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 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.
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 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.
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:
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.
I am grateful to Focus on Mexico, where I address the ever-changing topics in Mexico (and elsewhere) of independent living, assisted living, nursing care, Life Plan Communities (CCRC’s – there is only one so far with others being developed).
The next talk to the Focus on Mexico attendees is March 21 at 11:15 a.m. at a hotel in Ajijic, Mexico. See https://www.focusonmexico.com/focus-6-day-program/ Focus on Mexico offers seminars to folks interested in how to move to and/or live in Mexico. All presenters at Focus on Mexico are volunteers.
On Friday, March 29, I will be speaking at a FREE community event (open to the public) at the Lake Chapala Society Sala in Ajijic at Lake Chapala, Mexico at 2:00 p.m. on Why End-of-Life Planning is a Good Idea for Ex-Pats in Mexico.
Veladoras for Guadalupe and those we’ve lost, Mexico City Cathedral
Here below are links to articles I have written on the above-referenced subjects:
Wendy Jane Carrel, M.A., a Spanish-speaking senior care specialist, has spent over seven years traveling province to province in Chile, Ecuador, and Mexico researching senior living options. She acts as an advisor or liaison for those who wish assistance negotiating health systems, senior care options, end-of-life care, and disposition of remains.
While conducting research on health care and end-of-life options for older adults in Mexico, and volunteering at a Guadalajara palliative care hospital and hospice, I have witnessed both expected and unexpected deaths of Americans, Canadians, other foreigners, and Mexicans. In the case of Mexicans, the procedure following death is almost seamless, with rare exception.
Chapala Municipal Cemetery, Lake Chapala, Mexico
The question is, how will you prepare for such a situation if you are not Mexican?
Here is some of what I’ve learned in expat havens from Alamos to Ajijic, Mazatlan to Merida, and Tijuana to Oaxaca:
If you wish to save your family, other loved ones, and your neighbors considerable grief and time, it is important to understand what is involved when a foreigner dies in Mexico, and, to have a plan in place.
This goes for 18-year olds, 40-year olds, and especially for all persons over age 60.
Even though the subject is one many of us prefer to avoid, family and friends back home, as well as your local neighbors, will be grateful if you plan ahead. Planning ahead might even give you peace of mind!
WHAT TO BE AWARE OF
The system of law is different. If you are from Canada, England, or the U.S., you are accustomed to common law, not civil law based on Napoleonic code. The rules governing disposition of human remains in Mexico are not the same as at home. The time and bureaucratic requirements required to negotiate the Mexican system, post-death, can be daunting.
Mexico is a country with predominantly Catholic traditions. These traditions influence choices. If you are Catholic, the system may seem familiar, such as burial over cremation. If you had chosen to live in Buddhist or Hindu Asia, cremation would be a relatively easy matter involving fewer steps as cremation is common practice. Or, you could have opted for a Tibetan sky burial.
The Mexican culture, language, and way of thinking are unique. Most of all, procedures may be unfamiliar and complex.
PREPARING AHEAD FOR YOUR DEMISE & DISPOSITION OF REMAINS IN MEXICO
The key Mexican legal document you need to acquire for best outcomes is a “declaración jurada ” (more or less the equivalent of a living will) stating burial or cremation wishes. This document must be created before your demise. The declaración jurada will almost always insure your plan is followed. It is usually prepared by notaries (notarios). Current costs are approximately 1000 pesos in Jalisco state, for example. Note: powers of attorney (equally important for pre-death and health care complications), and wills regarding your property are separate documents. Once a year, older adults can receive a 50% discount in the month of September for wills relating to property (home, car, jewelry, and other assets).
Note: Some funeral homes offer notarized Letters of Intention for cremation or burial. This, in addition to your declaración jurada, is a somewhat reliable back-up. These funeral homes will give you a card to carry on your person at all times; the card contains your name and other details plus their contact information. Not all funeral homes offer this service. There is now the option of green burial in the state of Guanajuato through the Elizabeth Kubler-Ross Foundation in San Miguel de Allende.
Your Advance Health Care Directive or Five Wishes from home is not valid in Mexico even if notarized, apostilled and translated into Spanish unless you get lucky.
You are best off incorporating preferences from your Advance Health Care Directive or Five Wishes (https://fivewishes.org/) in your Mexican legal document. Most legal documents for foreigners, unless you live in a rural area, are written in Spanish on one half of the page, and English on the other. Again, this is the most important document you can obtain relating to your end-of-life wishes. Note: there is no guarantee your healthcare requests will be honored by doctors, hospitals, and ambulance services, just as in your home country. Your cremation request will be honored if it is in writing and your papers are presented.
Burial in Mexico
Burial in Mexico could be easier than shipping a casket home and less expensive, with one exception. Many cemeteries offer plots for purchase for a set period of time (usually six years) with the understanding that remains will be removed and buried elsewhere at the end of that period. Arrangements must be made in advance for relocation of remains or they may be removed to a communal grave.
Note: There is less and less room at cemeteries in heavily populated areas. According to some city Pantheon (cemetery) directors, families with plots are burying loved ones 10 persons deep.
The population from Chapala to Jocotopec (north Lake Chapala) just south of Guadalajara, for example, is around 100,000, including 20,000 full-time ex-pats (numbers not exact). There are approximately 80+ deaths per year among the ex-pat community according to Chapala’s Registro Civil, Civil Registry office.
Ajijic Cemetery along Lake Chapala serves a population of 10,000. It is full unless a family will sell you a plot there.
Ajijic Cemetery, Lake Chapala, Mexico
Cremation in Mexico
When death occurs in Mexico, local practices will govern how quickly a cremation can take place. In the state of Jalisco burial or cremation must be within 48 hours, or the body must be embalmed. There is one exception – a body can lie up to 30 days in refrigeration (if refrigeration is available and with permission) awaiting family members from out of country to view the remains. Then cremation or interment will take place. Cost for cremation in Jalisco, for example, is approximately 10,000 -15,000 Mexican pesos; costs for embalming, around 5,000 Mexican pesos. The prices escalate every year.
In Mexico your legal next-of-kin may request cremation or interment if you do not have a notarized living will with end-of-life wishes. It is unwise, however, to depend on good luck or miracles in this situation – again, best to have a Mexican living will.
Some churches in Mexico offer space for cremated remains in an urn or box in a mini-mausoleum setting. Here again, you are usually paying for a specified number of years.
Note: According to a U.S. Consulate web site, “if the deceased is to be transported between states in Mexico for cremation, the body must be embalmed. If the body is to be transported over 100 km a special transit permit is also required.”
Crematories
By law, a body is to be identified ahead of time. In Guadalajara, for example, no toe tags are used. Photos are taken of faces before the procedure. The name of the person is also written on a ticket. That ticket, serving as I.D., is inserted into a slot space outside the crematory machine.
Crematory Center, Guadalajara Municipal Cemetery, Mezquitan Country
Shipment of Remains Outside of Mexico
If you are American and wish your ashes or remains sent home, there is another step for a loved one or trusted advocate to complete after all Mexican death-related documents are obtained. (If you are Canadian, see the links in the Resources section below. Canadian procedures are not the same as American procedures). If your body has been cremated, a cremation certificate from the funeral home, an affidavit from the funeral director, and an original copy of the death certificate must be delivered to the nearest Embassy or Consulate. (See U.S. Government 7 FAM 258 DOCUMENTS TO ACCOMPANY REMAINS; these regulations were last updated January 18, 2013). If you die in a small city or rural area and cremation is your preference, understand the expense, effort, and permissions needed to fulfill this requirement.
According to the U.S. government, a consular officer will prepare a consular mortuary certificate to ensure “orderly shipment of remains and facilitate U.S. Customs clearance.” The certificate will be delivered to you in English and it will contain the essential information including cause of death.
As for shipment of remains in a casket, a U.S. consular officer will work to ensure that the Mexican funeral director and American funeral director are in communication to guarantee preparation of remains complies with local, U.S. Department of State, and federal requirements. All corpses going to the U.S. must be embalmed. The shipping time is approximately seven days.
Also note: DHL, Federal Express, and embassy diplomatic pouches cannot be used to ship cremated remains out of the country. There is no customs fee to ship remains to the U.S. Note: Shipment of remains outside of Mexico involves not only high cost, but red tape. Consider buying repatriation of remains insurance.
Other Details to Consider for Smoother Disposition of Remains in Mexico:
Someone to Act on Your Behalf
Are you living alone? If so, do you have at least three friends or neighbors who will follow through with your wishes and instructions if you die in Mexico? Note: Do not depend on legal next-of-kin (spouse) or significant other to represent you. What if you both die in a car accident or other tragedy? It is best to delegate additional persons or a trusted attorney to take charge.
A Physician
Do you have a working relationship with a medical doctor who can be called immediately by the designated person or persons to declare cause of death and write the death certificate so an autopsy can be avoided? Do not call 911,an ambulance (Cruz Roja or Cruz Verde), the fire department (bomberos), or the police. Call the doctor, obtain the death certificate (Certificado de Defunción – delivered with three copies), then call the funeral home. The copies of the certificate are then delivered to the local Civil Registry (Registro Civil), the Ministry of Public Health, and INEGI (the National Statistics Office).
In places with a number of expatriates, funeral homes sometimes have doctors who can appear if your doctor is on vacation, but most doctors prefer a relationship with you before they will appear and sign a death certificate. Note: If foul play is suspected, an autopsy will be required and the police and fiscalia (the district attorney’s forensics department) will be involved.
Funeral company
Have you selected a funeral service or transporter to collect your body and handle your remains? Using a funeral service is necessary in most of Mexico, unless you are in a remote, rural village where you may be buried in a local cemetery.
Guadalajara Municipal Cemetery, Mezquitlan Country
Organ donation
Do you want your organs donated? Mexico City’s UNAM, Programa de Donacion de Cuerpo, for example, will welcome your body for science. Are your wishes written in your living will or indicated on your Mexican driver’s license?
Where to Place Remains. Do you wish your remains to stay in country or shipped home?
Chapala Municipal Cemetery, Lake Chapala, Mexico
Someone to Act on Your Behalf, Part 2
Again, designate at least three people to be in charge of your affairs in Mexico in the immediate aftermath of your death. This is recommended based on witnessing situations in Ecuador and Mexico over a period of 12 years, and accompanying distressed family members. Your ex-pat friends may travel quite a bit or may not be present at the time.
Do your designees know which funeral service or transporter will collect your body? Do they know where your legal documents (passport, INM immigration green card, living will – specific for cremation or burial, contact info) are and how to pay the funeral home if not pre-paid? Do they know where to locate your bankcard, cash, and/or documents 24/7? Do they have a copy of your keys? Plan on leaving about 20,000 Mexican pesos or more for the certifying doctor, transportation, the funeral company, Civil Registry fees, and cremation so your friends are not left to raise funds.
Copies of Documents. There must be several copies of critical documents – passport, residence card, living will, death certificate, mortuary certificate, affidavit of Mexican funeral director, transit permit, et altri. The person(s) in charge must be told not to offer an original document to transit people, most bureaucrats, etc. – in most instances these entities receive copies.
Death Certificate (Acta de Defunción)
Who will obtain the Mexican government declaration of death with the appropriate stamps from the Civil Registry and the Ministry of Public Health? This is not only a death certificate but an authorization for burial or cremation. Some Mexican funeral homes have experience assisting with these matters, others not. Will your designees need to do it? Best to find out how to obtain the certificate in the state or province where you live so you can leave instructions. (See Resources section below the article with links to information about death certificates in Mexico).
Register Death with Your Country’s Embassy or Consulate
Who will obtain the proper documents from the U.S. Embassy or Consulate, the Canadian Embassy or Consulate, or other foreign government representative in Mexico not only to register the death, but for remains transported home? Some funeral homes are accustomed to offering this service, others not. The embassy or consulate will prepare a Report of Death from the death certificate. Your family member or representative will use this document along with the Mexican documents if or when remains are transported out of Mexico. At the U.S. Consulate you are entitled to 10 to 20 original copies in English.
Spanish language skills are imperative
Depending on English-speaking Mexicans during this process is not advised as they may not be available when you need them. Have someone at the ready who can negotiate procedures in Spanish. There are a number of facilitators, translators, and attorneys who speak English or other languages, best to keep their information handy.
What happens if you die in Mexico, have no spouse, no next-of-kin, no legal documents stating your wishes, and no legal representatives?
Your body will probably be transported to a morgue, usually a SEMEFO (Servicio Médico Forense – Medical Forensic Service) building with refrigeration. Not all SEMEFO buildings have refrigeration or space, even if they have refrigeration. See video links at end of article with tours of SEMEFO in Guadalajara, Mexico City, Sinaloa and the Yucatan. Your country’s representatives will be called. Each country has different procedures for handling such situations. Your body will probably be autopsied. Often, if no one claims your body, your remains will be placed in a communal grave in Mexico. Each state of Mexico and each rural area has different traditions and preferences.
Few people know where they will die or when. If you spend time in Mexico, or any Latin American country with deeply Catholic traditions, where family ties and support reign (i.e. you will be rescued and your loved ones will know what to do), as well as strict codes and preferences that may not be yours, please choose to prepare yourself.
Preparation hint: register your whereabouts and family contact information with your embassy or consulate The U.S. government, for example, has an excellent system for Americans at https://step.state.gov/. It is the Smart Traveler Enrollment Program and advises you of security risks in the place where you are living and assists with connecting family and others to you in case of emergency. Other places to register your emergency information are located in expat communities around the country. The registries are usually announced in local directories, magazines, English-language newspapers, or found by word-of-mouth. Some non-profit expat organizations provide registries as do churches and synagogues with English-speaking congregations.
End-of-Life Planning is critical for expats.
Create peace of mind for yourself, your loved ones, and your neighbors.
Note: Preparing medical directives for healthcare emergencies, and preparing wills, are subjects worthy of their own long articles and are not included above.
Note two: Physicians, funeral directors, cemetery directors, city and province officials (including a district attorney forensics office), one attorney, one notary, and a consulate were consulted with or interviewed in Mexico for this article.
Note three: If you are alone with no spouse, no children, and no one to rescue you, it is suggested you carry a copy of the funeral home card with contact information on you, plus a copy of key contacts including the notary public. When traveling, also carry a copy of your declaración jurada. If you have a car, it is recommended you keep a copy of your declaración jurada in the glove compartment.
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. She has travelled Mexico for several years researching health systems, housing, senior care, end-of-life care and planning, and, disposition of remains in order to connect Americans, Canadians, and Europeans with options for loved ones. She has investigated hundreds of senior living choices in 16 Mexican states. Her e-mail is wellnessshepherd@aol.com. Her web site is http://www.WellnessShepherd.com,
You have permission to re-post the entire article when you include author’s name, biography, and contact information as above.
https://wdef.com/2018/09/19/morgue-director-fired-over-stench-of-157-corpses-in-truck/ September 2018 article reporting on two tractor trailers filled with unidentified corpses as there is not enough refrigerated space at the morgue in Guadalajara. A report by the English-language Guadalajara Reporter stated that corpses of two unrelated Americans, who died of natural causes, were stored in the tractor trailers, an indication that some stored corpses were identified first, not that it makes being stored in a tractor trailer palpable.
https://www.youtube.com/watch?v=kWNr53cWfxk Sinaloa SEMEFO, a report in Spanish about abandoned corpses and no refrigeration 2016, “muerte indigna.” Apparently a new building has been constructed since with refrigeration. Note: in places of extreme humidity and heat with no refrigeration, imagine the stench.
https://www.youtube.com/watch?v=5fNXN6XycPA According to the video, “drug dealer” tombs in Sinaloa represent the opposite kind of ending from an abandoned body left at the morgue. The Jardines de Humaya cemetery in Culiacán, Sinaloa, is known for its extravagant mausoleums, not all that dissimilar from the concept of the Mamluk tombs in Cairo Egypt’s City of the Dead (circa 642 AD). The video shows the tomb of Ignacio Coronel that apparently cost millions of pesos or dollars.
https://www.youtube.com/watch?v=B-mHof2axB4 According to this 2017 documentary video from Mexico City, if after three weeks no one identifies a body, it will usually end up in a communal grave. In another report, some bodies may go to a medical school for study.
https://tomzap.com/dying.html Dying in Puerto Escondido, Oaxaca, a 2013 report. At that time it was estimated one needed about 12,000 pesos to pay for cremation, now transportation and cremation will come to around 20,000 pesos, depending on the funeral home.
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.
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.
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, 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/ .
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:
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.
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).
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.
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.
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.
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.
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.
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:
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 thought leader 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, 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 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 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.
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
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).”
I have been sitting hospice as a volunteer since 1999.
I currently have the honor of assisting at the only 24/7 palliative care hospital and hospice in the state of Jalisco, Mexico, http://www.juntoscontraeldolor.com, (United Against Pain).
It is beyond words to describe what I see and feel as patients come and go – those who get well, those who pass in our presence, those who have family, those who are estranged from family, those who have no family.
Every day is a lesson in human behavior, details of physical illness and care, psychology of illness, and feelings that occur as we observe pain and/or quiet passing of others. Every day, despite the circumstances, there is a demonstration of love.
In early 2016 we received a call from El Refugio (The Refuge) missionaries, a non-profit that rescues people from the streets of Guadalajara. They had found a tall (by American standards), emaciated man who appeared to be dying.
The man had been taken to Hospital Civil Viejo (the Old Civil Hospital) where admittance was refused. The missionaries called in desperation. They remembered Juntos Contra el Dolor serves all regardless of economic position or faith. Everyone deserves a respectful end-of-life.
The founder of the Juntos Contra el Dolor humanitarian model for Mexico, Dra Susana Lua Nava, urged the group to bring the man immediately. The man arrived dehydrated, malnourished, and appeared as though he would pass at any moment.
Mural at entrance to Juntos Contra el Dolor, palliative care hospital and hospice, Guadalajara, Mexico
We gently bathed him several times the first few days removing deep set black from his shoeless feet and body. We constantly changed the sheets and his gown. The odor was strong the first days and then dissipated. Around the fourth or fifth day the patient began to open his eyes. We started feeding him by mouth, little by little.
Each of us who entered his room – physicians, nurses, social workers and volunteers would have the same experience. We would talk to him, but he could only answer with sounds. At first we thought it was because he had lost almost all this teeth. We finally figured out he did not speak Spanish. He may have been a native Huichol from the mountains of Jalisco. We did not know.
But whenever we visited or fed him there would be light of appreciation in his eyes, and a slight smile on his strong, handsome face. When we stroked his forehead and hair or had our hands on his, he would bring our hands to his lips and kiss us. Tears would stream down his face. This is how he communicated. It made us wonder if he was ever attended to in his life. We too were moved. We felt deep compassion for him. We did our best to make him feel welcome and comfortable.
His name? He had no identification. One of the rescuers decided on “Rogelio”. We did not know his age. We guessed age 80. We did not learn the circumstances of his life of course. All we knew is that at this stage of his existence he was alone and abandoned.
But we were there. One of the missionaries would come when he could to stay by Rogelio’s side all night, as family members usually do.
There were humming sounds of prayer in the room each day from those who stood by him.
In less than two weeks Rogelio passed in the early morning hours, veladoras (candles) burning. I was there alone with the night nurse. We bathed and diapered him. We wrapped his hands and head in gauze. We wrapped him in a new sheet with his face peeking out. I silently talked to him and wished him a good transition. I cannot speak for others who tended to him but his presence was an inexplicable gift.
Most of the patients who come to us (or whom we go to at home) are surrounded by innumerable family members. Rogelio was no longer without support. Hopefully, we gave him a dignified death.
Miraculously, El Refugio found a way to pay for his cremation. They found a place for his remains under a tree (we do not know where) and said prayers for him. He was cared for by everyone along his journey. See https://www.facebook.com/elrefugio.cuarto Note: When unknown persons pass in Guadalajara their remains are placed in an unmarked communal grave in the city cemetery.
The International Day of Older Adults is celebrated, by proclamation of the United Nations, on October 1 every year.
In Mexico this event dovetails with the country’s Senior Day at the end of September. Festivities are held at senior centers, senior homes, and on DIF (government social service) grounds.
For those of you who haven’t been to Mexico, especially Guadalajara, its “tapatio” residents love to sing and dance no matter their age. Being around these folks will automatically lift your spirits. They love to dress up, eat well, and have fun. Most of all, they never give up despite mobility issues or aches and pains.
Tapatio singing seniors
In Mexico there are 7.5 million persons 70 or older. This number is expected to reach 8.5 million in 2020, and 10.2 million by 2030. According to the Mexican government, at 60 you are an older adult. It is unclear why the number of boomers and persons ages 60-70 are not included in the Mexican government statistics (INEGI) reports.
In the U.S. there are 70-80 million adults who will be over 65 by 2020.
This year I attended the Asilo Juan Pablo II senior day festivities (see earlier post September 2016) at http://www.WellnessShepherd.com .
Last year I attended an event at DIF’s Centro de Amistad Internacional (Center of International Friendship) on Calle Eulogio Parra 2539 just off Lopez Mateo in Guadalajara. It was co-hosted by the Office of Older Adults for the State of Jalisco, Mexico and by INAPAM ( the National Institute for Older Adults, est. in 2002). It was held on the first Sunday of October from 10 a.m. to 3 p.m.
Groups of seniors performed dances, ladies were offered free beauty treatments by the Irma de Zuniga make-up academy located on Lopez Cotilla in downtown Guadalajara (www.irmadezuniga.com), there were talks by gerontologists, nutritionists and others experts. Jhre Chacon and his team of healing touch trainees from UNCOA offered massages, Reiki, and other relaxing experiences for the guests. There were also poetry readings and card games.
Tapatio caballeros
older adult folkloric dancers, Guadalajara
healing touch holistic care for older adults, Guadalajara, offered by UNCOA
Queen for a Day make-up gift for older adults, Guadalajara
Ana Maria Luz Garcia, owner of the historic restaurant La Fonda de Arcangel Miguel (www.fondasanmiguelarcangel.com, housed in a colonial convent in the center of Guadalajara), hosted the buffet breakfast/brunch. Garcia is a passionate advocate for healthy living at any age.
Consuelo Manzo Chavez, Director of Older Adults for DIF presided with Alma Solis Montiel, who at the time was the Director of INAPAM but is now the Director General of the Institute for Older Adults for the State of Jalisco.
International Day of Older Adults with Senior Care Advisor Wendy Jane Carrel, DIF Director Consuelo Manzo Chavez, and former INAPAM Director Alma Solis – now Director of the Institute of Older Adults for the state of Jalisco, with unidentified older adult, and human rights attorney Laila Martinez de Santiago
Wellness Shepherd 
