Hijama, or cupping, clinics in Sana’a often are unclean and unlicensed [Archives:2008/1174/Health]

July 21 2008

By: Moneer Al-Homaidi
For The Yemen Times

The ancient acupuncture healing technique known as hijama in Arabic and cupping in English often is used to treat aches and pains, but it also can cause serious infections if done incorrectly.

Hijama is performed at the site of pain on the surface of the skin, which is cleaned and shaved, if needed. The practitioner then places a glass or plastic cup tightly over the skin, creating a small vacuum to draw the skin up inside the cup.

The cup is left clinging to the skin for 10 minutes – at most – before it is removed, leaving a red raised area on the skin's surface, something thought to improve blood circulation.

Once the cup is removed, a small vertical incision is made inside the cupped area with a razor blade. The cup then is reapplied to the same spot and remains on the skin until it is filled with blood. Hajjams, those who perform hijama, claim that drawing the “bad blood” out eases pain.

Afterward, the hajjam shows the patient the cup of bad blood, supposedly to give the patient a psychological boost as he or she is expelling the bad blood. The cupped and cut spots then are cleaned with a soft dry cloth. Finally, the cupped spots are left uncovered or – according to traditional method – an herbal powder is applied, after which the patient is instructed to keep the wounds dry for one day.

Hamoud Al-Halimi, a hijama specialist who studied traditional remedies in Syria, explains that hijama employs specific procedures and equipment, noting that the best results depend upon the sites cupped on the skin as well as the time of the year when the cupping is done.

He lists several points on the body where hijama typically is performed: the neck, back, shoulders, coccyx, mid-forearms, legs and heels. Al-Halimi also claims that the best time to do hijama is on the 17th, 19th or 21st of the lunar months in the spring or fall in order to avoid overheating during warm seasons or getting sick during the cold seasons. Hijama often is prescribed after asking patients to explain what ailments they are suffering.

Although Chinese practitioners have been doing it for 3,000 years, if done improperly, hijama can transmit diseases or cause infections. Many Yemeni hijama practitioners are illiterate, having learned the techniques by apprenticing with another experienced hajjam.

“Learning hijama doesn't require many training courses,” points out Zohair Mohammed Abdullah, a hijama student just beginning to practice on patients, “rather, it depends on practicing it.”

According to Egyptian hijama specialist Dr. Al-Saiyd Atyia Salama, some hajjams test a patient's blood pressure, but others don't. Some also don't consider a patient's age or whether they carry infectious diseases like HIV/AIDS. Likewise, some don't ask patients if they have certain diseases that can be affected by hijama, like diabetes, or whether they are sick and carrying any viruses.

Al-Halimi stresses that hijama must be done in a clean environment with fresh open air to get rid of the blood smell, as well as allow the patient to breath in and out while the cups suck out the bad blood. However, he didn't specify whether hijama should be done in a clean facility or not.

Many hijama clinics in Sana'a are unclean, operating without sterilized instruments and rooms without fresh air. A good number of hijama clinics practicing this type of acupuncture also are unlicensed.

As the Yemen Times observed hijama patients are doing cupping at the same time as their family members waited nearby. None of the four hajjams wore hygienic gloves or used a clean cloth to dry the wounds and the smell of blood hung in the air. Some hajjams readily admit that it's easy for germs to spread from one patient to another in this way.

However, the biggest problem is that many hajjams use unclean and non-hygienic razors, blades, cups and gloves, a practice that easily can spread diseases or cause infections in patients' open wounds.

Additionally, hajjams sometimes unconsciously use a blade twice on one patient or even use the same blade on different patients.

Because poor patients from the countryside rarely have enough money to pay for the treatment, which is around YR 4,000, they often are allowed to pay only YR 2,000, but that excludes the cost of using new instruments, according to Al-Halimi, who maintains that this happens at many hijama clinics.

He goes on to explain that the vertical incision into the cupped areas should be different from one patient to another, depending on their skin color. For example, if a patient has darker skin, the razor blade must be inserted deeply and very carefully, whereas it is inserted only slightly into Caucasian skin.

Some hajjams also don't consider the abundance, scarcity or viscosity of a patient's blood. As Salama notes, another common problem with hijama is that once the hajjam finishes drawing out the patient's blood, the incised area continues bleeding and it's difficult for hajjams to stop it.

Government view of hijama

“Cupping therapy could help cure some diseases, but only if there's control and monitoring by the state, particularly the Health Ministry,” says Abdullah Al-Ma'alimi, a blood disease specialist at Al-Jumhury Hospital. “Although cupping therapy is well-known, unfortunately, it's not implemented in the field nowadays.”

Al-Ma'alimi suggests the Yemeni Health Ministry's preventive medicine specialists manage and monitor hijama clinics in an effort to control their quality of care and limit the spread of infectious diseases.

The Yemen Times visited three Ministry of Health departments: the General Administration for Monitoring, the General Administration for Small and Private Institutions and the Medical Remedy department.

Desiring to remain anonymous, the general manager of the General Administration for Monitoring said his department isn't concerned with this type of alternative or traditional medicine.

He added, “Although we're supposed to monitor and check these clinics, the General Administration for Small and Private Institutions grants licenses for all different types of clinics, monitoring them at the same time.”

However, officials at the General Administration for Small and Private Institutions, who also requested anonymity due to the alleged sensitivity of the topic, maintained that they don't license hijama clinics because they practice alternative medicine.

The ministry's Medical Remedy department was closed for unknown reasons.