If you live in Mexico or Latin America, have you created a plan for what to do in case of an accident, natural disaster, or healthcare emergency?
Who is going to show up for you?! What if you are no longer able to speak and make decisions for yourself?
If you wish to save your family, other loved ones, and neighbors considerable grief and time, it is important to understand what is involved when a foreigner becomes ill or dies in Mexico or other Latin American nation.
Last month I had the pleasure of joining patient advocate and educator colleague Deborah Bickel of Be Well San Miguel to share with expats in San Miguel de Allende why it is wise to create a Mexican documentacion jurada (living will) or voluntad anticipada (advance healthcare directive). My role in the meeting was to give an overview of palliative care and hospice.
Deborah Bickel of Be Well San Miguel, Wendy Jane Carrel of Wellness Shepherd
We have each invested 11 years or more sharing with expats (Deborah in Mexico, Guatemala, and Nicaragua – me in Mexico and Ecuador) why planning is important no matter your age but especially if you are 55+.
Short list of reasons:
Mexican law is civil law. British, Canadian, and U.S. law is common law. There are major differences.
If you arrive with an Advance Health Care Directive or Five Wishes or other document legal in your native country, it will not be legal in Latin America unless you get lucky. In Mexico, you must create a documentacion jurada and/or voluntad anticipada if you want your wishes honored. These documents must be notarized.
Notaries in Mexico are experienced attorneys appointed by the Governor of State. Some will incorporate your home country wishes for you. These documents must be created BEFORE any accident, illness, or demise. In some instances documents are created by an attorney who is not a notary and then signed in front of a notary.
Regarding the voluntad anticipada, as of this date only 14 of Mexico’s 32 states offer a voluntad anticipada. The purpose of the voluntad, sometimes referred to as a directriz, is to avoid legal, medical, and bioethical problems that could complicate the situation for you the patient or your family.
Mexico is a country with predominantly Catholic traditions. These traditions influence choices. If you are Catholic, the system may seem familiar, such as burial over cremation. If you had chosen to live in Buddhist or Hindu Asia, cremation would be a relatively easy matter involving fewer steps as cremation is common practice. Or, you could have opted for a Tibetan sky burial. If you wish to be cremated, you will need a notarized document stating this wish.
Latin Americans have large family systems. If something happens to you as a Latin American, a family member will show up and know what to do. Most expats live in Latin America alone or as a couple, sometimes with children, often without a plan for emergency support.
The Mexican culture, language, and way of thinking are unique. Most of all, procedures may be unfamiliarand complex. Attitudes and response to accidents, illness, and death are different.
Non-Spanish speaking expats often need bilingual advocates to negotiate the system. At least three people are recommended to advocate for your wishes, and/or serve as your healthcare proxies. If one is not available when needed, perhaps another will be.
April 16 is National Healthcare Decisions Day in the U.S. and a reminder that if you do not yet have a plan, every day is a good day to work on one no matter where you live.
Aileen Gerhardt, a fellow patient advocate and educator in Boston writes “decide, document, designate, and discuss!!” Good advice.
Deborah’s extensive medical directive service for Guanajuato state Mexico may be found at:
Wendy Jane Carrel, MA, is a Spanish-speaking senior care advocate from California. She has travelled Mexico for several years researching health systems, senior care, and end-of-life care to connect Americans, Canadians, and Europeans with healing options for loved ones. She is a compassionate companion and palliative care liaison, legacy writer, co-founder of Café Mortality Ajijic/now Death Café Ajijic and founding member/speaker of the Beautiful Dying Expo (USA). She is a trauma-informed, gentle End-of-Life Doula (National End-of-Life Doula Alliance proficient), and a speaker and published author on subjects related to senior well-being. Wendy’s web site is https://www.WellnessShepherd.com
Looking forward to another trip to beautiful San Miguel de Allende in March 2023. If it were not so cold at night in that expat haven of 10,000 or more retirees, I’d travel there more often!!
In any event, pleased to be joining talented patient advocate Deborah Bickelof Be Well San Miguel for a talk about end-of-life planning, palliative care, and hospice in Mexico titled “Planning for the Third Stage of Life.”
Deborah will share the wisdom of preparing for your care, how she first learned to plan when she worked with AIDS in Africa, and how creating your Mexican Advance Healthcare Directive aka your “documentacion jurada” may assist in creating quality of life to the end of life. The ultimate message: there are good reasons for all foreigners in Mexico to obtain these notarized documents.
I will provide a brief history of palliative care and hospice in Mexico, the Mexican Palliative Care Law of 2009, what care is present now, where to find support, what the future may hold. My talk is based oneight years of research, conferences, studies for a Mexican palliative care diploma, volunteer years with a Jalisco palliative care hospital, site visits, and relationships with palliative care organizations and hospice providers in Jalisco (Guadalajara, Lake Chapala, Lagos de Moreno, Puerto Vallarta, Tepatitlan), Mazatlan, Merida, Mexico City, Morelia, San Miguel de Allende, and Tijuana.
The event is scheduled for 11:00 a.m., Wednesday, March 15, 2023, at the Kubo Hotel Cafe, Stirling Dickinson 28, San Miguel de Allende, Mexico.
Deborah holds an MA in Public Health from UC Berkeley. She is also a graduate of Stanford University’s Physician Assistant program where she later taught. She has been dedicated to healthcare advocacy in Mexico, Nicaragua, Guatemala, Cuba, and Africa. She is a fluent Spanish speaker. See https://bewellsanmiguel.com
My bio for this subject is as follows:
Wendy Jane Carrel, MA, is a Spanish-speaking senior care advocate from California. She has travelled Mexico for several years researching health systems, senior care, and end-of-life care to connect Americans, Canadians, and Europeans with healing options for loved ones. She is a compassionate companion and palliative care liaison, legacy writer, co-founder of Café Mortality Ajijic/now Death Café Ajijic, and founding member/speaker of the Beautiful Dying Expo (USA). She is a trauma-informed, gentle End-of-Life Doula (National End-of-Life Doula Alliance proficient), and a speaker and published author on subjects related to senior well-being. Wendy’s web site is https://www.WellnessShepherd.com
Aside from dedication to senior care in Riverside County, California (Coachella, Palm Springs, Rancho Mirage), I have made a point of visiting small and large older adult residences in places I travel to. During the last 25 years I have gratefully been received at innumerable homes in California, Chile, Ecuador, Italy, and Mexico.
I must say, after spending time in Mexican government (DIF homes – department of social services), non-profits (mostly run by nuns), and for-profit homes in 16 states of Mexico, Eishel Nuestro Hogar (Eishel Our Home) in Cuernavaca, is a standout.
Possible reasons why…
This residence functions well because those in charge are serving older adults as their mission. And with compassion. In this way, residents and personnel feel at home despite any minor shortcomings.
At Eishel the director, the physician in charge, and the Board of Directors are transparent. They welcome all who wish to learn about their residence. You may eat a meal, spend the night, or stay longer if you wish to acquaint yourself with the environment. This is unusual.
Few homes in Mexico choose to be as open. Few homes have web pages with authentic photos. For financial and social reasons, many Mexican homes, if they have an Internet presence, choose Facebook.
Culturally, Jewish people are super organized. They care and support each other well. Yes, this is a biased statement, yet it is based on years of observation. (I was NOT brought up in the Jewish faith).
Let’s do a walk through of Eishel Nuestro Hogar/Eishel Our Home :
First, I was expected. Nice !!
For obvious reasons, there is serious security. The modern compound is walled. Within double-locked doors the guards reviewed my ID, then called the administrator.
I was shown to the courtyard where I waited on a comfortable bench with a view through glass front doors to the synagogue. The air was crisp, dry, and warm. (Cuernavaca is known for its spring climate throughout the year).
Synagogue at Eishel Nuestro Hogar, Cuernavaca, Mexico
Within minutes the administrator (who came on her day off) greeted me with the physician in charge. They generously gave their time for a detailed and meaningful tour of the entire compound.
From an American point of view Eishel is a CCRC – a Continuing Care Retirement Community with independent living, assisted living, rehabilitation, nursing care, and end-of-life accomodation. The difference from most CCRC’s in the U.S. is that you offer a monthly donation, and do not own.
Eishel is an A.C., Asociación Civil, a non-profit that has existed in various forms since 1947, 75 years ago. (The first recognized assisted living with 24/7 care in the U.S. opened in Portland, Oregon in 1981).
The Eishel campus has lovely manicured grounds, two modern two-story residences, an outdoor theater, a sculpture garden, an herb garden, two gazebos, and a wall of plaques recognizing the donors.
A gazebo at Eishel Nuestro Hogar facing the independent living indoor/outdoor dining room
Eishel Nuestro Hogar Donor Garden
The fresh herb garden is maintained by residents, the chef, and kitchen staff. In addition to herbs there are tomatoes, lettuce, peppers, and more. Pineapples, blackberries and strawberries also grow on the grounds.
We visited residents in their comfortable airy rooms, the nursing floor, and stopped by the currently empty end-of-life suite with one large light-filled room for the resident patient and another room for his or her family.
Note : Even though some senior living administrators in Mexico have thought to create hospice within senior living, Eishel is the only residence I have visited that has sustained such a space. HOLA (Hospice of the Angels) tried this concept in their Morelia assisted living residence for two years during the pandemic. Unfortunately HOLA closed for a variety of reasons.
The nursing floor …
Eishel Nuestro Hogar Infirmary
Dr. Golub attending to patients in nursing floor day room at Eishel
Nursing floor dining room with views to nature and tables to accommodate reclining wheelchairs. Visitors from other countries have come to see the unusual curved tables so they might replicate similar practical tables in their nursing areas.
There are two sparkling, immaculate kitchens honoring kosher tradition.
Eishel’s current population of 72, with room for 140, is mostly Mexican. There are residents from Europe and the U.S. The languages most heard are Spanish, Yiddish, and English, in that order. Entrance is for anyone of Jewish faith either Ashkenazi or Sephardic. One must be 65 years of age, wish to live there, and agree to the rules. Persons with aggressive behavior or on dialysis are not admitted. Please see the web site which outlines requirements. Your monthly payment is a donation to the non-profit.
Photo of rehabilitation patio with Dr. Golub greeting residents, and Director Gonzalez in black and beige blouse dancing in front of a resident
Activities include movies (there is a theater), tai chi, trips, art classes, occupational therapy, and more. There is a library. A 70-year-old retired coffee table book author from Mexico City shared with me that he teaches writing. He lives at Eishel for « the fabulous year-round weather, intellectual conversation, the food, and the sense of community. »
According to the director, there is little staff turnover. Some employees stay 25 years.
Every two months Eishel publishes a full-color mini-magazine, a gazeta. There are articles by board members, residents, and staff on a variety of subjects.
Meaning of the name Eishel :
The Hebrew letters Eishel or Aishel (aleph, shin, lamed) are an acronym for Achila (feeding), Shtiya (drinking), and Linah (lodging). Since ancient times, Eishel denoted an inn.
In case you are wondering about population of Jews in Mexico and the rest of the world :
According to the Pew Research Center there are about 14 million Jews around the world representing 0.2% of the global population:
“While Jews historically have been found all around the globe, Judaism is highly geographically concentrated today. More than four-fifths of all Jews live in just two countries, the United States (41%) and Israel (41%).”
According to American Jewish Aging Services there are over 95 Jewish organizations or homes serving older adults in the U.S.
According to Wikipedia approximately 70,000 Jews (both Ashkenazi and Sephardic) live in Mexico (primarily Cuernavaca, Lake Chapala, Mexico City, Puerto Vallarta, and San Miguel de Allende). Another 230,000 live in Argentina.
The first Jews, known as Crypto or Converso Jews because they converted to Catholicism during the Inquisition in Portugal and Spain, came to the Americas with Christopher Columbus on his first expedition (according to Wikipedia and information from the University of Florida George A. Smathers Libraries). They were called cryptos because they secretly practiced their faith but were publicly Catholics.
Summation
My visit was satisfying. Eishel is an unusual Mexican senior home. Its administrators show they are vested in well-being. At this time the residents are mostly Jewish Mexicans and the help is mostly Mexican. The atmosphere is comfortable and convivial, likely the result of residents having much in common. The true reveal would be living there or visiting Eishel over a period of time.
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. She has travelled Mexico for several years researching health systems, senior care, and end-of-life care to connect Americans, Canadians, and Europeans with options for loved ones. She has assessed hundreds of senior housing choices in 16 Mexican states. Her web site is https://www.WellnessShepherd.com
One hour south of Guadalajara, Mexico’s second largest city, is the quaint village of Ajijic, a Pueblo Magico. For those of you who have visited or lived there, you have may have heard or read that the village is also known as the “City of Fallen Women.”
The Fallen Women are foreigners. Foreigners who have tripped on river rock, rough cobblestone, or lone pieces of steel rebar. They have broken hips, femur bones, wrists, or sadly lost their lives with complications from falls. Fewer men fall. As I write it is reported that one older adult male was walking in Chapala Centro, three miles from Ajijic, at 8:19 a.m. Sunday, September 26. According to a witness, he fell, hit his head, and died.
A few years ago, I felt just as sorrowful when I learned a similar story. I think of it often. A 60-year-old male fell in Ajijic, impaled his head on river rock, and died. Someone reported he was fit and had no health conditions. That may be true or not. No matter what, surviving a fall or dying from a fall is sad and painful, an event to be avoided no matter where you live. But if you are in Mexico it’s good to have a plan if you do fall and to walk with awareness even though it is easy to get distracted.
The worst-case scenario is falling and dying alone. In Mexico your body will be transported to the closest SEMEFO (Servicio Medico Forense or Medical Forensic Service) for an autopsy and your family and friends will have quite a challenge retrieving your corpse. Even if your government makes a call to assist, your government does not interfere or have influence with the Mexican government SEMEFO unless you get lucky.
Several ladies I’ve met at Lake Chapala have fallen on the street or at home. Fortunately, they were in company or had cell phones to call for help. They also had immediate access to doctors. They or companions had pre-organized for such an event, just in case. Recovery was rarely easy but thankfulness for rescue is the continued message.
A reminder for why I do not wish to fall anywhere, I wish to keep dancing. This lovely mural may be found at the base of Colon Street in the Pueblo Magico of Ajijic.
Fall Awareness Week was commemorated September 18-24 in the U.S.
Throughout the coming fall/autumn weeks fall prevention workshops are being held at senior centers in the U.S. Fortunately, in Mexico, most expat communities offer balance and exercise classes as well as services with local physical therapists.
Current statistics related to older adults falling in the U.S. (and Mexico):
The U.S. Center for Disease Control (CDC) and innumerable other studies report the following:
1 in 4 older adults fall each year
1 in 4 falls result in an increased level of care
Every 19 minutes an older adult dies from a fall (in the U.S.)
Persons with Alzheimer’s and other forms of dementia fall more, and person-centered care is critical for them
Falls are the leading cause of both fatal and non-fatal injuries for older adults
The cost of falls is $50 billion per year across the U.S. health system – emergency rooms, hospitals, rehab, and more.
Mexico’s INEGI (National Institute of Statistics and Geography) has population stats, aging stats, and mortality figures (but not by cause). On the Instituto Nacional de Geriatria Mexico City website I was unable to discover statistics related to falls. Studies of the last three years have focused on poverty, nutrition, care of chronic illness, and COVID. Nonetheless, falls happen in Mexico, and not just to expats.
With care and attention most falls can be prevented. When they are prevented, they save you and healthcare systems high costs financially, physically, and emotionally.
What should anyone of any age, especially an older adult, pay attention to now? Preventive measures?
1. Assess your fall risk. Protect your bones. Many older adults are not aware they may be walking around with osteoporosis, also known as the “silent disease”. The cost of a bone density test in Mexico is reasonable (for most). Discuss the results with your physician, chiropractor, or naturopath. Read about diet, exercise, supplements and more.
2. Join an exercise program focused on building balance and strength. Expat communities throughout Mexico offer pilates, yoga, training at gyms, and specialized classes for older adults at senior centers known as “centros geriatricos.” As mentioned, physical therapy may also be helpful.
3. Dress sensibly. Wear clothing you will not trip on. Wear sensible shoes that support and cushion your feet. Flip flops, for example, are not the best choice of sandal at a certain age, easy to twist an ankle.
3. Check your vision, hearing, and medications. Some medications may cause weakness, fogginess, forgetfulness. Be aware.
4. If you do fall, yes, there could be an emotional toll. You may feel shame or anxiety. Even if the fall is unwitnessed, best to share the information with chosen healthcare professionals and friends. It is fine to self-recover but letting someone know what happened will create a history to refer to and will assist healthcare professionals should you fall again (hopefully not).
5. Consider using a cane or walking stick. No need to stay inside. Movement is more important than no movement. Walk in safe places without skateboards, bicycles, and other moving forces that could harm you.
6. Consider making where you live safe and barrier free by following universal living design standards. Wood floors and linoleum are preferred as the materials cushion falls to some degree. No slippery or wet floors. Well-lit rooms and corridors. Grab bars. See links below in Resources for ways to create an environment friendly to falls and most disabilities.
7. Companions or buddies to keep an eye on you. Whether you are a solo ager, married, or with a significant other, it is wise to have at least two persons you can call for rescue. Make that three, with your doctor. As the National Council on Aging suggests, “make fall prevention a team effort.”
Wishes for your wellness and no falls! Please be careful.
Safely You is a San Francisco-based company focused on preventing falls in senior living and skilled nursing. Their well-documented report “The 2022 State of Falls” is available for download on their website. https://www.safely-you.com/
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. She has travelled Mexico for several years researching health systems, senior care, and end-of-life care to connect Americans, Canadians, and Europeans with healing options for loved ones. She has assessed hundreds of senior housing choices in 16 Mexican states. Her web site is https://www.WellnessShepherd.com.
At a certain point in life when one falls seriously ill, or the 55+ crowd is downsizing and retiring to another location or country, or when there are family discussions about assisted living, it becomes clear mortality may be in the offing (hopefully far off) and belongings will be left behind.
Is it possible to prepare for the time-consuming task of divesting now? And could this activity bring a sense of relief to you and your loved ones?
The Gentle Art of Swedish Death Cleaning: How to Free Yourself and Your Family from a Lifetime of Clutter (part of The Swedish Art of Living and Dying series) by Margareta Magnusson, first published in 2017, addresses some of these questions..
Contrary to what the title may infer cleanings take place before your demise. They are intended as an exercise for the living and do not refer to having someone else bear the burden of tending to belongings after your departure.
In Swedish the exercise is döstädning — a combination of the word “dö” (death) and “städning” (cleaning). As Magnusson explains, “Death cleaning is not about dusting or mopping up; it is a permanent form of organization that makes your everyday life run more smoothly.”
Such “cleanings” are a decluttering and organization system not dissimilar from lifestyle trend books and videos such as Marie Kondo’s hugely popular Konmari, a Japanese organizing system (I add European comforts), or centuries old Danish “hygge” and Norwegian “hugga” lifestyles focused on keeping and enjoying all that is cozy and easy. Hugge, a colloquial term in Norwegian, means to comfort, console, or hug, but it may also mean to chop, cut out, or pare down. If you are a minimalist, these concepts are already familiar.
The process is ultimately like spring and fall cleaning. It may also be thought of as mindfulness about what you choose to surround yourself with now. It may also be thought of as a chance to discuss your wishes for end-of-life.
Takeaways from Magnusson’s book:
Start in your 50’s (perhaps any age as it is never too early to be aware)
Contact loved ones and let them know your plans (tag items now)
Create an opportunity to discuss your End-of-Life plans, encourage candid conversation
Begin divesting of less important personal items
Gift possessions away gradually – furniture, books, collectibles, clothing
Keep mementos and items you cherish or are useful – photos, letters, diaries
Donate
Prepare a list of important documents and passwords
Continue decluttering
Initiate a plan for who will inherit your pet or pets
Focus on how this process will ultimately unburden children, executors, and others
Notice how you may feel less stress or feel happier and freer as you do it
This faux painting reminds me of gathering field flowers with my two sisters for our mother. A friend from Mexico loved it the minute he saw it, and it is tagged for him.
Considerations and Outcomes
The word death is off-putting for some but Magnusson’s intention is to invite us to simplify now to prepare for the inevitable – death in this lifetime. It is a practical and sensible way to help us reflect upon our legacies and what we are leaving behind. It is a kindness to those left behind creating a less burdensome aftermath. And to put it into perspective, it is the antithesis of being buried with all your belongings in a tomb for your afterlife as an Egyptian pharaoh. (Yes, the pharaohs left treasures for us to understand their civilization and we thank them).
Learning the Process Through Experience
I had the pleasure of living in Sweden as a student at the University of Stockholm International Graduate School. I rented rooms from older adults. I did not hear, read about, or witness this tradition.
It is not yet clear if döstädning is definitively Swedish, but Magnusson has certainly been the first to claim it as officially Swedish with her book. Based on my experience Swedes tend to be practical and realistic. In Sweden, you are cared for from cradle to grave with your taxes. Your burial is included. Gentle death cleaning makes sense culturally. It seems to be a Scandinavian custom.
Personal Experience
The unexpected demise of my beautiful mother taught me much. My father died, also unexpectedly, when my siblings and I were children. My mother put all her love energy into creating quality of life and fine memories for us to continue. One day she went for a routine surgery and did not survive. She had, however, organized everything just in case – life insurance, bank account, and a holographic will with a list of which heirlooms (paintings, silver, oriental carpets, family treasures) for each child. Even though I continue to choke up when remembering, it was an extraordinary gift of deep love and care. She modeled this concept without ever speaking of it, she had pre-planned all. A few years later, I began little by little to follow her lead.
Another quiet display of döstädning from the Greatest Generation: NOTICE WHEN SOMEONE OLDER STARTS GIVING THINGS AWAY. The action is a clue. It is likely they feel their moments in this lifetime may close in the not-too-distant future.
A lovely 80+ friend in Washington, D.C. called me one day and asked me to please visit. She was clear, “I am contemplating my demise.” Like me, she was a solo adult with no significant other, no children, and few relatives. She insisted I return to California with sacred items from her travels and family. It was an honor to receive the gifts given so tenderly. I treasure them and have marked them for homes with the next generation.
American Tole Tray from Raleigh, North Carolina and Washington, D.C. family via beloved friend, destined for godson and wife who collect antiques, always wished for a French tole tray but this one has far more sentimental value
Another older friend, a neighbor above, was a descendant of a Spanish land grant family. He also lived, as did the fine lady from D.C., an intercontinental and sophisticated life. He too was a solo ager with no spouse or children and insisted on giving me an Austrian tea set, some Mexican silver, and other charming items to enjoy playing house and entertaining with. He died shortly after I received these love mementos.
Even though I shared my heart with my behavior, I wish I had known then how to share what their presence in my life meant to me and had a chance to say goodbye.
I started divesting in my late 40’s because loss (in my life) happens without warning and without time to prepare – sudden deaths of loved ones and friends, accidents, financial disappointments. I cherish my life. I feel my mission has yet to be completed. I carry on with items that bring me the most pleasure or are useful. I am grateful to those that modelled döstädning for me.
Fortunately, there are millennials and Gen-Xers in my life (though not all wish to have possessions) – a niece, a godson with four little children, friends from Oaxaca with extended families, a beloved doctor friend, young women friends and others who thankfully are present to be recipients.
The photo does not do justice to this 1940’s piece from Indian Style with hand-placed fabrics over the poster. Tagged for a doctor friend who loves unusual East Indian and Persian art. Depicted are Krishna and Radha.
If it appeals to you, start with döstädning as a spring and fall cleaning or downsizing so you may focus on quality of life to the end of your life. I suggest starting before you imagine you need to and proceed slowly. You may rediscover meaningful photos, old friends, memories. May you be inspired to find homes for or donate items. Your efforts will be a kindness to those who survive you. Best wishes as you discover and enjoy possible benefits if you have not done so already.
“If you’re an expat, you’re probably already well-versed in the art of doing away with what no longer serves you so that you can make room for new adventures. In Latin America, where ample storage space is more of a luxury than a given, it can be extra important to make sure that one’s physical environment doesn’t suddenly turn into something resembling a dragon’s lair with mountains of “treasure” piled up all around.”
https://www.youtube.com/watch?v=u1TisVCm3D4 A mother (age 65) and her daughter listen to the audible Gentle Swedish Death Cleaning and have fun implementing some of the suggestions.
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. She has travelled Mexico for several years researching and studying health systems, housing, senior care, and end-of-life care to connect Americans, Canadians, and Europeans with healing options for loved ones. She has assessed hundreds of senior living choices in 16 Mexican states. Her web site is https://www.WellnessShepherd.com
“Navigating through Life’s Journey” was the theme for the 3rd annual Beautiful Dying Expo November 12-14 on-line produced by author and end-of-life doula Michele Little and co-produced by Christy Marie.
Over 1300 registrants logged in from 45 countries on five continents to learn or share about quality of life, palliative care, hospice, death, dying, green burial, grief, and more.
Not surprisingly most of the speakers who devote themselves to death and dying education have come to the space as a result of personal experiences with death – physicians, nurses, end-of-life doulas, psychologists, social workers, chaplains, family members, policy makers, and more.
There were many tender moments as well as offerings of humor, healing, practical action plans, and revelation. For many attendees the expo went by far too fast. Over 50 useful talks and exchanges included, among other subjects, how to write a holographic will and why (a holographic will is legal), Latin American perspectives on death, pediatric palliative care, surviving suicide, and veteran burial benefits. There were Death Cafes and a Sudden Widow Coach. Much to choose from!!!
“The timing for our exploration couldn’t have been more perfectly aligned as the past two years have impacted all of us and made us more aware of how precious life is,” stated producer Little.
“We needed a place we could go to find answers for our deep, unspoken questions about dying, death and grief. We needed to know it was okay to live, love, and be in joy.”
There were many highlights but one stand-out (I admit to bias because I know them), was the presentation by Rev. Dr. Saul Ebema and his after chat with producer Michele Little. Ebema survived the south Sudanese war and time as a child soldier to eventually become a hospice chaplain in the U.S. Little’s brother David was a NYC firefighter who lost his life trying to save others on 9/11 in one of the twin towers. His remains were never found. These two sentient beings talked about love, loss, the mysteries of death, and the sacredness of life. It was moving to listen to.
Rev. Ebema’s PTSD from witnessing the unmerciful deaths of his parents, his only brother, and the war still lingers. “I longed for a sense of community, for people to talk to, for people you can dream with, and tried to figure out this thing called life.”
Rev. Ebema reminded the audience that “life is a practice”, “grief and joy can co-exist”, and “being kind saves lives.”
Rev Dr. Saul Ebema is the president and founder of Hospice Chaplaincy. He founded and co-hosts “The Hospice Chaplaincy Show” a podcast about compassion and the psychosocial/spiritual aspects of end-of-life care. See https://hospicechaplaincy.com
Rev. Dr. Saul Ebema of Hospice Chaplaincy
Other speakers among the many (apologies to the amazing guests whom I was unable to listen to, thank you for your contributions):
The main presenter on the first morning was Gary Mallkin, a heart-centered, award-winning musician (20 Emmys) who shared how music may support us as we journey gently through grief. Music for Malkin is “innertainment”. “Everything is vibration and has intention, it can shift our attention, hearing is the last sense to go.” From Malkin’s point of view, “the most successful pharmaceutical would be a pill with music, music as medicine.” His website, featuring many spiritual luminaries may be found at www.wisdomoftheworld.com
Althea Halchuk, a Board-Certified Patient Advocate (BCPA) specializing in health law and founder of End Well Patient Advocacy gave an exceptionally articulate and important talk about Medical Surrogacy – who is going to speak for you if you become incapacitated. This is a subject that should be of interest to everyone, especially people who live alone, have no children, no spouse, no significant other, and no support system. Halchuk is also an advocate for Final Exit Network. She is based in Arizona. https://endingwellpatientadvocacy.com/
Dr. Mitsuo Tumita moderated a talk with Julie Stroud (now an End-of-Life Option Advocate) who witnessed medical aid in dying (MAID) for her father, and Joanne Kelley (now an author, INELDA End-of-Life Doula and End-of-Life Option advocate) who reluctantly witnessed her husband’s transition. They reiterated that no matter how you feel, i.e. you do not agree, you do not want your loved one to die, the dying person’s wishes must be front and center. They spoke of stigma attached to MAID, as well as “how MAID is often mixed up with suicide.”
Arlene Stepputat, a death educator and end-of-life doula from Santa Barbara, CA spoke about “Doulas at the Bedside” based on her experiences companioning over 20 folks on their journeys. “Bedside practice is the best teacher.” Arlene can be found at https://dyingtobegreen.com/resources/divine-doulas/
There were panels of End-of-Life Doulas as well as a presentation by Dr. Jamie Eaddy Chism, Founder of Thoughtful Transitions and INELDA (International End-of-Life Doula Association) Director of Program Development. Chism is devoted to black end-of-life care. See (https://www.thoughtfultransitions.org). Doula discussions included mention of gradual acceptance of their purpose (non-medical) in hospital ICUs, hospices, and private homes.
Author and radio personality Jane Asher hosted “In the Next Room” podcasts. On-line meet-ups in “rooms”, interaction during sessions also included write-in chats in the side bar. A myriad of multi-lingual panels (English/Spanish/Portuguese) were hosted by Wilka Roig of the Elizabeth Kubler-Ross Foundation Central Mexico. A blog about transpersonal psychologist Roig and her death education initiatives in Mexico may be found here https://wellnessshepherd.com/2021/04/30/end-of-life-education-and-end-of-life-doula-training-takes-off-in-san-miguel-de-allende-mexico/
Palliative care physician and gerontologist Karl Steinberg (a speaker at the 2019 and 2020 expos) focused his talk (missed this event) on the importance of bioethics in end-of-life care and also addressed the current controversy about the value of having an Advance Care Plan. Steinberg is the current Vice President of the National POLST (Physician’s Order for Life Sustaining Treatment – known as a MOLST on the east coast).
Ben Janzen, Dr. Theology, PhD, Grief Release Method specialist, Hospice Chaplain, and VITAS Bereavement Counselor, also a speaker in 2019 and 2020, gave a talk which I missed. He also participated in a panel discussion on grief.
Canadian Yvonne Heath of Love Your Life to Death and TedX speaker explored the concept of a joyful death with American physician and comedian Patch Adams. Yes, he is the person portrayed by Robin Williams in a movie with his name.
Terri Daniel, an interfaith chaplain, end-of-life educator, and grief counselor created a spiritual ritual for the opening and closing ceremonies. Daniel is the producer of the original After Life Conference (11th year), producer of the Conference on Death, Grief, and Belief (July 2022), host of Ask Doctor Death podcast. See https://danieldirect.net/
Producer-director Gay Gillingham of Dying to Know, a documentary created over several years of conversations between former Harvard psychology professors Ram Das (Richard Alpert) and Timothy Leary about the meaning of life and death, offered her film as the closing night gift. A link to the trailer and the movie may be found here: https://dyingtoknowmovie.com/
The 2022 Beautiful Dying Expo is scheduled for November 11-13. More information may be found at www.BeautifulDyingExpo.com as well as on the expo Facebook page which features Michelle Little’s interviews with guests dedicated to death, dying, and grief education.
The Beautiful Dying Expo is a non-profit project of the Institute on Violence, Abuse and Trauma, (IVAT). IVAT has been the fiscal sponsor since inception. The expo is organized by volunteers who, states producer Little, “wish to continue to build healthy communities globally.“
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. She has travelled Mexico for several years researching health systems, housing, senior care, and end-of-life care in order to connect Americans, Canadians, and Europeans with options for loved ones. She has investigated hundreds of senior living choices in 16 Mexican states. Her web site is http://www.WellnessShepherd.com
The most popular dental tourism places in Mexico seem to be Cancun, Guadalajara, Lake Chapala, Los Algodones, Mexico City, and Tijuana.
Below are two stories and some guidelines based on 20+ years of witnessing and eventually experiencing dentistry in Mexico that may provide some insight.
As with any country, it is best to conduct due diligence first, preferably on-site instead of from afar. I am not a dentist with in-depth knowledge and not in a position to recommend a dentist. Each of us has unique needs. There is no one size fits all. Do your best to choose who you feel is right for you and do your best to locate who has the years of specialization and training that match your needs. That is, of course, if you are intent on dental care in Mexico. More about vetting under “takeaways” and “resources” below.
Dental Care in Los Algodones, MX
My introduction to dentistry in Mexico was as Senior Center Director for the City of Coachella, at the time the sixth poorest city in the U.S.
My precious charges were Mexican born and spoke little English. They had emigrated to California as farmworkers during the “bracero” program of WW II. Most were low income.
Every few months we reserved a bus at a discounted rate, sometimes donated, to transport 40 seniors for a day trip to Los Algondones, MX, about two hours each direction.
Some “gringos” refer to this dental destination as Algodones without the “los”, or, as Molar City.
Note: Algodon means cotton in Spanish. Approximately 18% of Mexico’s cotton is grown in this region.
Algodones is located northeast of Mexicali, MX in the state of Baja not far from the California/Arizona border. Yuma, AZ is 15 minutes drive to the east. If you are coming from California there is a place to park on the U.S. side along a wire fence. We walked in. Some dental offices will send a shuttle to pick you up.
The sweet seniors were thrilled to travel, even for dentistry. They knew where to go based on previous experience or referrals they felt safe with. They felt better communicating with someone in their native language even though most dentists in Algodones speak good English. Thankfully, we did not have any dental casualties. The seniors were also excited to buy medicines at one of the many pharmacies (some meds that require prescriptions in the U.S. can be purchased OTC in MX for considerably less). They could also consult with a physician and/or enjoy a meal at one of the restaurants before heading home on our bus at the end of the day.
Dentistry has always been expensive so extended family in Coachella often pitched in to pay for procedures. Prices then and now are generally, but not always, 60-70% less than in the U.S.
Note: The Mexican border at Algodones is currently open limited hours due to COVID restrictions. Check with the Internet for details. You are considered an essential traveler if you are visiting Algodones for dental care. Americans and Canadians who have discovered Algodones often drive to Yuma, AZ and stay in a Yuma hotel – enjoying a mini-vacation near the Colorado River at the same time.
My 2021 dental story at Lake Chapala, Mexico (one hour south of Guadalajara, Mexico’s second largest city):
I have been more fortunate than most with dentistry managing 35 or more years without cavities, gum challenges, or dental needs other than prophylaxsis every 3-4 months.
In 2020, that changed. Ten months passed before an office was opened to have my teeth cleaned. I was in the little village of Ajijic when the dental hygienist discovered cavities in molars plus loose teeth, bone loss, and movement from sliding and clenching in my lower front teeth. (Yes, somehow without realizing it, the pandemic had affected me).
I interviewed a dozen dentists and four orthodontists. Some I paid a consult for (between $20 and $50) – a worthwhile investment to get a feeling of offices, the dentists, and more. And yes, I was blessed. I had the advantage of renting a room at the lake and did not have to leave. I also did not wish to travel during uncertain times even though my preference for dental care is in Los Angeles.
Ironically, the person I imagined I would not choose, is the person I chose, an endodontist who was focused more on my health than on earning money performing root canals. Nothing replaces attentive health care. In this instance – intelligence, honesty, and a slow medicine naturopathic approach. A most unexpected and welcome gift during a time of concern.
Other dentists wished to perform two root canals to start. This dentist felt removal of #15 molar might be a more healthful choice based on weak bones and slight cracks from clenching. She felt the tooth could crack and result in a serious infection. She was not certain about the second tooth until she removed the inlay, but we would get to that in due time.
I called the U.S. for an opinion. By a miracle the amazing dentist who did the restorative work years ago is still working. We sent him the x-rays. His conclusion was the same as hers. That fortuitous assurance felt good!!
There was trepidation on my part about removing the molar and the surgery involved. I asked friends to please pray, and they did. The dentist gave me a mild dose of lidocaine, coached me as she was giving it to me, mentioned she may have to take the tooth out in sections. Slowly but surely, the tooth came out in one piece and the experience was nothing short of a big relief. She gave me explicit instructions about food and beverage and a date to return to check the healing, and of course to call on her cell phone in case of an emergency.
The next tooth, #14. She gently removed the inlay, removed the decay, cleaned the space, inserted a white filling. She put a temporary cap over it. We waited a few weeks testing for heat and cold. I got lucky, we were able to save this tooth and cover it with a crown.
Next, three lower front teeth with varying degrees of bone loss. The least expensive and most expedient option was to place a metal splint behind the lower front teeth (splints can last up to 20 years), and create a night guard for the upper teeth with more strength than a standard retainer.
I was concerned about the stainless steel splint/wire step so I reached out to an acquaintance who used to teach at USC School of Dentistry. By great good fortune he turned up on an Internet search in Paris!!! Once again, I was guided by someone not only with outstanding credentials but someone who could assure me that the dentist’s choice was wise. I am forever grateful and this support gave me confidence.
Before the placement of the splint, I had two perio scalings with a periodontist who visits the dentist’s office from Guadalajara once a week.
On my own I did a search for an orthodontist as the orthodontist who works with the dentist managed to get COVID. The Internet led me to a man who studied at a dental school famous for orthodontia in Mexico City. He also had orthodontic training at NYU’s Department of Orthodontics!!! I hired a private driver to take me all the way to Guadalajara and stay with me. Mission accomplished.
Note: In my case my lower teeth were bonded cuspid to cuspid. Over the stainless steel wire there is a white cap to hold each tooth in place. If you are curious to see a photo of what the splint looks like there is a photo in the Resource section below at the specialtyappliances.com link. Fortunately, you are unable to tell from the front that there is a wire behind my lower teeth.
Orthodontic stainless steel splint, lower cuspid to lower cuspid, is not visible
Here included is the orthodontist’s link on Instagram which I found a few days after the work was done. You will get a feeling for the beautiful office space at Puerto Hierro but more importantly the quality of his work. He loves orthodoncia. https://www.instagram.com/ortodonciaraul/
If you are wondering why the dentist and the periodontist did not recommend anyone when asked it is typical in Mexico to not refer to other “colleagues”. That concept is worth an entire blog for another occasion.
I am now in Los Angeles and the orthodontic splint has been reviewed by an orthodontist, a dentist, and a dental hygienist who all remarked on how well placed it is and how well the work was done. Hurrah about that! And hurrah about my good fortune to have met the most compatible dentist and orthodontist who could do what is best for my long-term health.
Dental costs in Mexico, different by location:
Generally one-half to two-thirds less than in the U.S.
Please refer to DuckDuckGo link in resource section which provides average prices.
Some takeaways and suggestions:
Study credentials of several dentists, not just one.
There is no accreditation and review in Mexico with U.S. standards.
If you do not speak Spanish, note who speaks your language.
Some dentists are artists, some will care about your health and wish to build a following, others not.
How will you determine a dentist’s touch? Their manner? I like to see photographs of the dentist and their team and note energy and hands. These are reasons to meet the dentist ahead of time.
Note if there is transparency when the office speaks to you by phone or writes to you.
Make certain you understand prices in dollars and/or pesos and whether or not there are add-ons. Expect to pay in “efectivo” – cash – few offices provide use of credit cards.
It is best to be careful about recommendations of friends and info you read on expat sites. There are many well-meaning folks eager to share. Choices are relative. What may work for one person may not work for another. The key is what procedure or procedures you need. In Mexico, most dentists are specialists, not generalists.
Dental Tourism web sites don’t necessarily vet whom they list. Dentists generally pay them a fee to list and a percentage when someone comes through the web site. You could get lucky, or not.
In the U.S. it is easy to find relatively reliable referrals by calling a dental school. Dentists tend to be transparent about their education and specialties on their web sites. Yelp! in the U.S. will give you hints of who not to see and why. In Mexico it is more of a challenge to figure out who is who.
Again, narrow your list and try to visit in person before choosing.
Proceed slowly and carefully.
You will have no legal fallback if something goes wrong.
Trust your instincts, if something doesn’t feel right, it may not be. Simply absent yourself, there will be another choice. I would do this in any country.
Ideally, it would be nice to pay less, especially if you are on a budget.
Since you know your oral health affects the health of the rest of your body, and therefore the quality of your life, do your best to choose wisely and then pray. Wishes for best outcomes no matter what.
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. She has travelled Mexico for several years researching health systems, housing, senior care, and end-of-life care in order to connect Americans, Canadians, and Europeans with options for loved ones. She has investigated hundreds of senior housing choices in 16 Mexican states. Her web site is http://www.WellnessShepherd.com
Over the last 20 years, in Europe and most English-speaking countries, there has been a rise in the interest of death and dying education and related issues. There has also been more focus on a return to person and family-centered care that existed before modern medicine and continual interventions.
Even though Mexico’s Day of the Dead is dedicated to celebrating one’s ancestors every November 1 and 2, and family tradition is to be at home with the dying, there is a movement for more community outreach, open discussion of the subject, and a return to indigenous wisdom which may complement current customs.
U.S. educated transpersonal psychologist Wilka Roig, a Puerto Rican based in San Miguel de Allende, Mexico, founded the Elisabeth Kubler-Ross Foundation of Central Mexico in 2019 to meet this growing need.
“Whatever we can do to shift the paradigm, normalizing death, normalizing grief, that’s our mission,” comments Roig.
The Elisabeth Kübler-Ross Foundation in Mexico is a non-profit organization inspired by the work of Swiss psychiatrist, humanitarian and hospice pioneer, Dr. Elisabeth Kübler-Ross. Kubler-Ross’ seminal books (23) have been translated into more than 35 languages. On Death and Dying is her best known title (1969).
To meet the growing interest Roig hosts seminars (currently Zoom gatherings on-line in English, Spanish, and Portuguese) about serious illness, compassionate care, models of hospice care, green burials (Roig is dedicated to establishing a model in Guanajuato state), loss, grief, and more. The umbrella title is “Preparing for a Thoughtful Death” or “Preparandonos para una Muerte Cosciente” in Spanish.
Recent seminars have featured Ken Ross, Founder and President of the Elisabeth Kubler-Ross Foundation, and Dr. Christopher Kerr of Hospice and Palliative Care Buffalo, author of Death is But a Dream.
Dr. Christopher Kerr, Wilka Roig, MA April 21, 2021
Roig also hosts Death Cafes, Death Over Dinner discussions, and trains end-of-life doulas (non-medical professionals trained to care for psychosocial and spiritual needs of seriously ill patients and their families during and after the death process).
Roig is an end-of-life doula certified through INELDA, the International End-of-Life Doula Association based in New Jersey. Roig’s work as a doula is all volunteer.
According to Roig, she has been “accidentally” moving toward this work since childhood. “I’ve been listening, connecting, dreaming, embracing dying and loss, noting how the influence of the dearly departed is healing. Any work we do to be in touch with ourselves is end-of-life work,” adds Roig.
Since the beginning of time doulas, known as parteras (midwives), have been present in Mexico for births and deaths. There is a lineage of grandmothers, mothers, and daughters who do this work throughout the country. In many areas, where superstition reigns, end-of-life doulas are not spoken of, as they are sometimes associated with witchcraft.
During the pandemic Roig created an on-line 14-week doula course to teach compassionate accompaniment. She envisions community care that “encompasses teaching gardeners and housekeepers in different towns and states of Mexico how to be doulas and/or support end-of-life.”
Last year Roig trained doulas for Hola Hospice in Morelia, Michoacan. See article here:
“The Elisabeth Kubler-Ross Foundation is now an official place to begin the support of community death care in Mexico,” says Roig. Roig is moving closer to her goal of normalizing death and grief one person at a time.
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. She has travelled Mexico for several years researching health systems, senior care, and end-of-life care in order to connect Americans, Canadians, and Europeans with options for loved ones. She has investigated hundreds of senior housing choices in 16 Mexican states. Her web site is http://www.WellnessShepherd.com
Last month Steve Moran, senior housing veteran and colleague, kindly invited me to talk with him about senior living in Mexico. (Steve has experience in Mexico leading humanitarian missions).
We spoke about what I’ve learned and experienced researching healthcare, housing, and hospice in 16 Mexican states, mainly places where expats live.
He asked if there are any Belmont Village or Brookdale style developments. (There is a Belmont Village in Mexico City).
Belmont Village, Santa Fe section, Mexico City
When we finished the chat, I sent Steve an article to post on Senior Living Foresight that outlines what we discussed – current models for senior living and/or senior care in Mexico and what is up and coming.
Not surprisingly American, Canadian, Mexican, and Spanish senior care providers have been looking to expand or initiate development in Mexico.
Please note: I do not receive any referral fees or funds from any senior living homes in Mexico.
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. She has travelled Mexico for several years researching health systems, senior care, and end-of-life care in order to connect Americans, Canadians, and Europeans with options for loved ones. She has investigated hundreds of senior housing choices in 16 Mexican states. Her web site is http://www.WellnessShepherd.com.
When recovering from dental surgery and in an altered state, I was interviewed by colleague and dedicated senior care friend Steve Moran. For more than 10 years Steve has published an on-line magazine reaching thousands of U.S. senior housing executives and their teams – Senior Living Foresight.
Below is a link to our overview chat about Senior Living in Mexico which may be located on Steve’s web site, LinkedIn, and You Tube. (Please scroll to bottom of copy to find link if you are interested).
Part of the 36 minute video is out of sync; it also skips and flip-flops in places.
Toward the end Steve talks about a phone number. If you stay through that one minute, there is a brief mention of Medicare. One of the most asked questions by Americans looking to Mexico is: ” will Medicare be accepted”?
The video is not required viewing. 😉 The intention is to offer helpful information.
I am accustomed to researching, interviewing, listening, and participating in private one-on-ones. I am unaccustomed to being the center of attention. I have much to learn about being on camera.
Thank you Steve for including me in the discussion!!!!
Wellness Shepherd 