate the intestines.
7 Use wristbands that display the name of the pilgrim, his nationality, address, health condition and the name of his convoy.
8 Use tissues when sneezing and having common cold.
9 Refrain from exerting much physical effort, such as going shopping and walking in the markets, during hot weather.
10 Go to the nearest healthcare center immediately upon feeling any sickness.
11 Avoid overcrowding and pushing so as not to hurt yourself and others.
12  Avoid climbing stones and rocks.
13 Avoid sleeping or sitting in the tunnels and streets because they are not there for this purpose.
14 Keep your residence (house or tent) clean.
15 Take enough rest before and after performing every ritual of Hajj to refresh your body and help you to perform the rest of the rituals.
16 You should use an umbrella to avoid sun heat and heatstroke.
17 Avoid sitting near people who suffer from infectious diseases, such as common cold, to preserve your health.
18 Avoid slaughtering the Hadyy (sacrificial animals) outside the places dedicated for this purpose, such as streets or near tents, because this will expose you and your companions to diseases.
19 A pilgrim is recommended to take a small medical bag with him containing the medication that he needs to treat emergent diseases.
20 Carry a note containing the phone numbers of hospitals, emergency, civil defense, ambulance, police and so on, to ask for help when needed.
Finally, we ask Allah The Almighty to Protect the pilgrims and Help them perform their rituals easily. We also ask Him to Forgive their sins, Reward them and Accept their deeds and Hajj.

Health tips

Since an ounce of prevention is worth a pound of cure, and for the sake of the pilgrim’s health we will list some of the health problems that he may encounter and the ways of prevention. Allah Willing.

It is caused by prolonged exposure to the blazing heat of the sun, which makes the body lose large amounts of liquids and salts that are necessary for the body. The results include weakness of the muscles, drowsiness, complete fatigue and may lead to fainting in some cases. We advise you to avoid prolonged exposure to the heat of the sun. You should use an umbrella and drink large quantities of liquids.
Contagious diseases:
Contagious diseases, such as typhoid, cerebrospinal fever, flu and diarrhea spread widely in the season of Hajj due to the multitude of people coming from different countries from all over the world, and the lack of health awareness in some of these countries. Some of the pilgrims coming from these countries may carry the microbes that cause these diseases, thus, leading to their spread epidemically. May Allah Protect us. The pilgrim is advised to take proper vaccines produced for these diseases, avoid eating food without washing it well and drinking clean water and large quantities of liquids.
The symptoms of these diseases start with fever, fatigue and colic accompanied by constipation followed by mild diarrhea and pain in the stomach. Severe headache and vomiting may also occur. Once a pilgrim finds any of these symptoms, he should immediately consult the nearest medical center or hospital to run the necessary tests and take the proper medication to avoid complications that may endanger his life.
Some necessary health recommendations:
Recommendations relevant to some diseases:
1- Heart patients:
People who suffer from narrowness in the coronary arteries which supply blood to the heart muscle should take their medication regularly and avoid exhausting and stressing themselves. They should carry their prescription pills for expanding the arteries with them, which are placed under the tongue when they experience chest pain. They should also take full rest. If the pain becomes severe, they should consult the nearest medical center to receive the necessary treatment. Sometimes they may need to be transferred to specialized hospitals in order to complete the required tests and undergo intensive treatment.
2- Kidney patients:
People who suffer chronic kidney infections are advised to drink large amounts of liquids and avoid prolonged exposure to the sun. That is because when the body loses liquids through perspiration, this may lead to deficiency in kidney function.
3- Diabetics:
Diabetics who use insulin should keep their insulin shots in a cool place so that they do not lose their effectiveness. They should take their injections on time and have their meals on a regular basis to avoid a drop in their blood sugar level that may endanger their lives. Diabetics should not exhaust themselves, and they should avoid crowded places as much as possible. It is recommended that they carry small sugar pills to take upon experiencing symptoms of shortage of sugar, such as feeling of hunger or perspiration accompanied by heart beats. It is important that they consult the nearest medical center to have necessary modification to their insulin dose after testing the level of blood sugar.
4- Asthma patients:
People who suffer bronchial asthma have to receive their medication regularly, whether pills or inhalers. They should always carry along their inhalers that widen their bronchial tubes and use them when they find difficulty in breathing or chest wheezing. They should also rest and avoid crowds as much as possible lest they suffer asthma, in which case, they should consult the nearest hospital to receive intensive treatment in the form of oxygen taken via inhalers, or injections. They may need to take antibiotics in case of chest inflammation. A person who suffers from these disorders must drink large amounts of liquids and avoid prolonged exposure to the sun.
5- Hypertension patients:
Patients who suffer hypertension should bring along a sufficient quantity of their medication and take them on time. They should lessen the amount of salt in their food. It is recommended that they visit one of the medical centers to measure their blood pressure from time to time to make sure that it is within the normal range.
Finally, we wish all pilgrims a successful and accepted Hajj as well as a healthy and safe return home. We Pray Allah The Almighty to remove all afflictions from us and from all Muslims.

Pilgrim’s Medical Kit

Some pilgrims prepare themselves for Hajj by taking all the necessary precautions that enable them to perform Hajj safely. On the other hand, some other pilgrims are carless in this regard, because they do not take what is required for them to perform Hajj safely. A medical kit is one of these important precautions as it contains the necessary medications that a pilgrim needs while performing the rituals of Hajj.

There are two types of medications that a pilgrim’s medical kit should contain:
- Medicine for chronic diseases:
- Pilgrims who suffer from high blood pressure, should put the necessary medications in the kit.
- Pilgrims who suffer from diabetes should put in insulin injections and pancreatic enzyme tablets in their medical kit. ‎
- Pilgrims who suffer from asthma attacks should take inhalers to alleviate dyspepsia.
- Pilgrims who suffer from heart disease should take the necessary medications with them.
A pilgrim should bring enough amounts of these drugs with him after consulting his doctor regarding how to use them before     traveling.
II- General medications that a pilgrim needs to treat simple symptoms quickly before visiting a doctor or going to a healthcare center. The following are the most important of these medications:
1-Oral Rehydration salts such as sodium and potassium salts, which a pilgrim needs after sunstroke, heatstroke, severe diarrhea that may cause dehydration especially for older people. These salts are available in the form of powders or effervescent tablets. Pilgrims who suffer from high blood pressure should avoid using food and sodium salt.
2- Antipyretic drugs that are used for relieving pain and reducing fever such as “paracitamol”.
3-Expectorant cough medicine and common cold drugs, because the weather may be cold at night in these regions during this time of the year. This is how we most often get the cold, but vaccination before traveling can help in reducing the danger of infection or any other disease.
4-An ointment for the treatment of burns and some creams to alleviate inflammation and sunburn.
5-Antacid drugs for treating light stomach inflammation.
6-Stomach painkillers and drugs for alleviating pain of the digestive system such as “Buscopan”.
7-Medical gauze and cotton and disinfectant for wounds such as “Dettol”.
These are the most important contents of the medical kit that a pilgrim should carry with him during his travel and when performing the rituals to maintain his safety and health.

Health tips for Hajj

We all want to go…just once. But, unfortunately, many of us are plagued with those nagging questions: the what if and how to of our concern. Although there are many wonderful books available on the subject that we may have studied, it always helps to have some useful tips before embarking on the trip of a lifetime.

We all know that, during Hajj, pilgrims experience numerous events, meeting and mixing with a huge number of people and are constantly on the move from one place to another. Because of this constant journey, pilgrims are advised to pay extra attention to the condition of their health and not ignore what may, at first, appear to be insignificant symptoms. There are certain health and preventative steps that may help them to perform the Hajj rituals with minimum health. Some of these steps are now necessary conditions to get the official Hajj permit; while others are simply suggested health preparations. The prerequisites in combination with the subsequent useful may aid in making your Hajj journey a safe and an enjoyable experience.

Ask your doctor
It is highly recommended, before traveling to the Hajj, that every pilgrim consult his physician to know about new preventative procedures and necessary vaccines. Should the pilgrim be suffering from a certain disease, he has to ask the doctor for advice concerning his health condition and ability to endure the Hajj journey. It is also a good idea to bring a current medical report.

First aid kits to your aid
Every pilgrim is advised to have a medical, first aid kit to deal with any emergency that may arise during the Hajj rituals. Pilgrims now often perform their Hajj through organized groups that take care of these things. Each group of pilgrims may even have their own doctor, which is very useful. If you have to bring medicine, which you need, keep it in a safe place. Use special containers available at pharmacies for this purpose.

Got a medical card?
Pilgrims suffering from certain diseases must carry on their personal medical card like a bracelet that explains their medical condition in detail. This is important for receiving prompt treatment in case of emergency. The pilgrim must write the names and doses of the medicines he is currently taking so that they can be dispensed to him if they are lost.

You can never have enough toiletries-to-go
It is highly recommended that the pilgrims take with them all the equipment and material they may need for personal cleanliness such as: soap, towels, a toothbrush, a shaving kit, etc. If pilgrims observed the Islamic rules of cleanliness and properly disposed of their litter in the baskets and containers provided for this purpose, disgusting sights of trash piles and filthy streets would disappear from the Hajj season. Without the pilgrims help, efforts by municipalities will not be sufficient to eliminate all harms which may result because of lack of cleanness. Using common sense and keeping in mind simple rules can make Hajj healthier and safer for everyone, such as:

- Do not spit on the ground. This is a disgusting sight and more importantly, a dangerous way of spreading disease and infection.
- Do not litter the street; use trash bins and cans.
- In order to avoid infectious disease, use the toilets for urination and defecation; use them properly and keep them clean for others.

Wear the right stuff
Although it is mostly mild in Makkah and other places that are part of the Hajj rites, the weather this year can be cold and it is advisable that pilgrims coming from countries with different climates take this into consideration and bring with them suit-able clothes. Of course, these clothes are to be worn when not in the state of Ihraam.

Be cautious with the cuisine
Some pilgrims do not observe hygiene rules while preparing food. The main reason for the high incidence of infectious diseases such as diarrhea, vomiting, abdominal pain and enteritis (inflammation of the intestines) during Hajj is contaminated food.

There are some easy-to-follow and preventive procedures that must be observed. Choosing to ignore these procedures, however, may result in serious health problems and gastrointestinal (inflammation of the membrane of the stomach and the intestines) disorders.

The following rules are particularly important:
- Observe strict cleanliness; wash your hands with water and soap before and after meals and every time you use the bathroom.
- Clean cooking utensils and wash the fruit and vegetables thoroughly before eating them.
- Do not leave food exposed to open air, dust and germs.
- Drink only bottled water and use it for cooking. If bottled water is unavailable, use filtered and purified water; otherwise water must be boiled before it is used.
- Never buy salads and prepared food from street peddlers.

Chug a lug of liquid
Throughout the Hajj trip, the pilgrim loses substantial amounts of liquids through perspiration and that is why the pilgrim is advised to drink enough liquids to compensate for what he or she loses each day.

Safety and security first!
Hajj is an eventful season where approximately 2.5 million pilgrims get together for a period not exceeding one week. They live in overcrowded tents and move together almost at the same times. Furthermore, they come from various countries, speak different languages and have different levels of education. Because of all this, many accidents may and actually did happen during Hajj. This is why Hajj is an event when a pilgrim must restrain himself or herself and show a high degree of patience and tolerance, as Allah and His Messenger commanded.

Medical Tips for the Pilgrim

Allah The Almighty made it obligatory upon His slaves to perform Hajj once in a lifetime, as He Says (what means): {And [due] to Allah from the people is a pilgrimage to the House — for whoever is able to find thereto a way. But whoever disbelieves — then indeed, Allah is free from need of the worlds.} [Qur'an 3:97]

Hajj is an act of obedience to Allah The Almighty, purifies the soul and removes the sins and faults of the slave of Allah The Almighty. It is like a comprehensive Islamic conference to which people from all parts of the world travel.

Here we will quickly shed light on some important medical tips, since this massive gathering of people could be an easy prey to different diseases and epidemics. Therefore, it is necessary for the pilgrim to know how to protect themselves and safeguard their health.

We will start with the most common diseases in the Hajj season which all occur due to one reason, which is overcrowding:

Cold and Flu:
It is caused by various viruses. Prevention is possible by avoiding
sudden change in temperature, direct exposure to air-conditioners, sneezing and coughing in close proximity to others, throwing used handkerchiefs in inappropriate places, and avoiding touching infected people as much as possible. Moreover, a physician should be consulted as soon as one feels any of the symptoms.

Inflammation of the upper respiratory tract:
This inflammation occurs due to either lack of personal hygiene or infection by microorganisms; and in both cases it occurs due to reasons similar to the aforesaid ones. Nevertheless, preventive measures must be applied with greater strictness. In very few cases, secondary infections like pneumonia could occur, which is more serious and needs treatment for a longer duration.

Inflammation of the stomach and intestines:
The reasons behind this type of inflammation are contaminated food, and infection by parasitic, viral or bacterial microorganisms. Its symptoms are nausea, vomiting, abdominal pains, frequent diarrhea and in some cases headache and high temperature. Prevention entails taking care of both general and personal hygiene: washing hands frequently, washing fruits and vegetables, avoiding eating undercooked foods which could be contaminated, or consuming milk and dairy products without verifying the degree of sterilization and the date of expiry as well as having food and drinks in unclean containers. One should also use clean water from its main sources which have been supervised by health authorities.

This occurs as a result of excessive sweating and constant friction of the skin folds. This causes rash and redness of the skin, particularly for those who are overweight. This mostly occurs between the thighs, underarms and under the breasts in women. Prevention needs trying to lessen sweating and friction by avoiding walking for long distances in the heat as much as possible, wearing long underwear to prevent friction, (after ending the state of Ihraam (sacral state), using cold water to wash the area exposed to friction and using certain prescription drugs and medicated creams.

Heel Cracks:
This is a result of continuous walking in sandals which keep the heels uncovered and expose them to dust. This leads to the dryness of the horny layer of the skin and then to cracking. Prevention entails washing and drying the feet well, wearing socks (after ending the state of Ihraam), as this reduces exposure to dust, stepping with the whole foot on the ground and using moisturizing creams.

Acute renal pains:
Due to loss of fluids and exposure to severe heat, some people might develop acute renal colic and renal stones. This also could occur due to increase of salt deposition in the urinary tract due to increase of concentration of the urine, particularly in those who are prone to developing this condition.
To avoid such pains, pilgrims should drink fluids in large amounts, not less than 3 to 4 liters a day, avoid exertion that leads to heavy sweating and going out in severe heat as much as possible, and visit a physician when the symptoms occur. Those who are prone to developing renal stones should follow the medical instructions.

Causes of high temperature, fatigue, heatstroke and hypothermia:
The chief reason behind this is exposure to direct heat and sunlight.
Symptoms usually start with simple exhaustion, then comes the stage of heat fatigue, which occurs in most cases of heatstroke. This could be accompanied by a headache, weakness, dizziness, nausea, lack of appetite and sometimes a tendency to lose consciousness. The most serious condition is accompanied by fever or hypothermia. Symptoms start due to a disturbance in the mechanism of sweating which is a result of a malfunctioning heat regulatory system. Therefore, the patient may feel a headache, dizziness, fainting and abdominal pain, and then lose consciousness.
A pilgrim can prevent this by avoiding exposure to intense heat as much as possible, using umbrellas, tents and barriers to prevent direct exposure to the sun, drinking water and fluids, in order to replace the minerals and electrolytes lost by sweating. Immediate treatment is required as soon as the symptoms of heatstroke occur.

General medical tips:
Follow the health instructions, particularly those related to general and personal hygiene.
Have clean and properly packed food, liquids, dairy product and beverages.
Avoid exposure to heat and direct sunlight as well by using umbrellas and shields. One should expose himself to air conditioning in a suitable manner and without exposing oneself to it directly.
Wet the body and head, face and limbs with cold water from time to time during summer.
Consult a physician and visit the nearest medical centers as soon as one feels any exhaustion or fatigue or symptoms of illness to take remedial and preventive measures at an early stage.
Give due attention to the symptoms and transfer the patient to the nearest health center or hospital immediately, especially in cases of hypothermia. A patient should be put in a cold environment and cold compresses should be used.

The Healthy Hajj -

Modern medicine and the road to Makkah

A Divine calling
Every pilgrim, and not a few for a lifetime, dreams of a perfect Hajj—one that Allah accepts as righteous, that washes away all sin, that delivers one from that spiritual womb of the world in Makkah as pure as the moment one emerged from mother.

But mundane as it may be, good physical condition and health practices are realities that help make such dreams come true. For if one hopes to scale the lofty spiritual heights of Hajj pleasing Allah by visiting this first House of His in the company of millions of others proper bodily preparation unquestionably goes a long way to help.

That is the purpose of this (to some, perhaps, too worldly) piece: To help the pilgrim better fulfill his or her vision of this fifth of Islam’s famed Five Pillars, but once-in-a-lifetime obligation-in-odyssey. Bear with me as I take you round the physical paces of Hajj’s miracle traces. This will entail five cornerstones of our own: Physical factors, topographical tests, activity anxieties, medical maladies, and precautions and preventions. But first, here’s a bit of psycho-spiritual history, so we don’t lose focus.

The Creator Commands, the human heeds

Hajj, in many ways, is a commemoration of the typical divine mindfulness of the believing family of Prophet Ibraheem . From the 8th to the 12th of the sacred month Thul-Hijjah, which is the twelfth and last period of Islam’s calendar year, we travel to the Ka`bah in memory of his hallowed journey there with his wife Hajar, and eldest son, and father of the Arabs, Ismaa’eel .

We go round the house this prophet, father and son, built up together. We traverse the two mounts of Safa and Marwah in the very footsteps of our mother Hajar, walking where she walked and running where she ran. We stone the symbolic pillars where Ismaa’eel pelted Satan, who sought to stir him to disobedience against Allah and Ibraheem.

Yet above all, we ritually sacrifice a lawful gift-animal, to feed the world’s poor and ourselves, for the sake of Allah, in celebration of His deliverance of Isma’eel  from ritual death in the great test of faith faced and passed by Ibraheem  Friend of God.

Hajj thus becomes an individual obligation upon every adult Muslim who has the means to make it there. It is noteworthy that good physical and mental health forms part of that obliging condition. For Allah knew that Hajj would entail health hardships and physical rigors that its pilgrims had to be prepared to meet.

So on to preparation.

The three Hajj challenges to physical well being

To maximize the benefit of Hajj, the would-be pilgrim should account for four physical factors: Physical ability, mental strength, the environment, and medical conditions, existing and potential.

All valid worship involves two components: Intention and action, in that order. Sincere purpose is the precondition Allah has set for His acceptance of any of our acts of devotion. Physical adequacy is an essential part of actualizing that intention and performing it optimally.

In some ways, Hajj is unique among the obligatory rituals of worship. It challenges our physical competency in a succession of rites that place increasing demands upon our bodies and pose increasing “logistical” corporal difficulties.

In spite of our sincere intention, we may be unable to complete its rites (at least on our own), if we suffer one or another physically inadequacy. It is, therefore, crucial to embarking on Hajj and while on pilgrimage—that we honestly inventory our physical condition, that we pay it due attention, and that we maintain it, use it, or manage it in the best possible way. This is the single most significant step we can take in securing our own ability to satisfy its integrals and cope with its stresses and pressures as we move through its arduous stations and complete its profoundly fulfilling rituals.

To understand the changes that take place in the internal balance and stability of our bodies when we expose them to problematical environments, we need to know how they respond to surrounding conditions and how they adjust to a new environment. This is vital to the effective management of potential medical problems. The factors that affect this internal equilibrium when it comes to Hajj can be broken down into three general kinds, each subcategories specific to the pilgrimage experience:

A.  Factors that affect immunity, and increase chance of infection
1. Increasing fatigue from a long journey
2. Sleep deprivation
3. Tension and insecurity regarding the unknown
4. Calorie deprivation due to schedule change or lack of nutritional availability

B. Environmental conditions that predispose us to acquiring new conditions and making existing conditions worse

1. Local temperature variance from one area to another: Excessive heat can lead to heat-stroke or —exhaustion. Cold may bring on flu, upper respiratory infection (URI), pneumonia, and the like.
2. Air and ground contamination, and overwhelming of sanitary system: Air pollution causes respiratory ailments like URI, aggravation of asthma, and so forth. Sanitation problems bring about diarrhea diseases, hepatitis A, and so on.
3. Overcrowded accommodation facilities and random use of open space for accommodation increases exposure to atmospheric pollution and poor sanitation.

B. Human factors

1. Lack of education about sanitation and physical health: Coughing, sneezing, spitting, improperly reliving oneself and poor hand washing spreads infection.
2. Lack of compassion for others: coughing and sneezing in a crowded place, hand shaking without proper washing increases contagion.
3. Lack of sense of discipline: Overcrowding at gates and elevators, and the like, creates hazards for oneself and others.
4. Over enthusiasm for worship and disregard for rules: Particularly in attempting to kiss the Black Stone and in throwing pebbles at the Jamarat risks serious physical injuries.

Top Health

Makkah is nestled amid a complex ring of old worn mountains on the west coast of the Arabian Peninsula some 50 miles from the Red sea and 45 miles east and southeast of Jeddah. It is about 909 ft above sea level. Mina and Muzdalifah, two other Hajj stations, exist also amid such sloping chains. ‘Arafah, where everyone gathers for the central feature of Hajj, is a plateau plain, except for Mount ‘Arafah (Jabal Al-Rahmah), which is basically a hill. Because of this low mountain-surrounded landscape, in high traffic seasons the air quality can quickly deteriorate and stay as such till Hajj season is over.

Makkah covers a 10-square-mile area. Its 1.5 million inhabitants live on Hajj and ‘Umrah tourism that generates about $100 million a year.

Mina, Muzdalifah and ‘Arafah are east and southeast of Makkah. The shortest walking distance between Al-Masjidul Al-Haraam where the Ka`bah is to Mina is about 5 miles (8 km). ‘Arafah is about twice that distance from Makkah, with Mina and Muzdalifah in between.

The desert region’s weather is dry year-round with low humidity. Temperature, however, varies widely, flaming in summer, usually up to 120 F, and a cool 60 F average in winter. But the highs and lows can spike both dramatically higher and lower, drop to freezing in winter, particularly in the valley of Muzdalifah when a cold front blows from the north.

Madina on the other hand has a relatively cooler temperature. It sprawls across 66 square miles with 1.3 million residents. It is about 280 miles (447 km) north of Makkah. Visiting Madina is Sunnah and not a rite of Hajj, but most pilgrims make the trip for the sake of visiting our beloved Prophet Muhammad  and praying in the Haram (Al-Masjid-un-Nabawi) next to his grave.

Intense temperatures subject to remarkable swings, elevation changes, distances to be traversed as 2 million non-residents converge with twice that many locals and regionals. Particularly in the proximity of the Haramain. These are the geographical factors that form the health risk assessment. That individual pilgrims and medical professional must consider and prepare for.

This is, if you will, the topical context. But its proper medical evaluation requires us to first mix in the ritual content of Hajj. It is this we shall look at now.

The Healthy Hajj – II

Physical activity and ritual highlights of Hajj

Kinesiology is a word I want to introduce here. It is the study of the mechanics of motion as this relates to human anatomy. That is what we want to consider as we review the routine and ritual activities, and the prevailing human and topographical conditions, involved in making Hajj.

The Succession of Rites and Good Sense Prescriptions
1. Tawaaf (the seven circumambulations of the Ka`bah):

The distance it takes and speed at which you go around the Ka’bah will vary depending upon your proximity to it. In the company of millions, that variance can be huge. It’s not only a matter of how far you are horizontally from the Ka’bah, but what floor you’ve chosen to make tawaaf on. Many people love to make additional voluntary revolutions after completing the mandatory number.

Prescription: Make your Tawaaf a comfortable, slow pace. Adjust your plan of Tawaaf to an area or floor where the crowd flows to your liking, if possible. This is much safer because usually it is the crowd that dictates the speed. If you’re a particular slow mover or have someone elderly or with disability in your company, choose a time of day and place where the traffic is relatively lighter.

2. Sa’y: (the seven passes between):

Mount Safa and Marwah stand a short distance from the Ka`bah and roughly a half mile (800 meters) apart. The seven passes between them, emulating the steps of our mother Hajar, include four passes from Mounts Safa to Marwah and three from Mounts Marwah to Safa. That’s a total linear distance of 3.5 miles. So be ready. Unlike Tawaaf, Sa’y requires a faster paced walking, interspersed with jogging between green lights set overhead, for that is what Hajar did, in search of water or help for her baby Ismaa‘eel. For the physically fit, this will be only of moderate intensity, in terms of exertion. For the unfit, it is a more severe challenge. There is not much incline to worry about. The traverse has been tiled over evenly and the to-and-fro lanes are separated.

Prescription: Prepare for your sa’y by beginning a good daily walking regimen at least two months in advance, if your condition permits. Try to at least approximate its distances. A little interspersed jogging is even better, if you are able. For those who are elderly or unable, there is an intermediate lane between the to-and-fro traverses that is wheel chair and litter accessible. If this will be your choice, assign obligations and prepare for it in advance. Consult those who have been there and who know.

3. On the way to Mina:

Mina is the place of encampment in Hajj. Departure to Mina is normally from near the Haram, and the standard transportation mode is air conditioned buses, though thousands walk. Usually there is no time constraint. But the combined affects of over crowding tension, temperature, and pollution can be dangerously over-whelming for the vulnerable. Those walking could experience significant physical exhaustion with all the expo-sure, particularly since the crowds and carrying personal effects could turn the five mile trek into a journey of several hours.

Prescription: Arrange for an air-conditioned bus with your Hajj package, especially if you know your physical circumstances would make walking or other modes of travel overwhelming. Understand that even the mere embarking on the bus can be confusing in such crowds and may expose you to the outside elements much longer than you think. Drink plenty of water, plan medicines accordingly, and prepare to be patient through potential frustrations.

4. In ‘Arafah and Mina:

‘Arafah is about 2.5 miles (4 km) from Mina. Again because of heavy traffic it may take several hours to travel that distance. The weather in ‘Arafah is dry and hot. It is not as easy to find one’s way around as you might at first think. If you depart, go with a guide. Take water. Many people suffer heat sicknesses and disorientation, getting lost after separating from their appointed group, most often to climb the famed Jabal Ar-Rahmah. Departure to Muzdalifah after ‘Asr comes amazingly fast. The night in Muzdalifah usually passes quickly under the open sky. Adverse weather changes are uncommon. Coolness can come as a surprise blessing, but this is rare.

Prescription: Adverse weather effects can be avoided if precautions are taken. If you depart from your tent and group, go with a guide. Take sufficient water. If you get lost, look for one of the many aid facilities.

5. Back to Mina, the Jamaraat, sacrifice and Tawaaf al-Ifaadah (Az-Ziyarah):
The stay in Mina is generally relaxed. Throwing pebbles at the three Jamraat, however, has been associated with many difficulties and injuries because of the carelessness of the crowds. Unless done carefully, the pelting could be harmful to others.

Prescription: Stone the Jamraat at appropriate times. Do not be in a hurry. Stay away from the irresponsible pushers and shoves, who sometimes form themselves into human gauntlets out of ignorance. Do not get too close to the Jamraat, or pebbles will inevitably hit you. If you do get hit by accident, do not turn around and expose your face and eyes to risk. Take care on the upper levels not to place yourself too near the short walls. The infirm and elderly can appoint others to perform this task, if needed, and may depart Mina early, under the right conditions. Tawaaf Al-Ifaadhah, at the Ka `bah, can be done any time during the days of Tashreeq.

6. Days of Tashreeq

These are the recommended days of extended stay after completing the obligatory rites of Hajj, usually three (but may be longer). These are the days of feasting after sacrifice. This generates an enormous amount of ground and air pollution, putting a severe strain on the local authorities to maintain a healthy sanitary environment. It is, therefore, the time to be vigilant about hygiene.

Prescription: Be careful about what you eat, and from where you drink. Excessive hand washing is recommended, especially after any hand shaking or human contact. There is plenty of greeting and congratulating going on. The whether can be particularly hot and uncomfortable, so find places to rest with good ventilation. Be vigilant about utensil use and keep an eye on cooking apparatus and flames. Fire can catch and spread quickly in the sometimes high winds.

A Word on acclimatizing

The body needs one to two weeks to get used to extreme heat, which it does by a gradual increase in its capacity for sweat production. No one can acclimate to acute exposure to extreme heat. In this situation, the body temperature will quickly rise because of a lack of sweat production and serious heat illness (stroke or exhaustion) becomes inevitable when sweat production fails. Heat stroke can be fatal.

Similarly, the body cannot quickly adapt to hyper-exposure to extreme cold. The body tries to produce extra heat to maintain the core temperature by muscle contraction, or shivering. That’s a sign to get to warmth.

The healthy Hajj – III

Medical problems
Existing condition:

High risk group

People with the following existing problems are at high risks when under-taking Hajj. At the same time these are the people who emotionally and spiritually feel more inclined to make the pilgrimage. Therefore it is imperative that these pilgrims prepare themselves to the utmost while undertaking this sacred but difficult task. Some of them may be at a higher risk than others depending on the severity of their conditions.

For the purpose of risk management the following conditions will be included in the list:

1. Cardiovascular diseases: Congestive heart failure, artery disease and hypertension.
2. Respiratory diseases: Asthma and emphysema.
3. Metabolic diseases: uncontrollable diabetes insipidus, diabetes mellitus and patients with a whole history of thyroid.
4. Renal diseases: Chronic renal failure, particularly patients on dialysis.
5. Neurological diseases: History of disorders and accidents.

Acquired problems:

Heat related
1. Sunburn
2. Heat Exhaustion: Secondary to non-acclimatization, strenuous exercise associated with water depletion (with or without salt depletion)
3. Heat Stroke: Secondary to body’s inability to dissipate heat from the body secondary to failure to produce enough sweat. (Heat is lost through evaporation of sweat).

Infectious diseases

1. Meningococcal Meningitis with W135 strain
2. Hepatitis A and Malaria
3. Hepatitis B and HIV—from use of infected razors or scissors
4. Pneumonia and Tuberculosis

Upper respiratory infections

1. Pharyngitis, Sinusitis
2. Flu-like Illness: Very common and highly contagious but fortunately short lived; need simple measures to treat and prevent the spread

Gastrointestinal diseases

1. Travelers Diarrhea
2. Gastroenteritis
3. Bacterial or Parasitic Infection: Salmonellosis, shigellosis and amoebiasis

Precautions, prevention and treatment

Preparation and precautions:
Self assessment of financial and physical abilities
Detailed knowledge of medical conditions
Self education about Hajj and participation in group activities
Preparation of a will
List everyday necessities
Last needed the best medicines for cold, diarrhea, headaches, nausea, and vomiting
List persons or physicians for emergency contacts
Knowing adequate amounts of prescribed medications for existing conditions
Attend temporary mini camps to teach pilgrims about the rules and regulations of Hajj, First Aid, and measures. Education in symptoms of serious conditions, such as dehydration, hypotension and high fever

Preventive measures:

This may vary according to the country departure. Here are the common commendations:

At the country of Departure
1. Flu Vaccine
2. Meningococcal Vaccine
3. Prophylaxis for Malaria
4. Hepatitis A Vaccine
5. Compliance with the health regulations of Saudi Arabia
6. After Reaching Makkah
7. Maintain strict personal hygiene, good hand washing and wearing mask in areas of overcrowding
8. Avoid unnecessary sun exposure.
9. Use umbrella when possible
10. Avoid strenuous physical activity long walks in sun
11. Wear sun glasses
12. Carry liquid like water outside of Haram

Conditions needing profession help urgent

Some things you can treat yourself, but there are things that you can’t. If you notice one or more symptoms in yourself or in others, get proper medical attention without delay.

1. High fever with or without rigors and chills
2. Change in mental status
3. Seizure activity
4. Shortness of breath not responding to simple measure or prescribed medications
5. Chest pain not responding to nitroglycerine (in case of known heart condition)
6. Vomiting of blood or passing of blood from the rectum or excessive menstrual bleeding

Religion is advice

Hajj is a physical and collective migration of Muslims from all over the globe to visit the Sacred House of Allah, the Ka`bah, in the city of Makkah. But spiritually, it is an emigration to Allah in response to His ancient call. What an august honor for the chosen ones.

Hajj might sound rather difficult and complex. Yet once the intention is made Allah makes it easy on everyone, regard-less of age and physical health.

You might be surprised at the immense planning, preparation, and coordination by national and international establishments and health organizations to address Hajj health issues and the Hajj experience. Allah knows it and shall reward it according to its intention. But you and I, the individual pilgrims that make up these very special annual Hajj communities Allah’s specially invited guests to His Ancient House-we, most of all, need to do our parts to perform our personal pilgrimage with complete success, to make our Hajj that dream of a lifetime at last come true. Ameen.

Vaccinations for pilgrims

It is necessary for pilgrims to take care of their health, especially during the Hajj season that has a lot of over crowdedness and is rife transmission of diseases.

Consequently, they are advised to protect themselves against diseases by means of taking preventive vaccinations that will protect them, Allah Willing, from diseases that are spread during the Hajj season.
There are recommended vaccinations that should be taken before Hajj, noting that some of them are mandatory and others are optional:

1. Vaccination for cerebrospinal fever:
This is an important vaccination that must be taken by all pilgrims coming to the Sacred House of Allah.
As an important procedure, the dose should be taken at least ten days before traveling. The vaccination is effective for no more than three years.
Cerebrospinal fever is an infectious disease that is transmitted through the spray that is released from mouth and nose. It attacks the brain membrane and the spinal cord, and this leads to developing dangerous symptoms unless pilgrims are immediately placed under medication once they contract the disease.
There are some precautionary procedures for preventing the contraction of cerebrospinal fever: maintaining personal hygiene, ventilating bedrooms to let in fresh air and sun rays, washing hands after shaking hands with sick people, avoiding exposure to air streams, having adequate nutrition to reinforce immunity, avoiding crowded places if possible, avoiding sharing private things such as towels, tissues and cups with others. Using tissue is necessary when sneezing.

2. Vaccination for yellow fever:
Yellow fever is commonly spread in semi-desert African areas and in South America and Central America. Pilgrims who come from such places must be vaccinated against this disease.
Yellow fever is infectious, dangerous and has grave consequences. Symptoms include a sudden rise in body temperature, headache, dizziness, muscular pain and a collapse in liver and kidney functions.

3. Vaccination for influenza:
This is an optional vaccination for all pilgrims coming to the Sacred House of Allah. However, those who are more likely to contract influenza, as in the case of old people and other people with chronic respiratory diseases, diabetes and kidney failure, are recommended to take this vaccination. Most of th time, doctors recommend vaccination of influenza because there is a high chance pilgrims contract it because of crowding, the thing that affects the level of their performance of the rituals of Hajj.

4. Vaccination for pneumonia:
It is called pneumococcus vaccine, which is not given to all pilgrims, but to people with sickle cell anemia, or kidney failure or immunity deficiency, or people with removed spleens. It could also be given to old people, or to those who suffer from chronic diseases in liver, heart or lungs.

5. Vaccination for children:
In addition to taking basic vaccinations against main childhood diseases, namely whooping cough, diphtheria, measles, tuberculosis and tetanus, children must be vaccinated against diseases that are spread during Hajj.

6. Vaccination against cholera:
Cholera is a dangerous disease that is common in India and Pakistan. Pilgrims who come from these countries should take precautionary procedures against it. As such, they must be vaccinated against the disease to reduce its threats and effects on others.

7. Vaccination for typhoid fever:
This is one of the most serious fevers, as it is contracted via salmonella A, B, and C types. Infection is transmitted through food or drinks that are contaminated with salmonella bacteria.

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