Itchy conditions of the skin

People who suffer from skin conditions which cause intense itching, e.g., eczema, lichen planus, psoriasis, etc., are advised to visit their doctor to bring their condition under control to their best ability well before departure. Medications, both tablets and creams can be taken to stop the itching for the duration of the state of iḥ̣rām. Whilst in a state of iḥ̣rām, scratching of the skin and hair is forbidden.

Moisturizers must be used liberally throughout the stay in the Holy land, especially during ḥajj. Make sure that the moisturizers do not contain perfumes as perfumes are not allowed whilst in the state of iḥ̣rām.

For itchy conditions of the skin, moisturize, moisturize, moisturize.

Dental Care

A dental check is essential well before departure to make sure that all the teeth and gums are normal. If toothache occurs whilst there, and if a dentist is not available, a course of a broad spectrum antibiotic will help the pain until it can be attended to after ḥajj.

Have a dental check before departure.

Eye care

People who have an eye problem, e.g., glaucoma, must make sure that they take enough medication with them.

Those people who need reading glasses and those that cannot see well without glasses should take an extra pair of spectacles with them.

The white marble around the Ḥ̣̣aramain shine brilliantly in sunshine. It can be over-whelming. Sun glasses are essential for those with sensitive eyes.

PROBLEMS THAT MAY ARISE

Familiarise yourself with the address of the health mission of your country.

You may need their services.

Familiarise yourself with the hospitals and clinics in your area.

Diarrhoea and vomiting

Diarrhoea is usually caused by viruses or by infected food. Diarrhoea caused by viruses is usually contagious. Make sure that the food source is clean. Wash all fruit and vegetables thoroughly, peel fruit before eating, make sure that the food is well cooked, as cooking kills the viruses and bacteria. Make sure that the food is freshly cooked. Viral gastro-enteritis (diarrhoea, vomiting and fever) spreads by contact with an infected person. Keep away from the people who have the virus. If this is not possible, wash hands regularly after touching the infected person. Do not kiss or hug an infected person until they have recovered completely. If you are infected, keep away from other people until you have recovered.

Stop vomiting by using medications such as Maxolon, contromet, valoid, etc. Do not stop the diarrhoea as the body is trying to get rid of the virus. If diarrhoea occurs more than 6 times in 12 hours, then an anti-diarrhoeal agent such as lomotil or Imodium may be used to slow the diarrhoea.

Stomach cramps can be controlled by taking Buscopan or scopex.

Drink extra fluids (2-3 litres) in 24 hours, especially Zam Zam, rehydrating fluids and fruit juices. Eat easily digestible foods like soups and toast, rice, potatoes and pasta.

Avoid protein foods such as meat, chicken, fish, eggs, dairy products and fried and fatty foods for the first 48 hours. Then, a normal diet may be resumed.

When diarrhoea and vomiting are present, drink extra fluids preferably with electrolytes.

Constipation

Constipation is usually caused by inadequate fibre and/or fluid intake. The fear of using “unknown” toilets may cause people to postpone the use of the toilet. Familiarise yourself with the toilets. Take in adequate amounts of fibre (bran cereals, wholemeal or brown bread, dried fruit, fruit and vegetables). Make sure that adequate fluids are taken (2-3 litres a day or more).

Constipation may result in haemorrhoids and fissures. These may result in bleeding. Constipation, haemorrhoids and fissures can be very distressing.

To avoid constipation, eat a high fibre diet and drink adequate amounts of liquids.

Skin Care

Because of the harsh, dry conditions that can be encountered, dryness of the skin can become a problem.

Cracking of the skin is common, especially on the heels. It can cause deep fissures resulting in pain and discomfort with the possibility of infection developing (cellulites). This is especially important for diabetics.

A good moisturizer applied two or three times a day starting as soon as possible after arrival in Saudi Arabia will help the skin retain moisture and slowly acclimatize. To allow the feet to retain the moisture in the skin, it may be necessary to wear a pair of cotton or leather socks.

Take good care of the skin, especially the skin on the feet.

Scafing or scuffing of the upper inner thigh and scrotum

As men are not allowed to wear underwear, inflammation of the skin on the inner side of the thigh and scrotum can occur especially if the person is over-weight. The sweat and the rubbing of the thighs and scrotum during walking can cause a very painful rash and excoriation of the skin in this area. This condition can also occur in women who are overweight with their thighs rubbing against each other. This applies more so to people who are going to walk during ḥajj.

To prevent this condition, use Vaseline or any other non-perfumed moisturiser liberally to the inner side of the thig hs frequently throughout the state of iḥ̣rām.

If this problem does occur, a mild steroid cream will help in soothing the area until healing takes place.

Prevention is better than cure.

Swelling of feet

Due to the intense heat, it is not uncommon for the feet to swell. In healthy people, this is transient and is due to the dilatation of blood vessels in the lower limbs from the heat. As the body acclimatises to the hot conditions, the swelling should subside. If one suffers from any illness, especially heart disease, diabetes or high blood pressure, then one should seek the advice of a doctor.

Medicines

Most medicines are obtainable in Saudi Arabia. Because there is a possibility that medication taken regularly may not be available in Saudi Arabia, please ensure that an adequate supply (including an extra weeks supply, in case your flight is delayed) of medication is taken.

It is essential that a letter is taken from a doctor specifying the illnesses, the medication and the dosages.   These would include medications for High blood pressure, Diabetes, Heart Disease, Glaucoma, raised cholesterol, etc.

Medicines that may be helpful to take along include pain killers, tablets for nausea (Maxolon, Contromet or Valoid), for stomach cramps (Buscopan or Scopex), for diarrhoea (Lomotil or Imodium), for a runny nose (Allergex, Sinu-med, Actifed, etc), Phenergan if allergies are present, and any other medication that needs to be taken on an intermittent basis.

Avoid carrying liquid medication.

Delaying menses

It is possible to delay menses for a period by taking appropriate contraceptive pills or hormone tablets.   It is preferable to adjust periods 3-4 months before ḥajj using hormones so that no adjustment is required during the ḥajj period. It is possible and permissible to delay menses for convenience by taking hormones during the ḥajj period. Please consult your Family Doctor or Gynaecologist.

Marble Floors

The Ḥaramain in Makkah and Madina have extensive marble floors inside and outside. When the smooth marble is wet, as after rain or after washing, it becomes very slippery. Extra care should be taken not to slip and fall. Falls on the hard marble can cause serious injury to the back, hips, elbows and wrists. Leather socks may be used to minimize slipping.

As the marble shines in sunlight, sun glasses should be worn by people with sensitive eyes.

Walking on the marble in bare feet can cause the feet to dry out, resulting in cracks especially on the heels. Leather socks can prevent this from occurring. Use moisturizers, e.g., Heel balms, Glysolid cream, etc.

Take extra care when walking on wet marble floors in and around the Ḥaramain.

Before Ḥajj starts

From the 1st of Ẓ̣ul-Ḥajj, ensure that you are physically and spiritually fit for the 5 days of ḥajj. Treat all conditions that require attention. Do not over-exert or strain yourself. Have adequate rest. Try to connect with Allah Subahanahu Wata’ala. Walk with your ḥajj footwear to that your feet become accustomed to them. The main purpose of your visit is close. You need to be in peak condition.

The Five Days of Ḥajjj:     Do’s and Don’ts

Be as helpful as possible to all around you.

Do not push under any circumstances. It’s the pushing that may start a stampede.

Keep a space in front of you so that your feet are not injured.

Protect the vulnerable in your company. Men must protect their female companions.

Remain focused on your mission to please Allāh Subaḥānahu Wata’ālā.

Do not get side-tracked with worldly matters.

Avoid people who distract you from your concentration and focus.

Carry your medication in a safe, dry place.

Because of the extreme heat, insulin should be carried in a cold pack.

Do not carry unnecessary items of baggage-the lighter your bag, the better.

By taking care of your health, you will not compromise someone else’s ḥajj.

Please take all medication on time.

Watch your diet, if you are diabetic.

Do not over-eat. Eat small meals, drink adequate amounts of liquids and keep out of the sun unless necessary.

Do not deliberately restrict fluids to avoid using the toilet. This can result in disastrous consequences (heat exhaustion, dehydration and collapse).

Do not rush to stone the Jamarāt. Wait for a suitable opportunity and enjoy rejecting Shayṭān.

Avoid bending to look for lost footwear in crowded situations. You may get pushed to the ground and trampled.

If an injury is sustained, clean it well with an antiseptic solution or water. Use an antibiotic or antiseptic cream, if available. Seek medical help for deep wounds or severe sprains.

Please take enough supply of your regular medications as these may not be available on the way.

Immunisations

Yellow Fever Immunisation is essential for all pilgrims from Sub-Saharan Africa.

Menningococcal meningitis vaccine ( 4 strain – ACWL) is essential for all pilgrims. A Saudi Arabian visa will not be issued unless the above two vaccines, if applicaable are taken.

Vaccines should be taken at least two weeks or earlier. If there is a contra-indication for the vaccine, e.g., pregnancy, a letter from your doctor verifying the pregnancy must be sent to the Saudi Arabian Embassy for the visa.

Hepatitis A vaccine may be taken . This is not compulsory.

Influenza vaccine may also be taken. This is not compulsory.

Before Departure from Saudi Arabia

Every returning ḥajji must take one 500mg Ciprobay tablet, 24 hours prior to departure. This is to prevent the spread of Menningococcal Meningitis from the ḥajjis to their relatives on their return home. These tablets can be obtained from a pharmacy or from medical missions.

Conclusion

Adequate preparations to keep your health in good condition will, Inshā Allāh make the performance of ḥajj a spiritually uplifting and memorable experience.

May Allāh Subaḥānahu Wata’ālā take you safely and bring you back safely.

May you have a successful and acceptable ḥajj.

Dr Farouk Haffejee

Updated 9^th November 2007

28^th Shawwal 1428

Email: drh@rrmc.co.za

Islamic Medical Association of South Africa,        Telephone: +27312072250

Email: imakzn@eastcoast.co.za                          Fax: +27312072260

P. O. Box 701063,

OVERPORT 4067

DURBAN

SOUTH AFRICA.