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.

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.

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? 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. Ask for 10 original death certificates and an equal number of copies translated to your native language.

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 speaking 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.

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 that there are refrigerators, no answering the phone, poor communication, etc.

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 of 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 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://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

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

Mexico Palliative Care Non-Profit Holds Festive Fundraiser in Super-Competitive Environment

Mexican non-profits have a hard time surviving. One can say many non-profits, no matter the country, find it challenging to be sustainable.

In the state of Jalisco, there are over 800 registered A.C.’s, Asociaciónes Civiles, or non-profits. In all of Mexico, there are about 4,000 registered non-profits. That’s a lot of competition in a land where philanthropy, though existent, is not part of the culture.

Juntos Contra el Dolor of Guadalajara is a remarkable entity. It is a Mexican model for palliative care and hospice. Its resourceful, enthusiastic founder and palliative care educator Dra Susana Lua Nava is an ecumenical nun. Her team serves anyone of any belief system or economic background. All are dedicated to offering holistic pain relief for life-limiting conditions or at end-of-life.

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Administration volunteer Michele Carrillo, Madre Martina Zumaya Head of Nursing, Dra Susana Lua Nava founder, Dra Karla Rebollar of Juntos Contra el Dolor A.C.

In 2014 Dra Susana Lua Nava and Juntos Contra el Dolor received the prestigious state of Jalisco IJAS award for outstanding contributions by a non-profit.

Juntos Contra el Dolor’s 24/7 humanitarian effort includes not only medical attention at its 8-bed hospital but outreach and education to 65 or more patients and their families at home. For a Mexican non-profit dependent on donations, this is an achievement. Faith in the need, faith in all possibilities, and a lot of love are components of the Juntos ability to continue despite obstacles.

Every member of the team is a volunteer except the nurses. The team consists of palliative care doctors, psychologists, social workers, chaplains, and trained volunteers.

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Four social workers, two MD’s (far right), all Juntos Contra el Dolor volunteers

Juntos Contra el Dolor held its annual fundraiser, a Fiesta Mexicana gala, on Saturday, September 24.

The nuns and volunteers led by Dra Susana Lua Nava proved to be creative and super organized.
Every detail was attended to – philodendron plants, potted geraniums, Viva Mexico banners, red/green/white flags hanging from the ceilings, red/green/white bow ties over white blouses or shirts so people would know who the volunteers were, donated chocolate cake from one of the best bakeries in town, clean white table cloths and chair covers, a tequila bar, a hand-made hot organic corn tortilla corner, and a place for photos where guests could dress like a revolutionary from the Mexican independence. Fresh quality food included 10 guisados (entrees) prepared with love and served in Mexican pottery, a rarity at charity events in Jalisco. And, there was a romantic singing group Los Bohemios, plus an all-girl mariachi band dressed in hot pink and silver!!  A lively event and fun for all.
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Sweet volunteers Lola, Maria, and Nena
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Volunteer Juan with his lovely, sensitive mother – his father, her husband, passed away at Juntos Contra el Dolor in June 2016
beautiful Mexican ladies of the San Bernardo parish
beautiful Mexican ladies of the San Bernardo parish
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junior guests
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All-girl mariachi band from Guadalajara

Juntos Contra el Dolor provides weekly consultations in a donated space in San Augustin, a suburb to the west of Guadalajara. By January 2017 there will  be consultations for those suffering from pain at Lake Chapala, an hour from Guadalajara. The offices will be in the Church of San Juan Batista in San Juan Cosala.

As mentioned, the non-profit stays afloat by donations – usually in-kind support such as diapers, linen, paper supplies, fresh organic food, and new medicines.At the following link you can read what is needed and where one can make donations.  http://juntoscontraeldolor.com/Donaciones/don.html

Dr. Lua received three years of specialized palliative care training in the Canary Islands with Dr. Marcos Gomez Sancho, considered the leading palliative care physician and professor of the Latin world. Dr. Lua is a thought leader for Mexico, and author of  El Enfermo: Terreno Sagrado  (The Ill: Sacred Terrain).

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

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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.