Death in Mexico, Ex-pats in Mexico, Hospice Mexico, Palliative Care Mexico

Expats in San Miguel de Allende Contemplate A Thoughtful Death

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 expats 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 mind froze and I omitted helpful information. I sounded like a newbie instead of someone comfortable and experienced. Yikes!!!

Some clarifications for the listeners:

  1. 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, nutritionists, chaplains, 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 (and ultimately hospice) 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 Juntos Contra el Dolor, A.C.

Dr. Diane Meier, Director of the Center to Advance Palliative Care (New York) shares a three-minute explanation of the value of this service:

https://www.pbs.org/newshour/brief/348127/diane-meier

  1. 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.

One of the easiest openers is to ask what environment they wish for.

Windows and curtains open? Flowers or no flowers? Candles or no candles? Perhaps anointment with frankincense? 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 nor that of their family member.

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 into acceptance, 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.

Note: my service as a companion to the ill and their families in Mexico is as a volunteer. 

  1. 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
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 “Catholic” challenges as they relate to serving patients 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:

https://www.youtube.com/watch?v=TbKJ3N1q_kA&t=400s

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   

 

Assisted Living, Assisted Living Mexico, Death in Mexico, Dying in Mexico, Mexico Senior Living, Senior Care Mexico

Corona Virus Changes Plans for Jalisco, Mexico Older Adults, Travelers, and the World

Corona Virus is changing where we might be, what we are choosing to do, or what we are restricted from following through with in order to protect the health of others.

This is not a complaint. But it has come to signify postponing meaningful work or gatherings in person, especially with the vulnerable who depend on the presence of family and others who support them.

Circumstances have already created loss and a sense of abandonment for our elders worldwide. You may recall the sad circumstances of elders alone in ICU’s in Italy, as well as in assisted living homes in Georgia and Washington State in recent days where family members may not enter to hold their loved ones as they make their transitions.

Note: This post is being written from Jalisco, Mexico where I have been attending to older adults.

The state of Jalisco  (second largest state with Guadalajara as its capital), lead by Governor Alfaro and public health officials, is doing its best to tame the rise of Corona virus. There are several cases throughout the state, reportedly brought in by a group of wealthy Mexicans who traveled to Colorado to ski in mid-March or by travelers (foreign and Mexican) returning from Germany, Italy, and Spain. All persons except those in necessary services have been asked to stay inside through March 29 except for buying provisions or medicine. No travel unless necessary is another request. It is likely the date will be extended. Borders are still open but flights to other nations have diminished.  So far, not a single assisted living home in Jalisco has reported a case of the Corona virus.

I had plans to see colleagues in the Mexican highlands and then return home to California.  Plans have changed.

I wish to thank several colleagues whom I was going to meet with or revisit in March and early April – folks dedicated to the well-being of older adults.  May we meet again soon.

1001 thanks to Lydia Jane Failing, Francoise Yohalem, and Rev. Tom Roseillo of the Unitarian Universalist Fellowship outreach in San Miguel de Allende, Mexico. Warmest greetings and blessings to each of you, your fellowship, and your community-at-large.

I so appreciated your kind invitation to participate in the seminar “Thoughtful Dying in Mexico” with other colleagues March 20, even though it was necessary to postpone as a form of protection for all. My topic was to have been spiritual aspects of dying in Mexico based on psycho-social-spiritual support of older adults at Lake Chapala, plus my involvement with a palliative care mission in Guadalajara.

My thanks also to the owners of assisted living homes in San Miguel de Allende and Cuernavaca who were waiting for me, as well as to hospice nurse Elena Lopez of Hola Hospice and Luz Serena, an assisted living home in central Morelia with two rooms offering American standard hospice.  I look forward to visiting all of you and writing about your dedication to quality of life for older adults on other dates.

Many thanks to Café Mortality colleagues Debi Buckland, Jane Castleman, Loretta Downs, and Darryl Painter for their dedication at Lake Chapala. We cancelled gatherings for March and April for public health reasons.

Discussions of our wishes and mortality, especially at this time of crisis, may have been meaningful for attendees, not to mention this co-host. We will find other ways to reach out through Facebook posts and more.

And, last but not least, a big shout out to my care liaison colleague in San Miguel de Allende, Deborah Bickel of www.BeWellSanMiguel.com who is deluged with requests for assistance at this time. Deborah’s colleague, nurse practitioner Sue Leonard, was to have been on the UU Fellowship morning panel on March 20.

Where ever you are and whomever you are I pray you are safe, comfortable, and remembering to breathe.  As we reflect on the health of those around us, our own health, and new ways to reach out, let us remember the greater dangers for those less fortunate – the elderly, the homeless, and immigrants on the road, in camps, or in cages.

Please remember our healthcare workers, first responders, drivers, and food purveyors.

Please consider volunteering by sending money to a cause dear to your heart and/or healing thoughts for everyone on your path and on the planet.

And, remember to keep reading inspiring stories if you choose about nail salons converting to sewing centers to make masks, the Chinese manufacturer who sent medical masks in crates to healthcare workers in Italy with a poem by Seneca, the Italians who sing on their balconies to each other, the Spaniards who stand on their balconies applauding healthcare workers as they go off shift at a nearby hospital, the small businesses and their drivers offering take-out throughout the world, and thousands of other folks who make sacrifices as they continue to show up for others.

 

 

Dying in Mexico, Hospice Mexico, Palliative Care Mexico

Wellness Shepherd Wendy Jane Carrel Speaks to Ex-pats about Palliative Care in Jalisco, Mexico January 29

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 “New Healthcare 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/ .

Assisted Living Mexico, Dying in Mexico, Emergency Medicine Mexico, Ex-pats in Mexico, Senior Care Mexico

Wellness Shepherd Wendy Jane Carrel Shares with Ex-pats about Senior Care in Mexico, Preparing for Medical Emergencies, and Beautiful Dying

This is an exciting fall month for educational events.

Other than shepherding families to appropriate, compatible Mexican assisted living and ”nursing” care for their loved ones, pastoral care visits to sweet older adults at Lake Chapala (always a pleasure), and coordinating the production of health books (one a translation to Spanish), there are seminars to attend and blog about, plus informational talks I have prepared for ex-pats.

Here’s a partial calendar….

October 3   Future of Medical Cannabis conference on-line.  Medical cannabis is not yet legal in Mexico, lots of challenges related to its release, but all is possible. Am keeping informed of movements in the U.S. and Canada. Some U.S. doctors are titrating down opioid prescriptions and other pain meds for their patients- slowly, by introducing medical cannabis at the same time.

Oct 16        Beautiful Dying in Mexico Power Point presentation at Lake Chapala Society.  In honor of Mexico’s Day of the Dead, Dia de los Muertos, an overview of dying in Mexico – family and religious traditions, rituals, their origins and meaning, and why many Mexicans seem so comfortable with death. Told through stories I’ve been witness to volunteering at a palliative care hospital/hospice and/or as a friend on a village street in Ajijic, Mexico.

Oct 19        Medical Cannabis in Mexico Conference all day in Guadalajara

Oct 22       Preparing for Medical Emergencies at Lake Chapala Power Point presentation at Presbyterian Church

Oct 24-26  4th International Palliative Care Congress at UTEG in Guadalajara produced by www.JuntosContraelDolor.com, the palliative care hospital and service I volunteer with

Oct 30       Focus on Mexico Power Point presentation about Senior Care in Mexico, members only

Chapala Municipal Cemetery, Lake Chapala, Mexico
Death and Dying, Death and Dying Education, Death in Mexico, Dying in Mexico, End-of-Life Planning, Expats, Mexico

Why Creating an End-of-Life Plan for Expats in Mexico is a Good Idea

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
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.

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 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
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 10,500 Mexican pesos; costs for embalming, around 5,000 Mexican pesos.

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
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 seven 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 from California. Over a period of several years she has traveled state to state in Mexico researching senior care options. She volunteers at the only 24/7 palliative care hospital/hospice in Jalisco which also has a community outreach service. She has investigated, studied, and negotiated health systems, senior care options, end-of-life care and planning, and, disposition of remains in Mexico. See http://www.WellnessShepherd.com or contact her at wellnessshepherd@aol.com .

You have permission to re-post the entire article when you include author’s name, biography, and contact information as above.

© Wendy Jane Carrel, 2018

Resources (including American, Canadian, and UK government disposition of remains specifics)

https://travel.gc.ca/assistance/emergency-info/death-abroad Canadian government specifics for death and disposition of remains abroad

https://travel.gc.ca/docs/publications/death-abroad.pdf  smart tip sheet from the Canadian government

https://travel.gc.ca/travelling/publications/die-in-mexico  well-written protocol for handling death of a Canadian abroad (some advice applicable for Americans)

https://www.theguardian.com/money/2007/nov/28/expat-finance-health  well-written article about dying abroad applicable to U.K. passport holders.

https://mx.usembassy.gov/wp-content/uploads/sites/25/Consular-Districts-map.jpg  There are nine U.S. Consulates in Mexico, see map in link to locate the one closest to you

https://mx.usembassy.gov/u-s-citizen-services/death-of-a-u-s-citizen/  general info page about death of a U.S. citizen

https://fam.state.gov/fam/07fam/07fam0250.html  US State Department procedures for disposition of remains for an American citizen abroad

https://travel.state.gov/content/travel/en/international-travel/while-abroad/death-abroad1.html

https://travel.state.gov/content/travel/en/international-travel/while-abroad/death-abroad1/estates-of-deceased-US-citizens.html  how the U.S. Consulate can act as interim executor of your Mexican estate

https://travel.state.gov/content/travel/en/international-travel/while-abroad/death-abroad1/death-statistics.html   reporting death of U.S. citizen abroad

https://travel.state.gov/content/travel/en/international-travel/while-abroad/death-abroad1/return-of-remains-of-deceased-us-citizen.html  documents required for return of remains to the U.S. from abroad – consular mortuary certificate, affidavit of foreign funeral director and transit permit, U.S. entry requirements and customs, shipment embalmed remains

http://dof.gob.mx/nota_detalle.php?codigo=5079096&fecha=30/01/2009  information that is on the Mexican death certificate

http://www.salud.gob.mx/unidades/cdi/documentos/DOCSAL7761.pdf  Mexican death certificate sample

http://www.dgis.salud.gob.mx/contenidos/difusion/cdefuncion.html  Mexican death certificate sample

https://www.uv.es/GICF/4A2_Pena_GICF_11%20.pdf   death certificate Mexico

https://www.gob.mx/sre/acciones-y-programas/tramites-de-registro-civil  scroll down to see requisites for processing death certificates with the civil registry

http://www.contrapuntonoticias.com/2016/01/31/saturan-cuerpos-la-morgue-de-jalisco/  morgue specifics Guadalajara, Jalisco, in Spanish

https://www.youtube.com/watch?v=FMrXyatJW0c Guadalajara, Jalisco, morgue tour

https://www.facebook.com/pages/SEMEFO-Instituto-Jalisciense-de-Ciencias-Forenses/495279867165305  Guadalajara morgue FB page. If comments are to be believed, more bodies than there are refrigerators, no answering the phone, poor communication, etc.

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://mexiconewsdaily.com/news/6-cities-store-bodies-in-refrigerated-trailers/

https://www.youtube.com/watch?v=54FEr0Q1naI  SEMEFO Yucatan forensics. Director Dr. Luis Peniche is interviewed. There is a tour of the Yucatan morgue.

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://noticieros.televisa.com/videos/cadaveres-estudio-medicina/  cadavers for study at UNAM, Mexico City   April 2018  TV interview with forensic physician and professor

https://www.youtube.com/watch?v=pxxNfnOVWt8   the biggest clandestine burial ground in Mexico, according to this video, was an “extermination camp” in the state of Coahuila.

https://mexiconewsdaily.com/news/166-skulls-and-other-remains-exhumed/ another clandestine burial ground found in the state of Veracruz.

https://www.telegram.com/news/20171028/worcester-undertaker-asks-lawmakers-whos-responsible-for-unclaimed-dead?template=ampart  Outside Boston, MA, there is a funeral parlor that buries the homeless, abandoned, etc. It is an expensive undertaking (yes, pun intended), and would probably cost a lot less if green burials were permitted.

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.

http://www.pressrepublican.com/news/local_news/mexican-funeral-customs-differ-from-ours/article_f93a7231-0389-5ca7-9161-ffaeb7b523e2.html   An American in Puebla writes about the differences in American and Mexican end-of-life traditions.

http://www.redfuneraria.com/cremacion-o-entierro#anchor4

http://www.redfuneraria.com/mexico/funerarias  Mexican law regarding death (in Spanish)

https://mexiconewsdaily.com/news/nurse-did-well-selling-job-placements-organs/ a cautionary tale about illegal organ harvesting in Chihuahua, Mexico. All persons involved were Mexican, not foreigners.

https://trasplantes.jalisco.gob.mx/  CETOT  State Council of Organ Transplants

https://www.facebook.com/TrasplantesJalisco/

https://trasplantes.jalisco.gob.mx/acerca/ubicacion-y-contacto

https://es.wikipedia.org/wiki/Declaracion_jurada  – what a living will is

https://theconversation.com/amp/planning-for-death-must-happen-long-before-the-last-few-days-of-life-104860  An article from Australia about why planning for end-of-life “must happen long before the last few days of life.”