Nursing Care and Context in Theresienstadt. Barbara L. Brush. Over the past 5 years, nurses'roles as caregivers in ghettos and concentration camps during the.
Western Journal of Nursing Research, 2004, 26(8), 860-871 Western Journal of Nursing Research December 2004, Vol. 26, No. 8
Nursing Care and Context in Theresienstadt Barbara L. Brush
Over the past 5 years, nurses’roles as caregivers in ghettos and concentration camps during the Third Reich increasingly have become the subject of interest. Historians have focused particularly on the ethical dilemmas of caregiving practices that often deviated from normal care standards and situations. This article examines nurses and their work in one concentration camp, Theresienstadt, to demonstrate that even under the unique and horrible conditions of camp existence, contextual differences between camps provided nurses with different difficulties and opportunities. Although an extreme example, this article demonstrates the critical link between care and context as nurses practice across various settings and situations. Keywords: nursing; Holocaust; caregiving; concentration camps
Over the past decade, increasing scholarship has focused on women’s experiences during the Holocaust. Works by Baer and Goldenberg (2003), Fuchs (1999), Gurewitsch (1998), Ofer and Weitzman (1998), Owings (1995), Rittner and Roth (1993), and Tec (2003), for example, examined women’s roles as victims, conspirators, survivors, bystanders, and resistors before and during the Third Reich. Several historians have turned their interest to women’s roles as caregivers in ghettos and Nazi labor and extermination camps. The narratives of women in Ritvo and Plotkin’s (1998) Sisters in Sorrow: Voices of Care in the Holocaust provide riveting testimony of women’s compassion to others while struggling to survive under inhumane circumstances. Brush (2002) broadly examined nurses’ roles in ghettos and concentration camps, while Benedict (2003a, 2003b) focused on nurses’ work in Ravensbrück and Hadamar. Lagerwey (1999, 2003) and Martin (in press) explored the complex ethical dimensions of caregiving at Hadamar, Auschwitz-Birkenau, Bergen-Belsen, Ravenbrück, and Theresienstadt. These analyses demonstrate, in powerful and poignant ways, how context shapes and defines care, even under extreme conditions. Barbara L. Brush, R.N., Ph.D., F.A.A.N., associate professor, William F. Connell School of Nursing at Boston College. DOI: 10.1177/0193945904265333 © 2004 Sage Publications 860
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As this article demonstrates, even caring among the various concentration camps differed by virtue of the camp’s composition and purpose. Nurses in the concentration camp Theresienstadt, for example, considered their situation the “lesser of many evils” in contrast to their experiences in other camps. The differences between camps created marked differences in the ways and means for caregiving. This article focuses specifically on the experiences of nurses in Theresienstadt as a dramatic example of nurses’ resilience in the line of duty. Initially built in 1780 as a fortress for Austrian emperor Josef II, and later used by the Austrian army as a garrison town through World War I, “Terezin” was unique among the many concentration camps established by the Nazis to relocate, imprison, and/or exterminate millions of people during the Third Reich.1 In 1941, the Schutzstaffel (SS) declared the newly named Theresienstadt to be a “privileged” camp for Jews, a model prison intended to fool skeptical outsiders that inmates there were being well treated. Nazi propaganda spread the rumor that Theresienstadt was a “Jewish paradise” or settlement where relocated Jews could live peacefully among themselves, in a city of their own (Owings, 1995). One particularly successful campaign convinced elder Jewish Germans to make significant financial investments for a special place in the Theresienstadt “spa,” touted as an upscale “Ghetto for the Aged” (Lederer, 1983, p. 39). When the camp subscribers arrived, expecting to be escorted to their luxurious accommodations, they were greeted instead with the camp’s reality; Theresienstadt was a transit camp, or brief stopover, for many on their way to the gas chambers of Treblinka, Majdanek, and Auschwitz-Birkenau (Lustig, 1991). As an army post, Theresienstadt comfortably accommodated between 3,500 and 4,000 soldiers and 3,000 civilians among its 219 houses and 14 barracks (Adler, 1960). As a ghetto, Theresienstadt interned an average of 35,000 prisoners, with numbers reaching as high as 58,491 in September 1942 (Lederer, 1983). Cramped and unhygienic conditions bred illness and severe shortages of clean water, medicine, and food. Caregivers were soon critical to the comfort and survival of Theresienstadt’s large population. “I TOOK UP MY DUTIES.”
Perhaps the most in-depth first-person account of nursing in Theresienstadt is Resi Weglein’s (1988) Als Krankenschwester im KZ Theresienstadt: Erinnerungen einer Ulmer Judin (I Was a Nurse in Theresienstadt: Memories of a Jewess from Ulm). Written immediately after
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her 3-year internment in the camp (1942 to 1945), and reproduced years later with her sons’ permission, it is a key representation of female narrative in Holocaust historiography, and an important recounting of the meaning and practice of caregiving in the camp. Weglein and her husband were transported from their home in Ulm, Germany, to Theresienstadt on August 21, 1942. Loaded into a cattle wagon with 16 others, they arrived at the Bauschowitz train station the following day and were forced to walk 2 hours to the camp. There, they were herded through the “schleuse,” a collection point where deportees were registered, counted, searched, looted, and then routed either to camp for work or to a deportation train to the east (Lederer, 1983). The term schleuse was introduced by the SS as camp language in January 1942 to represent the function of a “sluice,” an artificial conduit that carries a flow (usually water) through a channel controlled by a gatekeeper (Oxford English Dictionary, n.d.). In the schleuse at Theresienstadt, the very old, the very young, and the very sick were funneled toward extermination; healthy prisoners were selected to remain in camp as new workers (Adler, 1960). Weglein (1988) vividly described her impression of Theresienstadt as she left the schleuse for one of the camp’s barracks, or kasernes. Each barrack was renamed after a German town, housed a specific population, and harbored its own reputation (Lederer, 1983). The Hohenelbe kaserne, for example, housed primarily older and sick inmates and became the main hospital and operating room area. Magdeburger kaserne was the central barracks for more privileged prisoners and prisoners with camp administrative responsibilities. Kavaliers kaserne, described by Weglein as a dark log house and one of the worst barracks, housed blind inmates from Berlin and the mentally insane. The Hannover and Sudeten kasernes were for men, while the Dresden kaserne, where Weglein eventually met up with her mother-in-law Bela, held thousands of women and children from all walks of life. Weglein likened the Dresden barracks to an “inferno” without lights, toilets, heat, food, water, or furniture. Its attic space was accessible by stairways with heavy wooden beams overhead and, because footing was treacherous in the dark, many older prisoners attempting to climb the attic steps fell and broke their hips within hours of their arrival (Weglein, 1988). The stench of feces, urine, and body odor in the packed and chaotic environment only added to the fear and confusion of the situation. Weglein and her mother-in-law found solace in each other’s comfort and probably recognized early on the importance of caring for and being cared about. Within days of her arrival, Weglein enlisted the aid of two others in organizing a
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makeshift “hospital” in one of the barrack’s rooms to care for the mounting numbers of seriously ill. They worked 18 to 20 hours a day providing care within their limited means and managed to find some mattresses to ease patients’ discomfort from lying on the stone barracks floor. In the early weeks of her internment, Weglein (1988) reported that five to six people died each day from complications of serious diarrhea. Suicide also claimed many lives as individuals jumped from barrack windows to their deaths. She recalled that she and others, despite being there a matter of days, had already “become so hard that we admired without pity, and sometimes with envy the courage of those people [who jumped to their deaths] and certainly we didn’t try to bring them back to life” (Weglein, 1988, p. 30). According to Adler (1960), 273 suicides and 211 attempted suicides were registered in Theresienstadt during the period in which Weglein noted her observation. Weglein (1988) later expressed shame at her own despondency and thoughts of suicide when she first encountered Theresienstadt’s horrendous camp conditions. Focusing on her nursing work, she confessed, forced her from giving in to despair: To work for the sick helped me find my way back. Very soon I recognized that I had to go through this hard time to get internally free. I had to go through all the misery, suffering, and sickness myself to be for others what I had imagined to be a nurse. (Weglein, 1988, p. 30)
Within a week of arriving in Theresienstadt, Weglein met nurse Emma Herzog. Herzog, who would die 3 years later of tuberculosis, took turns with Weglein standing in long lines to acquire food for their patients, while the other stayed behind to minister to the sick. They managed to get hold of wash basins and chamber pots and carried water back to the barracks several times daily from a water pump in a central courtyard. During her trips, Weglein (1988) remembered a “terrible smell” emanating from the courtyard; she later discovered that dead bodies were stored in a room next to a room full of potatoes meant for prisoner meals, both decaying in the warm days of summer and early fall. The nursing work was grueling, exhausting, and never ending as continuous transports brought thousands of new people to the camp each week. As Weglein (1988) put it, “Theresienstadt was a big infirmary . . . no place on earth could have shown so many sick and crippled at one time” (p. 32). Lederer (1983) noted that by 1942, 30% of the camp’s total population was sick with scarlet fever, typhoid, diphtheria, polio, or encephalitis. A terrible plague of flies in the late summer gave way to bitter cold by the end of October 1942, causing constant discomfort in the first instance and frostbitten
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fingers and toes in the latter. As the cold weather persisted and people huddled together to share warmth, they also shared body lice. There were, unfortunately, few caregivers available to care for the mounting ill and diseased. THE LESSER OF MANY EVILS
Hana Muller Bruml arrived in Theresienstadt from Czechoslovakia in late 1942 and was recruited almost immediately to work in the camp hospital by a physician hanging out a barracks window (Ritvo & Plotkin, 1998). Her arrival and willingness to nurse also corresponded to the period when the Nazis ordered all physically able prisoners to work. As part of this mandate, prisoners were organized in groups of 100 and given specific work tasks. According to Weglein (1988), most women worked as part of a “team of cleaners” (p. 38) whose job included, among other things, cleaning the camp sick rooms and toilets. Men were usually relegated to “play horse,” or perform tasks involving heavy lifting, along with sweeping the roads. Adler (1960) reported that the average work week was 69 hours, and few were exempted: “Every healthy ghetto-inmate, able to work, aged 16 to 60, no matter if man or woman, was subject to compulsory labor” (p. 376). After completing 4 to 6 weeks in their initial positions, prisoners could renegotiate work roles from menial labor to jobs in which they had previously worked; men often returned to work as bank tellers, craftsmen, and administrators. Women, who often had no prior out-of-home work experience, began to choose nursing even though many had no former nurse training. Whether trained or conscripted, however, nurses’ stories reflect similarities in their efforts to provide care with limited supplies and resources, as well as with considerable discomfort and risk. Bruml was assigned to nurse in a barracks housing children with infectious disease. She and the other mostly untrained nurses “did everything” from serving food, washing dishes and floors, making fires, disposing of patients’ urine and feces, to entertaining. “We didn’t have disinfectants,” she noted, “all we had was us, kindness, and trying to bathe the children” (as quoted in Ritvo & Plotkin, 1998, p. 30). Ruth Reiser was transported to Theresienstadt in June 1943. A trained nurse in a Jewish hospital in her native Czechoslovakia, she was immediately assigned to nurse in the Theresienstadt hospitals. Among her duties were washing patients, making beds, delivering food, and dispensing the limited amounts of medications. Although these nursing functions essentially mirrored traditional nursing job responsibilities during this period, the
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duress under which she and others worked was magnified many times over by their own status as prisoners and their exposure to risk of disease and death. As Reiser noted: “The hospital was very overcrowded . . . there were very few things which a normal hospital would have . . . no bathrooms . . . in spite of this, everybody tried to do the best for the patients” (as quoted in Ritvo & Plotkin, 1998, p. 69). Similar to Reiser, Ruth Knopp also arrived in a transport to Theresienstadt in the summer of 1943. A nurse in Berlin’s Jewish Hospital before deportation, Knopp’s initial work detail was in the camp’s lumberyard and later the laundry facility. During her latter assignment washing contaminated clothing and sheets, she contracted hepatitis and pneumonia and was sent to recuperate in the hospital. There, she was recruited to nursing, a job Knopp attributed to saving her life. As camp conditions worsened, she recalled more than 50 years later, nurses became increasingly important to camp life, such that they were often excused from transport to extermination camps: “Being a nurse saved my life. . . . they needed us there. . . . I was never selected for one of the many transports going from Theresienstadt to Auschwitz” (E. Benson, personal communication, May 23, 1997). Between 1941 and 1945, 140,000 men, women, and children from Czechoslovakia, Germany, Austria, the Netherlands, Denmark, Slovakia, and Hungary were deported to Theresienstadt. Of these, 34,000 died of starvation, 83,000 were sent to extermination camps, and countless others died from illness or suicide (Ritvo & Plotkin, 1998). Thus, even if nurses such as Knopp were initially spared transport to Auschwitz or other extermination centers, they were at daily risk for morbidity and mortality under the sparse and inhumane conditions of camp existence. An undated, unsigned letter to the International Council of Nurses (ICN) provides a rare outsider view of the dreadful conditions under which nurses labored and lived (The Czechoslovak Nurses, n.d.). The anonymous nurse author of the letter, titled The Czechoslovak Nurses and Health Staff during the War and Occupation, told of her experience as a nonprisoner nurse volunteer in the camp: When the first team of gallant nurses succeeded in entering the infamous Nazi torture chamber in Terezin, they came across unbelievable things. All the prisoners were terribly neglected, thin to the bone, lousy, unshaved, bitten by millions of fleas, most of them infected with typhus, typhoid, and other diseases, and with infected wound and bedsores. Our English colleagues may well imagine what it means to work in hot May days covered with rubber overalls. But our nurses, pupils of our training schools, who volunteered first for this duty, have overcome all the difficulties by their enthusiasm and superhuman effort. At the side of the doctors, they fought bravely filth, disease, and typhus and typhoid epidemics.
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This poignant letter, along with nurses’ memoirs, clearly demonstrate that nurses’work was a constant uphill battle against dysentery, tuberculosis, vermin, starvation, and infection. In the summer of 1943, Weglein (1988) described the massive infestation of “bugs and fleas” in all the barracks and the temporary but ineffective extermination process. Infectious diarrhea was associated with high mortality; Adler (1960) reported that 4,912 people in Theresienstadt died as a result of enteritis in 1942, 2,787 in 1943, and 671 in 1944. More interesting, Weglein (1988) mentioned the greater survival of patients in 1944, attributing it to prisoners’ physiologic and psychological adaptation to the severity of camp life, combined with the distraction of hard labor. As she put it: One had got used to the difficult life; one didn’t care when the bedbugs fell into one’s face in the night. The hunger still was worst, but as one was only a skeleton, one didn’t need a lot of food anymore, because the stomach had adapted to the conditions. One was content to a certain extent, when one could get up every day and hoped that it wouldn’t get even worse. The work was a real blessing; on duty one didn’t have the time to think. (p. 54)
Despite the Herculean efforts of nurses, physicians, and other caregivers across the camp hospitals, morbidity and mortality remained very high, especially among older prisoners. Abraham P., then age 21, reported that he had typhus so severely that he lost 80 pounds, could not sit down or walk, and lost his hair: “I was just bone. Period. There was not even a piece of flesh” (as quoted in Greene & Kumar, 2000, p. 206). Although Abraham survived the devastating effects of typhus, thousands of others died from similar diseases or through Nazi design. Weglein (1988) recalled, for instance, that the insane in Kavaliers kaserne were particularly vulnerable to midnight raids by the SS: “Time and again, the SS gave orders to take the people from their beds, and to load them on wagons without clothes and food. One never saw them again . . . but the screaming of these people still was in the ears of the nurses for weeks” (p. 28). One can well imagine the prisoner’s physical and mental states on November 11, 1943, when all camp inhabitants were assembled after an official census showed 50 missing people among the nearly 40,000 prisoners. Gonda Redlich recalled that the entire camp, except for the sick, assembled in a large, open field to be counted. He and others stood for 16 hours, from 7 a.m. until 11 p.m., and were repeatedly counted “as if we were cattle or sheep” (as quoted in Freidman, 1992, p. 135). Arnost Lustig (1991) testified that “eighty-year-old women and men, the sick, invalids, children and babies-everybody” (p. 18) lined up for general
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counting on a former military exercise field on the rainy, foggy, and windy morning of November 11, 1943. Beginning at 4 a.m., the prisoners were marched out to the field and arranged in groups of 100, in 20 lines of 5 rows each. Surrounded by machine guns and low-flying aircraft, the prisoners stood in their designated spots until counting began at 1 p.m. in the afternoon. The count was repeated many times by SS men who could not agree on the overall total. Prisoners were not fed or given water, and many dropped where they stood, including a woman who gave birth to her child. When the order came to return to the ghetto around midnight, it was raining heavily, and people ran as quickly as possible, trampling to death many older people, women, and children. In the aftermath, Lustig (1991) recalled, “Some 300 people remained in the rain-soaked grass until morning, dying, sick, exhausted, and finally, dead” (p. 18). Weglein’s (1988) memory of November 11, 1943, lies somewhere between Redlich and Lustig’s recollections. She was working in the barracks hospital on November 10, 1943, when all Theresienstadt occupants (she thought 30,000) were ordered to walk, regardless of age, and line up for a census count at 6 a.m. the following morning. They were forced to march 2 hours to the Bauschowitzer Kessel, an open area between Theresienstadt and the Bauschowitz Railway Station, for the count. Only 500 bedridden people were exempted, along with 10 nurses who were to stay behind and care for them. All other sick people deemed able to walk were forced to participate. Weglein was among the 10 nurses who remained in the barracks. She worked 27 hours without a break but considered that a better alternative than the march. Talking to others later, she discovered that prisoners had to stand on the same spot for hours, even urinating and defecating there. Aircraft flew overhead, and machine guns lined the field, creating an atmosphere of fear. She remembered that when the prisoners returned to camp around 10 p.m., they were “hunger-stricken and frozen stiff” (Weglein, 1988, p. 43) and that hundreds of elderly died of pneumonia as a result of long-term exposure to the cold and damp. Despite stories such as these, however, Theresienstadt was deemed “the lesser of many evils” among many nurse camp survivors (Greene & Kumar, 2000, p. 78). Ruth Reiser noted that for the “old people, people over sixty, there was no chance; but for younger people ‘it wasn’t that bad’” (as quoted in Ritvo & Plotkin, 1998, p. 75). Sent to Auschwitz from Theresienstadt, she noted, “compared to what came after, Theresienstadt seemed like heaven. There was still a certain dignity allowed to you; you were dressed in your own clothes; you could speak with others without restrictions; you tried to read, to think” (p. 73). Golly D. (as quoted Ritvo & Plotkin, 1998) a nurse
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working in the Berlin Jewish Hospital before her deportation to Theresienstadt on May 31, 1943, described her year and a half in Theresienstadt as “bearable” in comparison to her later internment in Auschwitz: “[In Theresienstadt] food was scarce but we were allowed to keep our own clothes. We looked civilized. There were little shops and there were lots of cultural activities. But this was also an illusion . . . in fact, the whole camp was a façade” (p. 79). CARE: LABOR OF LOVE OR LABOR OF LIFE?
There is striking linkage by nurse survivors between maintaining one’s identity and survival in Theresienstadt. Weglein (1988) named the patients and nurses in her memoir, describing their unique characteristics and personalities. This is in sharp contrast to memoirs by survivors in other camps, where identities were fundamentally lost to shaved heads and threadbare cotton pajamas. In Theresienstadt, unlike other camps, families and friends were often together, at least for short periods before deportation, so that caring bonds were created and prevailed even under the dire circumstances of camp life. In other words, because people stayed longer in the camp, they had the opportunity to develop relationships. Much as nurses develop close ties with their patients through their time-dependent interactions, nurses and patients in Theresienstadt also formed therapeutic attachments. It was the ability to care that many nurses in Theresienstadt equated with their own survival, either because they were deemed, at least initially, to be essential workers or because it gave them purpose. Weglein (1988) noted, “In difficult times you have to ask God for work and the people you may live for. Life in itself is nothing. To live for something is everything” (p. 14). Eva K. knew realistically that she “helped people get well so that could go into transport” but felt that at least she provided care and kindness to those who most needed it. Similar to Weglein, she worked long hours, 6 days a week, with night duty every third day. When one of the other nurses was sick, she worked even harder (Interview, Eva. K, 1986). Gertrud Groag described the physical strain of heavy lifting and the psychological strain of knowing that she was “helping save the lives of Hitler’s potential victims” (as quoted in Gurewitsch, 1998, p. 242) while continuing to provide care as best she could. Although there is no clear evidence to substantiate that nurses enjoyed improved quality of life over their fellow prisoners, there were minor amenities that may have assisted their survival. For instance, in April 1943,
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Weglein and 28 other nurses shared seven bunk beds in the “nurses’ room” in the Dresden kaserne. Forming a special bond, they cared for each other and became a tight knit group. They had access to warm water and baths when many others did not. Until October 1944, the nurses remained together while thousands of prisoners were transported from the camp. At that point, workers who had been previously exempted from transport, such as physicians and nurses, were then selected. Seventeen of the 28 nurses with whom Weglein lived were sent to Auschwitz in October 1944, accompanying their husbands, parents, or children. They were part of the 18,404 people sent to Auschwitz in 11 transports between September 28 and October 28, 1944, leaving only 11,077 (mostly women) inmates in the camp (Adler, 1960). Weglein (1988) recalled, “the ghetto at the end of October was very empty. While in the first year one couldn’t get out of the way of the people, now there was space for everybody” (p. 51). Only five nurses remained from Weglein’s original group of 28 to care for the remaining sick left behind. The nurses were ordered to relocate their sick rooms from the Dresden kaserne to the Genie kaserne to consolidate the sick and the remaining camp resources. With fewer nurses, each nurse cared for 65 patients during the day and from 110 to 150 patients at night: “Every one of us [nurses] couldn’t take it anymore, but nevertheless many made it through April 1945” (Weglein, 1988, p. 62). For each nurse in Theresienstadt, the experience of caring differed based on her years of internment, her own unique living and work arrangement, her personal constitution, and the scope of her practice understanding and responsibility. What nurses shared for the most part, however, was a commitment and a passion to do their duty, making do with what they had, and improvising along the way. Perhaps, as Ringelheim (1985) suggested, women were able to transform their preinternment experiences as nurturers more readily into caring than were men. Tec (2003) argued women’s work roles retained some semblance of continuity from their previous domestic lives. That Theresienstadt was a transit camp rather than an extermination camp provided the time necessary for women to create and sustain caring relationships, find meaning and purpose in a seemingly hopeless situation, and forge a path to self-survival. NOTE 1. One camp survivor told me that she and others refer to it as “Terezin,” refusing to use its German name. For purposes of consistency, however, I will use Theresienstadt throughout.
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Tec, N. (2003). Resilience and courage: Women, men, and the Holocaust. New Haven, CT: Yale University Press. The Czechoslovak nurses and health staff during the war and occupation [Letter]. (n.d.). Geneva, Switzerland: The International Council of Nurses Archives. Weglein, R. (1988). Als Krankenschwester im KZ Theresienstadt: Erinnerungen einer Ulmer Judin (I was a nurse in Theresienstadt: Memories of a Jewess from Ulm). Stuttgart, Germany: Silberburg-Verlag (A. Hebebrand, Trans., Medical University of South Carolina, 1999).