With the potential to change the paradigm of end-of-life care in Mexico, the country’s first hospice care center is now under construction in San Miguel de Allende. Phase One of Mitigare Hospice Care, a three-bedroom inpatient facility, should be completed by September 2024, and the second phase, a 400-square-meter training center with a 50-person classroom, is planned for 2026.
For the last eight years, Mitigare Cuidados Paliativos A.C. has provided palliative care to patients facing terminal diagnoses in the comfort of their own homes and offered support to their families. As Les Matthews, president of Mitigare’s board, explained, “Mitigare will still provide services in people’s homes, but now, when a patient’s caretaker needs a break, or when someone lives too far out in the campo (countryside) to receive regular care, they can come to our facility for dignified, specialized end-of-life care.”
“We will continue to demonstrate that hospice is more humane and cost-effective than dying in a hospital. Most doctors at hospitals, whose goal is to cure, do not have the right mindset to treat someone who has accepted the fact that they are dying.” In Matthews’s view, they tend to keep ordering invasive tests and expensive, ineffective procedures. The facility will enhance Mitigare’s capacity to train doctors, nurses, and social workers in end-of-life care, a medical specialty that is practically nonexistent in Mexico.
Matthews has extensive experience with hospice care in the U.S. He was a partner in a company that operated five hospices and is also a founding board member of the Foundation for Hospice Care, an organization based in Kansas City. The foundation has provided US $100,000 to the Mitigare patient care fund as well as US $225,000 toward construction expenses, a grant which was conditioned upon the city of San Miguel de Allende donating the land for the facility.
The municipal government donated 1,480 square meters — nearly 16,000 square feet — of land. “We’re proud that this is a public-private partnership,” said Mitigare co-founder and board member Lee Carter. “The city’s generous donation of land is a wonderful endorsement of the project. We received the use of the land for 100 years, with taxes and permit fees included… this is the first property the city has donated for any purpose in 10 or 15 years.”
The location at Prolongación Cuesta de San José 92 near the turn-off for the Charco del Ingenio Botanical Garden is ideal, as it is both near Centro (on a road easily accessible by ambulance) and is located within a five-minute drive of both the General Hospital and MAC Hospital.
Mitigare Cuidados Paliativos A.C. was founded in 2016, growing out of an earlier version of the organization, Hospice San Miguel, which was founded in 2009. The founders include Dr. Luis Vazquez, Martha Hamill Meléndez, Vicki Stein, Dra. María de Lourdes Tejeida Bautista, a Mexican palliative care physician and Lee Carter, an American with a passionate belief in the value of hospice care. Carter’s brother, who had pancreatic cancer, died with dignity in hospice, as did both of his parents. After moving to Mexico, Carter witnessed a friend die a difficult death without pain relief and became determined to provide hospice care in Mexico.
Of Dr. Tejeida, the organization’s medical director, Carter said, “She is amazing,” adding that she is board-certified in oncology and palliative care — one of the few physicians in all of Mexico to have both of those certifications, plus a master’s degree in public health.
Mitigare’s medical team consists of four doctors, a nurse and two thanatologists, social workers with extra training in the area of grief and death. Thanatos is the Greek word for death, and therefore thanatology is the study of death.
The team of thanatologists, led by Mtra. Martha Hamill Meléndez, help family members come together to create a familial environment in which the patient can have a peaceful, dignified death. They are also trained to help family members cope with anticipatory grief. After the patient dies, the team of thanatologists continues to provide counseling to family members for an additional six months or more. “This organization provides care equivalent in quality to that of any hospice in the U.S.,” affirms Matthews.
Carter reported that 90% of patients currently using Mitigare’s hospice services are Mexicans. “We charge according to a family’s ability to pay. Approximately 80% of our families receive financial assistance from our patient care fund, for which we are constantly fundraising. Currently, the average monthly payment is 2,000 pesos, although the average cost of services is 20,000 pesos. That’s a 90% discount. We’re happy to raise the money because we believe it is so important that anyone who needs hospice care can access it.”
A primary reason that hospice care is not widespread in Mexico is that, unlike in the United States, Canada and Europe, there are currently no government reimbursements for it. In the U.S., hospice became a Medicare benefit in the mid-1980s when the government saw that it was cost-effective. There are now 5,500 hospice programs in the U.S. — one for every 65,000 people — while for Mexico’s 130 million people, there is only one. The Mitigare team is confident that as more families begin to use hospice care and they experience how helpful it is to both the patient and family, it will become more commonplace in Mexico.
“It will also be of interest to the many expats living in San Miguel de Allende,” said Matthews, “that we have obtained Medicare approval. Qualified Medicare recipients can use their benefits to receive in-patient hospice care at our new facility.”
In addition to providing high-quality hospice care, Mitigare’s mission includes training doctors, nurses and other caregivers so that hospice becomes part of the fabric of Mexico’s end-of-life care. In 2019, the organization held a major conference, training 490 medical professionals from Mexico, the U.S., the Canary Islands and Costa Rica. “The typical medical school programs in Mexico and the U.S. really don’t train medical personnel in end-of-life care,” said Matthews. “So we will. We’ll be the epicenter for that critical training in Mexico.”
Board member Laura Rodríguez recommends that readers in the San Miguel de Allende area attend one of Mitigare’s upcoming seminars on preparing legally and emotionally to reach a dignified, “good” death. Rodríguez also invites readers to view a powerful film on the topic, titled Mai Morire (Nunca Morir), which will be shown on Thursday, April 4, at 5 p.m. at the Santa Ana Theatre in San Miguel’s Biblioteca Publica.
After the screening, the film’s producer, Paola Herrera, and representatives of Mitigare will discuss hospice care. More information about these events as well as ways to make a tax-deductible contribution in support of the organization’s mission are available at mitigare.org.
Based in San Miguel de Allende, Ann Marie Jackson is a writer and NGO leader who previously worked for the U.S. Department of State. Her award-winning novel “The Broken Hummingbird,” which is set in San Miguel de Allende, came out in October 2023. Ann Marie can be reached through her website, annmariejacksonauthor.com.
