Juntos Contra el Dolor – “we are helping diminish pain”
Juntos Contra el Dolor, A.C., the only 24-7 palliative care/hospice in Jalisco, Mexico, held a kermes to raise funds for its humanitarian medical effort which aides patients with chronic pain, and, at end of life. The Juntos team also provides psychological and spiritual support to families of patients.
The kermes was held on a Sunday from 8 a.m.to 2 p.m. outside the Templo of San Bernardo on Plan San Luis in northwestern Guadalajara, a church with 3,000 parishioners.
A Mexican kermes is an outdoor party for a special cause. To support the cause, people buy food and drink. The Juntos kermes served tacos with birria, quesadillas, homemade jamaica (a hibiscus drink) and horchata (a rice drink). Juntos brochures were on each table.
The nurses, who are the only paid staff (except for volunteer retired nurse Rocio), were taking care of patients at the hospital around the block..
The Spanish word kermes is derived from the Turkish word kermes which originally meant a handicraft bazaar to raise money for charity. It is also derived from the Dutch word kermesse, (kerk = church, mis = mass), a festival after mass.
setting tables for the kermes
Founder Dra Susana Lua Nava with volunteer nurse Rocio
volunteer nurse Rocio and volunteer coordinator Nena
volunteer social workers Silvia and Lupita
sister volunteers, administrator Sara on the right
August 17, 2016 at 3:18 am
Not long ago I addressed a group of Canadians and Americans at an Open Circle chat at the Lake Chapala Society in Ajijic, Mexico. Most of the attendees were full-time residents with the lay of the land, but curious newcomers attended as well.
The most meaningful part of the presentation? Introducing American and Mexican senior living owners to the audience. After the chat they were able to become acquainted with one another.
In the photo below, four Mexican registered nurse owners are represented. I am the person holding the microphone.
Senior Care Specialist Wendy Jane Carrel introduces owners of Senior Homes at Lake Chapala to Americans and Canadians
Senior Housing Forum posted my article based on the talk.. See http://tinyurl.com/zoz9zdf or https://www.seniorhousingforum.net/blog/2016/8/3/will-mexico-solve-senior-living-affordability-problem to read the entire piece, or, read below…
Will Mexico Solve the Senior Living Affordability Problem?
Published on Wed, 08/03/2016 – 4:55pm
By Wendy Jane Carrel, wellnessshepherd.com
If you cannot afford healthcare or retirement in Canada or the U.S., what are your options? Where do you look?
For the last five decades, and especially since the U.S. economic challenges that became apparent in 2007-2008, retirees have been choosing destinations in Asia, Europe, and Latin America.
Despite news about crime and drug cartels, Mexico reigns as the number one choice for most American and Canadians, primarily because of its lower costs, warmer weather, health care choices, and location so close to home.
According to U.S. Consulates in Mexico there is a current count of between 1.2 – 1.4 million Americans living in Baja California, Cancun, Lake Chapala, Mazatlan, Puerto Vallarta, San Miguel Allende, and other areas. (The number also includes Americans who are not retired). According to the Canadian Consulate in Guadalajara and the Canadians Abroad Registry, approximately 10,000 Canadians are registered in high season and 1,500 are registered as retired full time in Mexico. Not all Canadians register.
Choices for senior living in Mexico are not all that dissimilar to those in Canada and the U.S.:
Aging in Place – independent living in your own home or apartment
Aging in Community – co-housing
Assisted Living – if you require care and cannot afford full-time care at home
Nursing Care and Rehabilitation
Currently, at Lake Chapala, Mexico there are in the neighborhood of 20,000 retired Americans and Canadians.
North shore Lake Chapala, which includes the communities of Ajijic, Chapala, Jocotepec, San Antonio, and San Juan Cosala (40 minutes drive time from one end of north shore to the other), has several options for senior living with others being planned.
What is different from Canada and the U.S. is the cost of living, especially for health care, often up to two-thirds less.
What is also different is that there are no Life Planning (continuing care) models at Lake Chapala. A project was planned three years ago and has yet to be built. There is one, however, that will open in Mexico City sometime this fall.
Another difference is that in Canada and the U.S. Alzheimer’s and dementia patients are in separate areas on a campus. In most of Mexico, dementia patients are living and sharing the same space with older adults who have mobility issues, not dementia issues, and the care is rarely specialized.
Mexican senior homes are under the purview of the Ministry of Public Health and local fire departments. They are not tightly regulated and inspected as they are in Canada and the U.S.
What is available at Lake Chapala now?
Three co-housing/independent living options – one in Ajijic with three individual apartments and five casitas, a pool, lakeside views, and two meals a day; one in Riberas del Pilar on two levels where residents have their own apartment, are provided with two meals a day, and have access to a library, a gym, and a pool; and one in San Juan Cosala, focusing on health, green living, and sustainability.
At the first two if you become immobile or develop serious health issues you would need to move. At the property in San Juan Cosala (in development) you can invite caregivers to your living quarters.
Three assisted living homes specializing in Alzheimer’s and dementia care – one is run by a geriatrician and a nurse, the other two by nurses with doctors on call. One of these homes plans to add a second home in the near future for a total of four dedicated Alzheimer’s care homes at the lake to meet the growing need.
Six homes combine assisted living, nursing and some rehabilitation.
That number climbs to seven if you include two rooms above the offices of a physician in Ajijic (no rehab), and 9 if you include one owner who has three homes (no rehab).
It climbs to 10 choices with an American-owned recovery care center for plastic surgery (more like a B & B) where you can also rent suites. The recovery center has been in existence for almost 20 years.
The total number of choices reaches 11 if you include a low-income senior home in Chapala which also has Mexican residents.
Four properties have owners who live on site. These properties are either American- or Canadian-owned, or, owned by English-speaking Mexicans who focus on serving the expat community. There usually is one person who speaks English at the senior living options at Lake Chapala.
The above-mentioned places are private pay. Monthly costs for private pay assisted living at Lake Chapala range between $1,000 and $2,000 U.S. per month except for the home in Chapala. (The average U.S. private pay is $3200-$3500, and up to $12,000/month or more for Alzheimer’s care).
Most care homes at the lake have 12 or fewer residents. Service is considered personalized. In many instances there is the quality of “carino,” caregivers treating you like a lovable member of the family.
There are 125 senior living homes in the state of Jalisco, housing 1,723 elders. These numbers include only Mexican citizens. Not included are Americans and Canadians at Lake Chapala or in Puerto Vallarta. There are approximately 758,000 older adults in Jalisco state.
In Guadalajara, an hour from Lake Chapala, there are three models of senior care – private pay, non-profit care primarily with nuns (usually excellent quality), and government care (usually DIF, a social services entity that exists throughout Mexico). Prices range from gratis for the indigent to around $400-$800 U.S. for those with pensions, and up to $3500 U.S. for private pay.
Note: I have met Americans with incomes of $600 or less/month who are living comfortably and safely in Mexican assisted living homes throughout the country.
Canadian retirees make new homes in Mexico
Instituto Nacional de Estadistica y Geografia National Institute of Statistics and Geography
US State Department – Relations with Mexico
* Cover photo of Lake Chapala courtesy of en.wikipedia.org
** Map of Lake Chapala region courtesy of mexico-insights.com
August 4, 2016 at 9:43 pm
The Hospital Civil “Fray Antonio Alcalde”, also known as the Old Civil Hospital, produced its 21st International Geriatric and Gerontology Symposium July 7-9, 2016, at the Hilton Hotel auditorium in Guadalajara, Mexico. The theme was “Enfermedades Neurodegenerativas en la Vejez”, or, Neurodegenerative Illness in Older Adults.
There were about 250 attendees as well as one pharmaceutical company (Asofarma de Mexico, S.A.), one hospital supply company from Switzerland, and a private pay day care senior center (www.vidavi.mx) offering business cards, pamphlets, free pens, and carry bags to participants in the registration area.
Four geriatric physicians from the hospital organized the event – Dr.David Leal Mora (the international section), Dr.Hector Ivan Cruz Neri, Dr. Julio Alberto Dias Ramos, and Dra Rocio Garcia Talavera. Guest speakers were from Guadalajara, Leon, Mexico City, and the U.S.
Old Civil Hospital Geriatrics Symposium, Guadalajara, 2016 Dr. Rocio Garcia is at the podium, Dr. David Leal is the first man on the left with dignitaries from the public hospital system
There were memorable talks about the Use and Abuse of Antipsychotic Drugs, Managing the Symptoms of Parkinson’s, When a Day is 36 Hours, Evidence-Based Geriatrics, Government Assistance Programs for Older Adults, and Can We Prevent Dementia?
Peter V. Rabins, MD, MPH, Professor of Psychiatry, Johns Hopkins, and author
What stood out most were the physicians, both American and Mexican, who are exploring and interested in alternative non-drug options for dementia prevention. The common theme – we must all be vigilant in keeping our cognitive skills sharp to the very end, if possible.
(Have been working seven days for the last two months and will add more notes about the conference at a later date).
Israeli physicians have developed a surgery to remove shaking due to Parkinson’s disease http://healthamazing.co/2016/07/13/first-in-israel-surgery-that-removes-shaking-due-to-parkinsons-disease/
http://www.latimes.com/opinion/op-ed/la-oe-stone-solvadi-drug-pricing-20160705-snap-story.html By Daniel Stone, MD, internal medicine and geriatric specialist, Los Angeles, and, Pres of LA Society of Internists. Another physician calling for a stop to the increasing costs of drugs and “pharma greed”.
http://www.AlzheimersDementiaSummit.com focusing on dementia prevention and alternative remedies that already exist for protecting our brains and our minds. Produced by Jonathan Landsman, a natural health advocate with physicians and others as guest speakers – Dr. Russell Blaylock, Dr. David Jockers, Donna Gates, Dr. Mark Hyman, Josh Axe, Sayer Ji, Michael T. Murray and many others. I missed this July 2016 summit on line but believe it might be available to listen to.
http://goodlifeawareness.com/men-may-be-able-to-avoid-dementia-by-marrying-intelligent-women-researchers-say/ Don’t know if the studies are true, but this article caught my attention.😉
July 31, 2016 at 5:08 am
Dra Susana Lua Nava, a palliative care physician based in Guadalajara, Mexico, spoke to over 200 North Americans and locals at Open Circle on the Lake Chapala Society grounds in Ajijic, Mexico about pain relief for chronic conditions and end-of-life.
Her passionate presentation about the unmet needs in Jalisco state and throughout the country triggered many questions from the audience, plus more interest in bringing such services to the lake. Lake Chapala is about an hour’s drive from Mexico’s second largest city Guadalajara. An estimated 20,000 North Americans reside there during high season.
Dra Susan Lua Nava, palliative care physician, addresses Open Circle
It is a goal of Dra Lua’s non-profit Juntos Contra el Dolor, A.C., (United Against Pain), http://www.juntoscontraeldolor.com, to educate communities throughout Mexico about what palliative care is, and show how to offer comfort care to those with life-limiting diseases. Ideally, there would be models for this care in each state. Currently, palliative care is primarily found in three large cities at regional hospitals – Guadalajara, Mexico City, and Monterrey.
In 2009 the Ministry of Public Health of Mexico established guidelines for palliative care entitling all residents of the nation to relief from pain. The challenge has been that most people do not know exactly what palliative care is, nor where to find it. Palliative medicine is often confused with pain clinics which may offer medications but do not necessarily include a holistic support team for the patient and family members during such trying times.
As of yet, there is no dedicated palliative care/hospice team – physicians, nurses, psychologists, social workers, clergy, and volunteers working together at Lake Chapala. There have been previous efforts to establish a hospice. (The main cities at the lake are Ajijic, Chapala, San Juan Cosala, and Jocotopec. It takes around 40 minutes to drive from Chapala on the east end to Jocotopec on the western end).
There are a number of highly talented retired palliative care and hospice administrators, physicians, nurses, clergy, social workers, and others from Canada, the U.S., South Africa, and other countries at the lake. Several groups have formed to discuss how to establish a service that can serve all populations and will endure.
DVDs of the chat by Dra Lua can be ordered at http://www.opencircle-ajijic.org
Wendy Jane Carrel acts as translator for Dr. Lua’s talk on palliative care in Mexico
I performed a Cliff Notes version of Dr. Lua’s talk as there was much to cover in a short amount of time.
A week after the presentation to North Americans, Dr. Lua gave a public health talk on the same subject to local Mexicans at the Ajijic Cultural Center.
June 29, 2016 at 9:05 pm
Dr. Jose Gustavo Valladores, President of the Gerontological Society of Jalisco, addressed a group of older adults in a meeting room at Juntos Contra el Dolor Hospital in the parish of San Bernardo, Mezquitan Country, Guadalajara, a few days ago.
Valladores, a spry, humorous, and fit 75 year old advocated eating less, walking more, sleeping about seven hours, and learning to breath slowly and deeply for a more healthful life.
Dr. Valladores contends we do not need to eat as much as we continue to age. His comments remind me of a movement afloat in senior living in the U.S. called Grind Dining, serving small, elegant portions that are easy to see, easy to consume, and easy to manage, especially for those with arthritis, dementia, etc. Studies show health outcomes with such meals are positive.
Harvard-trained physician and gerontologist Bill Thomas of the Green Project and Eden Alternative has a not to dissimilar approach for aging well that he calls MESH. Move, Eat, Sleep, Heal.
The conversation for wellness in aging continues with this notable consensus among two gerontologists from two different cultures. A return to basics. Wise.
Dr. Jose Gustavo Valladores y Dra Susana Lua Nava
Dra Susana Lua Nava, the founder of the 24/7 palliative care hospital and hospice, was Dr. Valladores’ medical school student 20 years ago.
May 31, 2016 at 4:09 am
With two days of notice I decided to attend a three-day intensive on pediatric palliative care, February 22-24, 2016 at the University of Guadalajara Medical School (Building Q). It was part of the XVII CIAM (International Congress on Advances in Medicine Contributing to the Future of Health) and was hosted by the Nuevo Hospital Civil (New Civil Hospital) next door. The hospital is where University of Guadalajara Medical School students intern. I am glad I participated.
Until now I have witnessed palliative care (comfort care and non-invasive pain relief) for older adults with chronic conditions or at end-of-life. I knew I would be acquainted with some material. I also knew there would be quite a bit more for me to learn or hear repeated. Heart-rending stories and photos of children fading away were anticipated. And when I saw them, they surely took my breath away. Envision Marlo Thomas and her St. Jude’s Children’s Hospital efforts plus the images you’ve seen of children suffering from maladies across the globe.
Almost 100 physicians, nurses, psychologists, socials workers, and volunteers attended the 22-hour course hosted and organized by Dr. Yuriko Nakashima, a pioneer in this arena in Jalisco state, and a highly-regarded pediatrician and university professor. Yes, her name is Japanese; she is a Mexican citizen.
All speakers were excellent and exceptionally professional.
Dr. Yuriko Nakashima, Dr. Lisbeth Quesada Tristan, Dr. Jorge Ramos Guerrero, psychologist Ortencia Guiterrez Alvarez
Presentations by special guest Dr. Lisbeth Quesada Tristan of Costa Rica, referred to as the “abuela” or grandmother of pediatric palliative care, were a stand-out. (She’s actually young). Her work and a collaboration with her non-profit Fundacion Pro Unidad de Cuidado Paliativo (see www.cuidadopaliativo.org) were celebrated at a signing ceremony which included the Director of Guadalajara’s New Civil Hospital Dr. Francisco M. Preciado Figueroa, the Director of the Old Civil Hospital Dr. Benjamin Becerra Rodriguez, and Dr. Yuriko Nakashima representing both the New Civil Hospital Department of Pediatrics and the University of Guadalajara Medical School. Dr. Quesdada is also active with ICPCN, the International Children’s Palliative Care Network.
Dr. Quesada tackled the following subjects with enthusiasm, humor, intelligence, and wisdom:
She started with a definition of palliative care – comfort care, relief from pain, and non-invasive procedures for irreversible medical conditions, progressive diseases with no cures, premature babies, and end-of-life. She asked, do you believe in aggressive procedures with a child hooked up to machines until life’s end or should the child be held in your arms, hearing a soothing voice, feeling the vibrations of love, and feeling a sense of security? We are not clinicians of pain only, we are mostly providing quality of life in dire circumstances.
Is palliative care a right or a necessity for children?
The main things everyone should know about pediatric palliative care
When “hello” means “good-bye”
Communication and support for children and adolescents with terminal illnesses
From Cocoon to Butterfly, the metamorphosis of the suffering child
How to Deal with Dysfunctional Families
The implications of sedation
Here is a paraphrased summation of Dr. Quesada’s comments:
It is offensive to say terminally ill patients. Please be careful with word choice, think about saying “children with life-limiting diseases.”
We must be part of a new paradigm with extensive outreach, going to children in their homes. (Dr. Quesada’s non-profit also serves isolated villages in the mountains of Costa Rica)
Respect children, their rights (they have rights even though not legally competent), their pain, and their wishes
Everyone is important until the last minute of their life.
To work with children one needs huge passion.
We could not do our work without volunteers!!
“Santa morfina”, blessed is the existence of morphine to help relieve pain
“Amar es saltar.” Saltar literally translated is jumping but the meaning here is love is a way to overcome.
Pediatrician Dr. Jorge Ramos Guerrero (who holds a Master’s in palliative care from a Spanish university) delivered passionate, thoughtful reviews of…
History of Pediatric Palliative Care
Holistic Attention for Children in Palliative Care
Medicine Based on Positive Principles
Dr. Ramos outlined the history of care from Egyptian times to the present with artistic representations, the meaning of the Latin words Hospitum (providing hospitality) and Pallium (to relieve suffering), and reminded the audience that death is a normal process. He emphasized that the primary aspects of treatment are warm care by an interdisciplinary team, and that the objective is pain relief. He reminded the audience: this is not euthanasia. We are present in all moments to create quality of life until the end.
According to INEGI (government) statistics, there are 5-6,000 Mexican children with cancer each year and 56% of these children outlive their diagnosis. Part of holistic care is asking the patient what is most important for him or her. We must put ourselves in the patient’s shoes. With regard to current medicine, Dr. Ramos advocates a newer paradigm – more patient-centered care that offers the best science, the best communication (especially the ability to listen), and the best inter-personal relations.
Dr. Cesareo Gonzalez Bernal spoke of legal implications in palliative care at end-of-life, a subject that always needs continual review. Focusing on patient rights is key. Assisting a patient to die is against the law.
Dr. Regina Okhuysen-Cawley, a Mexican-born American physician working in Houston who specializes in palliative care and hospice, spoke of palliative care as it is used in intensive pediatric care, and how successful an integrative approach can be at the end of life.
Dr Patricia Ornelas and psychologist Ortencia Guiterrez Alvarez (Dr. Nakashima’s long-time colleague at Nuevo Hospital Civil) talked about how to confront death and offered each participant exercises in imagining his or her end-of-life.
Other themes covered by other pediatric palliative care pioneers were how to give the bad/sad news, ethical dilemmas in palliative care, the importance of the nurse on the palliative care team, and spirituality of children.
Madre Martina Zamaya Tamayo, a nurse nun with a Master’s in Bio-ethics, was in the lobby outside the Guadalajara Congress to represent the only 24-7 palliative care hospital in Jalisco, Juntos Contra el Dolor. See www.juntoscontraeldolor.com. She introduced Dr. Susana Lua Nava’s book El Enfermo: Terreno Sagrado (The Ill: Sacred Terrain) to the attendees. Representatives from a dermatological supply house gave out free samples of medicinal lotions.
It was an honor to be in the company of dedicated, informed, and passionate healthcare professionals focused on comfort care and pain relief for ill children.
No medical schools in Mexico currently offer specializations in palliative care, although according to a Human Rights Watch report from October 2014, six of the country’s 102 medical schools offer some courses. Palliative care diplomas can be received from a palliative care institute in Guadalajara or Mexico City but this is not the same as 2-3 years of specialty training abroad. Mexican doctors usually go to Argentina, Chile, or Spain for this specialization. Anesthesiologists can order morphine, others cannot, unless certified by the government through special courses. And for whatever reason, according to one of the speakers, pediatricians have not been readily included in the arena of palliative care in Mexico to date.
It seems to be in the hearts and minds of Mexican healthcare providers to develop and implement more palliative care services for children.
Dr. Rut Kiman of Argentina, representing the ICPCN (International Children’s Palliative Care Network), and Diedrick Lohman of Human Rights Watch, traveled to five states of Mexico in 2015 to see if a December 2014 initiative to include children in palliative care in Mexico was being implemented. They visited the states of Guanajuato, Hidalgo, Morelos, Queretaro, and Toluca. Although they found pediatric palliative care in its infancy, Dr. Kiman wrote “it is hoped it will soon be a reality in Mexico thanks to the efforts of professionals, non-governmental organizations, and health policy makers.”
March 14, 2016 at 3:43 pm
It is March 8, 2016, International Women’s Day.
There are amazing women (and men) on our planet. There are many whom we can honor – some are known, others are silently making contributions to advance humanity.
Last night I read a Help Age International article about Assegedech, referred to as the Mother Teresa of Ethiopia. I felt it would be fitting to pay tribute to her on this special day.
Assegedech’s story is heart-warming and inspiring. It’s a tale of a generous, sensitive woman from humble origins who happened to inherit a large property. She noted in an interview that she was fortunate to have a good father and a compassionate husband, both of whom were open to caring for those with less. She’s been on her own for many years now… in a big way.
With the support of Help Age International Assegedech expanded her home into a compound which houses almost 90 destitute older adults. It is, in addition, a sustainable community. Assegedech empowers the residents by offering them meaningful work in the gardens, if they are able. She keeps them active to their last days. She offers them a life of dignity.
Photo and by-line from Help Age International
Despite being in her 70s, Assegedech Asfaw shows no sign of slowing down.
Many blessings for Assegedech and all others who come to the aid of abandoned, frail, vulnerable elders on a daily basis. Photos of the Ethiopian seniors can be found in the link below. The full story is worth reading.
March 8, 2016 at 10:43 pm