Wilka Roig: Impacting End-of-Life Care in Mexico

by Garrett Drew Ellis

INELDA is striving to live up to the first word in our name: international. As an organization, we have a deep desire to inform end-of-life work with understanding and sensitivity to  practices from other cultures, not just those we experience in North America. That is one of the reasons we’re delighted to welcome Wilka Roig, a leader in the Mexican end-of-life landscape, to our group of trainers. 

Wilka brings a wealth of knowledge, experience, and cultural insight to our work. I recently interviewed Wilka about end-of-life care in Mexico and other parts of Latin America. As one of the few death doulas in Mexico, Wilka was able to explain many of the challenges and nuances of care that she and others have to deal with there.

 

The Mexican Landscape for End-of-Life Care

“In Mexico, the primary option beyond home care is the Mexican equivalent of nursing homes,” Wilka says. “Both hospice and palliative care services are extremely limited, rarely accessible, and vastly different from what is provided in the United States.” In spite of a recent requirement for public hospitals to have a palliative care unit, there are few formally trained palliative care physicians in Mexico, and those who have been trained are stretched far beyond their capacity. The units that have been created are usually staffed by physicians who are not trained in end-of-life care, but are placed there due to their seniority or rank.

Wilka shares that a palliative care movement is fomenting within smaller, private clinics. Those in need are in rural areas; the clinics are in urban settings not accessible to most. The beauty of being in Mexico is that many of the people in the field are very kind, and are often willing to do this heart-centered work for free. 

Additionally, hospice care in Mexico is not the same as it is in the U.S. “Most of the death care within Mexico happens within the confines of the family and community,” says Wilka. “Neighbors, friends, and both immediate and extended family are all highly involved in serving their loved ones as they are dying.” The U.S. models of in-home or even inpatient hospice care are generally unavailable, largely due to lack of awareness and funding.

 

Differences Between End-of-Life Culture in Mexico and the United States 

The good side of end-of-life care in Mexico, according to Wilka, is that the culture supports dying at home for most people, as opposed to the U.S., where the large majority experience death within the confines of a hospital or clinical setting. It’s not unusual for family members to gather and take turns in the care of their loved ones. There is also a strong history of traditional and indigenous cultures within Mexico in which people continue to take care of their birthing and dying needs without any outside intervention. 

Mexico does have a social service health care system that, while slow, is available to those who want and need outside intervention. However, most people express the desire to be at home when they are dying, surrounded by friends and family. After centuries of colonization, many people have a mindset of independence, saying that access to formal care should be available to them—but not at the exclusion of the collective care from neighbors, family, and other members of the community. 

According to Wilka, Catholicism plays a large part in Mexico’s death culture. The Catholic church has the most overarching spiritual influence on the country; however, Mexican Catholicism is influenced by an indigenous worldview, burial rites, and other rituals around death. Depending on where you find yourself in the country, you may experience more or less of the indigenous influence. In some regions, you may encounter a more conservative form of Catholicism where priests are required for absolution and for what might be seen as therapy in other countries.

 

Death Doulas in Mexico

Wilka is a thought leader within the death care community in Mexico. She serves as the president of the  Dr. Elisabeth Kübler Ross Foundation in Central Mexico in Central Mexico. She also works with the foundation globally and helps coordinate the foundation’s chapters in both Central and South America. 

There are no doulas in South America, not even birth doulas. Most end-of-life movements in South America focus on development of palliative care, death education, and hospice services. But in Mexico, under Wilka’s leadership, the death doula movement is taking a different tack: supporting family and friends in their care of the dying in people’s homes, as well as green burial and land conservation. She reports that this is very much a grassroots movement, since there is no awareness about death doulas within the Mexican healthcare system. Wilka and the doulas who work with her are also attempting to create awareness around the indigenous traditions of death care that have been alive and well for centuries within Mexico. 

Working in the shadow of mainstream culture, she and other Mexican doulas are attempting to bring the doula model to Mexico’s modern health care system. Their work also helps institute advance directives and other rights that are taken for granted in developed nations. 

 

The Future of Death Care in Mexico

For a long time, Wilka was the only person who identified as a death doula working within Mexico. The team of volunteer death doulas that she has trained are attempting to change this and to make the death doula model common and accessible to all people throughout Mexico. 

Currently, there is a working team of doulas in San Miguel de Allende, where Wilka lives and works. This is a volunteer team that has received doula education and supervision that works directly with families and individuals needing doula care. Wilka and the team’s physician handle specific medical and therapeutic needs. 

Future team training has already expanded and now includes two other states and cities in Mexico, including Mexico City. “My dream,” Wilka says, “is to see teams of doulas eventually working in each of the 32 Mexican states.” This dream includes reclaiming the richness of the Mexican death culture and decolonizing the shame tied to indigenous views on death and death care that have been mostly discouraged or forgotten. For example, clay pots that adorn many homes were once part of the process of burying remains, rather than using traditional caskets. “I’m hoping that people will rediscover some of the beautiful customs of our traditional culture and see them as viable options for individuals,” Wilka says. 

Wilka Roig, MTP, MFA, PLC, is a transpersonal psychologist, ordained minister, death doula, grief counselor, dream worker, educator, facilitator, writer, and instructor of tai chi, qigong, and Taoist inner arts. She is also a musician, photographer, performance artist, silversmith, baker, and mythmaker. Wilka is president of the Fundación Elisabeth Kübler-Ross México Centro, deputy director of education of the Dr. Elisabeth Kübler-Ross Foundation Global, co-chair of INELDA’s BIPOC Advisory Council, and a new INELDA instructor, as well as an advisory board member of the Beautiful Dying Expo.