Written by Mr M. Imran Zia BSc MBBS MRCS FRCEM PgDip (Med Ed)
Consultant in Emergency Medicine
Whipps Cross Hospital, Barts Health, London
Rather than giving a didactic lengthy narrative these articles will instead focus on the common medical themes leading up to, and then during the days of Hajj themselves. Hajj spans from the 8th to the 12/13th Days of the Islamic month of Dhul Hijjah.
This is the first of a series of articles being written in the spirit of helping prospective Hajj Pilgrims avoiding commonly seen medical mishaps based upon the authors 11 years experience accompanying pilgrims to Saudi Arabia for the Hajj.
- Article 1: Pre Hajj Preparation
- Weeks before departure
- Article 2: Hospitals in Makkah / During Hajj
- Article 3: Menstrual Issues
- 2 – 3 Days Before Hajj begins which is on the 8th Days of Dhull Hijjaj (Islamic Calendar Date)
- Article 4: Dehydration & Heat
- 9th and 10th of Dhull Hijjah (Day of Arafat and the Night in Mudzallifah followed by Tawaaf in Makkah)
- Article 5: Skin, Muscular and Foot care Issues
- 11th – 13th of Dhull Hijjah (Stoning at the Jamaraat)
- Article 6: A Common-sense approach
- Throughout the Whole Hajj Experience
Pre Hajj Preparation
In this article he will tackle pre Hajj preparation and cover the some common medical issues.
The basic requirement from the UK is that every pilgrim must have the meningococcal ACWY vaccine (Menveo/Nimenrix) and a certificate to prove it has been given. This needs to be submitted with each pilgrims passport. Without this the Saudi Arabian authorities will not issue a Hajj pilgrim visa. As well as this, although not mandatory, I would recommend you have a recent tetanus vaccine. Other desirable vaccines would be those that cover pneumococcus and Hepatitis. The rabies vaccine is not routinely needed unless you plan on going to some far aware desolate desert planes where stray dogs may live. Furthermore, even though it’s too early in the year, and so not available yet, as a routine I would advise pilgrims to take the seasonal flu vaccine. Finally I would suggest that in cases of uncertainty or ambiguity discuss your upcoming trip with your GP well in advance.
Pack plenty of common sense
The hajj journey requires lots of preparation and most pilgrims will spend much time on religious preparation with little or no regard directed towards their health. As such, here is a list of some obvious yet essential items for you to remember, whilst exercising a little common sense.
- Remember to take spare pair spectacles or sunglasses
- Deal with dental issues before you travel
- Carry a light coloured umbrella to shield you from the midday heat.
- If you need to sit frequently, take a small lightweight easy to carry folding chair/ stool
- If you need a wheelchair, take it with you.
- If you have a chronic medical problems carry the name of the hospital, your consultant and speciality treating you as well as their telephone and your hospital ID number. You never know, they may need to be contacted, should you fall ill.
The flight and Leg Clots
Depending on where you live, the vast majority of people will arrive into Saudi Arabia by air with the journey time being approximately 6 hours for a direct flight from the UK, and longer if it is indirect. These long flights often in economy class seats, cramped with little leg room do place passengers at risk of developing clots in the their lower legs (deep vein thrombosis). My advice is avoid a window seat and stick with aisle seats. This also makes it easier if you need to visit the washroom frequently.
To help avoid leg clots practice leg exercises whilst sitting in your seat. The British Hear Foundation advice is
- Walk in the aisle at regular intervals to stimulate the blood circulation in your legs
- Make simple movements of your feet – raise your toes whilst keeping your heels on the ground – for several minutes every half an hour.
- Make sure you are well hydrated before you fly
- Wear loose, comfortable clothing
For those at greater risk, such as pregnant ladies, those with cancers, the obese and those with a history of previous clots etc discuss the matter with your GP. They would be best placed to advise you on what you could take to minimise the risks.
Taking Medicines – both consuming and carrying
Over the years I have come across numerous example of patients just leaving their prescribed medications behind for reasons beyond me. I think it is sufficient to say that medications are usually given to aid well-being and health, not for fun. So do take and use them. If you feel however that you need to alter your medicines, don’t ask the friendly doctor whom you have only just met in your tour group, but seek advice from the person who probably knows you best, i.e. your GP.
Also medicines need to be carried and transported, so plan for this in advance. If you place all you medicines in your hold luggage, which may then get misplaced/lost do not assume that your medication can simply be purchased abroad. So carry your medicines on your person with extras placed in your hold luggage. Also, obtain and carry with you, a GP letter listing all the medication using generic and not brand names. Give a copy of this to your travel companion so they are aware.
This would be a good time to remind you that morphine based drugs are not permitted in Saudi Arabia and therefore should you need to carry morphine, you will definitely need a GP letter to cover you for this. Morphine is very difficult to obtain in Saudi Arabia and can only be prescribed by hospitals. So if you take and lose your oral morphine tablets or patches because you have chronic pain, accept that you are unlikely to get these unless you can persuade a hospital to give it to you. In such cases you will probably only be given one dose anyway.
This then leads me to talk about transporting a commonly taken drug, Insulin, used by many diabetic patients. Insulin is a protein and thus extremes of temperature will reduced its efficiency. The luggage hold can be near freezing and the midday Saudi Arabian heat can exceed 40 degrees. The solution is to invest in simple diabetic insulin carriage packs available from UK pharmacies such as Boots. I have personally tried the packs marketed by ‘FRIO’, which cost less the £20, are easy to use and keep insulin at the required temperature for journeys of up to 24 hours. Remember if you need to carry needles on the plane also get a GP letter.
Medicines (What, Where and from Whom)
However despite the best of preparations the vast majority of pilgrims will at some stage need to visit a pharmacy, at least once during their Hajj trip. These are dotted around everywhere and will give out medication, in most instances, without the need for a prescription. However it should be noted that some common UK available medications are not available there. I will list a few below
- Piriton – used for allergies and hay fever
- GTN spray – used by patients with chest pain
- Prednisolone – a steroid used in conditions such as asthma and inflammatory diseases.
- Fluclaxacillin – a commonly used antibiotic for skins infections in the UK
- Loperamide – more commonly known as Imodium used to help control diarrhoea
The pharmacists working there, often speak good English so if there is a medicine your reqiure, go in the early hours or very late when the pharmacy tends to be quietest and the staff can then give you due time and attention. Do not feel rushed into purchasing medicines from them. They will offer lots of choice but this should not be taken as a substitute for a doctor consultation.
So in summary prepare well and remember to pack the 6 essential P’s.
- Petroleum Jelly (Vaseline)
- Prescription list
- Patient information details (your)
About the Author
Mr Imran Zia is a Consultant in Emergency Medicine at the Whipps Cross Hospital, Barts Health, London.
He has travelled accompanying pilgrims as a medical advisor and tour group doctor to the Hajj for the last 11 years. Over this time he has gained a valuable insight into the common medical themes that affect pilgrims and how they can be addressed in a practical manner, at times where local medical help may not easily available. These short articles are being written with a ‘prevention is better than cure’ mind set. The numbers of years experience based upon exposure, dealing with illness in a congested foreign healthcare structure has placed him in the unique position to be able to share his thoughts with you all. He is a guest writer at CBHUK.