Emergency Medicine Mexico, Emergency Preparedness, Health & Wellness, Mexico, Palliative Care Mexico

PACE Pan-American Forum for Emergency Care and Global Health 2019 Theme: Global Health is Local

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).

PaceForum.org headquarters in San Miguel de Allende at Hotel Posada de las Monjas, a former monastery

 

The three-day conference focused 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.

 

PaceForum.org 2019  Hotel de Real Minas lobby mascots

 

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 for me 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.

Other presenters included Dr. Terrence Mulligan (creator of Emergency Medicine and acute care system development programs in over 20 countries); Dr. Camilo Gutiérrez (pediatric trauma); Dr. Robert Suter (President of the American College of Osteopathic Emergency Physicians on thromboembolic disease); Dr. Judith Tinitalli (expert in obstetrics and Editor-in-Chief of the best-selling Emergency Medicine text book); Dr. Gary Gaddis (specialist in low-resource settings); Dr. Monica Gaddis (specific issues in international emergency medicine); and Dr. Angel Rafael Braña-López public health instructor and preventive medicine specialist at Florida State University College of Medicine and San Juan Bautista School of Medicine in Puerto Rico. There were 36 other esteemed presenters.

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.

Cruz Roja (Red Cross) paradmedics at PaceForum.org 2019

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.

PaceForum.org breakfast meeting with Ms. Karen, Dr. Angel Brana-Lopez, Elena Lopez of Hola Hospice, Wendy Jane Carrel of Wellness Shepherd and Book Ambassador,, and Dr. Haywood Hall, founder of PACEMD, Pace Forum, and MedSpanish

“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:

Centro PACE/PACEMD.org

Hospitales 10

Colonial Marfil, Guanajuanto, MX CP 36250

Phone: 505 239-0143 (New Mexico number)

Phone: 473 733-0999 or 473 690-0654 (Mexico)

www.Centtro-PACE.org   info@pacemd.org   Monday-Friday 9 am to 5 pm

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.

Resources

https://paceforum.org/

https://www.visualcv.com/haywoodhall/ comprehensive bio of Dr. Haywood Hall with video

https://www.acepnow.com/article/dr-haywood-hall-is-a-driving-force-for-em-education-in-the-americas/   Emergency Medicine magazine interview with Dr. Hall in June 2019

https://www.epijournal.com/new-events/2019/8/15/the-2nd-pan-american-forum-in-emergency-care-and-global-health

https://Medspanish.com  Information about the organization, mission, methods and the results of decades of advocacy.

 

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/

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

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 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.

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

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