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.
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
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.
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
In January 2020 Los Angeles-based nurse and case manager Elena Lopez realized the first part of a 20+ year vision – to return to Mexico to open a hospice, the first in her native state of Michoacan.
There have been previous efforts since the 1970’s to create hospice homes in Mexico following models in Canada, the UK, and the U.S. For financial reasons, as well as the predominant family cultural value of caring for the ill at home through end-of-life, the hospice home model with others doing the caring has yet to be accepted or sustainable. There have been hospice homes but none have survived.
How will Lopez create a sustainable model?
Lopez’ residence Hospice of the Angels has married assisted living care with rooms for hospice. Assisted living is a concept prevalent in every state of Mexico.
Lopez has attracted not only local Michoacanos but Mexican-Americans with life-limiting illnesses who wish to live their last months in their native land. Note: It costs families in the U.S. up to $20,000 or more for remains to be shipped from the U.S. for traditional Catholic burial. Choosing Mexico for end-of-life helps defray these expenses for Mexicans living in Canada or the U.S. and allows local family to be present.
Lopez continues to train staff – nurses, caregivers, and volunteers, despite the pandemic -based on her professional experience in California at VITAS, Kaiser Permanente, and in private service. In 2020 her staff also received End-of-Life doula training (psycho-social practical and ritual support) with psychologist and doula Wilka Roig of the Elisabeth Kubler-Ross Foundation of central Mexico. Roig is headquartered in San Miguel de Allende. (See www.ekrmexico.org ).
Hospice of the Angels currently has 10 assisted living residents. The home hosted five hospice patients this year. There are 15 staffers including Luisa Fernanda Ruiz Montiel psychologist/tanatologist who holds a PhD (former professor), the accountant, and an attorney.
Despite COVID, Lopez and team have managed to keep the virus out of the home, and, host fundraisers. Residents are busy with small therapy dogs, arts and crafts, visits by priests, and music performances. Recently, American hospice nurse Ian McCartor, known for creating inspirational Legacy Songs for his patients in English and Spanish, played and sang at the home.
An out-patient hospice service in Morelia and neighboring areas has not been deemed practical. It is considered unsafe to send doctors, nurses, and caregivers out at night due to heavy cartel activity.
At Hola Hospice of the Angels, each room offers a bed for the patient and a bed for a family member, a model first instituted in Mexico by Dra Susana Lua Nava at Juntos Contra el Dolor, the first and only level one 24/7 palliative care hospital in the neighboring state of Jalisco. See www.JuntosContraelDolor.com
Mexican end-of-life care is provided through out-patient or in-home services in most states. Since the Mexican Palliative Care Law of 2009, there is now a broader view for care of the ill that includes those with life-limiting, painful illnesses that may last many years.
How to find Hospice of the Angels:
Fundación Hospicio de los Ángeles
Miguel Silva 149 Morelia, Michoacan de Ocampo, 58260, Mexico
Tel. 52 443 275-0279 office; 52 443 331-6647 cell; and USA cell 213 706-1111
Additional hospice project for Uruapan, Michoacan, Mexico:
Lopez is collaborating simultaneously with a Michoacano whose life dream has been to open a home for older adults. The gentleman donated land in a tranquil forest area. Part of the home will be dedicated to assisted living and nursing care, the other part to hospice which will be headed up by Lopez. Architect Ivan Marin of Morelia will fuse old Michoacano style (lots of wood) with Japanese Zen-style structure – healing light, views to nature from all sides, and tranquility (a hard-to-find concept in Mexico). Two years ago Lopez and Marin travelled to Japan to study hospice and architectural concepts they could incorporate. Lopez says she envisions a quiet, meditative, sacred place. They plan to break ground within two years.
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist, consultant, and Mexico senior living writer 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.
Corona Virus Mental Health – Healthflix.Onine Launches FREE Online Classes March 31, 2020 GMT with 100 World Thought Leaders Sharing Knowledge
My distinguished award-winning book clients, integrative psychiatrists Richard P. Brown, MD and PatriciaGerbarg, MD, join colleagues on-line to support the public during the current public health and mental health crisis.
Drs. Brown and Gerbarg, New York-based medical school professors known for their continuing trauma relief work at Ground Zero NYC, and with Syrian, Sudanese, Rwandan, and Rohingya refugees, have written innumerable articles and six noteworthy books.
See The Healing Power of the Breath from Shambhala Publications as welcome reading for these times.
Their participation in the Corona Virus Mental Health discussion begins March 31, 2020 Greenwich Time (London, UK) and continues for the next two weeks.
Details may be found in the press release I posted on the Internet at the following links:
One of the biggest pleasures for those of us dedicated to healthcare (for me senior care and palliative care from a social, spiritual, and administrative perspective) is to attend a conference where one can network and learn from thought leaders focused on a similar mission – best practices for quality care.
The 2nd PACE Pan American Forum for Emergency Care and Global Health held at Hotel Real de Minas in San Miguel de Allende, Mexico last month, was a gift for all attendees. (Below is a photo of Hotel Posada de las Monjas in SMA, a former monastery, where the PACEforum.org offices are located).
The three-day conferencefocused on innovative ways to offer medical training to communities in lower-resource, culturally challenging settings through technology (tele-mentoring, digital health monitoring), and one-on-one communication and care skills.
Public health leaders in Emergency Medicine shared years of accumulated knowledge from state, national, and international levels. Tracks included general emergency medicine, disaster management, obstetrics, pediatrics, the ECHO tele-mentoring program, rural and wilderness medicine, palliative care, and many more. Attendees received CME credits.
Each track was of the utmost importance.
The most meaningful tracks forme were physicians teaching palliative care to emergency resident physicians, a demonstration of a clinically proven mental health protocol for first responders and physicians to keep themselves and others calm through Breath-Body-Mind (trade-marked), and the presentation by internationally renowned social entrepreneur, university professor, and conference founder Dr. Haywood Hall who focused on the formidable impact the PACE program has had in Mexico, plus a current international concern, health and mental health issues at the US-Mexico border.
Thanks to the international work of Dr. Angel Braña-Lopez, and New York integrative psychiatrists Drs. Richard Brown and Patricia Gerbarg of www.Breath-Body-Mind.com who teach innovative programs to help people recover from trauma and mass disasters, I was able to travel to San Miguel de Allende. Many thanks also to Dr. Haywood Hall!! It was a privilege to attend.
Other attendees were medical school professors from Latin America (mostly Mexico) and the U.S., specialists, generalists, nurses, mid-wives, paramedics, community health workers and others.
More about PACE Global Health
PACE Global Health (aka Groupo PACE) is an off-shoot of the award-winning social impact program PACE MD, founded over 20 years ago “to improve emergency and general medical care in Latin America through community-based training in skills, knowledge and ability as well as to improve medical care in the US and Latino populations through MedSpanish’s language and cultural literacy training (offering CME and GME credits).”
PACE MD founder Haywood Hall is an Emergency Medicine Specialist, Telemedicine Physician, and Professor at the University of New Mexico and the University of North Carolina. He is an American fluent in Spanish language and culture, and is an Ashoka Change Maker Fellow who works with Duke University’s Innovations in Healthcare. His PACE program has trained and certified over 41,000 healthcare providers and 6,000 lay people in systems-based emergency care.
For his achievements in positively affecting the chain of survival through emergency care skills Dr. Hall has won the International Federation of Emergency Medicine Humanitarian Award as well as the College of Emergency Physician’s Hero of Emergency Medicine Award, LATAM’s Top 10 Social Impact Enterprise in Latin American and the Caribbean Award, the American Heart Association’s Silver Award, as well as 2nd place for Social Innovation from Mohammad Yunus Creative Labs.
“The future of emergency medicine is here and it’s up to us to pave the way,” states Dr. Hall. “As front line healthcare providers we are in a unique position to be agents of change. We know the exact problems that plague our societies.”
If you are interested in learning more about Latin culture and how you can use healthcare technology to reach low resource areas you may wish to attend the next Pan-American Forum for Emergency Care and Global Health (date not yet set), or contact PACE via the information below:
Another take away: What many people may not realize is the enormous effort and energy required to create innovative, sustainable public health programs, especially related to emergency medicine, which is often a 24/7 profession. Most participants, and PACE founder Dr. Hall, usually depend on their teaching income to fund their outreach passions and programs.
Note: PACE International is not to be confused with another PACE, a US federal Program of All Inclusive Care for the Elderly. The objectives are similar, however – to treat all with dignity, compassion, and quality care.
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.
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.
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!!
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.
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.
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.
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.
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.”
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.
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.
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.”
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.
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:
The next Cafe Mortality is scheduled for October 9, 2018. Please RSVP to firstname.lastname@example.org 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.
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.
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.
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.
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.
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.
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:
A group of American, Canadian, and UK ex-pats and “snowbirds” recently gathered for the first Death Café Ajijic, Mexico. There were 18 persons present at Café El Grano including an anesthesiologist, a hospice nurse, a hospice social worker, a psychiatrist, teachers, and others. There were two facilitators who work with end-of-life planning and transitions.
If the term Death Café (excuse the direct wording, I prefer Sacred Conversation) is new to you, you may hear it more and more. Death Cafes or Café Mortels began with Swiss sociologist Bernard Crettaz who held over 100 such meetings in his native country until recently. In 2011, Jon Underwood, inspired by Crettaz, created Death Cafes in England (see history at http://deathcafe.com/what/ ).
These all-volunteer social events to discuss death and dying respectfully and informally (no agenda) are now held in 52 countries including Australia, Europe, Canada, the U.S., and parts of Latin America where death has sometimes, but not always, been a foreboding and scary subject. Buddhist, Hindu, or Muslim countries, and places with indigenous populations tend to consider death a natural part of life and honor it as such more easily. Most café organizers work with end-of-life, and tend to focus on alternative, kinder, spiritual ways of departing. Note: There is a Death Café in Singapore.
“At a Death Café… our aim is to increase awareness of death to help people make the most of their (finite) lives,” states the Café web site. Most of all, the Café encourages an exchange of stories and perspectives as a way to embrace death.
What prompted a Death Café in Ajijic?
First, a number of retired ex-pats and visitors die in Mexico unexpectedly, and, they die without a health care directive and/or an end-of-life plan. There is a need for continued conversation and education.
Second, Loretta Downs, MA, has been speaking to locals at a popular venue, Open Circle (as well as at In the Heart of Awareness, the Buddhist center), about end-of-life for several years. She flies in from Chicago every January to deliver her talks. About 300 + persons show up to listen as she encourages her audiences to become friendly with the idea of mortality and to prepare for it – think about it, and express to others what you want. See http://www.endoflifeinspirations.com.
Third, yours truly, Wendy Jane Carrel, MA, has been speaking to ex-pats around Ecuador for three years and subsequently in Mexico with the same passionate message – make friends with your demise, please make a plan.
It seemed natural for Loretta and I to team up to host a Café for Lake Chapala.
My interests had been reinforced as a result of volunteering two years at Juntos Contra el Dolor, the only 24/7 palliative care hospital and hospice in the state of Jalisco, a model for Mexico. I was given the gift of observing how painful chronic and terminal illnesses are treated, the politics of medicine, the politics of opioids, cultural difficulties related to dying, family constellations, and the difficulties of running a non-profit in a rich country (yes, rich in many resources) with little tradition of philanthropy. Most of all, I learned the concept of a “good death” requires much education and outreach in Mexico as well as at home.
Loretta’s friend Nancy Gershman, who produces Death Café NYC, gave us welcome pointers before the Ajijic meeting. We followed Nancy’s advice – small tables of 3-4 for intimate conversation, one of us (Loretta) to circulate and ensure participant exchanges were flowing, see that anyone who was recently grieving the loss of a loved one was comfortable, followed-up by an evaluation to learn what we could do better the next time. https://www.meetup.com/Death-Cafe-New-York-City/
Because Loretta and I travel often, she is based in Chicago, and I in LA, we may not be producing other cafes until January 2019 unless another healthcare worker can pick-up in our absence.
Note: If you have not heard of Ajijic, it’s a sleepy Lake Chapala village, with a population of around 10,000, an hour south of Guadalajara. It is a popular tourist destination. Lake Chapala is home to around 20,000 full-time retirees from north-of-the border.