COMMON HEALTH PROBLEMS
DURING HAJJ
To fully appreciate the
physical dimensions of the Hajj let us consider the Hajj as a
dynamic system. On arrival you are going to be wearing the
Ihram clothes and once in Makkah you have to go for Tawaf or
the circumambulation the Ka'bah seven times and then perform
the Sa'i; the act of jogging seven times between the hills of
Safa and Marwah, a distance of 500 meters, i.e., a total
distance of 3.5 kilometers. On Arafat day all Hujjaj must
assemble on the Mount of Mercy from morning until sunset.
After sunset a mass exodus of
Hujjaj starts from Arafat, mainly on foot, towards Muzdalifah,
an open plain, where they spend a night under the open sky. In
the morning they head towards Mina, where they spend three
days in camps. Two rites are performed during this period
stoning the devil and sacrificing an animal. Each day the
pilgrim throws 21 pebbles at three stone monuments which
symbolize the devil. Each adult male is expected to sacrifice
a healthy animal, preferably a sheep. Approximately one
million animals are slaughtered during these three days. The
final rite of the Hajj requires the return of Hujjaj to Makkah
for a farewell circumambulation around the Ka'bah.
From this brief description of
the movements it can be seen that all the rites of the Hajj
entail strenuous physical effort. However, if the physical
exertion is increased beyond its natural limits, especially in
hot weather, one may suffer from various heat-induced
illnesses; this is particularly true for those with chronic
diseases.
Overcrowding is another major
problem since the area is limited and the numbers are
increasing annually. Accommodation is difficult to find and is
very expensive. Many Muslims prefer to sleep on the pavements.
Lack of sleep and the resulting physical exhaustion both
predispose to heat illnesses.
RESPIRATORY TRACT INFECTION
People from all over the world
bring with them all kinds of infections, and the unavoidable
closeness of the hundreds of thousands of Hujjaj facilitates
easy spread of those illnesses. Fatigue, and lack of sleep
from the physically demanding regimen of Hajj rites as well as
the over-enthusiastic exertions in salah and devotions, lower
one's immunity and resistance, thereby making one more
vulnerable to disease. Acute respiratory infection is very
common. Epidemics of flu-like illnesses are also very common.
The key point here is that
nearly all-upper respiratory tract ijifections (URI) are
viral. They will resolve spontaneously, and require no
antibiotic treatment. Patients should seek care only if they
experience symptoms consistent with complications of URI such
as prolonged illness with purulent nasal secretion, fever, and
facial pain; isolated sore throat with fever; shortening of
breath; productive cough with fever or shortening of breath,
or the subjective feeling of a severe illness. Try symptomatic
measures to minimize the symptoms of sore throat or flu, as
follows:
Drink lots of clear fluids
(water, juice, Sprite).
Take acetaminophen or
paracetamol to reduce pain and fever. For a cough try an
over-the-counter cough suppressant. For sore throat: gargle
with salt water; suck on ice cubes or lozenges; drink hot
water with lemon and honey. Wash your hands often. Flu is
spread through the air by coughing or sneezing. It may also
spread by hand contact.
HEAT ILLNESSES
Not all types of heat illnesses
are mentioned here to avoid confusion or unnecessary details.
It should be made clear, however, that heat can present major
challenges to persons making Hajj, and that they should take
such illnesses seriously.
HEAT EXHAUSTION
Commonly caused by dehydration
and loss of body salts. It is manifested by weakness,
headache, dizziness, nausea, vomitting, and diarrhea. An
increased body temperature and pulse rate may be present. The
treatment of heat exhaustion is by resting, getting out of the
heat/sun, sponging the body with water and fanning it, and
aggressively replacing fluids and salts. If not taken
seriously, this can progress to heat stroke. Patients
diagnosed as suffering from heat exhaustion should be admitted
to hospital where they are covered with large sheets of wet
gauze and fans used to aid cooling. IV-fluid should be
administered and a fluid balance chart kept monitoring urine
output. Nearly all patients recover and are discharged within
24 hours. Patients must be transferred immediately to the
nearest health care center.
HEATSTROKE
In this condition the body
loses its ability to regulate temperature and the body
temperature soars, often to above 106 degrees. Sweating may or
may not be present. The hallmarks of heat stroke are physical
collapse and mental deterioration ranging from confusion to
coma. This is a medical emergency and must be treated
aggressively with rapid cooling and IV-fluids if available. If
not, death or permanent damage to the kidneys, heart, or liver
may result. Emergency treatment can consist of cooling in
whatever water is available or removing clothing and
wetting/fanning the body. If able to drink, give the victim
water, or oral rehydration formula.
All patients diagnosed as
suffering from heat stroke should be cooled on the specially
designed Makkah Body Cooling Unit (BCU). This achieves rapid
reduction of the body temperature by evaporation from the warm
skin; the skin temperature is kept at 30-32 C (84-90 F) to
enhance vasodilatation and increase the heat flow.
PREVENTING HEAT ILLNESS
Even marginal dehydration
interferes with the body’s ability to regulate temperature. It
also makes a mild diarrheal illness more likely to become
serious. In hot climates you should always consume enough
water so that you must urinate every two to three hours. If
your urine becomes dark yellow it means that you are getting
dehydrated or that you are getting jaundiced! Here are some
preventive measures that help you reduce the burden of heat:
* Don’t be exposed to direct
sunlight but rather use an umbrella or other protective gadget
* Don’t leave your kids is
unventilated vehicles
* Drink plenty of water, even
if you are not thirsty (preferably Zam-zam water)
* Keep a close watch on
children to be sure they do the same
Reduce physical
activities by:
* Not walking for long periods.
Rather ride any available vehicle
* Trying to avoid crowded
places as much as you can and not rush when performing rites
* In case of weakness (e.g.
chronically-ill patient) and if you can’t handle the crowd
during stoning, it is permissible for you to go to Mina at the
end of the night to stone the Jamra before the arrival of the
crowd
* Taking enough time for rest
and sleep as needed
Last modified:
July 19, 2007
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