On Silence

A citation from Pathologies of Power:
"Dr. Plarr was a good listener. He had been trained to
listen. Most of his middle class patients were accus-
tomed to spend at least ten minutes explaining a simple
attack of flu. It was only in the barrio of the poor that
he ever encountered suffering in silence, suffering
which had no vocabulary to explain a degree of pain,
its position or its nature. In those huts of mud or tin
where the patient often lay without covering on the dirt
floor he had to make his own interpretation from the
shiver of the skin or a nervous shift of the eyes."
Graham Green, "The Honorary Consul"

I have often found that many of the patients in the poorest situations have been difficult to communicate with because of they would not volunteer information, would not express their complaints. I never knew if they lacked communication skills or they simple did not wish to speak or complain. In the case of non-english speakers, it could have been the language barrier.

This has also been very true in this part of the world. In Papua New Guinea, one of the pharmacists remarked about how "stoic the people in this country are." People will have suffered incredible injuries or illnesses, and will not express what I would have considered "the appropriate amount of concern." One lady complaining about a headache didn't even want to mention to me her huge draining abscess-looking-thing on her index finger. I, of course, freaked out. Her response was something like, "yea, it hurts."

Initially, I thought: I guess these people would have to be stoic to put up with all the difficulties they deal with. This includes having to walk everywhere for hours at a time, the resulting knee and back pain, not having enough fresh food available, a failed social services system, the terrible terrible heat and humidity, lack of sanitation, high crime rates, etc.
However it has come to my attention that this subject has been thought about before, and I can put it no better than the eloquence of Paul Farmer (sorry it was so long its paraphrased):

You don't have to be a doctor to know that the degree of injury, of suffering, is unrelated to the volume of complaint. I have seen the sullen, quiet faces in waiting rooms in Peru, say, or in prison sickbays in Russia.
Members of any subjugated group do not expect to be received warmly even when they are sick or tired or wounded. They wouldn't expect Dr. Plarr (from above) to invite a long disquisition about their pain. They wouldn't expect the sort of courtesy extended to the priveleged.
The silence of the poor is conditioned. To describe as stoic is not to be wrong, but rather runs of the risk of missing the great eloquence beneath the silence.
~paraphrased from Pathologies of Power

I could say something here, but I will just leave this with the power of those sentences.

~ryan