Teaching, Treating, and Bearing Witness in Tegucigalpa
By Lawrence Robbins, M.D.
(Patient details have been changed to protect privacy.)
In early August 2018, we began the groundwork for something long overdue: a headache education program in Tegucigalpa, Honduras’ capital city. The goal is simple but powerful—teach Honduran physicians how to diagnose and treat migraine and other headache disorders, so that care continues long after we leave.
The program will be based at the public teaching hospital, where Dr. Sofía Dubón, an exceptional neurologist and epilepsy specialist, is launching a small headache clinic. I’ll support her as it gets off the ground. If successful, this effort will help countless patients for years to come.
Familiar Faces, Real Impact
One of the first patients I saw was a woman I had treated months earlier. In March, she had stumbled into the clinic post-seizure after experiencing one on the bus—one of 20 seizures a month. We switched her to a medication we bring with us, and by August her seizures were down to about one per month.
She told me she planned to bring me a gift: one of her mountain chickens.
After several bus transfers, she arrived proudly carrying a large bag. I quietly told our interpreter I had no idea what to do with a chicken—especially on a plane home.
Inside the bag? Cucumbers from her garden.
Relief all around.
Children and Neurology: The Hardest Cases
I saw multiple children with severe neurological conditions—many the result of birth injuries, which are tragically common due to limited prenatal care and restricted access to emergency C-sections.
Two children with severe seizure disorders were essentially non-verbal and immobile. Their mothers were deeply devoted. One refused a cheaper medication and said simply, “Give him the best.” The family spends half their income on his medication.
A 10-year-old girl with seizures, ADHD, and learning disabilities stemming from oxygen deprivation at birth cannot afford medication. We supplied what we could, but support services and tutoring are extremely limited.
A 14-year-old boy experiencing two to three seizures a day had no access to medication at all. We provided Keppra, which we supply and which does not require blood tests—often an insurmountable barrier here.
Each uncontrolled seizure costs brain cells. Over time, you can see it in patients’ faces—the blankness, the dulling. It’s devastating.
The Reality of Limited Resources
Much of my work here is a constant balancing act: what is medically ideal versus what is possible.
Blood tests are expensive. Imaging is often unavailable. Many newer medications are out of reach unless we bring them ourselves.
I saw:
Patients with epilepsy who have been on older medications like Dilantin or phenobarbital for decades—medications with serious long-term side effects.
A man with Parkinson’s disease placed on the wrong medication entirely, likely due to limited options.
A woman with migraines taking a dangerous drug given her severe hypertension—treatment choices shaped by cost, not safety.
We do what we can: toothbrushes to combat medication side effects, multivitamins when affordable, careful medication choices that avoid the need for ongoing lab monitoring.
Mental Health Without a Safety Net
Mental health care is particularly fragile here.
I met:
A young man with untreated bipolar disorder and likely schizoaffective illness, dependent on a family overwhelmed by managing complex medications.
A 39-year-old woman with frontotemporal dementia, devastating at her age, cared for entirely by her sister.
A teenage boy with years of suicidal ideation, aggression, and emotional disconnection—his family terrified and exhausted.
There are few institutional supports. Families simply absorb the care.
Beyond the Clinic
Next door to the clinic is an orphanage. We spent time with the children there—resilient, affectionate, and startlingly self-sufficient. I watched them resolve conflicts without adults intervening.
The playground felt like something out of the 1960s—rough, imperfect, a little dangerous. It made me realize how protected children are in the U.S. This orphanage, despite limited resources, offers one of the safest environments many of these children will ever know.
We also watched groundskeepers cutting grass with machetes, teaching older kids alongside them. It’s cheaper than a lawnmower—and it works.
Why This Work Matters
Over and over, I am struck by the resilience of the Honduran people—especially women who have raised many children, sometimes losing one or two along the way, yet continue forward with strength and dignity.
This work isn’t just about treating headaches or seizures. It’s about building capacity, sharing knowledge, and offering continuity where there is often none.
Dr. Dubón and I trade patients, notes, and handwriting—hers legible, mine classic doctor scribble. We make it work.
Until next time…
Adiós.
— Larry R.