Dr. Ased ullah Soomro (Cardiologist)

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Makkah mukerrama
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(www.thenewslark.com) (Report By: Aamil Usnani from Jeddah) World muslim population is around one billion .Indonesia population wise is largest in muslim world so majority of hajji coming from Indonesia followed by pakistan .180 countries are participating in hajj with diverse socio- cultural and different languages .Over all urdu speaking hajji are in majority for ICU / CCU admissions during hajj.previously RTA, fire ,stampede and infectious diseases were commonest problems during hajj.Govt of Saudi Arabia has worked hard to overcome on these problems.
Now commonest cause of deaths and hospitalization are cardio-vasular problems ( heart attack, heart failure and cardiac arrest/ sudden cardiac deaths ) followed by strokes .despite lot of improvement to diagnosis and treatment of CV and stroke issues yet there are no or inaccurate data collection and hajj research gapes to formulate policies to prevent cardiovascular events through screening from native countries before planning for hajj. It may be difficult to start but not impossible.
Cardiac arrest / sudden cardiac death during hajj is very common but we do not have exact data and will not be possible in atleast near future because those who die out of hospital or on the way to hospital we just presume on the basis of verbal autopsy without knowing the exact cause of death especially cardiac versus non cardiac causes of deaths .
While working in Makkah and Madina learn different things ,it was totally different experience and problems which we had never seen in outside hajj cardiology world eg our first death during hajj 2019 was Arab lady with aortic dissection , ventricular septal rupture as complication of acute MI ,4 cases in 15 days which no body or high volume center see any where in the world. > 70 Primary PCI following acute MI on day of Arfat only .
Islamic research foundation of Indonesia in 2008 hajj documented 446 deaths during hajj out of 206831.276 were male ,329 were above 60 years ,only 14 deaths were in age 18 to 40 years 305 ,68% were in Makkah 106 24% in Madina and 35 8% in jeddah .
57% died in hospital and 36% out side hospital .
77% died during hajj days between 5 am to 9 pm.
66% were due to cardiovascular problems ( based on verbal autopsy and 28 % due to respiratory problems.
While working at al .ansar hospital in Madina in 2005 first 20 days before hajj majority of deaths and hospital admissions were due to heart problem and 2nd 20 days after hajj the main admissions were due to community acquired pneumonia.
95% Indonesian hajji coming through govt scheme 300 to 450 in one aeroplane accompanied by 2 trained nurses and one medical specialist to handle emergencies during their journey.
Hajjis who are admitted in hospital or mother’s who deliver before hajj are taken in ambulances ,air ambulance or in luxury well equipped buses from king Abdullah medical city and others hospital all are accompanied by trained nurses and specialist doctors to visit day of Arafat.
Cardiac arrest during hajj is complex and challenging It took me 8 years to work on this project and finally written 5 chapters on this hot issue .
Besides many other thing I found atleast one simple non expensive solution to creat awareness among all stake holders to learn BLS ( basic life support ) art and give some legal cover to those lay hajji who can perform cardio – cerebral ( CCR/ CPR ) IN EYE WITNESS Cardiac arrest any where from airport to throughout hajj journey .we have only 7 to 10 min to perform cardiac contration which can be done by BLS trained personnel who witness cardiac arrest without waiting for ambulance or doctor to arrive .it is possible and doable untill other strategies to revert cardiac arrest are available in sha Allah.

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