Trigger warning: Discussion of a nonfatal suicide attempt, self-harm, and depression.

I’asleep when our radio operator gently knocks on my container door. It’s 11:30 p.m. on March 1, the night before my birthday, and I’m in Malakal, South Sudan. I ask what’s going on, and he whispers, “Mike Hotel is calling!” It’s radio lingo for MSF Hospital. Ten minutes later, I’m in the Hope Center where we treat patients with mental stress and illness. Nineteen-year-old Thomas was there waiting for me, brought in by the police in handcuffs.

I’ve been in Malakal since the beginning of February. It’s the middle of the hot, dry season and the days are exhausting and the heat saps my energy. I’m the Mental Health Activity Manager for Médecins Sans Frontières (MSF), a medical humanitarian organization that’s also known by its English name, Doctors Without Borders. Between three psychosocial counselors, a translator, and me, we have our work cut out for us.

The first moments with a new patient are always the most interesting for me because you’re figuring out how to build a relationship. You have to find an access point; create trust.

I remove Thomas’s handcuffs and sit down opposite him. My translator takes a seat next to me. Everything is quiet.

My intuition tells me to keep silent. So Thomas and I, both with our heads bowed, sit there. Seconds feel like hours. I notice my translator getting nervous. It’s not an easy task for him, to be quiet. But finally Thomas looks up shyly. I smile and say, “Hello, my name is Raimund. I’m a psychologist. Can you tell me your name?”

After a seemingly endless pause, he says, “Thomas,” in a low voice.

“Hello Thomas. Nice to meet you!” I answer.

He’s just 19 years old. And he almost would not have gotten older.