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

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

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

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

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

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

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

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

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

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

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

Mazateca tradition of shamanic healing

The Mazateca culture holds unique health beliefs.

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

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

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

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

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

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

A Young Girl with Cancer

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

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

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

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

Mexican Palliative Care Law of 2009

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

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

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

Notes and references:

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

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

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

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

Researched and written by Wendy Jane Carrel

Photos by German Becercil and Jorge Gonzalez Gonzalez

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End-of-Life Care, Health & Wellness, Hospice, Mexico, Palliative Care, Palliative Care Mexico

Palliative Care/Hospice Juntos Contra el Dolor of Mexico Holds Kermes (Fundraiser)

Juntos Contra el Dolor - we are helping diminish pain
Juntos Contra el Dolor – “we are helping diminish pain”

 

Juntos Contra el Dolor, A.C., the only 24-7 palliative care/hospice in Jalisco, Mexico, held a kermes to raise funds for its humanitarian medical effort which aides patients with chronic pain, and, at end of life. The Juntos team also provides psychological and spiritual support to families of patients.

The kermes was held on a Sunday from 8 a.m.to 2 p.m. outside the Templo of San Bernardo on Plan San Luis in northwestern Guadalajara, a church with 3,000 parishioners.

A Mexican kermes is an outdoor party for a special cause. To support the cause, people buy food and drink. The Juntos kermes served tacos with birria, quesadillas, homemade jamaica (a hibiscus drink) and horchata (a rice drink). Juntos brochures were on each table.

The nurses, who are the only paid staff (except for volunteer retired nurse Rocio), were taking care of patients at the hospital around the block..

The Spanish word kermes is derived from the Turkish word kermes which originally meant a handicraft bazaar to raise money for charity. It is also derived from the Dutch word kermesse, (kerk = church, mis = mass), a festival after mass.

setting tables for the kermes
setting tables for the kermes
founder Dra Susana Lua Nava with volunteer nurse Rocio
Founder Dra Susana Lua Nava with volunteer nurse Rocio

 

 

 

 

 

 

 

volunteer nurse Rocio and volunteer coordinator Nena
volunteer nurse Rocio and volunteer coordinator Nena
social workers Silvia and Lupita
volunteer social workers Silvia and Lupita

 

sister volunteers, administrator Sara on the right
sister volunteers – Marta and administrator Sara on the right

 

End-of-Life Care, Expats, Hospice, Palliative Care, Palliative Care Mexico, Senior Care Mexico

Mexican Palliative Care Thought Leader Dr. Susana Lua Speaks to Expats about Unmet Pain Relief Needs

Dra Susana Lua Nava, a palliative care physician based in Guadalajara, Mexico, spoke to over 200 North Americans and locals at Open Circle on the Lake Chapala Society grounds in Ajijic, Mexico about pain relief for chronic conditions and end-of-life.

Her passionate presentation about the unmet needs in Jalisco state and throughout the country triggered many questions from the audience, plus more interest in bringing such services to the lake. Lake Chapala is about an hour’s drive from Mexico’s second largest city Guadalajara. An estimated 20,000 North Americans reside there during high season.

Dra Susan Lua Nava, palliative care physician, addresses Open Circle
Dra Susan Lua Nava, palliative care physician, addresses Open Circle

It is a goal of Dra Lua’s non-profit Juntos Contra el Dolor, A.C., (United Against Pain), http://www.juntoscontraeldolor.com, to educate communities throughout Mexico about what palliative care is, and show how to offer comfort care to those with life-limiting diseases. Ideally, there would be models for this care in each state. Currently, palliative care is primarily found in three large cities at regional hospitals – Guadalajara, Mexico City, and Monterrey.

In 2009 the Ministry of Public Health of Mexico established guidelines for palliative care entitling all residents of the nation to relief from pain. The challenge has been that most people do not know exactly what palliative care is, nor where to find it. Palliative medicine is often confused with pain clinics which may offer medications but do not necessarily include a holistic support team for the patient and family members during such trying times.

As of yet, there is no dedicated palliative care/hospice team  – physicians, nurses, psychologists, social workers, clergy, and volunteers working together at Lake Chapala. There have been previous efforts to establish a hospice.  (The main cities at the lake are Ajijic, Chapala, San Juan Cosala, and Jocotopec. It takes around 40 minutes to drive from Chapala on the east end to Jocotopec on the western end).

There are a number of highly talented retired palliative care and hospice administrators, physicians, nurses, clergy, social workers, and others from Canada, the U.S., South Africa, and other countries at the lake. Several groups have formed to discuss how to establish a service that can serve all populations and will endure.

DVDs of the chat by Dra Lua can be ordered at http://www.opencircle-ajijic.org

DSCN1311
Wendy Jane Carrel acts as translator for Dr. Lua’s talk on palliative care in Mexico

I performed a Cliff Notes version of Dr. Lua’s talk as there was much to cover in a short amount of time.

A week after the presentation to North Americans, Dr. Lua gave a public health talk on the same subject to local Mexicans at the Ajijic Cultural Center.

Aging, Health & Wellness, Mexico, Palliative Care Mexico, Retirement, Senior Care Mexico

Aging – Mexican Physician Advocates Eating Less, Walking More

Dr. Jose Gustavo Valladores, President of the Gerontological Society of Jalisco, addressed a group of older adults in a meeting room at Juntos Contra el Dolor Hospital in the parish of San Bernardo, Mezquitan Country, Guadalajara, a few days ago.

Valladores, a spry, humorous, and fit 75 year old advocated eating less, walking more, sleeping about seven hours, and learning to breath slowly and deeply for a more healthful life.

Dr. Valladores contends we do not need to eat as much as we continue to age. His comments remind me of a movement afloat in senior living in the U.S. called Grind Dining, serving small, elegant portions that are easy to see, easy to consume, and easy to manage, especially for those with arthritis, dementia, etc.  Studies show health outcomes with such meals are positive.

Harvard-trained physician and gerontologist Bill Thomas of the Green Project and Eden Alternative has a not to dissimilar approach for aging well that he calls MESH. Move, Eat, Sleep, Heal.

The conversation for wellness in aging continues with this notable consensus among two gerontologists from two different cultures. A return to basics. Wise.

Dr. Gustavo y Dra Susana 21 de mayo 2016
Dr. Jose Gustavo Valladores y Dra Susana Lua Nava

Dra Susana Lua Nava, the founder of the 24/7 palliative care hospital and hospice, was Dr. Valladores’ medical school student 20 years ago.

Aging, Hospice, Mexico, Palliative Care, Senior Services

2nd International Palliative Care Congress in Guadalajara, Mexico – Oct 2015

Juntos Contra el Dolor, AC (United Against Pain) a palliative care non-profit in Guadalajara, Mexico produced its 2nd International Palliative Care Congress (II Congreso Internacional de Cuidados Paliativos) at Expo Guadalajara October 29, 30, and 31, 2015. Physicians, psychologists, social workers, tanologists, nurses, and hospice volunteers participated in a study of the theme, Health Crisis: A Threat or an Opportunity for Growth?

Juntos Contra el Dolor Palliative Care Congress, Oct 2015, Mexico
Juntos Contra el Dolor 2nd International Palliative Care Congress, Guadalajara, Mexico   October 2015

Dr. Marcos Gomez Sancho, pioneer and thought leader in palliative care from Spain’s Canary Islands, was the main speaker. He spoke of the History of Death in Different Cultures, the Agony of Death vs. Dying in Peace, and, Advice for Family Caregivers in Terminal Situations. In addition to his own conclusions, he chose quotes from poetry, music, psychiatrists, and authors, as well as art work, to illustrate his main points:

the family must allow the ill person to make their departure

the experience of the person who is dying can help those who are witnessing their passing

the worst deaths are for those attached to machines (extreme personal pain, extreme financial costs)

the care team must be inter-disciplinary for best positive outcomes (attending to psycho-social, economic, physical, and spiritual needs of patients and families)

Dr. Marcos Gomez Sancho of the Canary Islands, Spain
Dr. Marcos Gomez Sancho of the Canary Islands, Spain, thought leader in palliative care signing one of his books

Dr. Gomez played a tape of Greek singer Demis Roussos’ Morir al Lado de Mi Amor (To Die Beside My Love), which reiterates a common last wish. He also quoted Austrian neurologist Sigmund Freud, “If you want life, prepare for death.”

Here below are You Tube links to Demis Roussos’ music in Spanish and French. (The Congress heard audio only, it did not view photos):

https://www.youtube.com/watch?v=193oMUtQzGE with Spanish sub-titles

https://www.youtube.com/watch?v=S5pu-FheBAo woman admirer’s production with no sub-titles

https://www.youtube.com/watch?v=QTBQm5RWUcw  in French

Other compelling lectures included anesthesiologist Dr. Beatriz Angelica Flores Garcia’s controversial topic Morfina vs. Marihuana. She outlined how morphine and marijuana can be used for pain relief. No one on the panel of professionals, nor anyone from the audience, could agree about use of either or both, and/or effects.

Psychologist Ortencia Gutierrez Alvarez focused her talk about crisis in the family as it relates to decisions. Conclusion? Allow free will of the patient. Psychologist Fabiola Montoya Martin del Campo who has worked with youth with cancer for over 20 years shared stories of the bravery and wisdom of children facing crisis. Dr. Cristina Orendain, a well-known naturopath with a number of health food stores in Guadalajara, spoke about tryptophan for pain relief and as a mood enhancer in our food and in supplement form.

Juntos Contra El Dolor founder Dr. Silvia Susana Lua Nava, an expert in palliative care and a nun, was the guiding light behind the conference together with Sister Martina Zumaya Tamayo, a nurse nun with a specialty in bio-ethics. They offer an integrated model for Mexico including best possible professional care with support for both patient and family. They welcome persons of diverse socio-economic background, religion, age, and race at their hospital for care, counseling, or to arrange in-home services.

 

Hda. Madre Silvia Susana Lua Nava, MD
Hda. Madre Silvia Susana Lua Nava, MD

Dr. Lua offered her own account about suffering and pain as an opportunity for spiritual growth. In 2015 she experienced three invasive surgeries, one to correct a surgery gone wrong. From age 19 to 2015 she endured five other surgeries. The presentation of how she learned to confront and overcome pain and the unknown was both amusing and inspiring. Dr. Lua is also the author of a book about palliative care which shares her insights, El Enfermo: Terreno Sagrado (The Ill: Sacred Ground).

Dr. Manuel Centeno from OPD Hospital Civil Guadalajara (the new civic hospital Dr. Juan I. Menchaca) addressed the most frequent problems treating patients with cancer of the colon. Nurse Elisa Gutierrez Andrade spoke of placement and complications involved with surgically implanted PEG’s (percutaneous endoscopic gastronomy), stomach feeding tubes. In both instances, explicit photos were shown and the lessons about care were clear and convincing.

Maria de Jesus Gonzalez Romo spoke of home nursing care and a not unusual circumstance – attending to men who have two families – two “wives” and two sets of children all meeting at the man’s death bed. Gonzalez spoke of what the patient suffers physically, psychologically, and spiritually – and how survivors deal with the patient’s pain and their own. Lots of drama – anger, forgiveness, fighting – but also a lot of love.

Attendees earned 20 continuing education credits and a diploma from the Colegio Nacional de Cuidados Paliativos de Jalisco, www.comecupal.com.mx

A note about palliative care in Mexico:

The Ministry of Public Health instituted a law in 2009 that all citizens should have access to palliative care (pain relief and comfort for chronic diseases and at end-of-life). In October 2014 the Human Rights Watch conducted a study which showed the availability of palliative care is uneven and limited throughout the country. There are also politics associated with obtaining opiods. See article at http://www.ehospice.com/ArticleView/tabid/10686/ArticleId/13355/language/en-GB/Default.aspx

A note about Juntos:

As with most non-profits, Juntos Contra El Dolor relies on donors – pharmaceutical companies, the Catholic church (which provides the housing), volunteers, and others. Throughout the year Juntos hosts weekly educational activities in an effort to support its professionals and its expenses. Dr. Nava and two other nuns are unpaid. Funds for cleaning supplies, diapers, kitchen items, linens, gasoline for in-home visits, nursing staff, nursing supplies, and upgraded office equipment are always in need. Juntos is registered as an international non-profit and all donations are tax deductible by deposit to the Juntos Contra El Dolor account at ScotiaBank CTA 01002517167. More information is available at tel. (52)(33) 3617-2417, http://www.JuntosContraElDolor.com, or at juntoscontraeldolor@gmail.com.

The web site for Dr. Marcos Gomez Sancho is http://www.mgomezsancho.com

 

End-of-Life Care, Hospice, Mexico, Palliative Care

World Palliative Care and Hospice Day – A Note from Guadalajara, Mexico

Juntos Contral El Dolor team
Juntos Contral El Dolor team

I have the honor of serving as an observer at Juntos Contra El Dolor (United Against Pain), a palliative care hospital and hospice in Guadalajara, Mexico.

Its founder, Dr. Susana Lua Nava, is a graduate of the medical school at UAG (Universidad Autonoma de Guadalajara).  She did further training in the Canary Islands with Dr. Marcos Gomez Sancho, considered a highly-regarded thought leader in palliative care.

Dr. Lua, also a nun, is dedicated to creating an integrative model for Mexico which addresses the needs of not only the patient, but of the family as well.

Her non-profit produces educational seminars on palliative care for both professionals and the public.  On October 29, 30, and 31 Juntos Contra El Dolor is sponsoring a 20-hour continuing education international conference at Expo Guadalajara entitled “Crisis en Salud: Amenaza o Crecimiento?” (Health Crisis: A Threat? Or an Opportunity for Growth?).

Pain management pioneer Dr. Marcos Gomez Sancho of Spain will focus on the “Culture of Death in the Latin World”, and “Dying in Peace.” Other themes include morphine vs. marijuana, the psychological struggle in patients with terminal diseases, how the family handles a crisis and makes decisions, interventions when pain is difficult to control, nutrition, and more.

Juntos Contra El Dolor is located in the parish of San Bernardo (Mezquitan Country), known for its dedication to social justice. There is a day center for Down’s Syndrome children, a drug and alcohol live-in re-hab, a senior home, and the hospital.

Juntos Contra El Dolor serves all regardless of socio-economic standing, religious preference, age, or race.  See http://www.JuntosContraElDolor.com.

Above is a photo of the Juntos team.  Dr. Lua is in the center.