J Relig Health DOI 10.1007/s10943-014-9970-8 IMPRESSIONISTIC REPORTING
Mass Gathering Medicine New discipline to Deal with Epidemic and Infectious Diseases in the Hajj Among Muslim Pilgrimage: A Mini Review Article Yousef Abdullah Al Turki
Ó Springer Science+Business Media New York 2014
Abstract Mass Gathering Medicine is one of the new disciplines in Medicine which deal with all health aspects in overcrowded areas. Mass Gathering Medicine is an important new challenging discipline which needs to be supported by all concern experts such as the World Health Organization, Centers for Disease Control and Prevention, ministries of health from all countries, universities, research centers, and all other experts in this field. Scientist and academic staffs from all countries should be encouraged to participate in narrowing the gap of knowledge for Mass Gathering Medicine. Postgraduate board or fellowship certificate should be encouraged internationally. Keywords
Mass Gathering Medicine Discipline Prevention Hajj
Overview of Mass Gathering Medicine Mass Gathering Medicine is one of the new disciplines in medicine which deal with all health aspects in overcrowded area for example: Hajj and Omrah in Makkah region, Saudi Arabia. Until now there is no agreement about the exact number of people to define the Mass Gathering religious and sports meetings, but definitely there are different religion meeting and sport meeting which though overcrowded; and the land mark of all these meetings (Donou et al. 2013). In October 23–25, 2010, the first international conference, The Lancet Conferences on Mass Gathering Medicine, Implications and Opportunities for Global Health Security, was conducted by the Ministry of Health of Saudi Arabia and the Lancet Infectious Disease and it was in Jeddah, Saudi Arabia where Centers for Disease Control and Prevention experts from World Health Organization, Center for disease control and preventions, and all other experts discussed and start the Mass Gathering
Y. A. Al Turki (&) Department of Family and Community Medicine, College of Medicine, King Saud University, P.O. Box 28054, Riyadh 11437, Saudi Arabia e-mail: [email protected]
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Medicine (2010). After 3 years on September 21–23, 2013, the 2nd International Conference on Mass Gathering Medicine at the Global Center for Mass Gathering Medicine was conducted by Ministry of Health in Saudi Arabia; all international experts from World Health Organization, Center for Disease Control and Prevention, international experts from different universities, ministers of health in Gulf region, and other experts discussed Mass Gathering Medicine came for 3 days, and they concluded supporting the implementation of Mass Gathering Medicine, doing more research to define the exact definition of Mass Gathering and other related scientific needs, and arranging regular meeting every 2–3 years (2013). The 2nd international Conference discussed about the research priorities on Mass Gathering Medicine needs the efforts of all scientists to expand knowledge in this new discipline. This paper tries to highlight and review the current concepts about Mass Gathering Medicine and tries to fill the gap of knowledge in this important future discipline.
Background on the History and Meaning of Mass Gatherings in the Islamic world Mass gathering meeting in Islamic worlds are important events among Muslims internationally all over the world. And one of the most important examples is Hajj among Muslims which takes place in Makkah in Saudi Arabia, In Islam, all adult Muslims should perform Hajj at least once in their lifetime for those who can travel and perform Hajj physically and financially. As in the Holy of Quran, the meaning of what Allah says: Allah, the Exalted, says: ‘‘And Hajj (pilgrimage to Makkah) to the House (Ka‘bah) is a duty that mankind owes to Allah, those who can afford the expenses (for one’s conveyance, provision and residence); and whoever disbelieves [i.e., denies Hajj (pilgrimage to Makkah), then he is a disbeliever of Allah], then Allah stands not in need of any of the ‘Alamin (mankind, jinn and all that exists).’’ The Holy Quran, Surat al Emran, Aya 9, the meaning offers this line of translation. Also the Prophet Mohammed the messenger of Allah Peace be upon him (PBUH) said, ‘‘(The superstructure of) Islam is based on five (pillars), testifying the fact that La ilaha illallah wa anna Muhammad-ar-Rasul-ullah [there is no true god except Allah, and Muhammad ((PBUH)) is the Messenger of Allah], establishing As-Salat (the prayers), paying Zakat (poor due), the pilgrimage to the House [of Allah (Ka‘bah)], and the Saum (fasting) during the month of Ramadan.’’ Al-Bukhari and Muslim. During Hajj, Muslims come from different countries either Islamic or non-Islamic, as some Muslims still living in non-Islamic countries, so annually around 3 million Muslims meet in the Makkah region in Saudi Arabia during specific time which is about 1 week from day 8 to day 13 in the month of Dhual-Hijja in the Hegira Arabic calendar. Most of Islamic Hajj activities happened but many of pilgrimage come to Makkah few days or weeks before that time and some of them stay a few days or weeks after Hajj period according to their travel schedules, so there will be overcrowded of Muslims people in that specific date and place, and for that reason those masses gathering events need a special healthcare system to deal with certain illnesses which can happen at the time of Hajj which need to be prevented by applying standard measures even before pilgrimage come to Hajj by vaccination against certain epidemic illnesses, and by educating pilgrims for all over the world about the importance of practicing preventive measures before, during and after the Hajj period. Also another example of a Mass Gathering meeting in the Islamic world is Omrah which is for adult Muslims who can perform it physically and financially at least once in a life time but it is not mandatory like Hajj. So in Omrah Muslims come to Makkah region at any time they prefer
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J Relig Health
during the year to perform Omrah in Makkah city in the Holy Mosque which can be accomplished during a few hours in 1 day though most Muslims stay longer in Makkah to perform prayers in the Makkah Holy Mosque, where most of them perform Omrah. For example during the month of Ramadan where Muslims like to perform Omrah either from inside or outside the kingdom of Saudi Arabia. Another example of Mass Gathering meeting in the Islamic world is visiting the holy mosque in Medina city in Saudi Arabia when they come to Hajj or Omrah but this is not mandatory. During certain times twhen there is overcrowding in Medina before or after hajij, and during the month of Ramadan where many Muslims visit the Holy Mosque in Medina to perform prayers. For that reasons, Ministry of Health in Saudi Arabia and World Health Organization arranged conferences in Saudi Arabia to discuss the importance of Mass Gathering Medicine in dealing with all preventive and health management issues for people during Mass Gathering meeting (2010; 2013).
Is Mass Gathering Medicine New or Old Concept? It is worthwhile to mention that scientists have published few articles in the recent decades taking about the medical care in Mass Gathering (Zeitz et al. 2002; Hines 2000; Michael and Barbera 1997; Arbon 2004). And one of those which has been published in Prehospital and Disaster Medicine 1997, mentioned about Mass Gathering Medical Care: in a 25-year review (Michael and Barbera 1997). Another article published on 2004 where the author mentions an important fact which might help in understanding Mass Gathering Medicine models: ‘‘These conceptual models are based on the idea that Mass Gathering health can be understood as an inter-relationship between three domains: (1) the biomedical; (2) the environmental; and (3) the psychosocial. Key features influence the rate of injury and illness and characterize each domain. These key features are more or less well-understood and combine to produce an effect—the patient presentation rate, and a response—the health plan. Anew element, the latent potential for injury and illness, is introduced as a mechanism for describing a biomedical precursor state important in assessing health risk during mass gatherings (Arbon 2004).’’
The Global Center for Mass Gathering Medicine Starting The Global Center for Mass Gathering Medicine under the important responsibility of Ministry of Health in Saudi Arabia, and in coordination with all experts in this field like World Health Organization, Center for Disease Control and Prevention, and all other experts from allover the world represents one of the initial important steps toward enlarging building up the discipline of Mass Gathering Medicine in the world (2010; 2013).
Mass Gathering Medicine and Hajj in Saudi Arabia Hajj period in Saudi Arabia is the most important Mass Gathering Meeting because it happens annually at a specific time and limited location in Makkah region, where about 3 millions Muslim come from all countries in the world to perform Hajj. For that reason, Mass Gathering Medicine is suitable to be implemented and practice in Saudi Arabia
123
J Relig Health
during Hajj and also during Omrah which happen daily all over the year in the Holy Mosque in Makkah and also during Ramadan in Makkah and Medina Mosque. One paper has been published in Lancet about Emergence of Medicine for Mass Gatherings: lessons from Hajj which add to the importance of Mass Gathering Medicine during Hajj in Saudi Arabia (Memish et al. 2012).
Mass Gathering Medicine and Infectious Diseases The most important health aspects which mainly concern the health authority all over the world is the worry about spreading of infectious diseases during Mass gathering like in religious meeting or international sport meeting. Even that Mass Gathering Medicine should deal with all aspects of health, prevention, and managements during Mass Gathering meetings. World Health Organization reports an important alert about Communicable disease alert and response for mass gatherings which help in understanding Mass Gathering Medicine.1
Mass Gathering Medicine and Comprehensive Approach of Physical, Psychological, and Social Aspects Dealing with health in Mass Gathering does not mean only physical illnesses or infectious diseases only but also psychological and social aspects, so it is important to stress about comprehensive approach in Mass Gathering Medicine, and by this comprehensive approach, we can reach a better understanding of Mass Gathering.
Mass Gathering Medicine and Research Priorities Mass Gathering Medicine is a new discipline where there are a lot of gap of knowledge to fully understand this discipline. Scientist and clinicians from different specialities who are involved in the health management and medical care of Mass Gathering should participate in buildup of gap of knowledge in this important future discipline (Tam et al. 2012).
Mass Gathering Medicine and Postgraduate Certificate Mass Gathering Medicine is an important discipline which deserves to be organized in an academic approach deserving recognition in international postgraduate certificate in Mass Gathering, This certificate could be a fellowship for physician graduates from emergency, community medicine, family medicine, or internal medicine and received postgraduate board certificate in their field, another option is to start a new well-recognized postgraduate board in Mass Gathering Medicine, but the question remains whether this board should be under which academic departments or in emergency medicine department or family and community medicine department, or others departments involved in medical care of Mass Gathering.
1
http://www.who.int/csr/mass_gatherings/en/.
123
J Relig Health
Conclusions Mass Gathering Medicine is an important discipline which needs to be supported by all concerned experts such as World Health Organization, Centers for Disease control and Prevention, Ministries of Health, universities, research centers, and all other experts in this field. Scientist and academics in all countries should be encouraged to participate in bridging the gap of knowledge for Mass Gathering Medicine. And, finally, postgraduate board or fellowship certification should be encouraged internationally. Conflict of interest None.
References Arbon, P. (2004). The development of conceptual models for mass gathering Health. Prehospital and Disaster Medicine, 19(3), 208–212. Donou S, Goufen Y, Welcher M, Berry T, O’Connor R, Brady W. (2013). Mass-gathering medicine: A descriptive analysis of a range of mass-gathering event types. American Journal of Emergency Medicine, 31(5), 843–846. http://www.ajemjournal.com/article/S0735-6757(13)00033-8/ Hines, K. (2000). Mass gathering medicine. Trauma, 2(2), 143–151. Memish, Z., Stephens, G., Steffen, R., & Ahmed, Q. (2012). Emergence of medicine for mass gatherings: Lessons from the Hajj. The Lancet Infectious Diseases, 12(1), 56–65. Michael, J., & Barbera, J. (1997). Mass gathering medical care: A twenty five year review. Prehospital and Disaster Medicine, 12(4), 72–79. Tam J, Barbeschi M, Shapovalova N, Briand S, Memish Z, Kieny M. (2012). Research agenda for mass gatherings: A call to action. The Lancet Infectious Diseases, 12(3), 231–239. http://www.thelancet. com/journals/laninf/article/PIIS1473-3099(11)70353-X/ The Global Center for Mass Gathering Medicine, Ministry of Health, Saudi Arabia. The 2nd International conference for Mass Gathering Medicine. September 21–23, 2013. Riyadh, Saudi Arabia. http:// gcmgm.com/ The Lancet Conferences: Global Forum on Mass Gathering Medicine. Implications and opportunities for global health security. 23–25 October 2010, Jeddah, kingdom of Saudi Arabia. World Health Organization. Global Alert and Response. Communicable disease alert and response for mass gatherings. http://www.who.int/csr/mass_gatherings/en/ Zeitz, K., Schneider, D., Jarrett, D., & Zeitz, C. (2002). Mass gathering events: Retrospective analysis of patients presentations over seven years. Prehospital and Disaster Medicine, 17(3), 147–150.
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Mass Gathering Medicine New discipline to Deal with Epidemic and Infectious Diseases in the Hajj Among Muslim Pilgrimage: A Mini Review Article Yousef Abdullah Al Turki
Ó Springer Science+Business Media New York 2014
Abstract Mass Gathering Medicine is one of the new disciplines in Medicine which deal with all health aspects in overcrowded areas. Mass Gathering Medicine is an important new challenging discipline which needs to be supported by all concern experts such as the World Health Organization, Centers for Disease Control and Prevention, ministries of health from all countries, universities, research centers, and all other experts in this field. Scientist and academic staffs from all countries should be encouraged to participate in narrowing the gap of knowledge for Mass Gathering Medicine. Postgraduate board or fellowship certificate should be encouraged internationally. Keywords
Mass Gathering Medicine Discipline Prevention Hajj
Overview of Mass Gathering Medicine Mass Gathering Medicine is one of the new disciplines in medicine which deal with all health aspects in overcrowded area for example: Hajj and Omrah in Makkah region, Saudi Arabia. Until now there is no agreement about the exact number of people to define the Mass Gathering religious and sports meetings, but definitely there are different religion meeting and sport meeting which though overcrowded; and the land mark of all these meetings (Donou et al. 2013). In October 23–25, 2010, the first international conference, The Lancet Conferences on Mass Gathering Medicine, Implications and Opportunities for Global Health Security, was conducted by the Ministry of Health of Saudi Arabia and the Lancet Infectious Disease and it was in Jeddah, Saudi Arabia where Centers for Disease Control and Prevention experts from World Health Organization, Center for disease control and preventions, and all other experts discussed and start the Mass Gathering
Y. A. Al Turki (&) Department of Family and Community Medicine, College of Medicine, King Saud University, P.O. Box 28054, Riyadh 11437, Saudi Arabia e-mail: [email protected]
123
J Relig Health
Medicine (2010). After 3 years on September 21–23, 2013, the 2nd International Conference on Mass Gathering Medicine at the Global Center for Mass Gathering Medicine was conducted by Ministry of Health in Saudi Arabia; all international experts from World Health Organization, Center for Disease Control and Prevention, international experts from different universities, ministers of health in Gulf region, and other experts discussed Mass Gathering Medicine came for 3 days, and they concluded supporting the implementation of Mass Gathering Medicine, doing more research to define the exact definition of Mass Gathering and other related scientific needs, and arranging regular meeting every 2–3 years (2013). The 2nd international Conference discussed about the research priorities on Mass Gathering Medicine needs the efforts of all scientists to expand knowledge in this new discipline. This paper tries to highlight and review the current concepts about Mass Gathering Medicine and tries to fill the gap of knowledge in this important future discipline.
Background on the History and Meaning of Mass Gatherings in the Islamic world Mass gathering meeting in Islamic worlds are important events among Muslims internationally all over the world. And one of the most important examples is Hajj among Muslims which takes place in Makkah in Saudi Arabia, In Islam, all adult Muslims should perform Hajj at least once in their lifetime for those who can travel and perform Hajj physically and financially. As in the Holy of Quran, the meaning of what Allah says: Allah, the Exalted, says: ‘‘And Hajj (pilgrimage to Makkah) to the House (Ka‘bah) is a duty that mankind owes to Allah, those who can afford the expenses (for one’s conveyance, provision and residence); and whoever disbelieves [i.e., denies Hajj (pilgrimage to Makkah), then he is a disbeliever of Allah], then Allah stands not in need of any of the ‘Alamin (mankind, jinn and all that exists).’’ The Holy Quran, Surat al Emran, Aya 9, the meaning offers this line of translation. Also the Prophet Mohammed the messenger of Allah Peace be upon him (PBUH) said, ‘‘(The superstructure of) Islam is based on five (pillars), testifying the fact that La ilaha illallah wa anna Muhammad-ar-Rasul-ullah [there is no true god except Allah, and Muhammad ((PBUH)) is the Messenger of Allah], establishing As-Salat (the prayers), paying Zakat (poor due), the pilgrimage to the House [of Allah (Ka‘bah)], and the Saum (fasting) during the month of Ramadan.’’ Al-Bukhari and Muslim. During Hajj, Muslims come from different countries either Islamic or non-Islamic, as some Muslims still living in non-Islamic countries, so annually around 3 million Muslims meet in the Makkah region in Saudi Arabia during specific time which is about 1 week from day 8 to day 13 in the month of Dhual-Hijja in the Hegira Arabic calendar. Most of Islamic Hajj activities happened but many of pilgrimage come to Makkah few days or weeks before that time and some of them stay a few days or weeks after Hajj period according to their travel schedules, so there will be overcrowded of Muslims people in that specific date and place, and for that reason those masses gathering events need a special healthcare system to deal with certain illnesses which can happen at the time of Hajj which need to be prevented by applying standard measures even before pilgrimage come to Hajj by vaccination against certain epidemic illnesses, and by educating pilgrims for all over the world about the importance of practicing preventive measures before, during and after the Hajj period. Also another example of a Mass Gathering meeting in the Islamic world is Omrah which is for adult Muslims who can perform it physically and financially at least once in a life time but it is not mandatory like Hajj. So in Omrah Muslims come to Makkah region at any time they prefer
123
J Relig Health
during the year to perform Omrah in Makkah city in the Holy Mosque which can be accomplished during a few hours in 1 day though most Muslims stay longer in Makkah to perform prayers in the Makkah Holy Mosque, where most of them perform Omrah. For example during the month of Ramadan where Muslims like to perform Omrah either from inside or outside the kingdom of Saudi Arabia. Another example of Mass Gathering meeting in the Islamic world is visiting the holy mosque in Medina city in Saudi Arabia when they come to Hajj or Omrah but this is not mandatory. During certain times twhen there is overcrowding in Medina before or after hajij, and during the month of Ramadan where many Muslims visit the Holy Mosque in Medina to perform prayers. For that reasons, Ministry of Health in Saudi Arabia and World Health Organization arranged conferences in Saudi Arabia to discuss the importance of Mass Gathering Medicine in dealing with all preventive and health management issues for people during Mass Gathering meeting (2010; 2013).
Is Mass Gathering Medicine New or Old Concept? It is worthwhile to mention that scientists have published few articles in the recent decades taking about the medical care in Mass Gathering (Zeitz et al. 2002; Hines 2000; Michael and Barbera 1997; Arbon 2004). And one of those which has been published in Prehospital and Disaster Medicine 1997, mentioned about Mass Gathering Medical Care: in a 25-year review (Michael and Barbera 1997). Another article published on 2004 where the author mentions an important fact which might help in understanding Mass Gathering Medicine models: ‘‘These conceptual models are based on the idea that Mass Gathering health can be understood as an inter-relationship between three domains: (1) the biomedical; (2) the environmental; and (3) the psychosocial. Key features influence the rate of injury and illness and characterize each domain. These key features are more or less well-understood and combine to produce an effect—the patient presentation rate, and a response—the health plan. Anew element, the latent potential for injury and illness, is introduced as a mechanism for describing a biomedical precursor state important in assessing health risk during mass gatherings (Arbon 2004).’’
The Global Center for Mass Gathering Medicine Starting The Global Center for Mass Gathering Medicine under the important responsibility of Ministry of Health in Saudi Arabia, and in coordination with all experts in this field like World Health Organization, Center for Disease Control and Prevention, and all other experts from allover the world represents one of the initial important steps toward enlarging building up the discipline of Mass Gathering Medicine in the world (2010; 2013).
Mass Gathering Medicine and Hajj in Saudi Arabia Hajj period in Saudi Arabia is the most important Mass Gathering Meeting because it happens annually at a specific time and limited location in Makkah region, where about 3 millions Muslim come from all countries in the world to perform Hajj. For that reason, Mass Gathering Medicine is suitable to be implemented and practice in Saudi Arabia
123
J Relig Health
during Hajj and also during Omrah which happen daily all over the year in the Holy Mosque in Makkah and also during Ramadan in Makkah and Medina Mosque. One paper has been published in Lancet about Emergence of Medicine for Mass Gatherings: lessons from Hajj which add to the importance of Mass Gathering Medicine during Hajj in Saudi Arabia (Memish et al. 2012).
Mass Gathering Medicine and Infectious Diseases The most important health aspects which mainly concern the health authority all over the world is the worry about spreading of infectious diseases during Mass gathering like in religious meeting or international sport meeting. Even that Mass Gathering Medicine should deal with all aspects of health, prevention, and managements during Mass Gathering meetings. World Health Organization reports an important alert about Communicable disease alert and response for mass gatherings which help in understanding Mass Gathering Medicine.1
Mass Gathering Medicine and Comprehensive Approach of Physical, Psychological, and Social Aspects Dealing with health in Mass Gathering does not mean only physical illnesses or infectious diseases only but also psychological and social aspects, so it is important to stress about comprehensive approach in Mass Gathering Medicine, and by this comprehensive approach, we can reach a better understanding of Mass Gathering.
Mass Gathering Medicine and Research Priorities Mass Gathering Medicine is a new discipline where there are a lot of gap of knowledge to fully understand this discipline. Scientist and clinicians from different specialities who are involved in the health management and medical care of Mass Gathering should participate in buildup of gap of knowledge in this important future discipline (Tam et al. 2012).
Mass Gathering Medicine and Postgraduate Certificate Mass Gathering Medicine is an important discipline which deserves to be organized in an academic approach deserving recognition in international postgraduate certificate in Mass Gathering, This certificate could be a fellowship for physician graduates from emergency, community medicine, family medicine, or internal medicine and received postgraduate board certificate in their field, another option is to start a new well-recognized postgraduate board in Mass Gathering Medicine, but the question remains whether this board should be under which academic departments or in emergency medicine department or family and community medicine department, or others departments involved in medical care of Mass Gathering.
1
http://www.who.int/csr/mass_gatherings/en/.
123
J Relig Health
Conclusions Mass Gathering Medicine is an important discipline which needs to be supported by all concerned experts such as World Health Organization, Centers for Disease control and Prevention, Ministries of Health, universities, research centers, and all other experts in this field. Scientist and academics in all countries should be encouraged to participate in bridging the gap of knowledge for Mass Gathering Medicine. And, finally, postgraduate board or fellowship certification should be encouraged internationally. Conflict of interest None.
References Arbon, P. (2004). The development of conceptual models for mass gathering Health. Prehospital and Disaster Medicine, 19(3), 208–212. Donou S, Goufen Y, Welcher M, Berry T, O’Connor R, Brady W. (2013). Mass-gathering medicine: A descriptive analysis of a range of mass-gathering event types. American Journal of Emergency Medicine, 31(5), 843–846. http://www.ajemjournal.com/article/S0735-6757(13)00033-8/ Hines, K. (2000). Mass gathering medicine. Trauma, 2(2), 143–151. Memish, Z., Stephens, G., Steffen, R., & Ahmed, Q. (2012). Emergence of medicine for mass gatherings: Lessons from the Hajj. The Lancet Infectious Diseases, 12(1), 56–65. Michael, J., & Barbera, J. (1997). Mass gathering medical care: A twenty five year review. Prehospital and Disaster Medicine, 12(4), 72–79. Tam J, Barbeschi M, Shapovalova N, Briand S, Memish Z, Kieny M. (2012). Research agenda for mass gatherings: A call to action. The Lancet Infectious Diseases, 12(3), 231–239. http://www.thelancet. com/journals/laninf/article/PIIS1473-3099(11)70353-X/ The Global Center for Mass Gathering Medicine, Ministry of Health, Saudi Arabia. The 2nd International conference for Mass Gathering Medicine. September 21–23, 2013. Riyadh, Saudi Arabia. http:// gcmgm.com/ The Lancet Conferences: Global Forum on Mass Gathering Medicine. Implications and opportunities for global health security. 23–25 October 2010, Jeddah, kingdom of Saudi Arabia. World Health Organization. Global Alert and Response. Communicable disease alert and response for mass gatherings. http://www.who.int/csr/mass_gatherings/en/ Zeitz, K., Schneider, D., Jarrett, D., & Zeitz, C. (2002). Mass gathering events: Retrospective analysis of patients presentations over seven years. Prehospital and Disaster Medicine, 17(3), 147–150.
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