Hajj is the annual pilgrimage to Makkah, Saudi Arabia and a central tenet of Islamic belief. Each year Saudi Arabia hosts 2.5 million pilgrim-travelers as they engage in Hajj rituals. Managing their health and safety during the world's largest mass gathering is a vast operation, supported both by diverse sectors within the Kingdom and broad international collaboration. The recent influenza A H1N1 pandemic posed special risk to this extraordinarily diverse gathering, which routinely draws visitors from over 140 nations and demanded extraordinarily imaginative and novel solutions.
In hosting the modern Hajj, the Kingdom has weathered two 20th century world wars, global outbreaks due to newly emerging disease (including SARS and meningococcal meningitis W135) all without missing a beat in the current decade of regional conflict. In this time, the Kingdom of Saudi Arabia has acquired a unique, resilient expertise concerning Hajj-related public health. Important observations relevant to public health planners everywhere are contained in this experience. Some of this experience is already informing the long-term response to the Haitian earthquake aftermath which will be marked by multiple diverse emerging infectious challenges and non-infectious environmental hazards. Yet the process of exchanging expertise is possibly even more instructive. Collaborative work on this scale is emblematic of the increasingly important field of global health diplomacy and the Muslim world has an enormous role to play in this new conversation.
First articulated by Health and Human Services Secretary Tommy Thompson, global health diplomacy usually encompasses acts of service from one nation to another. The US rebuilding of maternity hospitals in Afghanistan, or the deployment of the USS Comfort to serve as a site for temporary clinics in Vietnamese coastal waters are two recent examples. The IDF's dramatic emergency response to Haiti is another emphatic and much admired example.
Yet global health diplomacy is also at work when individuals engage in acts of public service. Many such acts begin simply with excited investigators sharing passionate enthusiasms. The collaboration and genuine friendship which developed between Dr. Scott McNabb from the Centers of Disease Control and Dr. Ziad Memish, Assistant Deputy Minister of Health to the Kingdom of Saudi Arabia is a case in point. As they struggled with the best responses to the global threat of pandemic coinciding with last year's Hajj, their work led to the single largest real-time mobile databasing system engaged to detect unfolding disease at any mass gathering. Senator John Kerry discussed precisely this endeavor in a speech on Sunday morning in Doha at the U.S.-Islamic World Forum. This joint US-Saudi team worked on a cutting-edge program to contain the flu using smart-phones for real-time disease mapping. Defying the odds, there was no spike in H1N1 flu cases after the Hajj. The on-the-ground collaboration was headed by Dr. Osama Ibrahim, an Egyptian-American public health expert at US Centers for Disease Control, and four other Muslim-American doctors. This international collaboration was realized only through both intense personal dedication and the confidence of massive agencies placed in their people. It paid off. The program was an unprecedented success, testament to the power of effective working relationships built with collaborative vision: all politics, it turns out, is personal.
Those who collaborate, write and disseminate information internationally are long aware of the latent value of such informal, positive exchange. In the 'Flat World' of medical academia, individual citizens exert immediate and palpable impact. Fostering such professional dialogues are 'everyday' (albeit unseen) acts of global health diplomacy. When investigators and physicians work in a shared space, unfettered by the global geopolitik, global health diplomacy becomes alive and vibrant.
Saudi Arabia's experience in international service through public health is substantial and the world needs to know about it. Vantage into this work has contracted during the initial post- 9/11 period, a silent casualty of the 'Global War on Terror' and the extent of its engagement during Hajj preparations are little known in the wider community.
Saudi Arabia is no stranger to global health diplomacy. While Crown Prince, King Abdullah launched the conjoined twin separation program at the King Abdulaziz Medical Center, (the flagship institute of Saudi Arabian National Guard Health Affairs) in Riyadh. In existence for 18 years, the Kingdom funded the program as an exercise in global goodwill. To date, twenty-five conjoined twin pairs from all over the world have been treated successfully.
Within the Kingdom, King Abdullah has long endorsed policies of public service in keeping with the Islamic principle of zakat (charity). This is the principle behind the Saudi Arabian public health system. Further, the exhaustive acquisition and dissemination of knowledge in the service of others is deemed the responsibility of every Muslim. With Hajj 2009 facing a serious pandemic threat, King Abdullah took an extremely personal interest in pandemic influenza planning, particularly so, given his role as Custodian to the Two Holy Cities, Makkah and Madinah, in Islam, to which 1.56 billion Muslims claim sacrosanct right.
Imaginative solutions with which the Kingdom has responded to public health challenges in Makkah at Hajj in the past have been diverse and innovative. Recent developments include international implementation of vaccination policies for outbreak containment; applying the physics of crowd dynamics to predict sites of potential turbulence informing civil engineering solutions, and the mobilization of the largest semi-permanent multi-sector health infrastructure surge capacity at any mass gathering. The Saudis know how to provide medical care for 2.5 million houseguests who 'drop in' ideally placing them to advise experts in addressing the pressing needs Haiti now faces.
Islamic scholars have long referred to Hajj as a metaphor for ideal societal behavior. These ideals encompass deference for the weak and disabled, a spirit of collective cooperation, the redistribution of power and a climate of patience and hope. At the center of these ideals is a unifying theme: collaboration. Almost 1500 years after the Prophet Mohamed made the first Islamic pilgrimage, Hajj is now yielding insights into advanced and complex public health challenges which are unlocked through collaborative exchange. Sharing such knowledge is a fundamental responsibility for the Muslim world and interactions like the CDC's with the Saudi Arabian Ministry of Health and other agencies in the Kingdom are precisely the portals for such exchange to ignite.
President's Obama's remarks in Cairo last year are particularly resonant at this time. Solutions to pandemic planning for Hajj 2009 did indeed require precisely the 'broader engagement' of which the President spoke in his speech to the Muslim world. Solutions for Haiti's crisis will require similar imaginative collaboration and represent a critically important opportunity for the Muslim world to rise to the fore in pursuing Global Health Diplomacy both for the benefits of others and to change the current negative attitudes towards Islam and its followers.
Days after the Cairo speech, underlining US commitment to international engagement, the Obama administration appointed Elizabeth Bagley the first State Department member to serve as Special Representative for Global Partnerships. Since then, Secretary of State Clinton has appointed a Special Representative to Muslim Communities who is focused on people-to-people engagement in Farah Pandith. Other appointments have also been created including Saturday's announcement of President Obama's special envoy to the Muslim world, White House official Rashad Hussain.
International collaboration, which academic medicine demands, fits perfectly with this renewed post-Bush Administration vision of cultivating American engagement internationally, but perhaps especially so with the Muslim World where medicine and science have long been culturally revered. Forward-looking agencies everywhere are identifying such opportunities to engage: the CDC's new Global Health Division is designed to meet exactly such challenges.
The need for US-Muslim relations to change was perhaps best articulated in the careful treatise published recently entitled "Changing US Muslim Relations," which identified the single most pressing crisis facing US foreign policymakers to be the low regard with which the US is held throughout the Muslim world. King Abdullah of Saudi Arabia has longed mirrored sentiments for positive engagement internationally and is now unfolding some of the Kingdom's most ambitious initiatives himself. Most notably, the King Abdullah University of Science and Technology (KAUST) was inaugurated this past fall. KAUST is founded on the overarching directive to promote and protect academic freedom and foster the international exchange this will demand and challenging some commonly held misperceptions concerning the contribution of the Muslim world to science or lack thereof.
Whether we grapple with the daunting task of managing a pandemic threat or addressing a colossal humanitarian crisis such as we face in Haiti we can only take comfort in shared solutions. The resulting multilateral dialogue ignited is certain to yield ongoing gains and will continue to jettison deeply held misconceptions both about the place of the Muslim world in innovative medicine and advancing science and equally the West's 'gate-keeping' of such activities. Responding to Haiti not merely by writing fat aide cheques, but by deeply engaging the intellectual capital, goodwill and imagination of the Muslim world is an extraordinary opportunity for building bridges between the West and the Muslim world while saving Haitians.
At the end of the post-9/11 decade, a period exhausted by tension, conflict and distress, global health diplomacy is the best possible export one nation can gift to others. Disease and suffering remain, even in the 21st century, universal. Solving these challenges speaks to humanity everywhere. Islamic philosophy suggests Hajj medicine contains the answers to many unknowns within its mysteries. Certainly Hajj represents the largest mass gathering anywhere in the world and its legacy is an extraordinarily unique expertise in rapidly deployed massive public health responses. It will take brave men, brave American men like Dr. Scott McNabb and brave Saudi men like Dr. Ziad Memish, through their academic and policy partnerships, through their idealism and their courage to bring the influence of such expertise to bear in new, innovative ways. Their largely unseen efforts and that of others like them will not only heal our sick, care for our wounded, protect our weak, but also change our world and its tremendous divides.
We are finding Saudi Arabia's experience of Hajj medicine contains rapidly evolving public health solutions to a number of global challenges. There has never been a better time to share this experience. Multiagency, multinational approaches to public health challenges are likely to become major vectors in the field of global health diplomacy, engaging societies globally, drawing the West a little closer to the East and ultimately healing the fractures and fissures of our time.
Poignantly, in reaching out to helping our fellow Haitian, we are helping all of humankind by broadening our engagement across all borders, across all creeds, across all politics, across all divides. Ultimately, through individual and agency acts of global health diplomacy , whether Hajj planners, aid workers, volunteers, donors, behemoth agencies, or military forces, little Haiti, I know, can heal us.
Follow Qanta Ahmed, MD on Twitter: www.twitter.com/MissDiagnosis