Aging, Death and Dying, End-of-Life Care, End-of-Life Planning, Health & Wellness, Living Abroad, Mexico, Retirement

Death Café Ajijic, Mexico; Ex-Pats and Snowbirds Talk Gently about Mortality

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 brash wording, I prefer Sacred Conversation or The 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.

DSCN2635
Wendy Jane Carrel and Loretta Downs, End-of-Life Guides, Planners, and Educators; Co-Hosts of Death Cafe Ajijic 2018

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/

Cafe El Grano, nice partitions for intimate conversation
Cafe El Grano, Ajijic, Mexico – nice partitions and small tables for intimate conversation – also a most accommodating owner 😉

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.

The DeathCafe.com web site indicates there are 9 death cafes in Mexico. I could only find one. It is located in Mexico City. See http://deathcafe.com/deathcafe/1695/ .

I have so much more to learn. I am now eager to return home to attend hospice social worker and end-of-life guide Betsy Trapasso’s Death Café LA https://www.facebook.com/deathcafelosangeles/   or Maggie Yenoki’s gathering in Pasadena https://www.facebook.com/deathcafepasadena/

References

https://www.counterpunch.org/2018/01/12/what-happens-at-a-death-cafe/   excellent overview of a Death Café gathering in Sonoma, California by Shepherd Bliss

https://www.theguardian.com/healthcare-network/2017/mar/09/death-cafe-learn-talk-dying-patients

https://www.washingtonpost.com/news/acts-of-faith/wp/2017/07/10/the-founder-of-death-cafe-has-died-but-his-movement-to-accept-the-inevitable-end-of-life-will-live-on/

https://www.facebook.com/DEATH-Cafe-Singapore-402018853254286/  a unique look at what Death Café Singapore is paying attention to

https://www.prospectmagazine.co.uk/magazine/take-me-to-the-death-cafe

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Aging, Alzheimer's, Assisted Living, Assisted Living Mexico, CCRC's in Mexico, Health & Wellness, Life Planning Communities Mexico, Living Abroad, Mexico, Mexico Senior Living, Senior Care Mexico

Guidelines for Choosing Assisted Living/Nursing Care in Mexico

Gardens at Casa de las Lunas in Puerto Vallarta with independent living, assisted living and respite care, private pay

According to realtors at Lake Chapala, Mexico, and the information desk at the Lake Chapala Society in Ajijic, the popular ex-pat retirement destination has received more than double the no. of potential renters, buyers, and information hungry folks from Canada and the U.S. than in years before. (Other popular retirement destinations are also seeing an increase in activity – see no. 3 below).

Among visitors intent on moving are travel aficionados looking for a unique cultural experience, the prospect of meeting stimulating people from all parts of the world, but more importantly, an opportunity to stretch their dollars.

And then there is senior living and healthcare, a subject of interest for most. For “sandwich-generation” boomers who lost savings and/or homes during the American recession of 2007-8, or spent savings for the education of millennial children or grandchildren, many are finding there may be little left for themselves or parents if assisted living or nursing care are ever required.

An added concern is that funding for Medicare and Medicaid in the U.S. are currently being challenged.

Alma, a non-profit home for 40 residents in San Miguel Allende

If the cost of assisted and continuing care in Canada (Canada takes care of its disabled, ill, and older adults through universal care programs but there is also private pay care) or the U.S. is not an option, there are more affordable options in other countries. The closest place to look is Mexico.

Here are guidelines for looking at assisted living and continuing care in Mexico, costing between $600 USD to $3500 USD/month, depending on the value of the American dollar and the Canadian dollar vs. the peso, the location, and the residence you choose:

  1. Take note – in Mexico the terms assisted living and “nursing home” are often one and the same, with exceptions. Care facilities are not known as they are north of the border – assisted living, rehabilitation, nursing home, and hospice. It is often an all-in-one approach. Also, with some exceptions, homes mix physically disabled residents with memory care residents.
  2. Select cities or areas you wish to be in for climate – coastal, desert, mountains. (Coastal tropical places cost a little more because A/C is expensive).
  3. If the future resident does not speak Spanish, seek places with ex-pat communities and English-speaking locals who are often a source of volunteers – Baja California Norte (Ensenada, Rosarito Beach, Tijuana), Cancun, Lake Chapala, Mazatlan, Mexico City, Puerto Vallarta. Or, choose smaller places such as Merida, and San Miguel Allende. Some care homes have all foreigners as residents, others locals and foreigners together. Usually one person on staff speaks English, sometimes more than one.
  4. Do the due diligence. Research places and determine costs. Most assisted living and “nursing homes” catering to foreigners have web sites in English easily found on Google Search.
  5. Consider private pay homes and non-profits, as well as residences run by nuns whether you are Catholic or not. Nuns often (but not always) provide quality care as most are nurses with a mission to serve, plus costs tend to be what Mexicans would pay if price is a consideration. Another level of care is found in government homes, some pleasant others not; some accept foreigners with residency cards. There are differences in every region of the country, and there are no rules.
  6. Note: no two places will be alike – financially, environmentally, socially, and in terms of care. Homes are not regulated with the strict standards one is accustomed to in Canada and the U.S.  However, there are places with quality care and high standards.
  7. Conduct site visits. Assess for yourself what might be an acceptable match in terms of environment and people. Would you or your loved one feel comfortable and safe? Do you like the space, the staff?  How are you welcomed? Do residents seem cared for or are they alone in “God’s waiting room” without attention and activities? Ask residents what they like best and what they don’t like. How clean is the home? Standards differ from place to place. Arrive at meal time… is there enough assistance for each resident? Is food fresh, nutritious, and nicely presented? Is it food you would or could eat? Does the home prepare meals compatible with health challenges? What about care plans and medication management? What about emergencies? How are these matters handled?
Patio at a private pay “nursing” home, Casa Nostra, at Lake Chapala

 

Casa de los Abuelos DIF (government) home for seniors, Morelia – these homes are intended for Mexican nationals but on occasion persons with residency visas who pay are accepted, depends on the place and availability

There are no simple answers for selection.

Ideally, we would all have perfect health to our last days and an abundance of funds which would allow us to receive the best possible care wherever we choose to live.

Note: CCRC’s (Continuing Care Retirement Communities, from independent living to demise), now referred to as Life Plan Communities, have not arrived in Mexico, with one exception. There are plans in the works for Life Plan Communities in Baja California, Cancun, and at Lake Chapala from American, Canadian, Mexican, and Spanish developers.

References:

https://www.youtube.com/watch?time_continue=2&v=6lYA7c1Pnuo   Ajijic, Mexico video 2017

http://www.pbs.org/newshour/bb/foreign-retirees-flocking-mexico/

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

Health & Wellness

International Coffee Day, September 30, 2017 – Is Coffee Good for Your Health?

I am neither a scientist, nor a physician. I am not a coffee expert.

What interests me (and probably you) is whether or not coffee is good for our health.

For a few years I stopped drinking coffee. I had read in a journal that coffee might create brittle bones. It may or may not be true. So for a while I drank alkalized water, and green tea, probably healthful alternatives.

But in recent years, traveling back and forth to Italy and around Latin America, I started drinking “macchiatos” or “cortados”. In San Francisco and Los Angeles I’ve been enticed by “Gibraltars”. Each of these treats are basically espressos with a little milk, miniature cappuccinos if you will. No sugar ever, no sweeteners of any kind. (Forgive me baristas, I do know there are subtle differences in the way you make each of the above coffees).

“Everything in moderation” was the mantra I kept in mind, and so I’ve continued.

On International Coffee Day I treated myself to an Illy Caffe from Italy – not organic, and not my favorite coffee. I still like Yemeni coffee best. But the Illy was wow!! The coffee cup and saucer in the photo below are part of a set gifted to me by sweet Norwegian neighbors, coffee lovers.

 

 

I did find an article about the possible carcinogenic effects of coffee roasting because of chemicals used. I’m assuming water processed coffee is still healthful. But I do not know. Nonetheless, there is legislation under consideration in the State of California to add warning labels to coffee bags and tins about possible carcinogenic effects from drinking coffee.

Here’s the article…

http://www.nydailynews.com/news/national/coffee-sold-california-carry-cancer-warning-labels-article-1.3520283

On the other hand, several articles speak to benefits – mainly increasing longevity, reducing the risk of stroke, reducing inflammation, boosting short term memory, helping headaches recede, and much more.

As I work in the areas of health and wellness with a focus on senior care, I’ve started to conclude that coffee, for those who enjoy it, and whose doctors have said it is okay to consume, might serve older adults well.

Articles about health benefits of coffee:

http://time.com/4962159/coffee-benefits-national-coffee-day/

https://www.caffeineinformer.com/7-good-reasons-to-drink-coffee

https://www.healthline.com/nutrition/top-13-evidence-based-health-benefits-of-coffee#section3

http://www.onemedical.com/blog/newsworthy/10-healthy-reasons-to-drink-coffee-2/

http://www.mercola.com/infographics/coffee-benefits.htm

http://time.com/4962159/coffee-benefits-national-coffee-day/

https://www.caffeineinformer.com/7-good-reasons-to-drink-coffee

https://www.healthline.com/nutrition/top-13-evidence-based-health-benefits-of-coffee#section3

http://www.onemedical.com/blog/newsworthy/10-healthy-reasons-to-drink-coffee-2/

http://www.mercola.com/infographics/coffee-benefits.htm 

http://www.cnn.com/2017/09/29/health/coffee-healthy-food-drayer/index.html

 

International Coffee Day web site is http://www.internationalcoffeeday.org

The International Coffee Organization is located in London, England and its web site is http://www.ico.org  .

 

Expats, Health & Wellness, Mexico

Alternative Healing Pop-Up Clinic at Lake Chapala Teams Americans, Canadians, and Mexicans

On Saturday, August 19, 2017, social worker/psychotherapist Toni Rahman, originally from Missouri, produced a Pop-Up Clinic to introduce alternative healing practitioners to each other at a Lake Chapala, Mexico refuge.

After a sage “cleansing” and blessing by Toltec shamanic student and host Craig Shanholtzer, nine persons introduced themselves and the work they do. An additional seven friends who support healing solutions came to learn and experience what the nine offer, and, to help get the word out to the community-at-large about resources at the lake.

It was a beautiful day spent on an inviting porch, in a splendid garden, or in quiet rooms either giving or receiving. “Magical”, “relaxing”, “wonderful” are the comments I heard.

 

Lake Chapala Pop-Up Clinic patio where participants were welcomed and got to know each other

 

Lake Chapala Pop-Up Clinic Healing Garden

 

Some healing arts folks who were present:

Toni Rahman, producer of the Lake Chapala Pop-Up Healing Clinic

Toni Rahman – psychotherapist, EMDR practitioner, angel card reader, and author of the newly released Being in My Body     http://www.ToniRahman.com

Kim Campbell – Canadian massage therapist with training in osteopathy

Doris Diaz, Kundalini yoga instructor

Doris Diaz – Kundalini yoga instructor, originally from Venezuela and Guadalajara, now a resident at the lake

Dara Eden, Reiki practitioner (far right)

Dara Eden – Usui Reiki Master Teacher/Intuitive Energy Healer, originally from California via one year in Vilcabamba, Ecuador    www.InnerChiMastery.com

Mahadevi – Thai massage therapist, ayurvedic consultations, from Colombia

Aracely Marquez – Mexican SCIO therapist (could not attend but will attend future Pop-Up Clinics)

Sophia Rose –  holistic therapist and coach, intuitive consultant, clinical hypnotherapist, and EFT practitioner from San Diego  www.catalystresource.com

Cynthia Rothchild – tantra teacher, watsu therapist, cosmic breathing teacher originally from Ohio  www.cincoelementosajijic.com

Earl Schenck, hands on healing and IET (Integrated Energy Therapy) practitioner for over 20 years

The next Lake Chapala Pop-Up Healing Clinic is scheduled for Saturday, September 23. The time and place will be announced on bulletin boards and in periodicals around Lake Chapala as well as on the sana-clinica.com web site sited below.

For more photos from the event click on this link:

http://sana-clinica.com/pop-up-clinic-ajijic-mexico/

Namaste mucho from Lake Chapala

Aging, Death and Dying, End-of-Life Care, Health & Wellness, Hospice, Palliative Care

Add Do Not Hospitalize to Your Advance Healthcare Directive or Five Wishes?

Can you have control over your end-of-life care? Is it possible to avoid aggressive medical treatment if you do not want it?

According to a Dartmouth Atlas study, 80% of terminally ill patients in the U.S. say they don’t want intensive treatments. 

My interpretation: Patients, whether terminally ill or not, are asking for comfort, quality of life for their last days, and relief from pain (palliative care).

The "End-of-Life Conveyor Belt": Dying patients are kept alive by machines, alone in a cold and sterile environment, their arms strapped down to the bed so that their catheters aren't dislodged. Photo: Getty Images, Jan Halaska / This content is subject to copyright.

Photo: Getty Images, Jan Halaska

“The ‘End-of-Life Conveyor Belt’ where dying patients are kept alive by machines, alone in a cold and sterile environment, their arms strapped down to the bed so that their catheters aren’t dislodged.”

The photo and statement above are from an article by Jessica Zitter, MD, for the Houston Chronicle.  She says, “my patients need to understand their options and make their own decisions.”

 

In order to make one’s own decisions in the U.S., such as avoiding hospitalization and invasive treatment, one must create an Advance Healthcare Directive or Five Wishes (an alternative advance directive recognized in 42 states and the District of Columbia). You must declare your specific medical wishes BEFORE such events might occur.

Your wishes must be notarized. Then they are legal. Be aware they may not always be honored by ambulance services or doctors in hospitals. Ideally, you will have an advocate who is your healthcare proxy or surrogate for healthcare decisions – usually a loved one with a copy of your wishes in hand.

It is also wise to prepare a POLST Physician’s Order for Life Sustaining Treatment (California) or MOLST Medical Order for Life Sustaining Treatment(New York). This way your wishes will be registered on an electronic record should you land in a hospital.

What is usually included in a healthcare directive?

It is common to include a DNR (Do Not Resuscitate), DNI (Do Not Intubate), or DND (Do Not Donate) organs or your body. These are personal choices – saving and prolonging life at all costs or not, tubes or not, donating or not. It is also common to designate a healthcare proxy or surrogate for healthcare decisions as mentioned above, someone you trust to make decisions in the event you cannot.

A recent article on Huffington Post reported on a request some folks are now including, a DNH (Do Not Hospitalize). See link below for entire article.

http://www.huffingtonpost.com.mx/entry/do-not-hospitalize-orders_us_59666c35e4b0a0c6f1e54ed9

I am currently in Mexico exploring senior care, palliative care, and end-of-life issues. The Do Not Hospitalize order got me thinking, even though I am in good health. So last week I updated my Mexican healthcare wishes because American and Canadian Advance Healthcare Directives are not recognized or honored if something happens in Mexico (or most of Latin America where Napoleonic code prevails, and not common law). I have a similar document for Ecuador. When anywhere outside the U.S. I carry a copy of my Five Wishes anyway.

Note: I am grateful to hospitals, one saved my life as I was not expected to survive my birth. In certain cases, such as extreme bleeding or falls, there may be no other option than a hospital. It would be wise to specify exceptions for hospitalization in your document if you decide to mention the preference. In my experience, most people in frail health want to be kept comfortable with palliative care at home, especially for their last days. In this circumstance, caregivers must know not to take you to a hospital.

Additional note: If you are traveling in Latin America, do not have health insurance with worldwide coverage, and are able to state your wishes cogently, and need hospital care, go to a public hospital. If you are accepted at a private hospital you will not be able to walk out the door unless every peso is paid.

An estimated 62% of Americans do not have an Advance Healthcare Directive.

I urge you to create your healthcare wishes if you haven’t already. I advise carrying a copy when traveling by air, train, or sea. Keep a copy handy in the glove compartment of your car … in case of emergency and for peace of mind.

References:

https://www.agingwithdignity.org/   where you can order a Five Wishes form in English or several other languages

http://capolst.org/   California Physician’s Order for Life Sustaining Treatment. You can download the pink form, fill it out, submit to your physician, who will in turn enter it into a statewide electronic system

http://www.dartmouthatlas.org/data/topic/topic.aspx?cat=18

http://www.houstonchronicle.com/local/gray-matters/article/What-Ted-Cruz-doesn-t-get-about-dying-with-dignity-10985879.php?cmpid=fb-premium

https://en.wikipedia.org/wiki/Advance_healthcare_directive

http://www.npr.org/2017/08/09/542390784/a-physician-explores-a-better-path-to-the-end-of-life   NPR/Terri Gross interview with Jessica Zitter, MD, a palliative care specialist

https://www.iadvanceseniorcare.com/article/memory-care/advance-directive-struggle-alzheimers-resident?utm_campaign=Vertical%20-%20Memory%20Care&utm_source=hs_email&utm_medium=email&utm_content=55520297&_hsenc=p2ANqtz-_ZuLjuUATBQhAi_dTeVehajW7RuvMRO7pZriRKLrolsP_2zJWe7N3QKGPp2sAzxtLBK5GEqz075MHAwzmHqrY33xvXzQ&_hsmi=55520297    an article which speaks to the complexity of advance healthcare directives

 

Alzheimer's, Dementia, Emergency Preparedness, Health & Wellness, Senior Services

Emergency Room Environment for Alzheimer’s Patients – Denver Hospital Takes the Lead

I would not call the emergency room featured in the article below “paradise”, but I would say it is a vast improvement over others in terms of amenities and should be considered for all emergency rooms, not only for those receiving persons with Alzheimer’s and dementia.

There are large clocks to read the time, big white boards written with exactly what tests and treatments you are receiving and how long they will last, softer lighting, no disruptive noises from monitors, curtains with soothing scenes to look at such as waterfalls.

The report claims the floors are designed with falls in mind but the bathroom floor looks like tile. No to tile! Use linoleum (rubber) or other material which can cushion falls and is quiet!!

Wondering if I missed seeing guard rails on the bed.

The senior TV correspondent in the video in the link falls short of being articulate, but the TV station footage captured at the hospital is worth viewing.

Congratulations to Denver’s Lutheran Medical Center for taking this first step. May the world follow your lead.

Note: The article in the link below was found on an excellent free weekly newsletter (via a Denver TV station). Alzheimer’s Weekly.

Death and Dying, End-of-Life Care, Health & Wellness, Humanitarian Rescue Older Adults, Mexico, Pain, Palliative Care, Palliative Care Mexico

Mexican Palliative Care Team Juntos Contra el Dolor Conducts Medical Mission in Remote Oaxaca State

Juntos Contra el Dolor, A.C., the only 24/7 palliative care and hospice service in the state of Jalisco, Mexico, leads a yearly (sometimes twice yearly) medical and humanitarian mission to assist the Mazateca (people of the deer) in remote mountain communities of Oaxaca state. The team is led by Juntos founder Dr. Susana Lua Nava, a renowned specialist in palliative care and hospice.

Palliative care in Mexico is generally provided by a team of doctors, nurses, social workers, psychologists, chaplains, and trained volunteers with the goal of relieving pain and creating a comfortable existence for patients physically, emotionally, and spiritually. An important part of the work is the educational component for families and caregivers. Hospice is an extension of palliative care for end-of-life.

This year a group of 13 Jalisco volunteers (two physicians, nurses, social workers, a nutritionist, and trained palliative care missionaries) drove from Guadalajara in a rented white van to the high Sierras of Oaxaca in southern Mexico. The trip took 14 hours. After arrival, they spent the night in a local church in Huautla de Jimenez, population approximately 32,000.  (See references and You Tube videos below for more info).

Juntos Contra el Dolor Medican Mission to Oaxaca
Juntos Contra el Dolor, A.C. palliative care team on humanitarian mission during Easter holiday to Oaxaca; man in red is Sr. Obispo Armando of Huautla di Jimenez; Dra Susana Lua Nava is in khaki vest; the woman on the far right holding palm fronds is a Huautla physician
Local Environment

Each day for nine days the team, divided into three groups, walked and climbed footpaths to families in the areas of San Andres Hidalgo, Chilchitlan, San Antonio, and Santa Carlota. Dwellings of each family are about an acre or more apart, sometimes kilometers apart.

There is no running water in the dwellings. There is no electricity except in rare instances. There is no natural gas. Wood is used inside homes and exposure to smoke can lead to respiratory illnesses. Some families do not have shoes.

The Mazateca homes, people, and clothing are clean and tidy. Personal hygiene is conducted with soap and small plastic bassinets of water.

“Although the trips are physically exhausting,” recounts missionary German Maria Becercil of Guadalajara, “they are an excellent reminder of how much I have and am grateful for – hot water, a refrigerator, a stove, and most of all my health.”

What was immediately noticeable to nutritionist Jorge Gonzalez Gonzalez of Tepatitlan, Jalisco, was the lack of food. Not enough food. This scarcity, he says, can lead to digestive illnesses – gastritis, colitis, stomach ulcers, pernicious anemia, and pyrosis (heartburn).  “Poor nutrition,” he continues, “also leads to low weight and low height, and metabolic illnesses such as diabetes and hypertension.” The mission hiked in with bags of food staples for the ill and their families.
Nutritionist Jorge Gonzalez w/Young Patient
Nutritionist Jorge Gonzalez Gonzalez with young Mazateca patient

Mazateca tradition of shamanic healing

The Mazateca culture holds unique health beliefs.

When illness strikes, they follow a tradition of shamanic healing with the use of “magic mushrooms” or salvia divinorum (a green paste made from a plant), mixed with cosmology and some Catholicism (altars, candles, and prayers). The ill person is usually laid on the ground over blanket-covered wooden slats.

The man in the photo below was thought to be dying of extreme stomach pain. His family placed the salvia (the green paste) on his head. It turned out he had a curable condition – ulcers – and the team was able to assist his healing.

Missionary German
Missionary German Becercil (in yellow) attending an elderly man whom he found with green salvia (Mazateca natural medicine) on his forehead

There is a general lack of knowledge among Mazatecas about many illnesses, especially cancer. There are no modern communications systems in rural areas. Few Mazatecas read or write. There are rarely funds to consult with a physician in Huautla, or to pay for medicine.  “The situation is hard for these appreciative and kind people. Without access they just get sicker,” comments missionary German.

The Juntos Contra el Dolor team is Catholic yet ecumenical. The team honors and works with traditions and belief systems of those they attend. Each mission has been able to address chronic pain and other needs, plus provide nutritional, emotional, and spiritual support. In addition to medical expertise and heartfelt prayers for patients and families, Dra Susana Lua Nava offers additional love and comfort by bathing the feet of those she cares for.

As many Mazatecas do not speak Spanish, local interpreters work with the mission.

A Young Girl with Cancer

This year, the team met an 18-year-old who had been diagnosed with stomach cancer in Puebla (the closest public (free) hospital).  Doctors did not tell her or her family she might die. Apparently no treatments were offered and no medicine was available. No education or instructions were given about what to expect or how to handle the pain.

It is possible there was no pain medicine available at the public hospital (often the case throughout Mexico). Perhaps the hospital did not have a palliative care team (likely), perhaps doctors were frustrated when there were no medicines to offer, or, perhaps the girl was discriminated against because she is indigenous and they wouldn’t give her medicine if they had it. There is no reliable account of what actually happened. Dra Susana Lua Nava and the team brought pain medicines and gave the family detailed instructions on how best to take care of their loved one.

Palliative Care Dr. Susan Lua Nava Reviewing Documents with Cancer Patient
Mexican Palliative Care Care Doctor Susan Lua Nava reviewing documents with precious cancer patient in the remote mountains of Oaxaca state

Despite the sad situations of illness encountered, missionary German concludes “in the 14 years I have been on humanitarian missions, I end up receiving much more than I have given.” Being with the noble Mazateca is always a gift. His sentiment was expressed by others who also felt humbled by the experience.

Mexican Palliative Care Law of 2009

The Mexican Palliative Care Law of 2009 states that anyone suffering from severe pain, especially with a terminal condition, has a right to relief from that pain. Unfortunately, the public is often unaware of this human right and where to find the help when needed.  http://www.calidad.salud.gob.mx/site/calidad/docs/dmp-paliar_00C.pdf

See also the Human Rights Watch report on palliative care in Mexico, “needless suffering at the end of life.”    https://www.hrw.org/news/2014/10/24/mexico-needless-suffering-end-life

Juntos Contra el Dolor, A.C.  (United Against Pain) is a non-profit palliative care hospital and hospice in Guadalajara, Mexico offering consultations, in-home care (65-70 patients), and in hospital palliative care and/or hospice service. The mission is supported by donations. Founder Dra Susana Lua Nava is the author of El Enfermo: Terreno Sagrado (The Ill: Sacred Terrain).  For more information write to juntoscontraeldolor@gmail.com  or call (52)(33)3617 2417 in Guadalajara. See http://www.juntoscontraeldolor.com  (currently under construction) and Facebook USA page at https://www.facebook.com/JuntosContraelDolorUSA/

Notes and references:

There are approximately 305,836 Mazatecas in Mexico. Each Mazateca community is usually less than 500 in number. The native language Mazateco is related to Nahuatl.

www.euromedinfo.edu/how-culture-influences-health-beliefs.html/   “Although Hispanics share a strong heritage that includes family and religion, each subgroup of the Hispanic population has distinct cultural beliefs and customs. Fatalistic views are shared by many Hispanic patients who view illness as God’s will or divine punishment brought about by previous or current sinful behavior. Hispanic patients may prefer to use home remedies and may consult a folk healer, known as a curandero (or shaman).”

https://mapcarta.com/19948092 map of the Sierra Mazateca
https://www.youtube.com/watch?v=_xwIOrTKbxo  Huautla de Jimenez video December 2016
https://www.youtube.com/watch?v=1SXFrih04NA    dancing at the gravesite of someone in San Andres Hidalgo
https://www.vice.com/en_us/article/salvia-velada-mazatec-shaman-ceremony-portfolio-v23n8  unique video by American interested in shamanism and plants

https://www.youtube.com/watch?v=9C5ETSgHWBo  Mazateca shaman known as the Corn Reader

Researched and written by Wendy Jane Carrel

Photos by German Becercil and Jorge Gonzalez Gonzalez