Indian Medical Mission at Hajj-2016: Mass-Gathering Medicine Perspectives, Challenges, and Opportunities in a Mission Posture

Document Type : Original Article

Authors

1 Army College of Medical Sciences and Base Hospital, New Delhi, India

2 INHS Kalyani, Vishakhapatnam, India

3 Command Hospital (EC), Kolkata, India

4 Public Health Consultant, Chennai, India

5 Director Medical Services, New Delhi, India

6 Army Hospital Research and Referral, New Delhi, India

Abstract

Introduction: Hajj is an annual mass gathering of over 3.5 million pilgrims congregating from 200 countries in the desert climate of Saudi Arabia. Mass gathering medicine at Hajj is challenged by issues of healthcare accessibility, infection control, on-site treatment, referral, evacuation, and response to disasters and public health emergencies. The Indian Medical Mission at Hajj 2016 established, operated, and coordinated a strategic network of mass gathering medical operations, the proceeds of which are discussed herein.
Methods: The mission was designed to provide holistic health security through health intelligence for pre-existing chronic diseases, epidemic intelligence for endemic and exotic diseases, public-health and disaster-health preparedness, and tiered healthcare through mobile medical task forces, static clinics, tent clinics, secondary care hospitals, and evacuation capabilities.
Results: Primary care, secondary care, and tertiary care treated 374 475, 930, and 523 patients, respectively. Patients exhibited limited compliance with pre-instituted treatments and precautionary protocols. Respiratory and gastrointestinal infections, cardiorespiratory, trauma, and heat illnesses were seen. Epidemic intelligence revealed an outbreak of food poisoning. Respiratory infections were reported by 90% of the healthcare personnel. Surge capacity was overwhelmed with patient throughput and ambulance transfers. Crude unadjusted mortality was 11.99/10 000.
Conclusion: The Indian Medical Mission at Hajj 2016 yielded solutions to the challenges faced during the 2016 Hajj pilgrimage. The mission posture of the Indian Medical Mission in Hajj presents a modus operandi for handling crisis scenarios in mass gathering. The situational analysis of the Hajj health mission calls for dynamic interventions in preparedness, clientele, and health systems.

Keywords


  1. Memish ZA, Stephens GM, Steffen R, Ahmed QA. Emergence of medicine for mass gatherings: lessons from the Hajj. Lancet Infect Dis. 2012;12(1):56-65. doi:0.1016/S1473-3099(11)70337-1.
  2. Shujaa A, Alhamid S. Health response to Hajj mass gathering from emergency perspective, narrative review. Turk J Emerg Med. 2015;15(4):172-176. doi:10.1016/j.tjem.2015.02.001.
  3. Manoochehry S, Rasouli HR. Recurrent human tragedy during Hajj. Int J Travel Med Glob Health. 2017;5(1):36-37. doi:10.15171/ijtmgh.2017.07.
  4. Ganjeh M, Einollahi B. Mass Fatalities in Hajj in 2015. Trauma Mon. 2016;21(5):e43253. doi:10.5812/traumamon.43253.
  5. Khan ID, Khan SA, Asima B, Hussaini SB, Zakiuddin M, Faisal FA. Morbidity and mortality amongst Indian Hajj pilgrims: a 3-year experience of indian Hajj Medical Mission in massgathering medicine. J Infect Public Health. 2017. doi:10.1016/j.jiph.2017.06.004.
  6. Khan NA, Ishag AM, Ahmad MS, El-Sayed FM, Bachal ZA, Abbas TG. Pattern of medical diseases and determinants of prognosis of hospitalization during 2005 Muslim pilgrimage Hajj in a tertiary care hospital. A prospective cohort study. Saudi Med J. 2006;27(9):1373-1380.
  7. Alzahrani AG, Choudhry AJ, Al Mazroa MA, Turkistani AH, Nouman GS, Memish ZA. Pattern of diseases among visitors to Mina health centers during the Hajj season, 1429 H (2008 G). J Infect Public Health. 2012;5(1):22-34. doi:10.1016/j.jiph.2011.10.003.
  8. Mandourah Y, Ocheltree A, Al Radi A, Fowler R. The epidemiology of Hajj-related critical illness: lessons for deployment of temporary critical care services. Crit Care Med. 2012;40(3):829-834. doi:10.1097/CCM.0b013e318236f49b.
  9. Yezli S, Assiri AM, Alhakeem RF, Turkistani AM, Alotaibi B. Meningococcal disease during the Hajj and Umrah mass gatherings. Int J Infect Dis. 2016;47:60-64. doi:10.1016/j.ijid.2016.04.007.
  10. Zumla A, McCloskey B, Bin Saeed AA, et al. What is the experience from previous mass gathering events? Lessons for Zika virus and the Olympics 2016. Int J Infect Dis. 2016;47:1-4. doi:10.1016/j.ijid.2016.06.010.
  11. Timeline: Annual pilgrimage frequently struck by disaster. The New York Times. January 12, 2006. https://mobile.nytimes.com/2006/01/12/world/africa/timeline-annual-pilgrimagefrequently-struck-by-disaster.html.
  12. Hajj stampede: At least 717 killed in Saudi Arabia. BBC News, Middle East. 2015.https://www.bbc.com/news/world-middleeast-34346449.
  13. Kollek D. An intro to mass gatherings. Centre for Excellence in Emergency Preparedness. Ontario-Canada. June 2014.http://www.ceep.ca/publications/Mass_Gatherings.pdf.
  14. WHO. Epidemic and Pandemic Alert and Response. Communicable Disease alert and response for mass gatherings. WHO/HSE/EPR/2008/8 Technical Workshop. Geneva-Switzerland: WHO; 2008:1-29. http://www.who.int/csr/mass_gathering/en/.
  15. Memish ZA, Assiri A, Turkestani A, et al. Mass gathering and globalization of respiratory pathogens during the 2013 Hajj. Clin Microbiol Infect. 2015;21(6):571.e571-e578. doi:10.1016/j.cmi.2015.02.008.
  16. Razavi SM, Sabouri-Kashani A, Ziaee-Ardakani H, et al. Trend of diseases among Iranian pilgrims during five consecutive years based on a Syndromic Surveillance System in Hajj. Med J Islam Repub Iran. 2013;27(4):179-185.
  17. Haworth E, Rashid H, Booy R. Prevention of pandemic influenza after mass gatherings - learning from Hajj. J R Soc Med. 2010;103(3):79-80. doi:10.1258/jrsm.2010.090463.
  18. Pane M, Imari S, Alwi Q, Nyoman Kandun I, Cook AR, Samaan G. Causes of mortality for Indonesian Hajj Pilgrims: comparison between routine death certificate and verbal autopsy findings. PLoS One. 2013;8(8):e73243. doi:10.1371/journal.pone.0073243.
  19. Razavi SM, Mohazzab Torabi S, Salamati P. Treatment and prevention of acute respiratory infections among Iranian hajj pilgrims: a 5-year follow up study and review of the literature. Med J Islam Repub Iran. 2014;28:31.
  20. Shirah BH, Zafar SH, Alferaidi OA, Sabir AMM. Mass gathering medicine (Hajj Pilgrimage in Saudi Arabia): the clinical pattern of pneumonia among pilgrims during Hajj. J Infect Public Health. 2017;10(3):277-286. doi:10.1016/j.jiph.2016.04.016.
  21. Khan ID, Basu A, Kiran S, Trivedi S, Pandit P, Chattoraj A. Deviceassociated healthcare-associated infections (DA-HAI) and the caveat of multiresistance in a multidisciplinary intensive care unit. Med J Armed Forces India. 2017;73(3):222-231. doi:10.1016/j.mjafi.2016.10.008.
  22. Benkouiten S, Charrel R, Belhouchat K, et al. Respiratory viruses and bacteria among pilgrims during the 2013 Hajj. Emerg Infect Dis. 2014;20(11):1821-1827. doi:10.3201/eid2011.140600.
  23. Al-Asmary S, Al-Shehri AS, Abou-Zeid A, Abdel-Fattah M, Hifnawy T, El-Said T. Acute respiratory tract infections among Hajj medical mission personnel, Saudi Arabia. Int J Infect Dis. 2007;11(3):268-272. doi:10.1016/j.ijid.2006.04.008.
  24. Gautret P, Benkouiten S, Griffiths K, Sridhar S. The inevitable Hajj cough: Surveillance data in French pilgrims, 2012-2014. Travel Med Infect Dis. 2015;13(6):485-489. doi:10.1016/j.tmaid.2015.09.008.
  25. Al-Tawfiq JA, Zumla A, Memish ZA. Respiratory tract infections during the annual Hajj: potential risks and mitigation strategies. Curr Opin Pulm Med. 2013;19(3):192-197. doi:10.1097/MCP.0b013e32835f1ae8.
  26. Jindal AK, Pandya K, Khan ID. Antimicrobial resistance: A public health challenge. Med J Armed Forces India. 2015;71(2):178-181. doi:10.1016/j.mjafi.2014.04.011.
  27. Akbar S. Indian Hajis have highest mortality rate, says study. Times of India, July 12, 2017.http://timesofindia.indiatimes.com/city/hyderabad/indian-hajis-have-highest-mortality-rate-says-study/articleshow/59555244.cms.
  28. Akbar S. Majority Indians hospitalized in Mecca, Medina during Haj in 70-90 age group. Times of India, July 12, 2017.http://timesofindia.indiatimes.com/city/hyderabad/majority-indianshospitalized-in-mecca-medina-during-haj-in-70-90-age-group/articleshow/59555251.cms.
  29. Khan ID, Sahni AK. Rapid diagnosis of dengue outbreaks in resource limited facilities. West Indian Med J. 2017;66(1). doi:10.7727/wimj.2016.095.
  30. Khan ID, Dogra PM, Ramphal SK,et al. Polymicrobial infections in a teenaged Renal Transplant Recipient. J Basic Clin Med. 2015;4(1):37-39.
  31. Khan ID, Gupta N, Rangan NM, et al. Evaluation of pre and post analytical variables in clinical microbiology services in multidisciplinary ICU of a medical college and tertiary care hospital. J Basic Clin Med. 2016;5(1):2-4.
  32. Alhaeli A, Bahkali S, Ali A, Househ MS, El-Metwally AA. The epidemiology of Dengue fever in Saudi Arabia: a systematic review. J Infect Public Health. 2016;9(2):117-124. doi:10.1016/j.jiph.2015.05.006.
  33. Sahni AK, Singh SP, Kumar A, Khan ID. Comparison of IS6110 and ‘short fragment’ devR (Rv3133c) gene targets with phenotypic methods for diagnosis of Mycobacterium tuberculosis. Med J Armed Forces India. 2013;69(4):341-344. doi:10.1016/j.mjafi.2013.02.003.
  34. Khan ID, Sahni AK, Bharadwaj R, Lall M, Jindal AK, Sashindran VK. Emerging organisms in a tertiary healthcare set up. Med J Armed Forces India. 2014;70(2):120-128. doi:10.1016/j.mjafi.2013.09.005.
  35. Khan ID. Challenges and opportunities in diagnosis and management of infectious diseases in developing country healthcare system. J Basic Clin Med 2016;5(1):1.
  36. Hutton A, Brown S, Verdonk N. Exploring culture: audience predispositions and consequent effects on audience behavior in a mass-gathering setting. Prehosp Disaster Med. 2013;28(3):292-297. doi:10.1017/S1049023X13000228.
  37. Khan ID, B. Asima, Khan SA. Operations throughput as a determinant of golden-hour in mass-gathering medicine. Int J Med and Med Res. 2017;3(1):52-58. doi:10.11603/ijmmr.2413-6077.2017.1.7804.
  38. Al-Ghamdi AS, Kabbash IA. Awareness of healthcare workers regarding preventive measures of communicable diseases among Hajj pilgrims at the entry point in Western Saudi Arabia. Saudi Med J. 2011;32(11):1161-1167.
  39. Pan American Health Organization, World Health Organization. Hospital Safety Index: Evaluation Forms for Safe Hospitals. Washington, DC: Emergency Preparedness and Disaster Relief, PAHO; 2008.
  40. Madani TA, Albarrak AM, Alhazmi MA, Alazraqi TA, Althaqafi AO, Ishaq AH. Steady improvement of infection control services in six community hospitals in Makkah following annual audits during Hajj for four consecutive years. BMC Infect Dis. 2006;6:135. doi:10.1186/1471-2334-6-135.
  41. Turkestani A, Balahmar M, Ibrahem A, Moqbel E, Memish ZA. Using health educators to improve knowledge of healthy behaviour among Hajj 1432 (2011) pilgrims. East Mediterr Health J. 2013;19 Suppl 2:S9-S12.