Today was another busy day at the Family Medical Clinic in Kondavil. Together with the registrar in Family Medicine, I was seeing the usual stream of patients—headaches, backaches, follow-ups for chronic illnesses, and plenty of medication adjustments. Just another day in primary care—or so I thought.
Among the patients was a 16-year-old schoolgirl, accompanied by her warden. Dressed in her school uniform, she looked visibly anxious. Her stated complaint was dysmenorrhoea—period pain. Two of our medical students had already begun taking her history and were presenting the case in the consultation room, which was bustling. Including myself, the registrar, the two medical students, and the patient, the room felt quite full. The warden waited outside in the reception area.Sensing that the environment might be overwhelming for her, I quietly stepped out and asked the registrar and the two female students to continue the consultation in a more comfortable and private manner. I felt instinctively that she would be more at ease speaking with female caregivers.
Shortly afterward, the registrar updated me. The girl had no significant physical symptoms of dysmenorrhoea. It turned out that her refusal to attend school had little to do with her periods. Underneath this seemingly routine complaint was a much deeper and more troubling picture.
She had a history of severe low mood, expressed a loss of interest in daily activities, and, alarmingly, had previously attempted to take her own life—once by ingesting pills and another time by cutting herself. The scars on her forearm told their own story. She was apparently very unhappy staying at the boarding house. Her background was marked by hardship—she came from Pungudutivu, from a family struggling with poverty, and her sister too was attending the same school.
When I later spoke with the warden, she described the girl as quiet, non-violent, and withdrawn. She frequently refused to eat or attend school and would sometimes go home and not return, citing financial reasons.
Recognizing the gravity of the situation, I discussed it with my team. There was no time to delay—we made an urgent referral to the Consultant Psychiatrist. I personally contacted the psychiatrist, who kindly agreed to see the girl immediately. We ensured she left with a proper referral and followed up with her warden to confirm she had made it to the clinic.
What began as a vague complaint of abdominal pain turned out to be something far more serious—a cry for help. We may never fully know the impact of that consultation, but I believe we may have helped save her life that day.
As a family physician, I am reminded again and again that our role extends beyond the symptom checklist. We are here not just to diagnose and prescribe, but to listen, to probe gently when things don’t add up, and to care for the whole person—and often their family too. Adolescent depression is a growing issue, both in Sri Lanka and globally, and it is frequently missed.
This time, we caught it. And I am grateful.
Grateful for the opportunity to serve. Grateful for the training that helps us look beyond the obvious. And grateful for the chance to practice a kind of medicine that touches lives in ways the textbooks don’t always teach.
Dr. Shane Halpe - SR Family Medicine
05.06.2025
#FamilyMedicine #AdolescentMentalHealth #PrimaryCareStories #RuralHealth #SriLankaHealth #CompassionateCare #MedicalReflections #YouthDepression #HiddenStoriesInHealthcare #KondavilClinic
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