Looking forward to another trip to beautiful San Miguel de Allende in March 2023. If it were not so cold at night in that expat haven of 10,000 or more retirees, I’d travel there more often!!
In any event, pleased to be joining talented patient advocate Deborah Bickelof Be Well San Miguel for a talk about end-of-life planning, palliative care, and hospice in Mexico titled “Planning for the Third Stage of Life.”
Deborah will share the wisdom of preparing for your care, how she first learned to plan when she worked with AIDS in Africa, and how creating your Mexican Advance Healthcare Directive aka your “documentacion jurada” may assist in creating quality of life to the end of life. The ultimate message: there are good reasons for all foreigners in Mexico to obtain these notarized documents.
I will provide a brief history of palliative care and hospice in Mexico, the Mexican Palliative Care Law of 2009, what care is present now, where to find support, what the future may hold. My talk is based oneight years of research, conferences, studies for a Mexican palliative care diploma, volunteer years with a Jalisco palliative care hospital, site visits, and relationships with palliative care organizations and hospice providers in Jalisco (Guadalajara, Lake Chapala, Lagos de Moreno, Puerto Vallarta, Tepatitlan), Mazatlan, Merida, Mexico City, Morelia, San Miguel de Allende, and Tijuana.
The event is scheduled for 11:00 a.m., Wednesday, March 15, 2023, at the Kubo Hotel Cafe, Stirling Dickinson 28, San Miguel de Allende, Mexico.
Deborah holds an MA in Public Health from UC Berkeley. She is also a graduate of Stanford University’s Physician Assistant program where she later taught. She has been dedicated to healthcare advocacy in Mexico, Nicaragua, Guatemala, Cuba, and Africa. She is a fluent Spanish speaker. See https://bewellsanmiguel.com
My bio for this subject is as follows:
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
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.
HOLA Hospice of the Angels/Hospicio de los Angeles Founder Elena Lopez with Charge Nurse Claudia
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.
Priest visits residents and staff at HOLA Hospice of the Angels/Hospicio de los Angeles in Morelia, Michoacan, Mexico
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.
This month I had the honor of participating in an on-going Zoom conversation about A Thoughtful Death with the Unitarian Universalist Fellowship of San Miguel de Allende, Mexico.
Care team member Lydia Jane Failing was the lively and engaged producer and host. Many thanks to her and team members Wilka Roig (co-host), Francoise Yohalem, Joan Wolf, and Rev Tom Rosiello.
Articulate and engaging producer/host Lydia Jane Failing of UUF SMA
They are dedicated to discussing why and how it may be wise for non-Mexican residents (full or part-time) to prepare for their demise legally, psychologically, and spiritually in Mexico.
I adore informal chats but for whatever reason when it was announced the conversation would be recorded just as we began, my energy froze and I omitted helpful information. I sounded like a newbie instead of someone comfortable and experienced. Yikes!!!
Some clarifications for the listeners:
Palliative Care
Freedom from pain is a humanitarian right. Few countries are able to provide it in part or fully. When it exists, it is provided by a trained and empathetic team of doctors, nurses, psychologists, social workers, chaplains, nutritionists and volunteers creating palliar (Latin) – comfort, support, and protection. This support extends to patient’s families and other loved ones.
Mexico has had a palliative care law since 2009 (modified in 2014). It states everyone is entitled to relief from pain, especially in the last six months of life. Few places in Mexico are able to provide or sustain such an important and needed service. Few people know the law exists, let alone where to go and how to access needed services.
Juntos Contra el Dolor, A. C. in Guadalajara is the first and only 24/7 palliative care hospital in the state of Jalisco. Its founder is nun physician Dra Susana Lua Nava, a palliative care thought leader. Every person, physicians included, is a volunteer except for two civilian palliative care nurses (day and night shift), and the cleaning lady. My social service for Juntos coordinating patient care, “companioning”at the bedside, community outreach, and raising funds has been and continues to be as a volunteer. All donations go directly to http://www.JuntosContraelDolor.com .
Lydia Jane asked: How do you bring a level of spiritual acceptance to the people you encounter when their transition is imminent?
I do my best to live by one motto: “The secret of the care of the patient is caring for the patient” – Dr. Francis W. Peabody at the Harvard Medical School, 1925.
When I am invited in, I recognize that someone is willing to share exceptionally sacred, tender, even mystical moments. It is an honor to companion.
Human engagement is about feelings. Each experience is different, intangible.
I do my best to bring authentic presence and friendship.
I say a prayer or meditate before I enter that I will bring my best in honor of this sentient being.
After introducing myself, I ask permission. Would you like me to accompany you?
If accepted, so far no one has said no, I learn what environment this person wishes for and imagines.
Windows and curtains open? Flowers or no flowers? Candles or no candles? Perhaps anointment with frankincense? Music or quiet? More pillows, a change of dressing gown? Bathing each day? Linen changes each day? Photos nearby?. Practical considerations. Then, sit quietly with full attention to needs of water, nourishment, and more.
“Companioning” seems to involve spontaneous creativity, trusting intuition about the care of the soul before you.
For those who are anxious, I guide breathing exercises which seem to help.
Each person teaches me, not the other way around. There are no rules. I feel any of us may be present by sitting quietly, hand holding (if wished for), and being open to whatever arrives. The journey is always theirs, not ours.
In my experience, most folks have answers inside as long as the person at the bedside is there as support.We are listening posts, and on occasion guides. I listen until something appears, perhaps a clue or a cue. Invariably feelings are expressed. The process is usually slow.
In my experience people who are fading surprise themselves intoacceptance, but not all. Some folks see someone waiting for them. Most folks seem to wish a witness alongside, someone honoring their existence in order to lapse into peace. Others may prefer to make their transition alone and will do so when everyone has left the room.
Invariably, the process follows divine timing.
Note: my service as a companion to the ill and their families in Mexico is as a volunteer.
No burials of bodies on your property in California. Ashes of loved ones have been known, however, to be buried not just at sea but under trees, rose bushes, and more.
More thank yous:
My appreciation for our conversation extends to talented designer and technology wiz Diana Amaya for making certain we were appropriately situated. Thanks also to Wilka Roig psychologist, death doula, Director of Elizabeth Kubler Ross Foundation SMA, and first speaker.
Dr. Pepe Valencia, San Miguel de Allende, Mexico
On June 10 San Miguel de Allende gerontologist and thanatologist Dr. Pepe Valencia talked candidly about how he has overcome government and church challenges as they relate to serving patients in pain at end-of-life in Mexico. He has been serving older adult residents, expats in particular, for over 40 years. Here is the link to his talk:
On June 17 Carlos F Chancellor, Jungian-Archetypal Psychotherapist, Somatic Movement Educator, Integration Therapist, Dream Worker, Mythologist and Storyteller joined the program. His sensitive and healing talk can be listened to at: https://www.youtube.com/watch?v=0iFcrgQadZc&t=107s
On June 20, Felicitas Rusch-Lango, a life coach and yoga instructor offered breathing exercises to calm anxiety, poetry, Buddhist wisdom, and more. https://www.youtube.com/watch?v=l7yTnvhQyes
Wilka Roig is continuing the A Thoughtful Death dialogues through the Elizabeth Kubler-Ross Foundation Central Mexico. Please write info@ekrmexico.org or Wilka at info@wilkaroig.com for more information on how to participate. The June 30 talk was by a member of the Green Burial Council in the U.S.
May this find you, your loved ones and all beings well and healthy.
Deep bows
Wellness Shepherd Wendy
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. She has travelled Mexico for several years researching and building relationships with 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.
Senior care specialist and palliative care liaison Wendy Jane Carrel will speak at the Lakeside Presbyterian Church in Riberas del Pilar, Lake Chapala, on Wednesday January 29, 2020 from 2-3 p.m. about “Palliative Care and Hospice in Jalisco.”
The free public talk will cover Carrel’s years on a palliative care mission in Guadalajara, and introduce what is currently available in Jalisco for pain management, especially at end-of-life.
On January 22, same time, same place, Dr. Sam Thelin, who has a general medical practice in Chapala serving ex-pats, will review “NewHealthcare Options at Lakeside.” Thelin, an American, studied medicine at the highly-regarded private medical school UAG (Universidad Autonoma de Guadalajara). See http://www.drthelin.com
Wendy Jane Carrel, MA, is a Spanish-speaking senior care consultant 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. You may read more of her history at https://wellnessshepherd.com/about/ .
Wellness Shepherd 