Aging, Assisted Living Mexico, CCRC's in Mexico, Death in Mexico, Dying in Mexico, End-of-Life Planning, Expats, Life Plan Communities Mexico, Mexico, Nursing Homes Mexico, Senior Care Mexico

Senior Care Specialist for Mexico Talks about Assisted Living & Nursing Care in Mexico, and Why End-of-Life Planning for Ex-pats is a Good Idea

I am grateful to Focus on Mexico, where I address the ever-changing topics in Mexico (and elsewhere) of independent living, assisted living, nursing care, Life Plan Communities (CCRC’s – there is only one so far with others being developed).

The next talk to the Focus on Mexico attendees is March 21 at 11:15 a.m. at a hotel in Ajijic, Mexico. See https://www.focusonmexico.com/focus-6-day-program/   Focus on Mexico offers seminars to folks interested in how to move to and/or live in Mexico.  All presenters at Focus on Mexico are volunteers.

On Friday, March 29, I will be speaking at a FREE community event (open to the public) at the Lake Chapala Society Sala in Ajijic at Lake Chapala, Mexico at 2:00 p.m. on Why End-of-Life Planning is a Good Idea for Ex-Pats in Mexico.

Here below are links to articles I have written on these subjects:

https://wellnessshepherd.com/2018/09/11/why-creating-an-end-of-life-plan-for-expats-in-mexico-is-a-good-idea/ 

https://www.seniorhousingforum.net/blog/2016/8/3/will-mexico-solve-senior-living-affordability-problem   

https://wellnessshepherd.com/2017/10/10/guidelines-for-choosing-assisted-livingnursing-care-in-mexico/

 

Wendy Jane Carrel, M.A., a Spanish-speaking senior care specialist, has spent over seven years traveling province to province in Chile, Ecuador, and Mexico researching senior living options. She acts as an advisor or liaison for those who wish assistance negotiating health systems, senior care options, end-of-life care, and disposition of remains.

 

 

 

 

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Death and Dying, Death and Dying Education, End-of-Life Education, Health & Wellness

Unique Learning Experiences at Death Cafe Santa Barbara and Death Cafe Santa Monica

In January of 2018 Loretta Downs, M.A. gerontology, and I co-founded Death Café Ajijic aka Café Mortality Ajijic at Lake Chapala, Mexico.

The first café started the next month with the intention of encouraging the mostly retired community to talk about and prepare for end-of-life, not only to save loved ones and neighbors a lot of grief and time, but to provide a space to talk out feelings, hopefully leading to more well-being.

Because we travel a lot, we invited other health professionals in the community to join as volunteer hosts. We have been fortunate. There is now a rotating team to handle responsibilities for the all-volunteer events starting in 2019. We continue to do our best to improve the experience for attendees. One of the best ways for me to learn is to experience other Death Cafes.

For those of you unfamiliar with Death Cafes, they have been in existence since 2011 and are now in 63 countries of the world.  See www.DeathCafe.com for a café near you.

I was recently in Santa Barbara, CA, originally a Spanish mission post, to attend the Santa Barbara Death Café.

It was a pleasure to enter the donated venue at 11 E. Carrillo Street, the Hill-Carrillo Adobe. Beautiful place built in 1825. It is on the National Registry of Historic Places.

Hill-Carrillo Adobe, circ 1825, Santa Barbara, CA
Hill-Carrillo Abode, Santa Barbara, CA

There are three dedicated hostesses in Santa Barbara. One of them provides her grandmother’s tea cups and linen. Others bring cake or cookies.  Attendees offer donations to defray expenses.

Death Cafe Santa Barbara tea table

One of the surprises for me was that Santa Barbara Death Cafe provides a mobile library. They bring books in a large carton each month for participants to check out!!  I love this idea!! 

Death Cafe Santa Barbara lending library

Participants in Santa Barbara are all adults, mostly older adults. In a group of about 20, there were two men, one a recent widower.  We introduced ourselves to each other at a long, rectangular table, one by one, sharing briefly what brought us to the café.

Conference table at Hill-Carrillo Adobe, Santa Barbara, CA

We dispersed after the introductions to talk in groups of three, four, or more. It was organic, and attendees were encouraged to move to another group if they so desired. I see how attendees return over and over again. The hostesses and environment feel cozy and safe.

Thank you Death Café Santa Barbara and Center for Successful Aging for your hospitality!!!

I also attended an intimate Death Café in Santa Monica a few days prior to the Santa Barbara Café. It was hosted by a lovely woman at her office space. She is a psychologist, grief counselor. death doula, and drama therapist from Pasadena. There were five of us all together. The counselor led by asking why each came, and the other three participants, each in their 30’s, were off and running, lively and engaged from the start. Time went by quickly. This multi-talented lady also offers a Death Goes to the Movies night. Recently she screened a documentary about a psychiatrist/musician preparing for his green burial.

Both cafes in Santa Barbara and Santa Monica were unique, rewarding experiences. You may find the next dates for these Death Cafes or others near you at http://www.DeathCafe.com.  If you do not find one, perhaps you may have a desire to start one.

Please see the following links for articles about two of the cafes in Ajijic if you are interested – how we organized, and how attendees shared experiences at the end.

https://wellnessshepherd.com/2018/02/25/death-cafe-ajijic-mexico-ex-pats-and-snowbirds-talk-gently-about-mortality/

https://wellnessshepherd.com/2018/08/12/the-death-positive-movement-is-alive-amongst-retiree-ex-pats-at-lake-chapala-mexico/

Caregivers, Death and Dying, Death and Dying Education, End-of-Life Care, End-of-Life Education, Hospice

All Volunteer Hospice of San Luis Obispo County Sustainable for 41 Years

For the last few years I have had the good fortune to visit palliative care and hospice entities in California as well as in six states of Mexico with the objective of learning more about what works, what’s missing, and what might work in Mexico for years to come. There are challenges based on cultural differences, but all is possible.

I am comparing various models – hospitals and facilities (medical), in-home community outreach (medical and/or volunteer), all volunteer, government, non-profit, and for profit.

Hospice of San Luis Obispo County (HSLO) has been on my radar for some time because it is a successful, locally based non-profit volunteer hospice that has sustained itself for 41 years!! For those of you who are familiar with the operations of non-profits, this is an extraordinary achievement.

Aside from serving the public, HSLO educates and trains locals and others as end-of-life doulas (companions). They host Death Cafes and much more.

The sustainability is based on more than dedication and love – mainly inventive ways to engage the public, an especially hard task in a difficult economy.

Hospice of San Luis Obispo County, California office

I am so pleased I was finally able to visit HSLO. I am indebted to the Executive Director and the Director of Volunteers, the few paid staff, for a warm, meaningful, memorable exchange.

HSLO is one of six hospice services in a county with a population of around 284,000. It is the only volunteer in-home hospice supported by the generous energy of over 200 volunteers. They serve approximately 5,000 persons per year.

Any county resident with life-limiting illness is served through “in-home respite care, emotional, spiritual, practical and non-medical support, and grief counseling support (group and individual).”

Other services are education about dying and death for professionals, caregivers and the community, doula programs, Death Cafes, Threshold Choirs, and Pet Peace of Mind groups.

From my perspective their outreach and activities place HSLO in the vanguard of the “death care and the death positive” movement that is sweeping North America and beyond.  It is exhausting but rewarding work.

Additional treat: I was blessed to attend HSLO’s annual Light Up A Life candlelight vigil held at the San Luis Obispo Mission on a nippy, rainy evening. Names of those who have passed were read out loud during the hour service that included a choir. Later we carried candles outside for readings and prayers.

Light Up A Life Candlelight Vigirl, San Luis Obispo Mission, California

Anyone may pay a fee (fundraising) to have the name or names of loved ones read at Light Up A Life. This lovely event is repeated during one week in December in different cities of the county.

HSLO was created in 1977 and has an excellent reputation through word-of-mouth.

Services are provided without charge; no insurance company is billed. 

HSLO relies on community donations, fundraising events, grants, doula training fees, and the time of its over 200 volunteers.

Hospice of San Luis Obispo County is a remarkable operation.  So much goodwill!!  A great gift to the community.

The home which serves as office was bequeathed to HSLO by Dorothy D. Rupe; it bears her name.

1304 Pacific Street, San Luis Obispo,CA  93401  tel. (805)544-2266

http://www.hospiceslo.org/

HSLO is a member of the Better Business Bureau and is a Top Rated Non-Profit.

 

Chapala Municipal Cemetery, Lake Chapala, Mexico
Death and Dying, Death and Dying Education, Death in Mexico, Dying in Mexico, End-of-Life Planning, Expats, Mexico

Why Creating an End-of-Life Plan for Expats in Mexico is a Good Idea

While conducting research on health care and end-of-life options for older adults in Mexico, and volunteering at a Guadalajara palliative care hospital and hospice, I have witnessed both expected and unexpected deaths of Americans, Canadians, other foreigners, and Mexicans. In the case of Mexicans, the procedure following death is almost seamless, with rare exception.

Chapala Municipal Cemetery, Lake Chapala, Mexico
Chapala Municipal Cemetery, Lake Chapala, Mexico

The question is, how will you prepare for such a situation if you are not Mexican?

Here is some of what I’ve learned in expat havens from Alamos to Ajijic, Mazatlan to Merida, and Tijuana to Oaxaca:

If you wish to save your family, other loved ones, and your neighbors considerable grief and time, it is important to understand what is involved when a foreigner dies in Mexico, and, to have a plan in place.

This goes for 18-year olds, 40-year olds, and especially for all persons over age 60.

Even though the subject is one many of us prefer to avoid, family and friends back home, as well as your local neighbors, will be grateful if you plan ahead. Planning ahead might even give you peace of mind!

WHAT TO BE AWARE OF

The system of law is different. If you are from Canada, England, or the U.S., you are accustomed to common law, not civil law based on Napoleonic code. The rules governing disposition of human remains in Mexico are not the same as at home. The time and bureaucratic requirements required to negotiate the Mexican system, post-death, can be daunting.

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.

The Mexican culture, language, and way of thinking are unique. Most of all, procedures may be unfamiliar and complex.

PREPARING AHEAD FOR YOUR DEMISE & DISPOSITION OF REMAINS IN MEXICO

The key Mexican legal document you need to acquire for best outcomes is a “declaración jurada ” (more or less the equivalent of a living will) stating burial or cremation wishes. This document must be created before your demise. The declaración jurada will almost always insure your plan is followed. It is usually prepared by notaries (notarios). Current costs are approximately 1000 pesos in Jalisco state, for example. Note: powers of attorney (equally important for pre-death and health care complications), and wills regarding your property are separate documents. Once a year, older adults can receive a 50% discount in the month of September for wills relating to property (home, car, jewelry, and other assets).

Note: Some funeral homes offer notarized Letters of Intention for cremation or burial. This, in addition to your declaración jurada, is a somewhat reliable back-up. These funeral homes will give you a card to carry on your person at all times; the card contains your name and other details plus their contact information. Not all funeral homes offer this service.

Your Advance Health Care Directive or Five Wishes from home is not valid in Mexico even if notarized, apostilled and translated into Spanish unless you get lucky.

You are best off incorporating preferences from your Advance Directive or Five Wishes (https://fivewishes.org/) in your Mexican legal document. Most legal documents for foreigners, unless you live in a rural area, are written in Spanish on one half of the page, and English on the other. Again, this is the most important document you can obtain relating to your end-of-life wishes. Note: there is no guarantee your healthcare requests will be honored by doctors, hospitals, and ambulance services, just as in your home country. Your cremation request will be honored if it is in writing and your papers are presented.

Burial in Mexico

Burial in Mexico could be easier than shipping a casket home and less expensive, with one exception. Many cemeteries offer plots for purchase for a set period of time (usually six years) with the understanding that remains will be removed and buried elsewhere at the end of that period. Arrangements must be made in advance for relocation of remains or they may be removed to a communal grave.

Note: There is less and less room at cemeteries in heavily populated areas. According to some city Pantheon (cemetery) directors, families with plots are burying loved ones 10 persons deep.

The population from Chapala to Jocotopec (north Lake Chapala) just south of Guadalajara, for example, is around 100,000, including 20,000 full-time ex-pats (numbers not exact). There are approximately 80+ deaths per year among the ex-pat community according to Chapala’s Registro Civil, Civil Registry office.

Ajijic Cemetery along Lake Chapala serves a population of 10,000. It is full unless a family will sell you a plot there.

Ajijic Cemetery, Lake Chapala, Mexico
Ajijic Cemetery, Lake Chapala, Mexico

Cremation in Mexico

When death occurs in Mexico, local practices will govern how quickly a cremation can take place. In the state of Jalisco burial or cremation must be within 48 hours, or the body must be embalmed. There is one exception – a body can lie up to 30 days in refrigeration (if refrigeration is available and with permission) awaiting family members from out of country to view the remains. Then cremation or interment will take place. Cost for cremation in Jalisco, for example, is approximately 10,500 Mexican pesos; costs for embalming, around 5,000 Mexican pesos.

In Mexico your legal next-of-kin may request cremation or interment if you do not have a notarized living will with end-of-life wishes. It is unwise, however, to depend on good luck or miracles in this situation – again, best to have a Mexican living will.

Some churches in Mexico offer space for cremated remains in an urn or box in a mini-mausoleum setting. Here again, you are usually paying for a specified number of years.

Note: According to a U.S. Consulate web site, “if the deceased is to be transported between states in Mexico for cremation, the body must be embalmed. If the body is to be transported over 100 km a special transit permit is also required.”

Crematories

By law, a body is to be identified ahead of time. In Guadalajara, for example, no toe tags are used. Photos are taken of faces before the procedure. The name of the person is also written on a ticket. That ticket, serving as I.D., is inserted into a slot space outside the crematory machine.

Crematory Center, Guadalajara Municipal Cemetery, Mezquitan Country

Shipment of Remains Outside of Mexico

If you are American and wish your ashes or remains sent home, there is another step for a loved one or trusted advocate to complete after all Mexican death-related documents are obtained. (If you are Canadian, see the links in the Resources section below. Canadian procedures are not the same as American procedures). If your body has been cremated, a cremation certificate from the funeral home, an affidavit from the funeral director, and an original copy of the death certificate must be delivered to the nearest Embassy or Consulate. (See U.S. Government 7 FAM 258 DOCUMENTS TO ACCOMPANY REMAINS; these regulations were last updated January 18, 2013). If you die in a small city or rural area and cremation is your preference, understand the expense, effort, and permissions needed to fulfill this requirement.

According to the U.S. government, a consular officer will prepare a consular mortuary certificate to ensure “orderly shipment of remains and facilitate U.S. Customs clearance.”  The certificate will be delivered to you in English and it will contain the essential information including cause of death.

As for shipment of remains in a casket, a U.S. consular officer will work to ensure that the Mexican funeral director and American funeral director are in communication to guarantee preparation of remains complies with local, U.S. Department of State, and federal requirements. All corpses going to the U.S. must be embalmed. The shipping time is approximately seven days.

Also note: DHL, Federal Express, and embassy diplomatic pouches cannot be used to ship cremated remains out of the country. There is no customs fee to ship remains to the U.S.  Note: Shipment of remains outside of Mexico involves not only high cost, but red tape. Consider buying repatriation of remains insurance.

Other Details to Consider for Smoother Disposition of Remains in Mexico:

Someone to Act on Your Behalf 

Are you living alone? If so, do you have at least three friends or neighbors who will follow through with your wishes and instructions if you die in Mexico? Note: Do not depend on legal next-of-kin (spouse) or significant other to represent you. What if you both die in a car accident or other tragedy? It is best to delegate additional persons or a trusted attorney to take charge.

A Physician
Do you have a working relationship with a medical doctor who can be called immediately by the designated person or persons to declare cause of death and write the death certificate so an autopsy can be avoided? Do not call 911, an ambulance (Cruz Roja or Cruz Verde), the fire department (bomberos), or the police. Call the doctor, obtain the death certificate (Certificado de Defunción – delivered with three copies), then call the funeral home. The copies of the certificate are then delivered to the local Civil Registry (Registro Civil), the Ministry of Public Health, and INEGI (the National Statistics Office).

In places with a number of expatriates, funeral homes sometimes have doctors who can appear if your doctor is on vacation, but most doctors prefer a relationship with you before they will appear and sign a death certificate. Note: If foul play is suspected, an autopsy will be required and the police and fiscalia (the district attorney’s forensics department) will be involved.

Funeral company
Have you selected a funeral service or transporter to collect your body and handle your remains? Using a funeral service is necessary in most of Mexico, unless you are in a remote, rural village where you may be buried in a local cemetery.

Guadalajara Municipal Cemetery, Mezquitlan Country

Organ donation
Do you want your organs donated? Mexico City’s UNAM, Programa de Donacion de Cuerpo, for example, will welcome your body for science. Are your wishes written in your living will or indicated on your Mexican driver’s license?

Where to Place Remains. Do you wish your remains to stay in country or shipped home?

Chapala Municipal Cemetery, Lake Chapala, Mexico
Chapala Municipal Cemetery, Lake Chapala, Mexico

Someone to Act on Your Behalf, Part 2
Again, designate at least three people to be in charge of your affairs in Mexico in the immediate aftermath of your death. This is recommended based on witnessing situations in Ecuador and Mexico over a period of seven years, and accompanying distressed family members. Your ex-pat friends may travel quite a bit or may not be present at the time.

Do your designees know which funeral service or transporter will collect your body? Do they know where your legal documents (passport, INM immigration green card, living will – specific for cremation or burial, contact info) are and how to pay the funeral home if not pre-paid? Do they know where to locate your bankcard, cash, and/or documents 24/7? Do they have a copy of your keys? Plan on leaving about 20,000 Mexican pesos or more for the certifying doctor, transportation, the funeral company, Civil Registry fees, and cremation so your friends are not left to raise funds.

Copies of Documents. There must be several copies of critical documents – passport, residence card, living will, death certificate, mortuary certificate, affidavit of Mexican funeral director, transit permit, et altri. The person(s) in charge must be told not to offer an original document to transit people, most bureaucrats, etc. – in most instances these entities receive copies.

Death Certificate (Acta de Defunción)
Who will obtain the Mexican government declaration of death with the appropriate stamps from the Civil Registry and the Ministry of Public Health? This is not only a death certificate but an authorization for burial or cremation. Some Mexican funeral homes have experience assisting with these matters, others not. Will your designees need to do it? Best to find out how to obtain the certificate in the state or province where you live so you can leave instructions. (See Resources section below the article with links to information about death certificates in Mexico).

Register Death with Your Country’s Embassy or Consulate
Who will obtain the proper documents from the U.S. Embassy or Consulate, the Canadian Embassy or Consulate, or other foreign government representative in Mexico not only to register the death, but for remains transported home? Some funeral homes are accustomed to offering this service, others not. The embassy or consulate will prepare a Report of Death from the death certificate. Your family member or representative will use this document along with the Mexican documents if or when remains are transported out of Mexico. At the U.S. Consulate you are entitled to 10 to 20 original copies in English.

Spanish language skills are imperative
Depending on English-speaking Mexicans during this process is not advised as they may not be available when you need them. Have someone at the ready who can negotiate procedures in Spanish. There are a number of facilitators, translators, and attorneys who speak English or other languages, best to keep their information handy.

What happens if you die in Mexico, have no spouse, no next-of-kin, no legal documents stating your wishes, and no legal representatives?

Your body will probably be transported to a morgue, usually a SEMEFO (Servicio Médico Forense – Medical Forensic Service) building with refrigeration. Not all SEMEFO buildings have refrigeration or space, even if they have refrigeration. See video links at end of article with tours of SEMEFO in Guadalajara, Mexico City, Sinaloa and the Yucatan. Your country’s representatives will be called. Each country has different procedures for handling such situations. Your body will probably be autopsied. Often, if no one claims your body, your remains will be placed in a communal grave in Mexico. Each state of Mexico and each rural area has different traditions and preferences.

Few people know where they will die or when. If you spend time in Mexico, or any Latin American country with deeply Catholic traditions, where family ties and support reign (i.e. you will be rescued and your loved ones will know what to do), as well as strict codes and preferences that may not be yours, please choose to prepare yourself.

Preparation hint: register your whereabouts and family contact information with your embassy or consulate  The U.S. government, for example, has an excellent system for Americans at https://step.state.gov/. It is the Smart Traveler Enrollment Program and advises you of security risks in the place where you are living and assists with connecting family and others to you in case of emergency.  Other places to register your emergency information are located in expat communities around the country. The registries are usually announced in local directories, magazines, English-language newspapers, or found by word-of-mouth. Some non-profit expat organizations provide registries as do churches and synagogues with English-speaking congregations.

End-of-Life Planning is critical for expats.

Create peace of mind for yourself, your loved ones, and your neighbors.

Note: Preparing medical directives for healthcare emergencies, and preparing wills, are subjects worthy of their own long articles and are not included above.

Note two: Physicians, funeral directors, cemetery directors, city and province officials (including a district attorney forensics office), one attorney, one notary, and a consulate were consulted with or interviewed in Mexico for this article.

Note three:  If you are alone with no spouse, no children, and no one to rescue you, it is suggested you carry a copy of the funeral home card with contact information on you, plus a copy of key contacts including the notary public.  When traveling, also carry a copy of your declaración jurada.  If you have a car, it is recommended you keep a copy of your declaración jurada in the glove compartment.

Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist from California. Over a period of several years she has traveled state to state in Mexico researching senior care options. She volunteers at the only 24/7 palliative care hospital/hospice in Jalisco which also has a community outreach service. She has investigated, studied, and negotiated health systems, senior care options, end-of-life care and planning, and, disposition of remains in Mexico. See http://www.WellnessShepherd.com or contact her at wellnessshepherd@aol.com .

You have permission to re-post the entire article when you include author’s name, biography, and contact information as above.

© Wendy Jane Carrel, 2018

Resources (including American, Canadian, and UK government disposition of remains specifics)

https://travel.gc.ca/assistance/emergency-info/death-abroad Canadian government specifics for death and disposition of remains abroad

https://travel.gc.ca/docs/publications/death-abroad.pdf  smart tip sheet from the Canadian government

https://travel.gc.ca/travelling/publications/die-in-mexico  well-written protocol for handling death of a Canadian abroad (some advice applicable for Americans)

https://www.theguardian.com/money/2007/nov/28/expat-finance-health  well-written article about dying abroad applicable to U.K. passport holders.

https://mx.usembassy.gov/wp-content/uploads/sites/25/Consular-Districts-map.jpg  There are nine U.S. Consulates in Mexico, see map in link to locate the one closest to you

https://mx.usembassy.gov/u-s-citizen-services/death-of-a-u-s-citizen/  general info page about death of a U.S. citizen

https://fam.state.gov/fam/07fam/07fam0250.html  US State Department procedures for disposition of remains for an American citizen abroad

https://travel.state.gov/content/travel/en/international-travel/while-abroad/death-abroad1.html

https://travel.state.gov/content/travel/en/international-travel/while-abroad/death-abroad1/estates-of-deceased-US-citizens.html  how the U.S. Consulate can act as interim executor of your Mexican estate

https://travel.state.gov/content/travel/en/international-travel/while-abroad/death-abroad1/death-statistics.html   reporting death of U.S. citizen abroad

https://travel.state.gov/content/travel/en/international-travel/while-abroad/death-abroad1/return-of-remains-of-deceased-us-citizen.html  documents required for return of remains to the U.S. from abroad – consular mortuary certificate, affidavit of foreign funeral director and transit permit, U.S. entry requirements and customs, shipment embalmed remains

http://dof.gob.mx/nota_detalle.php?codigo=5079096&fecha=30/01/2009  information that is on the Mexican death certificate

http://www.salud.gob.mx/unidades/cdi/documentos/DOCSAL7761.pdf  Mexican death certificate sample

http://www.dgis.salud.gob.mx/contenidos/difusion/cdefuncion.html  Mexican death certificate sample

https://www.uv.es/GICF/4A2_Pena_GICF_11%20.pdf   death certificate Mexico

https://www.gob.mx/sre/acciones-y-programas/tramites-de-registro-civil  scroll down to see requisites for processing death certificates with the civil registry

http://www.contrapuntonoticias.com/2016/01/31/saturan-cuerpos-la-morgue-de-jalisco/  morgue specifics Guadalajara, Jalisco, in Spanish

https://www.youtube.com/watch?v=FMrXyatJW0c Guadalajara, Jalisco, morgue tour

https://www.facebook.com/pages/SEMEFO-Instituto-Jalisciense-de-Ciencias-Forenses/495279867165305  Guadalajara morgue FB page. If comments are to be believed, more bodies than there are refrigerators, no answering the phone, poor communication, etc.

https://wdef.com/2018/09/19/morgue-director-fired-over-stench-of-157-corpses-in-truck/   September 2018 article reporting on two tractor trailers filled with unidentified corpses as there is not enough refrigerated space at the morgue in Guadalajara.  A report by the English-language Guadalajara Reporter stated that corpses of two unrelated Americans, who died of natural causes, were stored in the tractor trailers, an indication that some stored corpses were identified first, not that it makes being stored in a tractor trailer palpable.

https://mexiconewsdaily.com/news/6-cities-store-bodies-in-refrigerated-trailers/

https://www.youtube.com/watch?v=54FEr0Q1naI  SEMEFO Yucatan forensics. Director Dr. Luis Peniche is interviewed. There is a tour of the Yucatan morgue.

https://www.youtube.com/watch?v=kWNr53cWfxk   Sinaloa SEMEFO, a report in Spanish about abandoned corpses and no refrigeration 2016, “muerte indigna.”  Apparently a new building has been constructed since with refrigeration.  Note: in places of extreme humidity and heat with no refrigeration, imagine the stench.

https://www.youtube.com/watch?v=5fNXN6XycPA  According to the video, “drug dealer” tombs in Sinaloa represent the opposite kind of ending from an abandoned body left at the morgue. The Jardines de Humaya cemetery in Culiacán, Sinaloa, is known for its extravagant mausoleums, not all that dissimilar from the concept of the Mamluk tombs in Cairo Egypt’s City of the Dead (circa 642 AD). The video shows the tomb of Ignacio Coronel that apparently cost millions of pesos or dollars.

https://www.youtube.com/watch?v=B-mHof2axB4   According to this 2017 documentary video from Mexico City, if after three weeks no one identifies a body, it will usually end up in a communal grave. In another report, some bodies may go to a medical school for study.

https://noticieros.televisa.com/videos/cadaveres-estudio-medicina/  cadavers for study at UNAM, Mexico City   April 2018  TV interview with forensic physician and professor

https://www.youtube.com/watch?v=pxxNfnOVWt8   the biggest clandestine burial ground in Mexico, according to this video, was an “extermination camp” in the state of Coahuila.

https://mexiconewsdaily.com/news/166-skulls-and-other-remains-exhumed/ another clandestine burial ground found in the state of Veracruz.

https://www.telegram.com/news/20171028/worcester-undertaker-asks-lawmakers-whos-responsible-for-unclaimed-dead?template=ampart  Outside Boston, MA, there is a funeral parlor that buries the homeless, abandoned, etc. It is an expensive undertaking (yes, pun intended), and would probably cost a lot less if green burials were permitted.

https://tomzap.com/dying.html  Dying in Puerto Escondido, Oaxaca, a 2013 report. At that time it was estimated one needed about 12,000 pesos to pay for cremation, now transportation and cremation will come to around 20,000 pesos, depending on the funeral home.

http://www.pressrepublican.com/news/local_news/mexican-funeral-customs-differ-from-ours/article_f93a7231-0389-5ca7-9161-ffaeb7b523e2.html   An American in Puebla writes about the differences in American and Mexican end-of-life traditions.

http://www.redfuneraria.com/cremacion-o-entierro#anchor4

http://www.redfuneraria.com/mexico/funerarias  Mexican law regarding death (in Spanish)

https://mexiconewsdaily.com/news/nurse-did-well-selling-job-placements-organs/ a cautionary tale about illegal organ harvesting in Chihuahua, Mexico. All persons involved were Mexican, not foreigners.

https://trasplantes.jalisco.gob.mx/  CETOT  State Council of Organ Transplants

https://www.facebook.com/TrasplantesJalisco/

https://trasplantes.jalisco.gob.mx/acerca/ubicacion-y-contacto

https://es.wikipedia.org/wiki/Declaracion_jurada  – what a living will is

https://theconversation.com/amp/planning-for-death-must-happen-long-before-the-last-few-days-of-life-104860  An article from Australia about why planning for end-of-life “must happen long before the last few days of life.”

Assisted Living Mexico, Health & Wellness, Living Abroad, Mexico, Mexico Senior Living, Nursing Homes Mexico, Senior Care Mexico

Wendy Jane Carrel Speaks on Mexican Assisted Living, Nursing Care at Focus on Mexico

Throughout 2018, I have been invited to address Focus on Mexico participants, a lively and engaged group of mostly retirees from Canada and the U.S. curious about Mexico, curious enough to perhaps make a move.

I talk about senior living options, including possibilities at Lake Chapala.

I share a power point presentation with a few statistics and show photographs based on several years of due diligence and relationship building in 16 states of the country. I review independent living, assisted living, and nursing care – what’s here, what the differences are from home, what’s missing, and what is being created for the next generation that may be in need – boomers.

My VOLUNTEER talk shares an insider’s view for those who wish to consider living south-of-the-border. Other speakers focus on real estate, banking, buying cars, health insurance, medical care, bringing pets, etc.

My next talk is the week of October 29, 2018.

Wendy Jane Carrel with Michael Nuschke, Director of Focus on Mexico, addressing participants

If you are interested to learn about Focus seminars and activities, please see their web site at http://www.FocusonMexico.com. The popular education group is celebrating its 20th year.

Note: My articles are posted on http://www.WellnessShepherd.com. Sometimes they are re-posted on other web sites. If an article does not have my by-line, it is not by me. And, I do not post lists.

Some folks with good intentions, but without senior care experience and/or education, write articles and create lists with recommendations. Unless they are health care professionals, they may not be conversant with possible challenges of moving older adults from one nation to another, where the staff turnover is high, how the staff is trained, how med management is handled, what the activities are, and other subjects related to quality of life.

Death and Dying, Death and Dying Education, Death in Mexico, Dying in Mexico, End-of-Life Education, End-of-Life Planning, Expats, Health & Wellness

The Death Positive Movement is Alive Amongst Retiree Ex-pats at Lake Chapala, Mexico

In the course of one week of August 2018 a fellowship, a Death Cafe, and a talk group at Lake Chapala, Mexico hosted events related to considerations for end-of-life.

These events, intentionally or not, are part of the growing Death Positive movement around the world – places to share, plan, or think about what we want; to consider how we foresee our own passing; and to learn from others who openly share their experiences.

Wikipedia’s explanation of Death Positive: 

“The death positive movement is a social and philosophical movement that encourages people to speak openly about death, dying, and corpses. The movement seeks to eliminate silence around death-related topics, decrease anxiety surrounding death, and encourages more diversity in end-of-life care options available to the public.”

See https://en.wikipedia.org/wiki/Death-positive_movement

Retiree ex-pats ages 50+ from Canada, Germany, the U.S., and the UK gathered at three different venues to hear or participate in interesting, lively, or poignant discussions about mortality.

The venues:

Lake Chapala Unitarian Universalist Fellowship

On a sunny lakeside morning, the fellowship hosted an inspirational, memorable service devoted to End-of-Life.

Sandy Wallin was the service leader. The sermon, “What I Learned from Charlie,” was delivered by Lew Crippen.  Hymns related to transitions – I’ll Fly Away ( performed on a recording by the Humbard family), plus One More Step, and Spirit of Life. The postlude was Handel’s The Trumpet Shall Sound.

Crippen’s sharing was an endearing, sometimes funny, but definitely moving tale about how witnessing the dying of his beloved rescue cat taught him more about love and life.

Lew Crippen, Unitarian Universalist, Lake Chapala, Mexico

Service poetry included Mending Walls by Robert Frost, and the surprisingly amusing Let Me Die a Young Man’s Death (Roger McGough), beautifully read by Wallin.

Note: The tenets of the Universalist Unitarians have much in common with palliative care and hospice – “to honor the inherent worth and dignity of every person,” plus “justice, equity, and compassion in human relations.”

See http://lakechapalauu.org/

Cafe Mortality Ajijic aka Death Cafe Ajijic

A group of American, Canadian, and German retirees and others recently gathered for the third Café Mortality Ajijic in Mexico August 2018. Thirty persons sat in an engaged way at  six round tables and one rectangle table (added at the last minute) at Min Wah Restaurant. Conversation was uncommonly lively. Participants included a hospice chaplain (a new café volunteer), a hospice nurse, a hospice volunteer (a new café volunteer), three psychologists, a psychiatrist, one professor, one journalist, and others.

Currently, there are three co-hosts sharing the duties – Debi Buckland, Wendy Jane Carrel, and Loretta Downs, each with 20+ years devoted to some or all aspects of end-of-life care, planning, and transitions. Each Cafe Mortality is introduced by one of the hosts. The August café was heralded by Loretta Downs who flew in from Chicago to lead.

Jade Young and Laura Petit, observers and volunteers at Cafe Mortality Ajijic, August 2018

In the last few minutes, a representative from each table stood up to share with attendees interests and concerns discussed – how to die peacefully at home in Mexico, how to take one’s life legally in Mexico, how to die on your own terms in Mexico (have your wishes honored), and what happens in the afterlife.

These all-volunteer social gatherings which discuss death and dying respectfully and informally (no agenda) are now held in 52 countries. See http://deathcafe.com/  

A review of the first Death Café Ajijic, held in February 2018, may be found at the following link:

https://wellnessshepherd.com/2018/02/25/death-cafe-ajijic-mexico-ex-pats-and-snowbirds-talk-gently-about-mortality/

The next Cafe Mortality is scheduled for October 9, 2018.  Please RSVP to wellnessshepherd@aol.com if you wish to attend. Note: the venue may change.

Open Circle Ajijic

David Acuff, PhD, talk show host, and author of 15 books, spoke to over 300 attendees at Open Circle Ajijic on Creation of the Afterlife: Perspectives of Different Cultures. He brought forth views from Native Americans, Australian aborigines, Judeo-Christians, Buddhists, and Hindus about what happens when we die. He interspersed his presentation with audience breaks asking those present to find a partner to ask questions with such as…Where are we going after our demise? As at Café Mortality, the audience was fully engaged with the subject, voices were animated and lively.

David Acuff, PhD speaks about the After Life at Open Circle Ajijic

In closing, Acuff offered a new view of afterlife suggested from findings at tombs of the Nazca mummies in Peru. Perhaps, he shared, there is evidence we are not alone in the world. According to DNA research in the spring of this year, mummies from 300 A.D. and 1400 A.D. had three fingers on each hand and were not homo sapiens.

Maybe we do go somewhere else, time travel, or reincarnate… all food for thought.

https://www.news.com.au/technology/science/archaeology/threefingered-mummies-found-in-peru-are-not-human-says-scientist-and-may-be-aliens/news-story/d27160119d077bf407b03c6562e15712

Open Circle’s mission is “to improve understanding of our community and our world.”  The web site is http://opencircleajijic.org/

 

Hospice Physician Karen Wyatt
Death and Dying, Death and Dying Education, End-of-Life Care, End-of-Life Education, End-of-Life Planning, Health & Wellness, Hospice, Palliative Care

Death & Dying Education – A Chat with End-of-Life University’s Karen Wyatt, MD

Award-winning author, podcast host, and hospice physician Karen Wyatt connects healthcare professionals and the public with information about healing options for the dying through End of Life University, which she founded in 2013.

Backstory:

For three years+ I have been dedicated to a palliative care/hospice mission for Mexico. Even though I am back and forth to California, I am continually on the look-out for how care and support for patients and families is being provided on a national and global basis.

What interests me are differences place to place as they relate to education for providers, physicians, patients, and families – what’s missing, what’s working, what options and perceptions about dying are offered. 

This is where Colorado-based hospice physician and thought leader Karen Wyatt comes in. She brings my quest to my computer in an open and engaging way through her END OF LIFE UNIVERSITY web site podcasts. Colleagues share experiences, feelings, information and wisdom about how they are advancing best practices for end-of-life.

Dr. Wyatt’s approach to death and dying is holistic, with a special emphasis on sacred and spiritual aspects of our transitions. 

The goal of her effort is a national dialogue for “creative healing… opening the heart of Western medicine.”  The podcasts, connections, and resources are a welcome gift not only for healthcare professionals but the public as well.  See www.EOLUniversity.com.

In conjunction with the university, Dr. Wyatt launched an on-line book club in January 2018, The Year of Reading Dangerously, where she introduces one book per month about an aspect of end-of-life, and, interviews the book’s authors live on-line. Participants type in questions on-line or ask via the phone line they are listening on.

 

Hospice Physician Karen Wyatt
Karen Wyatt, MD, Founder of End-of-Life University

Interview with Dr. Wyatt

Please share with us about your personal history, and, what led to your work in end-of-life care.

I trained to be a family doctor. I had no knowledge of death and dying or hospice.

Three years after my residency, my father died by suicide. His sudden death upended my world. I felt guilty. I had training in psychiatry and couldn’t save my dad. I floundered for a long, long time trying to get through the grief. Three years after his death, I still felt very lost. I was wondering if I would ever smile or feel joy again. Suddenly a voice said, “call hospice.”  It was my voice, and I have no idea where the message came from.

I didn’t even know if there was a hospice in the Utah community I lived in. I searched “hospice” and found one. I called and asked if they needed a volunteer. When they discovered I am a doctor they enthusiastically exclaimed “oh my goodness!” The Hospice Director, stunned, continued to ask “what made you call us now?” I just had an inspiration, I replied. The Director continued, “Our medical director resigned 30 minutes ago and now you’ve called us.” Just like that I became a hospice medical director. I was guided to this place, and I knew it for sure when I met the team.

What inspired the creation of End-of-Life University?  What led you to gather fellow end-of-life colleagues to share what they know with each other and the public? 

Years in hospice have brought me profound spiritual experiences. I have learned many lessons about how to live my own life. Hospice has helped me live a life of appreciation and that brought me to the decision to write a book.  Many patients had asked if I could tell their stories one day. I made a promise to do so.

 

End-of-Life Book
by Karen M. Wyatt, MD

Writing a book was a long process and is what probably inspired the eventual creation of EOL University. I began the book in 1999 and finished in 2010. I felt I must live the lessons of the book in order for it to be complete. The book was published in 2012 and it was then I realized for the first time that the population, in general, was resistant to talking about death and dying. It seemed people were not ready or open; it was the last thing they wanted to talk about. It was then I knew I wished to do something to change this, something different needed to happen.

Brainstorming led to the question, what else may I be involved with other than a blog or writing? (At the time, Wyatt was posting occasional articles on Huffington Post and in local newspapers). The year was 2013 and I began listening to on-line interviews on other subjects and realized no one was doing this on-line for death and dying. I started the research to find people to interview. It was fun, I loved it (and still do). I was learning so much and wished to keep it going. That was five years ago. I am grateful to the Internet and social media as networks for good.

What response did you receive when you first began End-of-Life University?

End-of-Life University is always a work-in-progress, unfolding. In the beginning I felt no one was listening to the interviews, and that no one cared. The interest grew slowly over time. I learned consistency is important, showing up regularly.  I followed the top web sites in Google search. I recognized ranking makes a difference. Over the years EOL University has gone from 200 to 4,000 subscribers. There is a lot of patience on my part.

I knew I was in it for the long haul, and it was the right thing to do whether I received validation for it or not. In the last couple years, whenever I’ve been at a conference, I kept meeting people who have been listening to the podcasts.  Some would say, “every week, your interviews got me through two terrible years when my mother died, or “I’m interested in working in end of life because of your podcasts.”  One of most important things I learned is that your heart tells you to continue, even if there are signs showing otherwise.  You don’t know the impact you are making, but someday you may find out. Always trust your heart. 

How did the concept of creating the book club with its engaging title, the Year of Reading Dangerously, take hold?

 I felt it would be important. There are so many books, and books are another wonderful way people can learn about death and dying. The goal is to reach people.  The concept of reading and discussing a different book each month had been with me for a while. So late one night I posted the book club on Facebook to see if there might be any interest. I was imagining maybe 20 persons might respond, and if so, that would be great. Well 150 had signed up! Now over 1,000 have signed up.  It’s never too late to join. The response has been so positive I am thinking about continuing the book club in 2019.

What I like most about the club are diverse points of view, completely different voices with unique perspectives discussing end-of-life. I owned some of the books and hadn’t read them yet. Some of the authors I had invited to talk about their books suggested others. Katy Butler, author of Knocking on Heaven’s Door: The Path to a Better Way of Death, suggested Megory Anderson’s book Sacred Dying: Creating Rituals for Embracing the End of Life. Ken Wilbur is a friend and I felt his story Grace and Grit would be compelling.

I find a lot of our listeners are going through their own personal struggles related to death and dying. It seems energetically powerful and perhaps healing if people around the world are reading the same books. There is something enormously attractive about bringing people a shared body of useful knowledge.

See https://www.eoluniversity.com/yearofreading

Dr. Wyatt has retired from her medical practice. Her focus is end-of-life education. She enjoys speaking to audiences across the U.S. and has discovered that “threads” connecting those who do this work remain strong. “Death has called us in and somehow we end up sharing our experiences with others,” she says.

The “death positive” movement has taken off in recent years. Dr. Wyatt’s End-of-Life University and her podcasts seem to be at the right place at the right time.

It was almost 20 years ago when Bill Moyers’ PBS series ON OUR OWN TERMS showed that those of us who tend to the dying wish “to assure patients they can have a ‘good death’ one that fits them, their families, and their culture.”  This is Dr. Wyatt’s mission as well. More people are now receiving the message.

 

Thought: What do you wish for your end-of-life?

Links where you can learn more or support the non-profit, all volunteer End-of-Life University:

www.karenwyattmd.com

www.eolu.com

www.patreon.com/eolu    donations to non-profit End-of-Life University

https://www.amazon.com/What-Really-Matters-Lessons-Stories/dp/0982685548/  link to Dr. Wyatt’s award-winning book