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Travel Medicine for Hajj/Umrah – Tips for Staying Healthy
This document has been prepared as a supplement to the travel medicine education you should receive from your primary care physician. God-willing it will serve as a quick reminder of travel tips and serve as a tool that will allow you to have a healthy pilgrimage. Throughout the document references to common health conditions such as diabetes, high blood pressure and elevated cholesterol levels will be made. It is absolutely imperative that those of you who do have such conditions review with your physician your medications and have a firm understanding of your personal health issues before your journey begins. May Allah bless all of you with a successful journey and please keep the author in your prayers. Dr Faiz G. Malam MD CCFP
Before your journey it is a good idea to see your physician to have a routine check up. This will not only ensure your health prior to the journey, but will also allow you to renew any medications you may need for it. Furthermore, this visit will also enable you to pick up medications (to be included in a list below) that may come in handy should you fall ill during your journey.
Preparations for the journey include appropriate vaccinations. Currently due to concerns regarding meningitis the Saudi government requires meningitis vaccination (ACYW- 135) also known as Menomune . Other vaccinations to consider (although not a requirement for visa purposes) include Hepatitis A vaccination, Typhoid fever vaccination, Tetanus vaccination and medications to prevent malaria. These vaccines are particularly useful for those who are planning to visit Asian countries prior to or after Hajj. Vaccinations Checklist REQUIREMENT Physical Conditioning
One of the most challenging aspects of the pilgrimage is the amount of physical exercise that is required during the pilgrimage. Often a complete set of tawaf can approach a few kilometres worth of distance. Unfortunately this is more exercise than most Muslims do an entire year. Needless to say it would be ideal to prepare oneself physically for the journey by starting an exercise program. After consulting with your physician, start a program of brisk walking and jogging for twenty to thirty minutes a day before your departure. Gradually increase this regimen to an hour every day or every other day.
What makes the tawaf even more challenging is that it is done barefoot on hard marble floors. Occasionally patients who have diabetes will have trouble with their feet due to complications of severe diabetes. Dry feet are prone to cracking and can lead to wound infections and pain. For that reason travelers should purchase a non perfumed lotion from the pharmacy. This will keep the skin moisturized and prevent cracking/infection. Protecting the feet from skin infections is important to all pilgrims especially those who suffer from complications of diabetes. Of note, it is important to choose a skin product that will allow water to penetrate it, thus ensuring ones wudu is not compromised.
The hard marble floors of the holy mosques can lead to foot, knee and back pain. I would suggest that you purchase a pair of leather socks (khuf) and a set of gel shoe inserts (e.g. Dr Scholl’s) to put inside the socks. For men you can wear the leather socks with the inserts ONLY when NOT in ihram. It is of tremendous benefit in helping reduce sore feet. Most do not find the leather socks to be slippery on the marble floor during tawaf. I personally found the leather khuf with gel inserts to be of tremendous benefit which allows one to perform an abundance of nafl tawaf in Mecca and walking in Medina. While You Are Traveling Avoid Deep Vein Thrombosis (DVT) DVT is a type of blood clot that may develop with certain medical conditions. Seek advice from your doctor regarding DVT if you have any of the following medical conditions:
• previous history or a family history of DVT
• recent surgery or trauma involving lower limbs
• any abnormalities of blood clotting factors
To decrease the likelihood of developing a DVT during your flight, wear loose and drink plenty of fluids. Finally, stand up and stretch your arms and legs every couple of hours, and avoid crossing legs while seated in the plane.
Taking Care of Your Body
The Hajj can be physically strenuous, thus one cannot emphasize enough the importance of physically preparing yourself prior to the journey.
While overseas, it is essential to get good rest, eat well and drink plenty of fluids. The average temperatures during Hajj hovers around 30 degrees Celsius but due to humidity levels it can feel much hotter. For patients with diabetes, high blood pressure and cholesterol, drinking lots of water is extremely important for maintaining their health and ensuring their medications are working appropriately.
The sun is also prominent during the day so pack a white umbrella and sunglasses to protect against the sun. Drinking plenty of water will help against dehydration and heat stroke. Furthermore, during the winter months, night temperatures can dip into single digits (Celsius) so ensure a sweater is packed for the tents in Mena and Muzdalifa.
Finally, our immune system is at its peak effectiveness when the body is well rested, kept warm and has been nourished well. So pace yourself during the journey, eat well, sleep well (keep yourself warm in the tents) and drink plenty of water.
Keeping up the Immune System
Our immune system is at its peak effectiveness when the body is rested, kept warm and has been nourished well. So pace yourself during the journey, eat well, sleep well (keep yourself warm in the tents) and drink plenty of water. Nevertheless, since the nature of the pilgrimage will not always allow for the routine your body is most used to, and people will be bringing with them strains of bacteria you have not had any experience defending yourself against, supplements that boost the immune system can be highly valuable. Apple cider vinegar: An excellent tool for preventing and helping overcome infections during travels is a tablespoon of apple cider vinegar twice daily. It should be taken away from meals. The organic variety is often superior in quality. Echinacea pupurea: Think of Echinacea as a shield. If you use it PRIOR to getting sick the shield prevents infections from entering your body. However, if you already have an infection and you start using Echinacea, then the shield will PREVENT the illness from readily leaving your body. Therefore you should start taking Echinacea tablets two weeks before you travel. They will help your body's resistance and preventatively ward off colds once you arrive in Mecca. Probiotics: Probiotics are useful for those who are prone to getting upset stomach while traveling. It has the advantage of minimizing diarrhea, a common symptom of overseas travels and also helps recovery from diarrhea. Oregano oil: Only to be used at the first stage of infection, and not instead of antibiotics, oregano oil should be part of everyone's travel kit. It has potential anti-bacterial, anti- viral, anti-fungal and anti-parasitic properties, and can be used at the initial onset of traveler's diarrhea as well as a cold or flu. Since the pilgrimage is not that long, it's best to begin taking it when you know you will be around large crowds. That may entail about a week of consistently taking oregano oil; then for the duration of the trip, when you are in less contagious circumstances, it can be used only as symptoms arise. Again these are just some suggestions. I would AVOID taking all of these items simultaneously. From personal experience I would encourage using the apple cider vinegar regularly and using the oil of oregano as needed for infections. If your cold or flu symptoms continue getting worse, it is important not to continue with these medications! Antibiotics can be lifesaving, and should not be put off due to a preference for natural remedies. Eat carefully
Steaming-hot, well-cooked food is usually safest. Always be careful eating foods from street vendors and unpasteurized dairy products. During Hajj time many food vendors along the street will have meat precooked on the side in preparation of large crowds of customers. Insist on having your food made fresh from the grill/rotisserie. Also peel fruits you purchase from vendors for yourself.
Zamzam water is readily available throughout the mosques. In Mecca and Medina there are metal cups in the wudu area that many people drink from and is also used to perform wudu. AVOID using the metal cups to drink out of, as you can pick up an infection from it if a sick Hajji used it prior to you. There are plenty of disposable cups throughout the mosque for drinking, ensure that you have picked up an unused disposable cup and use it instead.
If you decide to visit a restaurant, the water may not be from Zamzam. Therefore at such places drink water only from commercially sealed bottles or drink carbonated beverages (pop/soda). Avoid ice as it may have been made from unclean water. Finally depending on where your accommodations are, use bottled/Zamzam water when you brush your teeth.
Although the Saudi government does a commendable job maintaining washroom facilities, there are times where soap is not readily available after utilising the washroom. This scenario is particularly common in the bathrooms within the food courts of the larger hotels. Therefore keep a miniature travellers version of a non-perfumed hand sanitizer with you in your personal fanny pack. This will keep your hands clean and protect against infection.
Finally for the men, be mindful of the barbers who cut your hair after completing your Umrah/Hajj. In the rush of Hajj mistakes can occur, so always insist on the barber using a fresh blade to shave your head should you decide to do so. A dirty blade can be the source of numerous concerns including hepatitis and tetanus.
For Ladies Only
Where appropriate, women should contact their family doctor well in advance to prescribe the necessary medication to avoid menstruation during the trip.
Medications to Bring Cough and Cold
A common condition seen during the Hajj is a persistent cough and sore throat. Speak to your doctor about a prescription strength cough syrup that can help with the nagging cough of a flu bug. The flu bug may also cause you to develop a sore throat. Ensure that you bring along lozenges and a mouth wash to keep the throat and mouth free of germs. Common symptoms of the flu also include body aches, chills and fevers. Pack some Tylenol and/or Advil to help with these symptoms. Diarrhoea and Upset Stomach
As with all journeys there is always the chance of getting travelers’ diarrhoea. Most often this is caused by poorly prepared food. Speak to your doctor regarding antibiotics and medications such as Imodium to stop the diarrhoea. It may also be a good idea to take along a sachet (packet) of Gatorade to protect from dehydration. Mixed directly with cold bottled water, it will serve to replenish fluids.
You may also want to purchase health insurance for your journey. Although the Saudi government has set up free medical clinics, a Hajji may encounter illness during layovers in countries throughout Europe and Asia. Currently, if you become ill while travelling outside Canada, OHIP will pay only up to a maximum of $400 (Canadian) per day. Those who wear a medic alert bracelet should remember to bring that along in case of emergency. Finally, if carrying syringes or needles be sure to carry a physician’s letter documenting their medical necessity.
WHAT TO DO AFTER YOU RETURN FROM HAJJ
Most patients that I see after hajj suffer from some form of respiratory illness – usually a persistent cough and flu like symptoms. Often these are viral illness’ (usually viral bronchitis) but they can progress into an infection that requires treatment. I would recommend that everyone make an appointment with their family physician after returning for hajj (in fact its probably best to make the hajj follow-up appointment BEFORE you leave for hajj). This way you can be assessed for any concerning infections. Most “hajj coughs” are self-limited and usually subside on their own, though a short course of certain treatments can help speed up recovery.
CHECKLIST Things to include in a first-aid kit for traveling
Your prescription medicines preferably in their original containers.
Medicine for diarrhoea and upset stomach. Talk to your doctor about getting a
prescription for an antibiotic (e.g. Ciprofloxacin ) you can take in case you get
severe diarrhoea. Other medications to bring include (Pepto Bismol ),
loperamide (Imodium ), antacids (Zantac ) and Gatorade packets.
Cough and cold medicines including Tylenol cold/Advil cold and a prescription
Pain medicines such as acetaminophen (Tylenol ) and ibuprofen (Advil )
Decongestants and antihistamines for allergies. The kinds that don't cause
sleepiness are better when you are traveling.
Antibiotic ointment (Polysporin ) and adhesive bandages for cuts and scrapes
Non-perfumed lotion to protect from cracked skin (particularly for the feet)
Medicine for motion sickness, such as dimenhydrinate (Gravol )
Scissors, tweezers, nail clippers, thermometer (for children), and mirror
Non-perfumed hand sanitizer (Purell ) for use prior to eating and after using the
Children particularly younger ones will require acetaminophen (Tempra ) for NECESSARY MEDICAL INFORMATION
NAME and HAJJ GROUP: _____________________________________
Family Doctor’s name: _____________________________________
Family Doctor’s Phone Number: _______________________________
Emergency Contact Person: ________________________________
Emergency Contact Phone Number: ____________________________
Medical History Current Medications
THIS DOCUMENT CONTAINS MEDICAL INFORMATION PLEASE DO NOT MAKE AMENDMENTS TO IT WITHOUT PERMISSION FROM THE AUTHOR 2011
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