H&H - Hajj and Health

As we to strive our hardest to make use of these blessed ten days of Dhul Hijjah by performing good deeds, fast, reading Quran, Dhikr (Remembrance of Allah) and seeking His forgiveness. Millions of our brothers and sisters around the world are travelling or are currently present in Makkah to perform Hajj. Hajj is the Arabic phrase for ‘Pilgrimage’ and is the 5th pillar of Islam. Allah subhanahu wa taala says in the Quran:

“... And Hajj (pilgrimage to Makkah) to the House (Ka‘bah) is a duty that mankind owes to Allah, those who can afford the expenses (for conveyance, provision and residence); and whoever disbelieves (i.e. denies Hajj, then he is a disbeliever of Allah), then Allah stands not in need of any of the ‘Alâmin (mankind and jinn).” [Qur’an 3:97].

For those who are fasting these ten blessed ten days, here is an article about how to maintain your health whilst fasting:
http://www.hafsaabbas.com/articles/keep-fit-and-maintain-your-energy-during-ramadhan


This article below will circulate for those who are travelling to Hajj or Umrah. I will try to make it concise and will be as a bullet point format in sha Allah.

General Advice

-          Always ensure that you have a general health check-up with your G.P before departure especially the elderly, pregnant, chronic diseases (heart/renal/lung/diabetes) and cancer.

-          Ensure that you aim to keep active for Hajj, exercise appropriately. For instance, gradually increase your walking distances before travelling

-          Those with diabetes, asthma, epilepsy – ensure that it is control at optimum level before travelling. In addition, this applies to individuals on anti-coagulant therapy with warfarin.

-          Ensure that you have enough medications with you travel. If you need to carry medications in hand luggage. Prior approval is needed from the airline, airport and letter from your G.P stating your conditions is done due to security reasons.

-          Women who want to delay their menstruation/monthly periods need to speak to their G.P who may prescribe hormonal therapy. This needs to be done well in advance.

-          Ensure you carry a first aid kit that includes plasters, dressings, anti-septic lotion etc.

-          Ensure that your ID that entails personal information and accommodation details need to be accompanied at all times. There also needs to be details for UK contacts for emergency.

-          Ensure that you have the vaccinations necessary. There is a section about it later on in the article. Vaccines are less effective in individuals with certain types of cancer or undertaking chemotherapy. If you previously had a stem cell transplant or chemotherapy, your immunity may be low or have lost it to diseases you were previously vaccinated against. Thus, you may need new vaccinations.

-          Be aware of your surroundings and in an emergency call 997.

-          Ensure that you have travel insurance that declares all your medical conditions

MERS-CoV

• MERS-CoV stands for Middle East Respiratory Syndrome.
• It is a viral respiratory illness which was first reported in Saudi Arabia in 2012 and spread to other nearby countries in the Middle East according to Centers for Disease and Prevention (CDC).
• Symptoms include pyrexia (fever), cough, Dyspnea (shortness of breath).
  
• Saudi Arabia Ministry of Health have advised that the following are at risk and should postpone their Hajj and Umrah for their own safety:
  

1)     Eldery (65+)
2)     Chronic disease (respiratory/renal/heart/diabetes)
3)     Immunodeficiency (congenital/acquired)
4)     Malignancy and terminal illnesses.
5)     Pregnant women
6)     Children under the age of 12.

Vaccinations

The following should be given before being able to go to Umrah or Hajj with visa.

Meningococcal Meningitis

-          This is given to adults and children above the age of 2 whereby a quadrivalent vaccine against meningitis which has been issued not more than 3 years and no less than 10 days prior to arrival in Saudi Arabia.

-          Currently the UK Travel Health Advisory Board (NaTHNaC) and the Saudi Government recommend that all Hajj pilgrims are vaccinated against meningitis (ACWY) using the conjugated meningococcal (ACWY) vaccine.

Those who are coming from countries out of the UK should have the following vaccinations:

• ·         Yellow Fever vaccine – This is given to individuals whose countries have Yellow Fever outbreak. 
  

 

• Poliomyelitis vaccine – This is given to individuals whose countries have Polio virus outbreak such as Afghanistan, Pakistan, Cameroon, Nigeria, Somalia, Guinea, Equatorial Guinea, Ethiopia, Iraq, Palestine (the West Bank and Gaza), Syrian Arab Republic, Madagascar, South Sudan and Yemen. 
  


• Tetanus and Polio Vaccine - All travellers need to ensure that they are updated with tetanus and polio vaccines where 5 doses are given for tetanus vaccine and 5 doses is given for polio vaccine. However, if it has been more than a decade (10 years) since a polio vaccine has been given, then a booster dose is required.
  


• Seasonal Influenza – This is given especially to the elderly and individuals with immunodeficient and chronic diseases.
  


• Measles and Rubella vaccines.
  


• Rotavirus vaccines – Rotavirus commonly causes diarrhoea in children. This vaccine will help protect them from rotavirus. It is given as part of a routine childhood vaccination schedule.
  

Travelling on Air

-       If you have a heart condition or clinical history of heart disease, travelling via air increases your chance of deep vein thrombosis (DVT). This occurs when blood travels too slow via the veins. Consequently, this forms a clot that blocks deep veins.
-       There is no immediate symptoms of DVT but it can cause swollen thigh, paleness, increased heat around the affected area.

Recommended Tips

• Walk around whenever you can.
• Leave room so your legs can stretch.
• Wear loose, comfortable clothing.
• Drink plenty of water.
• Perform anti-DVT exercises which consists of raising your heels, keeping toes on floor then bring them down. Perform 10 times and at least every half an hour.
• It is ok to use glyceryl trinitrate (GTN) spray whilst travelling. Due to regulations, liquids and creams even medications cannot exceed 100ml in hand luggage. Prior approval from the airline, airport, and letter from your own doctor is needed if you want to carry more than 100ml of any medications needed.

Climate


- Even during the autumn and winter, during the day in Saudi Arabia, temperatures can reach 30 degrees which puts pilgrims at risk of:

•  Sunburn 
• Sunstroke
• Heat exhaustion, 
• Heat stroke 
  
• Dehydration. 

-    In the winter months the temperature during the night can fall to a very low level and pilgrims should be prepared for this by having sufficient warm bedding and clothing with them.

Recommended Tips

•  Wear comfortable and good quality footwear - Hajj pilgrims spend lots of time walking and the sand can be hot and cause burn. This is very important especially for those with diabetes.  
• Due to plenty of people being present, it is important that you keep them in a small bag so your footwear does not get lost.
• Familiarise yourselves with the climate before undertaking Hajj
•  Have rest
•  Maintain hydration by drinking lots of fluids
•  Seek shade where possible or use an umbrella
• Use sunscreen factor 15 or higher.
  

 Common diseases

Malaria 
- This is present throughout the year but predominantly from September to January. 
- Areas that are at risk are mainly in the South Western regions of Saudi Arabia except for Mecca, Medina, Jeddah and Taif and the Asir Province as they are high altitutde areas. Thus, the risk is low in both cities Mecca and Medina. 
- However, the journey between both cities is 6 hours on road and passes through a high risk location for malaria. 

Recommended Tips

• Ensure that the air conditioning is on if travelling during daytime. This lowers the risk of malaria as mosquitoes can be excludes and bites can be avoided.
• The use of a good quality insect repellent will help prevent bites from insects and ticks, which can be a problem at Hajj or Umrah.
• Malaria Prophylaxis is not necessary for Hajj and Umrah – however those travelling to other countries to visit

           friends and relatives after/before pilgrimage should discuss with their G.P.

 
Travellers' Diarrhoea 


- This is common during Hajj and all Hajj pilgrims are at risk especially the elderly, the young, those with chronic diseases that may have a chance of being dehydrated. 
-  Those travelling with a low budget are at greater risk. There is greater risk whilst:
1)     consuming food that have been contaminated during preparation/storage.
2)     Unpasteurised dairy products
3)     Contaminated water
4)     Raw unpeeled fruits/vegetables.


-    Majority of cases, TD lasts approximately for a few days and may require medications.
-  There is no vaccine that can protect one from TD.


Recommended Tips

• Medications such as loperamide relieves symptoms by slowing the bowel movement and can sometimes increase water absorption. It should not be taken if there is blood in stools, high temperature nor is given to children. 
• You can reduce your risk of TD by maintaining good personal hygiene practices such as washing your hands before and after going to the toilet, eating or preparing food with soap and water thoroughly. 
• The use of anti-bacterial wipes and hand gels to prevent spread of infections.
• Avoid drinking camel milk unless it is pasteurized or boiled, or eating their undercooked meat.
• Avoid having unpasteurised milk, cheese, or any dairy products.
• Avoid consuming raw/undercooked seafood.
• Drink plenty of bottled water to avoid dehydration.
• Avoid drinking tap water or use it to brush teeth.
• Do not add ice in drinks.
• Boiled water/hot drinks made with boiled water are safe.
• Do not eat food that has been kept in room temperature or exposed to flies.
• Do not eat undercooked, fruits and vegetables or even salad. Unless you’ve cleaned and peeled them yourself.
  
• Avoid sharing towels, flannels, cutlery or utensils with others
  
• Wash soiled clothing and bed linen separately from other clothes and at the highest temperature possible (e.g., 60 degrees or higher for linen).
• Use disposable tissues when coughing or sneezing and dispose of them appropriately.
• Avoid hand contact with the eyes, nose and mouth.
  

 
Blood-borne Viral infections.
-       Examples include Hepatitis B, Hepatitis C and HIV.
-       Hepatitis A – caused by a Virus and can be transmitted via contaminated food/water. Strawberries/lettuce are at risk as well as Crustaceans such as oysters and crabs. Symptoms include – loss of appetite, weakness/fatigue, nausea/sickness, fever/pyrexia as well as jaundice (yellowing of the skin and eyes).
-       Hepatitis B caused by a virus and is the major cause of chronic liver disease and cancer. Symptoms are similar to that of Hepatitis A but in addition, abdominal pains (tummy pains) and flu-like symptoms can also occur. It is transmitted via blood transfusion, needles and unsterilized medical equipment.
-       Blood-borne infections can also be caused when shaving the heads via non-sterile blades.

Recommended Tips

• It is important to check that the barbers are licensed as they are tested for these viruses and use disposable. Single-use blades.

• Hepatitis A vaccination – There are three types:

1.      Monovalent vaccine (protects against Hepatitis A).
2.      Combined Hepatitis A and B (protects against A and B).
3.      Combined Hepatitis A and Typhoid fever vaccine (protects against Hepatitis A and Typhoid).

-  Hepatitis A Vaccination should be given up to two weeks before you leave. 
-  It can also be given up to the day of departure if needed. 
-  Babies under the age of one are cannot be vaccinated. 
-  Protects for a year. 
-  A booster dose is given 6-12 months after 1st dose and can protect for at least 20 years. 
- After having Hepatitis A vaccination, you may experience some side effects such as tiredness, nausea, headache, loss of appetite.
- Before being vaccinated, double check with your G.P if you are pregnant/breastfeeding/immunodeficient/allergies.

• Treatment for Hepatitis B 
  

- If it is acute, pain killers can relieve symptoms. 
- If it is chronic, treatment is dependent on how affected is the liver. 
-  Medications are prescribed to slow the viral production and prevent liver damage.

Typhoid fever
- It is severe is a serious type of bacterial infection caused by Salmonella typhi. 
- It is transmitted via contaminated food/water.

Recommended Tips
- The combined Hepatitis A and Typhoid vaccine. 
- There also two main vaccines that can prevent Typhoid that work by stimulating the body to produce antibodies (proteins that fight infection) to avoid you from getting ill by typhoid bacteria:


1) Vi vaccine – given as a single injection is more effective than Ty21a vaccine. 
- It isn’t suitable to those with low immune system such as people with HIV.
-  It is not suitable to individuals with cancer who are receiving chemotherapy.
-  It is not usually suitable for children under six.


2) Ty21a vaccine – given as three capsules to take on alternate days

- Vaccine is given a month before travel.
- None of the vaccines are 100% effective which is why maintaining personal hygiene especially when drinking and eating is crucial. 
- There can be side effects such as headache, feeling sick/nausea, abdominal pain and having fever (1 in 100 experience hyperthermia [high temperature 38 degrees and above)])

 
Travel Sickness
- Symptoms can include hot flushes and paleness. It can occur in children more than adults.

Recommended tips

• Hyoscine-containing remedies are mainly effective and can be brought from pharmacies or on prescription.
• Avoid staring at moving objects such as cars.
• Avoid heavy meals before/during travel.
• Avoid spicy and/or oily food
• Have short breaks.
• Ginger is good and can be taken as biscuits, tea, tablets.
  

Jet lag.
- This is caused due to weakness, disturbed sleep via travelling.

Recommended Tips. 

•  If you are flying to Saudi Arabia overnight, ensure you get rest before you travel, and get a bit of sleep on the flight. This will aid to help you stay up when you arrive at the destination.
• Few days before travelling, start to get up and sleep earlier.
• During your journey, stay hydrated and avoid caffeine drinks such as coffee, tea, cola as they can disturb your sleep.
• Wear eyeshades, earplugs that may help sleep.

Travelling with Asthma,

- Anything that can trigger your asthma, can make it worse, such as dust, tobacco smoke etc

Recommended tips

• Before travelling, ensure that you see your G.P/nurse for review. 
• Take spare inhalers
• Take print-out of the medications you take incase you need medical assistance.
• Mass gatherings can lead to shortness of breath. Always follow instructions when travelling in large groups.
• Wear face masks
  

Travelling with diabetes 
 
Recommended Tips

• To make sure you still eat healthily and have a balanced diet.
• Speak to your G.P on how the climate can affect your condition
• Carry your Diabetes ID always.
• Carry your medications as the climate may influence your insulin and blood glucose levels. Thus, bring a letter from your G.P to explain how to carry syringes/injections and insulin is crucial. Test your blood glucose levels frequently.
• Do not store insulin in checked-in luggage as the freezing temperatures in the hold may damage it. Place it in bubbly wrap, then towel.
• Wear comfortable shoes.
  

Returning home

On your return from Hajj or Umrah visit your G.P for a check-up or if you had continuous cough for more than 3 weeks, diarrhoea, fever, vomiting, jaundice