HAJJ: Check you HEALTH first
Pilgrims are exposed to demanding circumstances and are supported by an unfamiliar healthcare system
CAREER BY PROF M S KHUROO
Hajj Health Check-Up: By law every Hajj pilgrim must undergo a dedicated health check up. This check up should stratify health risk to the pilgrim. It is worthwhile that all pilgrims carry an identity card which gives their demographic information, health risks (especially diabetes), blood group, allergies and contact number in case of emergency.
Potential Hajj pilgrims with following illnesses should be discouraged from journey on medical grounds as these may predispose the incumbents to exceptionally high health-risk:
• Unstable coronary heart disease like effort angina or recent heart attack, overt heart failure, heart enlargement with low ejection fraction (on Echocardiogram), uncontrolled severe hypertension and difficult heart rhythm abnormalities
• Lung disease requiring continuous oxygen, severe de-saturation at rest or on effort (fall of partial pressure of arterial blood oxygen), severe obstructive or restrictive lung function tests
• Elderly with stroke and severe physical disability and severe disabling osteoarthritis knees
• Diabetics with uncontrolled blood glucose levels; prone to keto-acidosis; severe target organ damage
• Elderly with cataracts and significant visual impairment (need surgery and improvement in visual acuity prior to allowing Hajj)
• People who carry communicable infection diseases like tuberculosis; can be allowed after infection is controlled
Potential Hajj pilgrims falling under following groups cause higher health hazard and decision about Hajj should be taken after counseling the families:
• Children below 12 years; prone to dehydration and tolerate infections poorly
• Pregnant mothers with advanced stages of parturition
• People with co-morbid diseases which are controlled on medication/life style modifications. Such pilgrims should carry a medical report along with adequate supplies of medications from their primary physician.
Hajj Health Drill. Hajj may be the sole international journey for most pilgrims from developing countries including India. While so, they are exposed to demanding circumstances to fulfill religious obligations (manasik) and supported by an unfamiliar healthcare system which is stretched to the full. To face these challenges pilgrims need a Hajj health drill. Pilgrims should be shown and interpreted good quality videos of the actual journey they are envisaging. These should define check-in procedure for flights, use of toilets in flight and at many locations, traffic signal rules and road crossing, simple sanitary practices, hand washing, use of face mask and practices of waste/sewage disposal during Hajj. Pilgrims must watch and simulate drills of essential religious obligations like Tawaf, Sai between Safa and Marwah etc. Exercise program like daily swift walk for 20 minutes should be encouraged for at least 6 weeks prior to travel. Self-monitoring of health indices should be encouraged. Use and availability of a thermometer is helpful in monitoring body temperature. Patients with high blood pressure should know how to use an automatic blood pressure apparatus, carry one with them and use it on regular basis. Diabetics should be trained to use a glucometer to monitor blood glucose and counseled on its application. Diabetics should be educated on symptoms of hypoglycemia and carry Glucose (not cane sugar) supplies to ward an impending attack. Elderly on multiple medications should be able to recognize the tablets and self-help for dug intake for several weeks prior to travel. A chart listing drugs with their shape & color and time schedule should help such pilgrims. All pilgrims should carry supplies of on-the-counter available medications for common ailments. This includes simple analgesics like paracetamol for pain and fever, safe antibiotics tablets for respiratory infections, anti-emetic for vomiting, anti-spasmodic for tummy ache and anti-diarrheal tablets for GI upset. A prescription defining medication carried by the pilgrim is essential for scrutiny at the check in points. All pilgrim-groups should carry a first-aid kit and somebody from the group should be trained in its use for minor injuries. Group leader or attending medical officer should be aware of all health units in Makkah, Mina, Arafat and Medinah and have contact numbers of such units. It shall be advisable if all pilgrims carry a cell phone and are able to contact their group leader or Hajj-physician if needed. Thus adequate practice on use of cell phones may be envisaged for such circumstances.
Hajj Health Practice. Each pilgrim has to understand and use broad guidelines to look after his health and health problems so that he can fulfill religious obligations (Manasik) with least disturbance. Fatigue is a common occurrence and should be dealt by adequate rest and sleep. Heat-related issues - heat exhaustion and life-threatening heat stroke - can be avoided by adequate water intake and by avoiding direct exposure to sun. If unavoidable, use of light-weight umbrellas is an alternative. Fever, catarrh and cough are common and should be managed early on by analgesic tablet and on-the-counter antibiotic. GI-upset like tummy ache, vomiting and diarrhea should be managed by corresponding tablets and by maintaining adequate fluid intake. Attending and use of local medical centre should be used judiciously as it may affect religious obligations (Manasik). All patients suspected to have heat stroke (rising body temperature above 1020 F and conscious disturbances) need to attend such units as an emergency. Respiratory infection causing breathing disturbances, chest discomfort, and blood-tinged phlegm suggest pneumonic illness and need hospital visit. Diarrheal illness causing fainting, low urine output and low blood pressure need hospital visit for intravenous fluids. Febrile illness which does not settle in few days and causes debility should receive medical attention. Pilgrims with underlying co-morbid illnesses should receive medical attention early on as simple flu like illness or GI upset may worsen their underlying condition. It is worthwhile to take Hajj doctor in to confidence while attending medical centers.
Feedback at Khuroo@yahoo.com
Lastupdate on : Mon, 19 Sep 2011 21:30:00 Makkah time
Lastupdate on : Mon, 19 Sep 2011 18:30:00 GMT
Lastupdate on : Tue, 20 Sep 2011 00:00:00 IST
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