One of the things that intrigues and saddens me is the transition I note in the medical records of a young girl as she grows into womanhood.
Initially most girls attend the GP for simple coughs and colds. All is rosy. A little paracetamol makes everything alright. She is her parents’ cute little thing with no cares in the world. She skips about the clinic curious about everything, as healthy as can be. The snuffly nose is likely viral and not needing anything done other than paracetamol for a slight fever.

She attends again just as she starts puberty. She is with mum and suddenly she needs 6 months of antibiotics to keep her acne at bay. No matter how I reassure her that her spots are an expected outcome of growing up and nothing to worry about she is adamant that they are ruining her life and must be fixed ASAP.

Four months down the line, we are discussing contraception and she seems to have turned into this stranger who can barely smile. Her heavy and inexpertly applied mascara discloses that she is getting initiated into womanhood. Who is this male that will not let our little girl enjoy the simplicity of girlhood? I miss her innocence!

How can I tell her that it’s just too early to start ingesting all sorts of hormones?

How can I make her understand that this is the time to study and build a solid foundation for her future? I mention gently that she doesn’t have to feel obliged to have sex at 14 years but she looks strangely at me and huffs ‘I am the only one not having sex yet in my class!’

She visits me all the time now. She keeps forgetting to take her contraceptive pill, she can’t stand the contraceptive injection, ‘Wouldn’t it make me fat?’ She screams when I suggest it.

‘The coil then?’

‘No! I don’t want anything down there!’

‘What of an implant in your arm?’

‘Does it hurt?’ she asks fingering the tiny rod I have shown her.

‘No we will numb the area and pop it in. You won’t feel a thing.’ She is happy with that.

I ask about school.

‘They are nuts!’ She replies.

She attends again. I smile when I see her name on my screen. I call her into the consulting room. She walks in with ‘my boyfriend.’

‘Who?!’ I silently scream.

‘Where is mum?? Who is this boyfriend?’

I keep my questions to myself and force myself to listen.

The tests are back. My little no-longer-so little girl has Chlamydia! I am furious but cannot show it. I give them both treatment and sternly explain the importance of using condoms with new sexual partners.

I wonder again about school.

She is wearing her school uniform concealed under a jacket that looks like a man’s one. I notice it is creased and slightly too short and too tight for her. Does she look tired or is it my imagination? Has she been home at all? I wonder.

She attends two weeks later, unable to pee.

‘What’s wrong?’

‘It is so sore and I have got rashes all over my pussy!’

She has Herpes this time around. ‘Boyfriend needs to be treated as well,’ I explain as I pass a catheter to drain her bladder.

‘Stupid man! He left me! ‘Her Lips quiver as she tries not to burst into tears.

‘Sorry to hear that.’

I am silent as I finish up and remove the catheter.

She is back in three weeks. We can’t find her period!!

‘What of the implant?’

‘Oh I attended last month and took it out.’

‘Seriously?! But I thought boyfriend was at large….’

‘I have a new partner. He is so gorgeous! We are going to have a baby’ she explains excitedly.

I am completely stunned.

I prescribe folic acid and book an appointment for the midwife.

I feel foolish for asking about school. I don’t want to dampen her joy. Am I old fashioned? Have the times left me behind? At sixteen, I was neck deep into my Science books not necking with a bloke. The last thing on my mind then was having a baby.

She attends with her new bloke two weeks later. ‘We want a termination’ he explains. ‘We are not ready for a baby yet.’

She doesn’t say much. She clutches his hand as if it is her lifeline. I look at her and feel hopeless. Her mascara is smeared around her eyes that look so tired. She has been crying.

I need to be sure this is what she wants. She nods her agreement when I ask her directly. I desperately search for my little girl in the eyes that I look into. A stranger stares back at me. I arrange an appointment at the TOP clinic.

She returns not too long after. I anxiously look at the corridor as I let her into the consulting room. Surely she is not alone, is she?

She cries her heart out. I offer tissue after tissue. She has symptoms of mild depression. I counsel her. I recommend ‘Beating the blues’ ‘mood gym’ or what about a nice book at the library? ‘I don’t know where the library is,’ she replies.

I am about to suggest more but she cuts me short, impatiently.

‘My friends say I need antidepressants.’

Your friends!!? Are they doctors by any chance?

We reassess next week. She is adamant that only tablets will fix her mood. She will cut herself if I don’t do something.

‘Cut?’

She rolls up her sleeves and shows me tiny shallow cuts on her arm.

‘Why?’ I ask, ‘what will you do in summer when it’s time to wear short sleeves? How will you hide your self inflicted scars?’

I refer her to the psychiatrist.

She is started on medication.

It’s been twenty years.

My little girl has turned into a bitter hardened woman with alcohol as her closest companion.

We are trying to save what is left of her liver.

‘Please stop drinking so much,’ I plead.

‘Why?’ She spits.

I am on a home visit but there is nowhere to sit.

Clutter all over. I can easily count up to 10 empty bottles of beer.

‘What of work?’ I ask desperately hoping for a tiny ray of sunshine.

She laughs at my stupidity.

Her ‘friends’ come in.

‘Please leave now,’ she asks as the two men sweep off clutter from the sofa unto the floor so they can sit.

The three of them light up their cigarettes laughing at nothing. They seem like zombies.

I want to scream at them, to leave my little girl alone but as I open my mouth to speak, I gulp in smoke, I choke. My eyes burn. I feel like they are receding into the distance. I can still see them laughing but I can’t hear any sound. Am I going crazy?!

I run out into the street and greedily inhale some fresh air.

Sadness engulfs me. Longing for what should be threatens to overwhelm me.

When the call comes, I am not shocked. ‘We found her in a pool of vomit,’ says the police man. She may have choked on her own vomit, they think.

‘We need a doctor to come and PLE,’ he asks.

I find a reason not to go. I have a migraine. I plead with my colleague to go.

I want to remember her as she was many years ago. Bubbly, full of life, excited about everything… Not stone cold, covered in vomit.

RIP my little girl.

What can we do to keep our young girls from sliding into these patterns?

Where are the fathers?

Where are the mothers?

Where are the big sisters?

Where are the big brothers?

Where are the leaders?

Where are the heroes and heroines our girls can look up to?

It is indeed an epidemic of lack of decent role models.

How many more of our young people shall we lose before we find the role models?

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Dr Adaeze Ifezulike is a Family Physician/GP who is passionate about healthy lifestyles, weight management, optimising sexual health and wellbeing particularly among women and youths. She is the author of ‘Medicine abroad: compulsory for medics trained outside the western world’ https://amzn.to/2tUCdX6 and ‘Understanding contraception’, an Amazon Best seller.