Going To Hajj? Your Health Kit

Hajj is a lifetime journey for which the faithful hearts are longing. Indeed, it is a great favor Almighty Allah has bestowed upon His servants so that they can draw closer to Him and have their sins forgiven. As the performance of Hajj requires physical, psychological, and financial ability, all the would-be pilgrims need to be aware of all the health aspects of Hajj.

What is the best age for performing Hajj? What are the health aspects necessary to bear in mind during this season? What is the best nutrition that would aid our bodies during the Hajj rituals? How to avoid dehydration and other health problems outdoors?

To tackle this important topic, Dr. Amira Ayad, a pharmacist, nutrition specialist, and natural health consultant, provides answers to all these questions.

Should we be concerned about an outbreak of a SARS-like virus during the current Hajj season?
Fear and panic are the number one enemies of your immune system. It is highly important not to panic or worry. Stress and worry are proven to undermine our immunity greatly. Enjoy the moment and cherish your spiritual journey with a deep belief that “Never will we be struck except by what Allah has decreed for us; He is our protector.” And upon Allah let the believers rely.” (At-Taubah 9:51). This, of course, does not mean neglecting to take our precautions and follow the worldly means for prophylaxis and/or healing. For more on those, please refer to question 3 below.

And, remember, as long as you are fit, the viruses won’t stand a chance, in shaa Allah, so start taking care of your health early on before departure. Eat healthy, exercise, and get enough sleep and rest. And follow the prevention methods to the best of your ability.

What are the vaccinations required for Hajj?
There is one mandatory vaccine for all Hajj travelers, the meningococcal vaccine; you can’t take your KSA visa for Hajj without proof of vaccination.

Some physicians recommend additional vaccines like the Pneumococcal Vaccine, which is recommended for adults above 65 years and other vulnerable groups like people with chronic diseases like diabetes, heart diseases (except high blood pressure), lung diseases (including asthma), and compromised immunity individuals. You should also make sure that you are up-to-date with your polio vaccination (check with your physician if a booster dose is needed). The US CDC (Center for Disease Control) further recommends a seasonal influenza vaccine to reduce the risk of flu. But this remains a personal choice. It is essential to take the vaccines at least 2 weeks before traveling.

I’ve heard about the spreading coronavirus in KSA recently. How can we immunize ourselves against it?
Coronaviruses are a large group of viruses related to the one causing the common cold. Some of them, however, could cause serious illnesses.

WHO (World Health Organization) and CDC recommend general measures of self-care and hygiene as a protective measure. As with all flu and common cold viruses, a healthy body with a healthy immune system can easily deal with them. I believe that our body has the tremendous ability of self-healing and regeneration.

During the season of Hajj, due to the large crowd, the spread of respiratory diseases is very common. Most of these are common, known viruses that our body either already has immunity from or can take care of, like a common bout of cold or flu. Still, prevention is better than cure, so when you are in a crowded area, put a face mask, take good care of your personal hygiene. Wash your hands often, use disposable tissue papers, and avoid touching your eyes and nose. And of course, whenever you can, keep your distance from people who look sick.

Eat healthy food rich in fresh fruits and vegetables. You can take vitamin C supplements (500-1000 mg) for further protection; start at least a week before you leave and continue taking them while there. Vitamin C fights cold viruses, protects mucous membranes, and promotes the production of interferon, the body’s own natural antiviral protein.

Raw honey with freshly squeezed lemon is great for sore throats and cough,s or even as prophylactic every morning.

Zinc strengthens immunity, and its lozenges are reported to relieve symptoms and reduce the duration of the common cold and sore throat.

Take echinacea extract to boost your body’s natural defense mechanism (it is available at most health food stores and pharmacies – make sure to get the alcohol-free extract, not the tincture).

Finally, you can ask your physician to prescribe an antibiotic for you to carry along in case of need. A broad-spectrum antibiotic like ciprofloxacin or amoxicillin will do the job. I do not recommend taking it as prophylactic; just keep it with you to take it if respiratory infection symptoms start to surface. If the symptoms are severe, though, you might consider seeing a physician. But as I said earlier, it is highly important not to panic. Stress and worry are proven to undermine our immunity greatly.

Every time I go to Hajj or Umrah, I return to my homeland extremely sick with a very harsh case of the flu, although I always take the influenza vaccination before traveling. Shall I stop taking vaccinations? And what makes it ineffective that way?
Taking the vaccination is totally a personal choice, and its effectiveness is also a personal reaction that no one can predict. You have to weigh the advantages and disadvantages and decide for yourself.

Common cold and influenza are caused by more than 200 different viruses that cause various degrees of upper respiratory tract infections. These viruses can readily mutate (i.e., alter their genetic makeup), constantly creating new strains that pose new challenges to our immune system and make permanent immunity against the flu impossible.

Influenza vaccines deliver an inactivated (i.e., containing dead viruses) or attenuated (i.e., containing weakened viruses) dose of influenza viruses. The shot is aimed at boosting our body’s immune system to synthesize the required antibodies for fighting against the upcoming flu. The problem is, among those hundreds of strains of flu viruses, only three could be included in the vaccine shot. Pharmaceutical companies have to take a calculated ‘guess’ on the most possible ones to appear in the flu season. And, since the vaccines need around 11 months from development till they reach the consumers, and given the fact that the flu viruses have a tremendous ability to readily mutate into new strains, we cannot be certain that these are the right three strains anymore.

Again, as I told you, vaccination remains your personal choice, although I have to mention that it is highly recommended by the WHO and CDC.

Personally, I did not take the vaccine when I performed hajj, nor did my husband on his 2 pilgrimages or any of his Omra trips. In some of those, we caught bad flu that managed to take its course and heal, alhamdulillah, but did not stop us from continuing our rituals, and in other cases, we did not fall ill, alhamdulillah.

So, it is totally up to you to decide which course to take. Just in any case, follow all preventive and immune-boosting measures you can (refer to question 3). And remember our Prophet’s saying: “No fatigue, no disease, no sorrow, no sadness, no hurt, no distress befalls a Muslim, even if it was the prick he received from a thorn, but that Allah expiates some of his sins for it” (Bukhari & Muslim). So, even your flu bout, if any, won’t go in vain in shaa Allah.

What is the suitable age to perform Hajj rituals?
As Allah told us, performing hajj starts to be an obligation on every Muslim at the age of puberty if he/she is capable (financially, physically, and psychologically). So, due to its physically demanding rituals, it is best to perform it when we are still young and fit. There is no specific age, of course, but I guess the age of twenties and thirties seems to be the best choice, as during that time we are grown up yet young enough to withstand the physical and emotional stress, and of course understand, heed, enjoy, and cherish the spiritual benefits.

Still, I have to say here that I have met many people in their forties and fifties who are healthier and more fit than their younger counterparts. So, in the end, health and vitality are the best determinants rather than age.

What is the maximum number of hours or minutes I could stay outdoors under the direct sun?
This largely varies according to the temperature and according to your body’s personal ability. My advice is to stay in the shade whenever possible, wear a sunblock (I prefer a physical sunblock, not a chemical one), sunglasses, and carry an umbrella in the area where shade is not an option. Most importantly, listen to your body, and don’t ignore any early signs of dizziness, headache, drowsiness, or fatigue. Drink plenty of fluids; water is the best hydrating liquid, of course, so carry with you a small bottle of water at all times. And avoid prolonged exposure to the sun.

Thank God I took the meningitis vaccine. But I need to know what could cause its infection for me during rituals, and what the side effects of its vaccine are, as my friends made me afraid of it.

Meningitis is a bacterial infection of the membranes covering the brain and spinal cord (meninges). It is a very serious disease, yet it is not highly contagious, alhamdulillah. Both viral meningitis and bacterial meningitis can be spread through direct contact with nose and throat secretions, which is why personal hygiene is extremely important, especially in crowded places like during hajj.

Meningococcal vaccine has been around for a long time now and has proven to be relatively safe. Like any medicine, of course, it may have some side effects, but it has not been shown to cause any serious harm. The rare side effects include symptoms appearing directly following the vaccination, like jerking or seizure-like movements. These usually subside with rest for 15-20 minutes after the shot. Some people getting the vaccine could show redness or pain at the injection area, which usually disappears within 1 or 2 days. In very rare cases, an allergic reaction has been reported directly after the shot, and this should be dealt with by the physician giving the vaccination.

What are the health precautions necessary to bear in mind while eating or drinking in Mecca and Medinah?
Unfortunately, diarrhea is one of the common diseases encountered during hajj. The most important precaution is to drink only bottled water (or Zamzam water from the mosque) and do not eat food that has been exposed to the sun or heat for a long time. You can eat packaged food like biscuits and crackers, fresh fruits or vegetables after thorough washing, and cooked food if it is freshly cooked and served hot.

Follow all regular hygiene measures: washing hands very well, washing your fresh vegetables or fruits thoroughly, covering all your food…

If you experience diarrhea, note that the most essential measure is proper hydration. If the diarrhea is severe, consult a physician; meanwhile, take a rehydrating salt (available over the counter in all pharmacies) to avoid dehydration.

Which one is more hygienic and safer to use during Hajj, the flush toilet or the squat one?
“Usually, the squat one is safer, especially in crowded areas. It is less in contact with the person using it, so it is less likely to transmit diseases.

In both cases, though, it is good to carry a sanitizer and your own toilet paper. Try to get the least possible contact with the toilet, and needless to say, wash your hands thoroughly after use.

I have performed Hajj 4 times so far, Elhamdulillah, yet when I return home, I always go into a terrible psychological condition and depression that lasts for two months or so. What can I do?
Hajj is a highly spiritual journey. It touches the heart and soul much more than it affects the body, and this is the main purpose. I am not sure of the reason behind your depression, though. Is it the feeling of homesickness for that holy place? Or is it because you are back to the usual life stresses and challenges you were temporarily relieved from? Or maybe it is because you worry if your hajj has been accepted by Allah SWT? You need to sit and reflect on the origin of your depression. Knowing the source is essential for us to deal with the problem. You may want to sit with a friend or consult a trusted scholar or psychologist to clear up some issues. Most importantly, don’t surrender to your depression, seek repentance and ask Allah forgiveness, adjust your intention and He SWT will help you through your challenging times.

On the physical level, mild depression could result from a deficiency in essential fatty acids and the neurotransmitter serotonin. You can take fish oil supplements (or DHA or flaxseeds- all are good sources of essential fatty acids) and 5HTP (5-hydroxytryptophan), a natural supplement that helps restore serotonin levels and boost the mood.

Vitamin D deficiency could also have a hand in this. Go outdoors, get exposed to the sun whenever you can, and eat lots of fatty fish.

Why doesn’t Saudi Arabia require a hepatitis C vaccination?
I can’t answer for them. But what I know is that hepatitis C is mainly transmitted through contaminated blood. So, no wide risk like in the case of the disease transmitted through the respiratory tract. The only risk you should be aware of during hajj is when men shave their heads; they need to make sure that the blades used are disposable, clean ones, or better yet, take your own shaving kit along.

Can I take my baby with me to Hajj, or would this be unsafe for her immunity?
I do not recommend it. The packed place is a high risk of transmitting disease, especially for a baby with a still-developing immune system. And another real risk is the pushing around during many of the rituals and the unavoidable human stampede that you sometimes encounter.

Is the chemical composition of Zamzam water different from that of other well waters?
Yes, many studies show the high quality and purity of Zamzam water compared to other waters, but, personally, I think there is much more to it than chemistry and much more than what we can explain with our current technological and scientific instruments. As I studied energy medicine for years, I saw the instant shift in water energy when we simply say a prayer or mention Allah’s name while holding the cup. This energy had been recorded under the electron microscope by the Japanese researcher Masaru Emoto, who saw water molecules as carriers of information. So imagine what the energy of the water that our Prophet PBUH told us about is: “Zamzam water is for whatever is intended in drinking it” (Ibn Majah, Ahmed & Hakim).

My old mum is going to Hajj with me this year. What are the health prerequisites for her? How to take care of her properly during Hajj?
Same general precautions as all of us regarding food selection, hygiene, and sun exposure, but with special stress on some important points for old age:

– Hydration is very important in advanced age, as older people get dehydrated quickly and usually without noticing it. And especially avoid unnecessary sun exposure.

– Avoid crowded places. Try to avoid performing the rituals during peak hours. And, whenever possible for you to do it in her place, it will be better (like in rajm-throwing the stones- for instance).

– You can ask for wheel chair for tawaf… if needed, just ask her not to overstress herself.

I’m on medication for high blood pressure. What are the things to avoid during the pilgrimage?
First, you should bring a sufficient (or even some reserve) quantity of your medication and remember to take it on time. If your medication involves diuretics like thiazide and thiazide-like medication, it is important to remember to hydrate well, as you are at more risk of losing body water. As usual, anti-hypertension recommendations reduce salt in your food, and if possible, bring along your meter to monitor your blood pressure during your travel. If this is not possible, you can usually measure it at local pharmacies or medical centers upon any sign of disturbance.

Avoid stress and overexertion, and avoid too much sun exposure. Eat plenty of leafy green vegetables (thoroughly washed) and fresh fruits and vegetables.

By Amira Ayad Health Consultant – Egypt