Download PDF of this full issue: v51n1.pdf (21.1 MB)

Silent Scream

By Paul Giannone

I feel it in my body. Like a parasite bouncing around looking for something to eat or an exit. This is the by-product and the flotsam and jetsam of traumatic events. I believe all who have witnessed war, natural disasters and disease control efforts such as COVID – 19 have it in some form. The mind cannot help analyzing traumatic events and sometimes in utter cruelty the mind keeps replaying them in your head. An endless loop of pain. I look at my 40 years in international public health. I worked in 35 countries dealing with war, refugees, disease control programs, landmine removal projects, often on the fringe of war zones. I try to channel these mental replays into the positive. I think of all the wonderful people I have met the beautiful countries visited in Asia, Africa and the Middle East.

But then the destructive mental analysis begins. My thoughts drift from Vietnam until now. What could I have done better? Did my decisions help or kill people? Should I have known more or studied more. In terms of disaster response, the Sphere manual had not yet been created. A helpful tool to specifically state minimum requirements for refugee or war/disaster victim's requirement for food, shelter, clothing and security.

The mental torque is amplified by the fact that I have not cried since 1970. I cried a great deal in Vietnam that year. I long for a soundproof room that I could walk into and scream until my throat bled and the simple pressure release of tears has denied me. But such things do exist. I tell people about my "war wound" and they do not seem to get it. The inability to cry hurts. I worry if something bad happens to my wife or daughter I will not be able to cry and those around me will think I am a soulless shell.

The irony is that my inability to cry worked well for me in my professional life. I spent years in desperate situations in refugee camps, mined areas and war/disaster sites. Angola, Bosnia, Cambodia, Sierra Leone and Rwanda were my work areas. But in my visits to these sites no victims need to see a crying public health advisor trying to come to their aid. You remain stoic and tough. Like in Nam, never let anyone see you afraid or scared.

I ask when will the tears come? When can I scream aloud?

Paul Giannone is a 40+ year career public health emergency responder, planner, director and author. He received a Bachelor of Science (cum laude) in Community Health Services from the State University of New York at Brockport in 1974 and a Master's Degree in Public Health with a concentration in Population and Family Planning from the University of Michigan, Ann Arbor in 1976. His public health career began "under fire" as a two tour (1969 ? 1971) Public Health Advisor with the 29th Civil Affairs Company in the Republic of Vietnam (Bronze Star, Army Commendation Medal, and the South Vietnamese Public Health Medal).