The performance of ḥajj is obligatory on all adult Muslims who have the means to make the trip to the Holy City of Makkah.   ‘Umrah is regarded as a minor pilgrimage with only part of the required procedures performed. Whosoever enters the mi'qāt (boundary of the Holy Land) has to perform ‘umrah, which includes tawāf (seven circuits around the Holy Kabah) and sā’i  (seven times between Mount Safā and Mount Murwa).

 Good health makes it easier not only to enjoy   ḥajj and ‘umrah in the pleasure of Allah Subaḥānahu Wata’ālā but also to make maximum use of the opportunity to make as much ‘ibādah as possible.    It is, therefore, very important for those performing ḥajj to be both physically and spiritually prepared to perform this once in a lifetime ibādah.  Here are some health guidelines to make the performance of ḥajj and ‘umrah easier. These guidelines must be accompanied by your own doctor's advice pertaining to your own health needs.

Physical fitness:

 The performance of ḥajj and ‘umrah is easier for physically fit people.   If you have decided to perform a walking ḥajj, then it would be very important for you to be as fit as possible.  This will require walking as much as possible, starting about 6 to 8 weeks before departure, walking greater and greater distances as the time of departure arrives. 

 A brisk walk for about an hour three times a week going up to 5 kms at a time would be sufficient to prepare for a walking ḥajj.  Start slow and increase the walk as you become fitter. The sandals or slippers that are to be used during ḥajj and ‘umrah need to be broken-in if new to make the feet accustomed to the footwear.  

 Men are not allowed to cover their heads during ḥajj and ‘umrah.  Furthermore, in the case of ḥajj, men may have shaven their heads recently from the performance of Umrah.  It would, therefore, be advisable to expose the head to the sun whilst exercising before departure so that the head (scalp and face) and neck can become accustomed to the sun.   This can also be done in Saudi Arabia before ḥajj starts.

The sooner exercise is started, the better.  For those who can, jogging would be an excellent form of exercise.  Even if one is not performing a walking ḥajj, the exercise will help tremendously.

 If you are overweight, go on a strict diet and an exercise programme to lose weight.

For those who are disabled, wheel chairs are freely available both in Makkah and Madinah. Physical fitness is therefore very important.

Fluid Intake

 Because of the harsh weather conditions (very hot and dry conditions), one must drink water in abundance. Tap water is not safe to drink. One can brush teeth, gargle and make wudhu with tap water. Zam Zam is freely available.  Drink as much Zam Zam as possible. Bottled water is also available and distributed free on the days of ḥajj. Fruit juices are also available. Fluid intake should be about 8 to 12 large glasses a day, i.e., 2-3 litres a day.  If your urine is concentrated, your body fluid levels are down.  Ensure that you pass at least one litre of urine a day.  This is important to rid your body of toxins. Restricting water intake to avoid going to the toilet can lead to heat exhaustion and dehydration.

Drinking very cold fluids in hot conditions can cause a sore throat.  Please make sure that drinking water is safe.  Drink adequate amounts of fluids especially Zam Zam throughout your stay.

Food Intake

One should continue to eat a healthy, well balanced diet and should be wary of eating unusual foods. One should be cautious about purchasing food from street vendors.  Make sure that your fibre intake is high to avoid constipation.  If one is on a particular diet, e.g., diabetic, please maintain your diet strictly.

 The ḥajj authorities in Saudi Arabia do an excellent job of keeping the Zam Zam water area and containers as clean as possible. Clean drinking cups are always available.  

 Have a well balanced diet, high is fibre.

 CONTROL OF EXISTING HEALTH PROBLEMS

  It is very important for anyone who takes regular medications to have enough supplies available for use during their stay in the Holy land. 

Medications are available from Pharmacies in Saudi Arabia.   Please take a prescription or a list of your medications from your doctor with you in case your medication gets misplaced or runs out. The names of the medication may be different and can be confusing.  It is far better to take adequate supplies of your own medication.  Make sure that you continue to take your medication regularly.  Sometimes, flights are delayed out of Saudi Arabia following ḥajj. Please take at least a week's extra supply of your medication for this eventuality.

Arthritis

Arthritis needs to be controlled well before departure.  The treatment of the arthritis would involve decreasing the inflammation in and around the joints that are affected.  Once the inflammation has settled, then light exercises to strengthen the muscles around the affected joint would help tremendously.  Be guided by your doctor with the help of a physiotherapist.

Start treatment well before departure.

People who suffer from arthritis of the weight-bearing joints (back, hips,knees,ankles) should lose weight if they are overweight. Less weight would result in a decrease in load bearing on the joints.  Exercise the muscles of the lower limbs to strengthen them. Stronger muscles take the pressure off the joints.

If enough time is not available to lose weight or to exercise, enough anti-inflammatory medication and pain killers should be taken to control the arthritis there.

 Control arthritis well before departure.

 Back Strain

Back strain is a common problem.   Most people suffer some back pain during their lifetime.  Back strains take time to heal sometimes up to a month.   Prolapsed discs take longer to heal.   Therefore, in those people who have a history of back strain or a backache, it is strongly recommended that every precaution be taken not to strain the back unnecessarily. 

Travel with light bags, preferably with wheels.    These can be pulled along without being carried.

Avoid lifting heavy articles.

Proper lifting of heavy articles involves not bending the back but bending the knees and lifting with a straight back.  It will be better to allow others who are not going to ḥajj to do the lifting, e.g., relatives who are not going, hotel staff, porters at airports, etc. 

If a back problem already exists, extra care needs to be taken not only in lifting but also in sitting in awkward positions or on very low chairs, bending and twisting awkwardly, etc.  Treatment should start well before departure. 

Travel light.

Lift luggage correctly.  Find others who are not performing ḥajj or ‘umrah to lift the luggage.

 Fungal Infections of the feet

Fungal infections of the feet present as either a dry scaly very itchy rash or little fluid-filled blisters between the toes or on the sole of the feet or around the heel.   Fungal infections thrive in moist conditions, as between the toes or under the feet after bathing and after wudhu.  The fungi cannot grow without moisture.  It is therefore a good habit to dry the feet and the areas between the toes with a paper towel or tissue and to wear open sandals when possible so the feet may dry out.  Fungal infections are contagious.

If a fungal infection is present, this must be attended to especially if diabetes is present.  Fungal infections of the feet resulting in cracks or damage of the skin can get secondarily infected with other bacteria causing cellulites.  This can take up to a week or two to resolve with antibiotics and leg elevation.  

Fungal infections can be treated with an anti-fungal agent until cured.   Terbenifine containing cream or gel may be used to cure the infection.  Please consult a Doctor, if extensive or if the medication does not respond to treatment. 

Treat fungal infections well before departure to prevent complications.

 Diabetics

 Good diabetic control needs to be achieved before departure.

A glucose monitor (glucometer) should be taken and enough strips to last for the duration of the stay.  Glucose levels must be taken regularly, both fasting and 2 hours after a meal.  These results should be written down on a chart.  This becomes important if a Doctor needs to be consulted.

A proper diabetic diet is very important and must be maintained throughout the stay. Beware of fruit juices that have sugar added to them.

Enough medication must be taken for the duration of the visit. An extra weeks supply of medication should be taken in case there is a delay in return flights from the Kingdom.

Diabetics must take extra care of their feet. Scratches, tiny cuts and fungal infections must be treated promptly with an antibiotic cream like Bactroban until they heal.  Cellulitis can result from untreated wounds

Apply extra moisturiser to keep the skin supple and elastic. 

Care of  nails of the feet is also important.  Remember that open sandals will be worn for the duration of ḥajj. Feet can get trampled upon in the crowds.  Nails should be well trimmed and not "catch" on clothes. 

When walking, allow enough space in front so that  feet are not trampled.

Complications from wounds can easily arise in diabetics resulting in unnecessary pain and discomfort and a possibility of missing ḥajj.

Following a diabetic diet is very important always but especially before and during ḥajj.

Regular, correct medication and good control must be maintained throughout the stay. 

A glucose monitor should be taken with enough test strips to last for the  duration of the ḥajj period.

High Blood Pressure

High blood pressure must be well controlled before departure.  Medication must be taken regularly.  Enough medication must be taken to last for the duration of the trip.  An extra weeks supply of medication should be taken in case the flight is delayed. Blood pressure must be checked regularly. Those on diuretics (water tablets) may need to have their medication adjusted due to the extreme weather conditions in Saudi Arabia.  This should be done in consultation with a doctor. Consult a doctor if there is dizziness, headaches which do not settle, disorientation or swelling of the ankles and feet.

Gout

Those who suffer from gout must make sure that they continue their preventative

 medication.   They should also take with them a supply of medicines that usually help them during an attack of gout.  Continue with a strict diet, avoiding purine-containing foods such as red meat, canned sardines or anchovies, etc.

Asthma

Those who suffer from asthma must ensure that their asthma is well controlled with preventative medication. Good control must be achieved before departure.  Preventative medication must be continued throughout the stay. Adequate supplies of medication must be taken, especially preventative medication, broncho-dilator inhalers and tablets.

Asthmatics must seek medical attention urgently if their regular medication does not relieve an attack.

Good asthma control is essential.

Continue in Part 2