Medical Aspects Of Haj 2017 Dr Fayaz Memon

Medical Aspects Of Haj 2017 -Dr. Fayaz Memon -MS Orth (Bom) -Fellow Arthroscopy & Sports Medicine (Germany) -Consultant Orthopaedician & Sports Medicine Specialist --Wockhardt Hospital -Prince Aly Khan Hospital -Habib Hospital -M. H. Saboo Siddique Hospital -Honorary Asst Prof. of Orthopaedics -Grant Medical College & Sir JJ Group of Govt Hospitals- Mumbai

Introduction � Niyyah � Health related issues during haj � Prevention � Cleanliness � Health � Don’t Get infected nor infect others � Help yourself and Others � Important Signs and Symptoms � Management in Emergency situations � Dos and Don’ts – General and Specific

Health related issues during haj • Non communicable diseases • Communicable diseases – Infectious • Injuries/disasters and calamities

General idea about spread of infection in the population

Modes of transmission of infections

Contact • Direct- By physical contact • Indirect-By intermediate common object • Droplet- Via Coughing or sneezing

Non- Contact • Airborne- Via Dust/Droplet/Ventilation • Vehicle- Through a common source like food/water etc • Vector Borne- transmission by insects/animals etc

General Prevention against communicable diseases

General precautions • Hand Hygiene • Masks • Use separate towels/bed sheets etc for each one • Keep personal & common areas clean • Cover Mouth, stand clear • Consume Clean(Preferably hot) food • Use Insect coils/anti mosquito creams

Proper Hand wash technique

Medical and Health aspects � � � Before Haj – At Home At Boarding cities (Mumbai/Delhi etc) At Airport and In Flight At Jeddah/ Madinah At Makkah During Haj � � � � � At Mina to Arafat At Arafat to Mujdalifah At Mujdalifah to Mina/Jamaraat At Jamaraat/ During Rami At Mina – (Shaving etc) Before and during Tawaf – e – Jiyarah Back to Mina At Mina Back to Makkah At Makkah to Madinah At Airport Back to India and Home

Before HAJ- At Home �Prepare yourself for Haj- Exercise/Walk. �Stop Smoking/ Alcohol/ Any other addiction. �Learn proper Vudu. �Make habit of 5 daily prayers. It has huge medical benefits. �Grow beard. Its more hygienic if maintained in islamic way. �Learn to use the COMMODE CHAIR.

�Investigations for fitness

�Treatment of pre-existing diseases – DO-NOT Hide them or overlook them. �Vaccination – Meningitis/OPV/Specific from time to time. DONOT FORGE.

�Fitness certificate from certified Doctor. – DO NOT FORGE.

�Attend training camps by authorized & trained personal. �Preventive Measures- Dos and don’ts �Train yourself for emergency situations – Do Not Panic

�Finish off with any due surgeries on you- ask your Doctor about recovery period. �Treat any Open Wounds adequately by a Specialist in the field.

�If you are carrying children, keep pram/carriers handy. �If you are accompanying elders, keep wheelchairs etc handy.

List Of Medicines and Equipments to be carried along during Haj �Checklist Available with volunteers �Medicines of pre-existing diseases including injections if any- Sufficient stock (Carry proper prescriptions) �Basic OTC Medicines like PCM, Rash skin creams, Antacids, Analgesics, ORS (Adequate) etc.

�Thermometer(Keep Safe) / Glucometer (If Diabetic)/ BP Apparatus (Electronic) / Spectacles-goggles / Swabs. �Dressing materials like Sterile gloves, sterile gauzes, povidone iodine solution, bandages, micropore sticking etc �Personal cleanliness items – Soap/ Ear-buds/ skin creams etc

�Knee-cap / Braces/ Crepe Bandage/ Spinal Belts. �Masks / Umbrella (White) / Slippers (properly fitting) – They are ALLOWED IN EHRAM.

Remember!!!!! �Sound Physical and Mental Health �Use Preventive Measures – Cleanliness (Self and Community) And Purify your clothings. And avoid uncleanliness �Don’t get infected yourself �Don’t Infect Others

�Take proper medicines – ON TIME �Help others learn and execute �See your Doctor at early stage of a disease �Use antibiotics judiciously – ONLY ON PRESCRIPTION BY DOCTOR

�Listen to instructions from authorities �Read/listen/train about behavior in crowds and in emergency situations. �Keep Phone number of a known Doctor �Regularly wash hands with soap at every place

At Boarding Port �Try and Reach a day or two prior to boarding date to avoid last minute running �Re- check Health and Training Card �Recheck stock of medicines.

�Know dispensary timings and Hospital affiliations locally for any health issues �Do- Not overlook small infections such as fever / gastro-enteritis / cough / Burning Micturition etc. �Use Dispensaries judiciously. �Behave well with Health personals – they are there to help you.

�Do-Not self medicate- Refer instead

�Personal and community hygiene to be maintained. �Remember other batch of Hajis will follow you. Keep Toilet/ Bathroom/ Rooms/ Premises clean. – We are MUSLIMS. ALLAH IS WATCHING. �Carry personal medicines for 3 -4 days in hand carry along with Prescription. �Put rest of the medicines in the Luggage.

Important Signs and Symptoms!!! �Fever �Cough/Cold �Excessive Vomiting �Severe Diarrhoea �Abdominal Pain

�Chest / Left arm/ Left shoulder pain �Acute Low back Pain radiating to one/both legs �Epileptic seizure/coma/ Unconsciousness. �Nasal Bleeding

� Sudden loss of vision � Breathlessness and uneasiness with/without chest pain � Severe Headache � Early symptoms of an epidemic disease (will be specified from time to time) � Any Injury.

At Airport and In Flight �Maintain Discipline. Others should love you for your discipline. �Accompany minimal people to the airport. �Avoid overcrowding or fighting at airport. �DO NOT talk loudly – Maintain calm. Volunteers are there to help you. And be moderate in your pace and lower your voice; indeed, the most disagreeable of the sounds is the sound of donkeys. (31: 19)

�Maintain cleanliness- Especially in the toilet areas. �Carry adequate disposable tissues. �Pray Salah at designated areas- DO NOT block others.

�Use trash bins for the trash. DONOT throw anywhere. It can cause health hazards to others. �Finish off your needs like Food/ Toilet/Medicines/ Vudu etc at the airport itself. �Use proper sized slippers. Avoid walking on wet floor. Clean if found wet- it’s a sadaqah.

�While Boarding in flight – DO NOT Push others. Maintain queue. Take care of children and elders. Sacrifice. �Travel Light. �In flight DO NOT rush to catch seats. Its only a matter of 3 -4 hours. Its your testing time.

�If salah time is due - Pray on your seats only. Do NOT be in search of standing place for salah. EVERYONE wants to pray and SPACE is LESS. �Use toilets judiciously. Maintain DRYNESS. Use TISSUES. Accompany elders and children. �In case of Emergency situations, follow instructions by the crew. Be patient. Do Zikr. Almighty Allah Will Help you.

�Do not Rush to Get out of the flight. Use Queue. Have Patience.

At Destination �Use Mask if required/ notified at the airport- It is allowed in Ehram �Present Health card on demand.

�In case of emergency inform the volunteers. Do not take any symptom mentioned earlier lightly. You may not get attention after you have left airport for Makkah en route. �AVOID DIRECT SUN. Use Umbrella if Needed. �Maintain Hydration – Plenty of oral fluids. It’s a different weathere.

� Finish off your nature’s call needs/ vudu/ salah AT THE Airport itself. � Do Not PICK heavy luggage if you can’t. Take Help. � Take your seats. DONOT travel standing. � CARRY IDENTIFICATION ALWAYS.

At Makkah �Do Not be in a hurry to finish off Umrah. If tired – rest and hydrate yourself adequately before umrah. �Take all important helpline phone numbers from the office. �Locate the nearest dispensary in your area. Keep Hotel card and your identification with you always.

�Be prepared to walk for 10 odd kms per day. �Avoid rush/ Direct sun/ Un-authorized Street food. �DO NOT Pray in open sun unless forced to. Avoid rush at Hadr-e-aswad. Don’t play heroics. You may injure yourself or others.

�Maintain hygiene in your room, toilets, kitchen, general areas, and streets. �Sleep Well.

In Case Of Natural Disaster � In case of Natural calamities/ storms/ heavy rains – Stay back in the hotel rooms. � Avoid Streets if you are out. Enter the nearest shade/hotel asap. � If you are in THE HOUSE OF ALLAH in such situation DONOT LEAVE. Follow instructions. They have world class infrastructure to deal with such situations. Be calm and patient.

�Use your mobile phone – dial emergency numbers – call for help. �Do Not endanger yourself in helping others. NO HEROICS �Do Not touch LIVE electric wires during rains/ storms. �Evacuate the exits. Make yourself familiar with alternate exit points to get out of there. �Do Not stand or walk on slippery ground. You may fall in crowd. �Avoid going near the accident area. �Cover your chest and head

Dos and Don’ts in Makkah �Do Not Over-Walk before umrah in Ehram – It may give problems to your inner thighs if you are fat. Use skin cream (Without odour) if needed. �Do Not Climb high mountains if you are NOT confident. The temperatures and dryness there may be life threatening at times. Its NOT the part of HAJ.

�Avoid Selfies. Avoid Mobile Games- It can give you Headache/ sleep deprivation. �Sleep Well when you get a chance. That will make you fresh for further ibadah.

�Do Not be Over Zealous in front of the treating doctor. There may be more emergency patient in front of him. Doctor knows his duty well. Behave well like a MUSLIM

Remember!!! � Use Wheelchairs during UMRAH in their designated tracks so that you don’t injure others. � Use services of authorized BARBERS only. Insist on disposable RAZORS. � Throw trash in dustbins � Use plastic bags for footwears. Avoid contamination.

During Haj �At Mina � Carry only necessary things � Carry essential medicines. � Do not Carry luggage away from body. That may cause you back pain. Prefer trolley bags instead.

�DO NOT stamp on Beddings. This can cause contamination. �Maintain Personal and community cleanliness as said before. �Know Where is the nearest dispensary – For yourself as well as to help others if need arises.

� Know the designated Metro station for your tent. Do not use other station even if that seems near geologically. You may get stuck due to barricades. � Avoid Direct Sun. � Do Not fiddle around with electric circuits for phone recharge. � Do not try to repair A/Cs yourself. Call the moallim’s office.

� Plenty of Oral Fluids. Heat can be lethal. Cover as much allowed by shariyah in ehram. Use Umbrella. Use Masks if needed to avoid cross infection. � DO NOT believe in or spread RUMOURS. � Remember there adequate medical facilities including Ambulances, Dispensaries, Primary and tertiary care hospitals in MINA, Arafat, Mujdalifah. They are indeed FULLY EQUIPPED. � Even during the worst disaster 2 years back, there was NOT a single thing short of supply during entire Haj.

�Mina To Arafat �Use the Mode of transport designated for you by HCOI. Follow Instructions by the authorities. They are there to help you. �Carry medicines/ ORS/ Fluids.

�Carry Sprinkler bottles. �Carry small fans. Thin beddings. �Know the map and route of your destination. �Use Queue. Stop if needed. Do not push.

�Use umbrella if needed. Rather prefer it even if its morning 7: 30 am. �Keep Important emergency contact numbers handy. �Drink adequate fluids en route. �Maintain cleanliness en route. Use trash bins.

�Use mask if needed. �Tell the name of your COUNTRY rather than your indian state if you are lost. �Carry identity always.

�At Arafat � Go to Masjid Nimrah in Arafat – IF YOU CAN. However remember all cannot be accomodated there. Use Hikmah. � Heat may be Inhibiting there. Sprinkle water on head and faces. Use fans to beat the heat. � Plenty of Oral fluids.

� Cleanliness – self and community (Toilets etc). � Use trash bins. Create them if not present. � In case of emergency dial Emergency numbers- preferably with someone who speaks ARABIC. � Do Not be stubborn in taking medical help. � Children may NOT ask for water, however feed them water at adequate intervals. Heat may cause trouble for them. � Stock up adequate fluids for further journey after sunset.

�Arafat To Mujdalifah �Most difficult journey �Stay hydrated. Finish your basic needs at Arafat itself. �Be prepared to wait long hours. It’s a whole city on the move. Be patient. �Use designated transport for you. Maintain discipline mentioned earlier.

Who spends (in the cause of Allah) during ease and hardships and who restrains anger and who pardon the people-and Allah loves the doers of good. Indeed, Allah does not like those who are self deluding and boastful

�Avoid going against the rush. �If wait is for long time, do not hesitate to SIT DOWN. �Help Others. Give water to elders and fellow hajis. �For senior citizens and children – Lifts may b available at metro stations.

�At Mujdalifah �Do Not Block the streets or footpaths. Emergency services cannot reach you of you block them. �Keep Cleanliness - self and community. �Preferably stay at the area designated for you by the HCOI.

�Help others. Be Patient. Maintain calmness. �Drink adequate water. �Use trash or create one. Cleanliness is half the Imaan.

�Mujdalifah to Mina/ Jamaarat �Descipline as explained previously. �Preferably go to Mina, fresh up and then leave for Jamaarat.

�Avoid taking children/ elderly/ luggage to jamaarat for rami. �Do not leave your dependents un attended on streets or on metro stations at any time. You are calling for trouble then. �Know the proper routes to your tent before hand right from metro stations or Mujdalifah, else you may have to walk several kilometers in heat due to barricades and one ways.

�Plenty of ORAL FLUIDS. Sprinkle water on heads. Use shades to walk if possible. �*****USE UMBRELLA ALWAYS***** �DO NOT Push. DO NOT Walk against the flow. �Avoid rush. If you fall down get up quickly. Help others get up quickly. If you cannot get up due to rush CRAWL on sides. COVER your chest and head.

� Walk to Jamaraat only if you can. Else use Metro rail from your tent site. � Use designated one ways only. � Keep yourself well fed and well hydrated. � DONOT Believe in rumors or spread them. � In case of emergency contact the Hindi/ Urdu speaking volunteers en route. You will find them everywhere.

�At Jamaarat �Maintain discipline �Do not stand in way. Go as close to jamaarat and perform Rami. �Leave the place as soon as you are done.

�At Mina� Qurbani from authorized personals only. � Shaving by authorized barbers only. Insist on disposable razors. � Keep Bathrooms and toilets clean. Do not Choke them up. It can cause health issues to you and fellow Hajis. � AVOID Direct sun. Plenty of oral fluids. � Take Adequate rest. Apply Ointments to inner thighs if lacerated due to walking

�Before and during Tawaf –e-jiyarah �Take adequate rest before leaving �Be prepared to walk about 12 -15 kilometres over all. Be well hydrated and moderately fed. �Be prepared for the rush. Maintain discipline. Be Patient. �Rest and fresh yourself before leaving for Mina

�At Jamaraat in next two days to follow the same as explained before.

�In Case Of Death – Inform the Moallim’s Office

Back to Makkah �Use Mode of transport designated by Moallim for you. �Maintain Discipline. �Take all belongings and medicines without fail. �Maintain sanctity of place. Do Not Litter. Keep place as clean as you found it when you first entered it.

Makkah to Madinah � Carry Medicines. � Adequate water. � Be prepared for Long drive and longer procedural waits. Keep calm- its necessary and unavoidable. � DO NOT travel standing � Keep cleanliness. Do not litter. Use litter bins.

At Madinah �Avoid contamination �Cleanliness. �Know the nearest dispensary. Know all emergency numbers from the nearest office. �Do not overcrowd at Riyad-ul-jannah Propjhet’s (saw) grave. Everyone gets the chance. �Females should wait for instructions for their time to visit Riyad-ul-Jannah. �Use masks if necessary.

Back Home �Do Not Over Shop. Your luggage may over shoot the limits. Difficult to pick up. �It might take longer to reach the destination – keep Medicines stock of 2 -3 days in hand carry. �Rest adequately before travelling back.

THANK YOU

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