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Introduction
Sabarimala, a majestic mountain nestled in the Western Ghats of Kerala, India, is home to the Sree Dharma Sastha Temple, dedicated to Lord Ayyappa. This sacred site attracts over 50 million visitors annually, making it one of the largest pilgrimage destinations in the world. Perched 4,133 feet above sea level, Sabarimala is surrounded by 18 lush green hills and is located within the Periyar Tiger Reserve, a biodiversity hotspot.
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| Trek way to Sabarimala |
Situated in the Ranni-Perunad village, Pathanamthitta district of Kerala, the temple opens only during specific seasons—Mandala Pooja (mid-November to late December), Makaravilakku (January 14), Maha Thirumal Sankranti (April 14), and the first five days of each Malayalam month. The Sabarimala pilgrimage is not just a religious journey but also a test of faith, endurance, and devotion.
A Test of Faith and Physical Endurance
Unlike most other temples, Sabarimala is accessible only by foot. Devotees, known as Ayyappans, undertake a 41-day Vratham (austerity and self-discipline period) before making the trek, abstaining from meat, alcohol, tobacco, and personal indulgences. Pilgrims wear black or blue clothing, walk barefoot, and carry the 'Irumudi Kettu' (a sacred travel kit with offerings for Lord Ayyappa).
The trek to the temple involves navigating steep forest routes, rocky terrain, and physically exhausting climbs. While spiritually fulfilling, the journey also presents significant health risks—a challenge that led to the implementation of the Sabarimala Sanjeevini Mission.
Health Challenges During the Pilgrimage
Despite its religious significance, the pilgrimage poses serious health hazards due to the physical exertion, extreme weather, overcrowding, and lack of timely medical intervention. Several studies highlight the high incidence of medical emergencies among devotees.
Alarming Health Statistics
- 43.4% of pilgrims reported experiencing at least one health issue during their journey.
- The patient presentation rate at health centers (2014–2017) was 4,999.6 per 100,000 pilgrims.
- Hospital referral rate: 19 per 100,000 pilgrims.
- Mortality rate at health centers: 18.5 to 21 per 100,000 pilgrims.
- Coronary Artery Heart Disease (CAHD) accounted for 97.6% of fatalities, though it reduced slightly to 85.1% over three years
- https://www.sciencedirect.com/science/article/abs/pii/S1477893920302738
Recent Reports on Pilgrim Fatalities
During the 2023–24 Mandala Pooja season, 24 deaths were reported due to heart attacks. Although emergency medical camps were set up along the pilgrimage routes, the sheer volume of devotees and the intense physical strain made cardiac complications a serious concern.
Common Health Issues Among Pilgrims
- Cardiovascular Problems: Many middle-aged and elderly devotees suffer from undiagnosed or unmanaged heart conditions, leading to sudden cardiac arrests.
- Dehydration & Heat Stroke: The combination of humidity, exhaustion, and inadequate hydration increases the risk of heat-related illnesses.
- Respiratory Distress: Dust, high-altitude oxygen variations, and overexertion trigger respiratory illnesses and asthma attacks.
- Musculoskeletal Injuries: Pilgrims frequently experience sprains, fractures, and slips due to the rugged terrain.
- Infections & Gastrointestinal Disorders: Unhygienic food, lack of clean drinking water, and improper sanitation lead to diarrhea, food poisoning, and infections.
Sanjeevini Mission: A Lifesaving Initiative for Pilgrims
Between 2013 and 2016, I was fortunate to be associated with the Sabarimala Sanjeevini Project, a public-private partnership (PPP) model aimed at saving lives through quick response, resuscitation, and pre-hospital emergency care for collapsed devotees.
The Need for Sanjeevini
Before Sanjeevini, emergency medical care was limited to two cardiology centers—one at Pamba and another at Sannidhanam, with an additional center midway. The trekking path is approximately 4–5 km uphill or downhill, making it extremely difficult for emergency patients to reach medical aid.
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| Cardiology Center in Sabarimala |
When a pilgrim collapsed due to cardiac arrest, reaching the nearest cardiology center was often impossible in time, leading to irreversible cardiac conditions and fatalities. The actual death rates were much higher than documented in government records, as proper emergency response mechanisms were lacking.
Implementation of the Sanjeevini Project
Hands-on training in life-saving skills at Sabarimala from 2013 to 2016
The Sanjeevini project introduced a structured emergency response system, including:
- Training for Ayyappa Seva Volunteers & Police in:
- Basic Life Support (BLS)
- AED Operations
- Trauma Transport Principles
- Disaster management
- First Aid for Snake Bites, Burns, Syncope, and More
- Deployment of Emergency Care Centers every one kilometer along the trekking route, equipped with:
- AEDs (Automated External Defibrillators)
- CPR Equipment
- Glucose Monitoring Kits
- Oxygen Therapy Facilities
- Round-the-Clock Emergency Response:
- Two ANGELS EMCT volunteers stationed at each emergency care center.
- One ACLS ambulance and five BLS ambulances positioned at Pamba for critical patient transport to Kottayam Medical College (the nearest tertiary care facility).
- 260 Hours of Specialized Training for Emergency Medical Technicians (EMTs) to handle critical on-scene emergencies.
The team received special training in disaster management from SDMA
Key Contributors to the Mission
Dr Saiju - On the extreme left side was the man who supported the project passionately
This mission was possible due to the dedicated efforts of:
- Dr. Shaiju (NRHM Program Coordinator)
- Dr. Devakiran (District Medical Officer, Pathanamthitta)
- Justice Sri. Babu (Special Commission for Sabarimala Affairs)
- District Collector Sri. S Harikishore IAS, who officially recognized the impact of the mission.
- ANGELS EMCT volunteers, Aster DM Healthcare EMS Team, and Emergency Medicine Residents from Aster Group of Hospitals, Kerala.
Impact of Sanjeevini Mission
Prior to 2013, emergency care in Sabarimala was uncoordinated and ineffective. After meeting Justice Sri. Babu, I explained the urgent need for a structured emergency response. He issued a judicial order to implement a life-saving mission in Sabarimala, leading to the successful deployment of Sanjeevini in 2014 and 2015.
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| Quality time with Justice Babu - He made the palpable changes in emergency care in Sabarimala |
The project:
- Saved 15–25 lives per year during the pilgrimage season.
- Prevented 150+ morbidities annually.
- Created a blueprint for emergency response models in large-scale religious pilgrimages.
The district collector officially recognized the efforts
However, in 2016, a new government took office, and the Sanjeevini project was discontinued due to policy changes.
Conclusion
The Sabarimala Sanjeevini Mission was a pathbreaking initiative in emergency medical response for mass religious gatherings. The PPP model effectively mobilized government support, private healthcare expertise, and trained volunteers to save lives.
While the project may no longer be operational, its impact remains undeniable. As a devotee of Lord Ayyappa, I feel truly blessed and honored to have led and contributed to this life-saving mission.
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| The media reported the efforts vividly |
Final Thought:
Sabarimala is not just a spiritual journey—it is a test of resilience. Pilgrims must prioritize their health, while authorities must continue investing in emergency response systems to prevent avoidable tragedies.
"Faith and safety must go hand in hand."
"Swamy Saranam"
