Health concerns during Hajj

Each year about 3 million people from all over the worldconverge in the holy city of Mecca to perform once in a lifetime obligation-Hajj. This year more than ten thousand Hajjis from J&K will be part of thisentourage which is a spiritual, enthralling and a divine experience. This stayvaries from 2 to 6 weeks for the pilgrims from different part of the world.Since most of the times it is once in a life travel, the visit to Saudi for theHajj and beyond for our Hajjis is about 6 weeks for the government arrangedpilgrimage and may vary from 3 to 4 weeks in case it is privatelyarranged.  Amongst these Hajjis mostwould be elderly and likely to suffer from some form of chronic medical diseases– hypertension, diabetes, prostate enlargement, chronic respiratory and heartailments being the most common. Some may also be suffering from some rarerdiseases for which they may be taking life saving medications. In the followingfew paragraphs, Hujjajikaram will find some information which will benefit themhealth-wise.

Take a hand out of your disease. If a person is sufferingfrom any disease it is important to have a brief medical report from yourdoctor mentioning the disease/s one is suffering from as well as the list ofmedications that the person is taking along with the dosages and timings. Incase one doesn’t have a medical report better carry some of the latest hospitalprescription that mentions your illness and treatment. Keep a photocopy of thisreport/card in the sling bag or in your identity card holder for a readyreference and keep the original in the luggage as an alternative.

   

Keep a supply of your routine medications along with. Manywill be on antihypertensive, antidiabetic, anticoagulant and other types ofmedication which one should carry in ample quantity for 6 weeks or more. Oneshould have a small quantity kept in the hand baggage to be used whiletravelling (so that one doesn’t miss on the dose) while keeping the bulk in thecheck-in luggage for use later. In case of injections especially insulin, it isbetter to have them in the hand baggage and hand them to the airline staff sothat they keep them in cold storage during the long  to and fro flight. Inhalers and otherrespiratory devices should also be kept handy lest you need them in case ofemergency.

Vaccination. Before you travel there is a set ofvaccinations which are optional (hepatitis A, B, typhoid, rabies) or mandatory.It is mandatory to have the meningococcal vaccine in all and to have  influenza vaccine especially in children lessthan 5 years, elderly more than 65 years and individuals with specific healthconditions like asthma, kidney disease, chronic heart or lung disease andimmune compromised people (at least 10 days prior to commencing Hajj). Forpatients with respiratory and kidney diseases it is better to have thepneumococcal vaccination after consultation with your doctor. Since people fromboth the hemispheres converge there, one may acquire a disease for whichvaccination may be helpful.

Once you reach the cities of Makkah and Medina. As soon asyou land and have some rest, arrange your medications at a proper place andkeep a supply for a day or two always in your sling  bag, as one mostly stays in the holy mosquesmost of the time rather than be at the apartment (so best to have the medicineswith you). In case of insulin better to have the schedule as per the timingswhich one adapts to during the Hajj. Also at the place of your stay in the twocities, check out with some locals regarding the nearest health facility,usually provided by the Hajj Committee of India or by the local authorities.There is a medical centre adjacent to the two holy mosques which one should beaware about. Since the area is huge and one gets lost easily in the rush, it ispreferable to jot down the location of the health centre on a piece of paper oron your mobile mentioning the nearest entry gate and some land mark which willhelp to localize the centre in case of an emergency.

Beat the heat. This time around Hajj will be in midsummer,the hottest time in this part of the world. Temperatures can soar up to morethan 50 degrees Celsius and heat exhaustion is common. To keep one fit in suchhot weather is a real challenge especially for the elderly and children. Ensurea high fluid intake throughout 24 hours and try to avoid direct sunexposure(use hat or an umbrella) whenever possible. Have a water soaked towelon the head to negate the effects of scorching heat. Have bath regularlythroughout the day. Some cardiac and kidney disease patient who are on waterlosing pills (diuretics) should consult their doctors before departure fortheir temporary stopping as this may lead to dehydration and other problems(never stop on your own).

Personal hygiene. In such a mammoth gathering one is liableto contract or transmit infection to others, through contact, gastrointestinalor respiratory route. Washing hands regularly before and after eating as wellas after going to toilets, covering your mouth and nares with a mask in crowdedareas, avoid contact with people who are sick, avoiding raw/ unwashedvegetables, raw milk and undercooked meat will help to lessen disease spread.Most pilgrims cook their own food and in such cases, freshly and thoroughlycleaned vegetables should be used. Menstruation poses a special challenge inwomen and after due consultation with their doctor they can start hormonalpills to avoid their cycles during the pilgrimage. Elderly men who have anenlarged prostate need to strictly adhere to their medication and preferablystay within the reach of the wash rooms at the holy mosques.    

Have a small additional medication pouch. I usually advicemy patients who are going for Hajj to carry some important and additionalmedications in case of emergency. This includes few tabs for pain, sore throat,respiratory infection, gastroenteritis (diarrhea), common cold, allergies andointment for some common fungal skin infection as well as few small bottles ofhand sanitizers. This strictly should be done on doctors’ advice with clearinscription on the medication of how it should be taken. This will save theperson time and also having the medications available he or she may take themedications at the first instance. Though not a medication but my adviceto  people having short sightedness(myopes)  that they should carryadditional spectacles because there is a chance of losing or damaging one.

If one gets symptoms that are not remitting. If a personcontinues to have symptoms despite the first aid he has taken, it is preferableto go to the nearest health facility that you must have jotted on as youarrived in either of the two cities.

Once you are back. Hajj is tiring and on return, one getsless time to relax considering our social set up and norms. It is important toreport to your treating doctor any new signs like fever or respiratory symptomsthat a Hajji develops within 4 – 6 weeks of his return, as this may be adisease contracted from the visit and likely was incubating within (MERS orZika).

One should not panic under any circumstances as the healthcare in that part of the world is outstanding. Also the fact that there is amedical mission from Hajj committee (comprising of doctors, nurses andparamedics) who are accompanying the Hajjis in both the holy cities and oneshould easily communicate with them in case of any clarification, help or anemergency.

(Dr Muzafar Maqsood Wani is Consultant Nephrologist, SKIMS,Soura)

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