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Caring for the Aging Survivors of Early Life Trauma Due to War Holocaust Survivors: Case in Point Training Manual

The following is the Training Manual that the Holocaust Resource Project uses for staff and student professional development in the areas of working with elderly survivors of the Holocaust and genocide. (David, Tafler and Goldhar discuss the Manual as a teaching tool in the following article.) We have chosen to reproduce the Manual in its entirety so that the information contained can be immediately disseminated and shared.

Fifty-five years after liberation, the remaining survivors of the Holocaust are turning to geriatric services and supports; and their ability to reach compassionate and knowledgeable resources is imperative. We hope this Manual will contribute. As the survivors are a diverse and evolving group, so must also be the resources that support them. As colleagues you are invited to use this material, share it and customize it to suit your requirements, hopefully entering into a dialogue with us regarding improvements and feedback. At a later date we will publish an evaluative study of how the Manual was received by over 2000 caregivers from a range of disciplines. We respectfully request that the Holocaust Resource Project and Baycrest Centre for Geriatric Care be referenced and copies of any additions or changes be shared with us.

Thank you for your cooperation,
Paula David, MSW, CSW; Jodeme Goldhar, MSW, CSW
Holocaust Resource Project
Baycrest Centre for Geriatric Care .

The Holocaust Resource Project at Baycrest Centre has compiled and edited this resource package to educate and sensitize direct service providers working with elderly survivors of the Holocaust and their families. This material is to support caregivers and staff in the challenging and rewarding tasks involved in supporting aging survivors. The Holocaust Resource Project will be available with current resources and for consultation on an ongoing basis.

Baycrest Centre will be continuing to accumulate data on the changing needs and requirements of aging survivors and their caregivers. This Training Manual is intended to be an evolving and responsive tool that will be updated and modified as both the needs and services change. We respectfully request that the users of this Manual join us in the effort to keep it relevant, and share new information and material as it is realized. The Manual continues to change and develop as new knowledge and contributions are shared.

The Holocaust Resource Project, at Baycrest Centre for Geriatric Care, is committed to ensuring optimum care for elderly survivors of the Holocaust and their descendants.

The Material in this Booklet Includes:

A) A brief chronological overview to put Survivors of the Holocaust and the Second World War in an historical perspective.

B) A list of Triggers that may bring back difficult memories for a Survivor. Reminders of the trauma of the Holocaust are always present; different ones for different people. When a Survivor is ill, cognitively or physically impaired or just feeling vulnerable; different events, objects or comments may become triggers provoke a strong or difficult reaction.

It is important to remember that what may be a trigger for one individual may not cause another any difficulty at all.

C) Words and terms relevant to the Holocaust as well as brief glossaries of commonly used Yiddish, Hungarian and Russian words.

The sources for the material in this section are from the Holocaust Resource Project at the Baycrest Centre for Geriatric Care. The presentation is enriched with the video "Painful Memories" created by Menorah Park, Cleveland, Ohio, the co-operation of the Holocaust Education and Memorial Centre of Toronto as well as the ongoing support and input from the residents, patients, clients and staff of the Baycrest Centre.

Baycrest Library Resources

The Baycrest Hospital Staff Library has an extensive collection of material on the Holocaust and Jewish history and customs.

For more information please call the Library (416) 785-2500 Ext. 2351

The Holocaust Resource Project

In addition to a range of relevant articles, we provide loan and viewing opportunities for resource videos

Some of the resource videos provided by the Holocaust Resource Project include

1. "Painful Memories"
2. "The Long Way Home"
3. Canadian Jewish War Veteran Video
4. "Jewish Life at Baycrest"
5. "A Tribute to Courage; Stories of Survival"
6. "The March of the Living"
7. "No Greater Honour A Record of Canadian Jewish Military Service
8. "Survivor Testimonies"
9. "Children of Terezin

A Brief Historic Overview of the Holocaust

1933

Hitler becomes Chancellor of Germany
First concentration camp set up at Dachau
First anti-Jewish law passed in Germany

1934

Hitler declares himself both President and Chancellor of Germany

1935

Nazis define a "Jew" as anyone with three Jewish Grandparents, or anyone with two Jewish grandparents who claim to be Jewish

1937

Buchenwald concentration camp set up
Jewish Passports are declared invalid for foreign travel

1938

Germany takes over Austria
Jews forced at gunpoint into Poland
Kristallnacht begins

1938

Germany declares war on Poland
World War II begins
First polish ghetto set up in Poland at Protrkow

1940

First time that German Jews are sent to concentration camps
Germany occupies Denmark
Germany invades Holland, Belgium and France
Auschwitz concentration camp set up
France surrenders to Germany
Japan joins Germany and Italy in Axis Powers
Warsaw ghetto set up
Hungary, Romania and Slovakia join the Axis Powers a

1941

Germany occupies Greece and Yugoslavia
Germany invades Russia
Massacre of 35,000 Jews at Babi Yar, near Kiev
Mass extermination begins, Birkenau opened
Massacre of 19,000 Jews to Odessa
Japanese attack Pearl Harbour, United States joins the Allied Powers

1942

Deportations to Auschwitz begin
Dutch, Polish, French, Belgian and Croatian Jews sent to extermination camps
Norwegian, German and Greek Jews sent to concentration camps

1943

Ghettos organizing resistance
Jewish partisan groups gather in forests to fight
Nazis order destruction of all ghettos in Poland and Russia.
Armed resistance begins in many ghettos Armed resistance in Treblinka camp
Large ghettos destroyed at Minsk, Vilno and Riga
Armed resistance in Sobibor extermination camp

1944

Germany occupies Hungary
Hungarian Jews sent to concentration camps
Allies invade France
Russian army liberates Maidanek camp
Remaining Jews in Kovno, Shavil and Lodz ghettos are sent to concentration camps and the ghettos destroyed
Jews still at Theresiendstadt ghetto are sent to Auschwitz
Beginning of death camp marches, 40,000 Jews are marched from Budapest to Austria

1945

Auschwitz is abandoned by the Germans, some prisoners begin death march toward Germany
Prisoners from Buchenwald begin four day death march
Russian army enters Germany from the east as other Allied troops enter from the west
Hitler commits suicide in his underground bunker
May 7. Germany surrenders, War in Europe ends
August 15. Japan surrenders, World War II ends
November 20m 1945-October 1, 1946. Nuremberg War Crimes Trials begin

Circumstances That Have the Potential to Trigger Difficult Memories for Survivors of the Holocaust

A trigger is something that may bring back difficult memories for a Survivor. Reminders of the trauma of the Holocaust are always present; different ones for different people. When a Survivor is ill, cognitively or physically impaired or just feeling vulnerable; different events, objects or comments may become triggers.

Many normal day-to-day activities or situations may be a trigger that provokes an adverse physical, emotional or behavioural reaction. For those survivors who are hospitalized or in a long term care facility, many aspects of the institutional environment may invoke more than one trigger for residents who are survivors.

It is important to remember that what may be a trigger for one individual may not cause another any difficulty at all. All frail survivors may respond to any number of triggers with a specific memory or a flooding of memories, but the cognitively impaired may respond to a particular trigger and actually feel as though she is reliving the memory. Aging, sickness and impairment may make some survivors susceptible to triggers that were not an issue when they were younger. Caregivers need to be aware of the more common triggers, and appreciate that even common triggers recall unique and different memories.

Event or Trigger	Potential Responce	Reason
Taking a shower	• Refusal • Unusual fear • Crying, • Screaming • withdrawal	In the concentration camps, The Nazis herded Jews into the gas chambers, telling them they were going to shower. They were stripped and pushed into rooms that looked like shower rooms. They were crammed in for maximum efficiency, the doors were locked and poisonous gas came out of the shower heads.
Taking a bath	• Refusal • Unusual fear • Crying, • Screaming • withdrawal	Nazi 'doctors and researchers' conducted horrific experiments with Jews immersed in tubs of water. They included electroshock, freezing and scalding. Many inmates were dipped into tubs of harsh chemicals for cleansing and delousing purposes.
Fear of Public or Strange Washrooms; Smell of Urine or Faeces	• refusal to use washrooms incontinence or with-holding • adverse reaction to strong smells	The Jews were transported to concentration camps on cattle cars, without sanitation for days at a time. Many died in transit. Strong smells were everywhere. In the camps there were no washrooms, just makeshift facilities and no privacy. Sanitary conditions in the camps were almost non-existent. The smell of waste may easily trigger the memory of those train rides and their tragic destinations
Lack of Privacy	• withdrawal • secrecy	Whether in a ghetto, concentration camp or in hiding, there was no privacy for the Jews, and at any given moment, the world as they knew it could be turned inside out. Being forced to be with others could be very frightening.
Event or Trigger	Potential Responce	Reason
Small spaces, crowded conditions, lack of personal space	• anxiety • withdrawal	During the war, Jews were either forced into ghettos or concentration camps or survived in hiding. All of these meant cramped, over-crowded and desperate living conditions. In the ghettos, six families were commonly assigned to one small apartment. In the camps, six individuals could be sleeping on the same wooden tiered shelf.
Medical History --taking or Personal Questions	• refusal to cooperate • upset or depression	Routine medical histories can be family mysteries for survivors. They may not know family medical histories and sadly most relatives died prematurely and violently. Simple questions can raise complex memories.
Requests to do Medical Procedures	• refusal • distrust • fear	Many survivors underwent atrocious experimentation by 'doctors' and 'technicians' in the name of treatment or research. Many 'patients' died in the process, and the survivors were often left with life-long damage.
Shaving, Hair Cuts and Personal Grooming	• refusal or anxiety re hair cuts or shaving • extreme anxiety re baldness	For camp inmates and in the ghettos, personal grooming and privacy were next to impossible. Upon arrival at the concentration camps, all men and women had their heads shaved, so that often individuals were unrecognizable. This was a further form of humiliation.
Receiving injections	• refusal • fear	Many survivors were tattooed with numbers for identification. These were done without anaesthetic with series of needles. Once tattooed, only numbers identified them.
Institutional Wristband Identification	• removal • refusal to wear	Wristbands could be reminders of being depersonalized during the War, known only by number or location.
Lining Up for Treatment or Service	• refusal of treatment • anxiety in line	In the camps, Jews lined up for food rations, 'toilets', roll call, deportations and even murder. Sometimes they were awakened in the middle of the night and made to stand at attention for hours--until guards felt like releasing them. Military order and line-ups were the norm.
Medicinal, Antiseptic or Strong Smells	• strong physical or emotional reactions	Sanitation in the camp barracks and in the ghettos consisted of the dumping of harsh antiseptics over refuse and waste. People were often placed in lye prior to medical experimentation, and these smells may have horrible associations.
Illness and feeling unwell	• denial • attempts to disguise symptoms	In the concentration camps, the ill and the elderly were immediately sent to the gas chambers. If a person became ill, the safest route would be to keep it secret and remain out of sight.
Event or Trigger	Potential Responce	Reason
Secure areas, locks on doors, physical restraints, Limited access	• frantic trying to 'escape' • assuming they are trapped • panic n	Survivors were forced into walled ghettos, barbed wire enclosed concentration camps, barred prisons etc. All personal freedom was removed and any chance of escape was very slim. No escape meant eventual death. Jews in hiding rarely showed their faces in public for fear of exposure. Today, any sense of limited movement of restraint can be very difficult.
Flashlights Examining lights or bright lights	• fear • anxiety • refusal to cooperate	Camps and ghettos were lit at night by bright searchlights to ensure everyone remained in place. Guards used flashlights to find people in hiding and round them up for deportation.
Family members or visitors saying goodbye, Staff changes	• inability to let go • depressive reaction • withdrawal	Throughout the War, Jews saw their children, parents, other relatives and friends being taken away or murdered in front of them. Most never saw each other again. After the War, survivors went through series of discoveries as they realized the enormity of the losses. Separation is difficult and can be terrifying.
Foreign languages or heavy accents	• distrust and fear	Rarely did the guards, soldiers and authorities of the roundups, camps and ghettos speak Yiddish, the first language of most survivors. A foreign language or a strange accent usually meant trouble.
Loud voices and sounds	• distrust and fear	The guards and soldiers in the ghettos and camps were never quiet and gentle. Jews were yelled at, shoved and forced in all communications.
Sounds of others crying or screaming	• fear or similar reaction	Survivors lived through many different and painful horrors. The sounds of grief and tears are ready reminders. The combination of loud noises, others anguish and the inability to respond may be very upsetting.
Dogs and Animals	• unusual fear • revulsion	Dogs were used as guard dogs and attack dogs in rounding up Jews, imprisoning and intimidating them. Dogs were often used to discover hidden Jews. Nazi pets were generally given more and better food than inmates.
Group organizing, directing people to line up, or to the left or right	• refusal • moving quickly away • fear	Upon arrival at the Concentration Camps, Jews would be "selected"..for life or death, and sent to the left or the rightƒ.either directly to the gas chambers or to the slave barracks. These 'selections' were often the last time that family members saw each other.
Routines and schedules	• non-compliance • direct sabotage	The Nazi war-machine was an efficient and orderly attempt to annihilate all Jews. They were known for their efficiency and keeping on schedule.
Event or Trigger	Potential Responce	Reason
Meal Time And Food Presentation	• refusal to eat • overeating • hoarding of food • chronic unhappiness with food	Withholding of food, designated minimal portions, rough handling, and almost inedible foods were dished out to long lines. Many starved to death. Thus, poor service, (perceived or real) small portions or new foods could be difficult.
Not enough food/Hunger pangs	• food hoarding or hiding • eating too fast	Hunger was an ever-present feeling during the war years. Many starved to death. Not feeling hungry and always having left-over food could be very important. Often trading, stealing or hoarding food could be punishable by death, so secrecy is also a factor.
Jewish Holidays	• anticipatory fear • not involved in festivities	During the War, the Nazis often raided Jewish communities, killing and rounding up Jews on Jewish holidays; knowing they would be either at home or in the synagogue. Many Jews were murdered in their synagogues while observing a Jewish holiday.
Christian symbols	• adverse reaction to jewellery, holiday decorations or seasonal music	Christian symbols such as the cross or Christmas decorations were part of the culture of the enemy. These symbols reflected that the camps were not representative or supportive of Jewish people. As such, these symbols today have the potential to trigger a difficult memory.
Ambulance or Fire Sirens, alarms, bells, whistles	• extreme anxiety in an ambulance • adverse reactions	Sirens, whistles and bells were often the signals for people to be rounded up and deported. They were also used to define the times in the camps and precede public announcements to prisoners.
Night-time or dark rooms	• extreme fear	The most dangerous time was at night; when in the darkness all type of atrocities could happen.
Nightmares	• extreme dis-orientation	In the camps, sleep may not have offered much needed rest, as nightmares about the daytime would intrude. Nightmares about the past may be more vivid today.
Reminiscence	• refusal to discuss relatives or family history	While many survivors have the need to tell and re-tell their story, others cannot bear to recount their tragic past. Even simple questions regarding family or country of origin may be too difficult to discuss.
Certain recorded or live music	• anxiety • refusal to listen	Concentration camps often had loud speakers and camp personnel might select their favourite music. Those or similar pieces would be reminders of those days. Also, some Yiddish music might bring back reminders the people who sung or played these songs and are now gone.

Common Terms and Words Occurring in Conversations with Survivors of the Holocaust

Shoah:
the Hebrew word for the Nazi Holocaust.

Holocaust:
the persecution and murder of European Jews during the Second World War, primarily between the years of 1933-1945. Six million Jews perished including one million children.

Nazi:
the ruling party of Germany during the Second World War; a person who belonged to the party

Hitler:
the ruler of the Nazi Party; who was determined to annihilate Jews and Gypsies and create a 'pure race' to rule the world. He died in 1945/

Final Solution:
the official Nazi term for the extermination of all of world Jewry.

Shtetl:
a Yiddish word for the villages that Jews lived in

Ghetto:
a confined walled area of a city that Jews were herded into, many families in a single home and stripped of all rights. Many starved in the ghettos or succumbed to disease from poor living conditions. Eventually the ghettos were evacuated to the death camps.

Camps:
refers to the locked areas that where Jews were brought from all over Europe crammed into boxcars. Labour Camps is where Jews were used as slave labour and fed just enough to keep them functioning. If they were unable to work, they were killed. Concentration Camps were holding places where people either starved to death or were eventually killed. Death Camps were specifically for planned systematic extermination of all inmates. Nearer the end of the War, most camps became death camps.

Gestapo:
the commanding forces of Nazi Germany who supervised the planned murder of the Jews and others.

Lager:
the sleeping barracks in the concentration camp

Partisans:
underground resistance fighters which included many Jewish men and women

Magen David:
Hebrew for the Star of David; the symbol of Jewry around the world, the symbol of pride on the Israeli flag, and the badge the Nazis made people wear to identify themselves as Jews.

Yiddish:
the language spoken by many of the Jews of Eastern Europe.

Eretz Yisroel:
Hebrew for the land of Israel, which was declared a nation in 1948, and finally a legal and safe destination for many survivors.

The Old Country:
what many immigrants refer to as the country of their birth

Yom HaShoa:
Holocaust Remembrance Day throughout the world. Survivors may light Yahrzeit (Yiddish for 'memorial') candles for family lost in the Holocaust.

Yizkor:
Hebrew for "remember" and the Prayer for the Dead.

Some Common Yiddish Words

Yiddish is written in Hebrew characters, from right to left. The following list uses English letters and is written as the words are pronounced. (from Jewish Life at Baycrest)

 

English	Yiddish	English	Yiddish
Greetings		Eating
Hello, Goodbye	Shalom	Fruit	Frukht
Good day, Hello	A Gutn Tog	Tea	Tey
Good Night	A Gutte Nakht	Coffee	Kave
Good Morning	Gut Morgen	Meat	Fleish
Congratulations	Mazal Tov	To finish eatingl	Oyfesn
Good Sabbath	Gut Shabbos	Oyfesn	Broit
Happy Holiday	Gut Yontif	Soup	Zup
How are You?	Vos Makht Ihr	Water	Vaser
Be Well	Zayt Gezunt	Hungry	Hungerik
		Milk	Mikekh
At the Bedside		Meat	Flaish
Warm	Varem	Drink	Trink
Hot	Heys	To eat	Ess
Cold	Kalt	Have you eaten?	Hot ir gogesn?
Ache, pain	Vaytic	Taste	Tam
Sick	Krank
Thirsty	Durshtik	Time Frames
Hungry	Hungerik	Day	Tog
Tired	mid	Night	Nakht
Well, healthy	gezunt	Tomorrow	Morgn
Physician	doktor	Year	Yor
Hand	hant	Yesterday	Nekhtn
Nose	noz	Today	Naint
Head	kp	Week	Vokh
Feet	feess	Month	Monatt
Ear	oyr	Morning	Morgn
Eye	oyg	Noon	Mittog
Neck	halds	Evening	ovnt
How do you feel?	Vi filt ihr?
		Feelings
Daily Tasks		To laugh	Lakh
To wash	Vash	To dance	Tantsn
To undress, take off	Oiston	To sing	Zingen
To dress, put on	Onton	To weep	Vainen
To wake up	Vakh oif	To cry out, scream	Veyn
To get up, rise	Off steyn	Alone	Alain
To drink	Trinken	Joyful, happy	Freylakh
To eat	Ess
To bathe	Bodn	Family Members
To sit	zitz	Grandmother	Baba, Bobbe
To sit down	Zetsn	Grandfather	Zaidye
To sleep	Shlof	Mother	Mamme
		Father	Tateh
Miscellaneous		Sister	Shvester
A kind deed	Mitzvah	Brother	Bruder
Gentile	Goy	Daughter	Okhter
To thank	Danken	Son	Zoon
Please	Bitte	Boy	Yingela
Money	Gelt	Girl	Meydl
How many/much	Vifil	Child	Kind
Home	Haim	Grandchild (ren)	Eynikl (ech)
No	Nain
Yes	Yo
What is this?	Vos iz doz

Some Common Hungarian Words

Word or Phrase: English	Hungarian	Phonetic Spelling
How are you?	Hogy vagy?	"hod fudge
How are you feeling today?	Hogy erzi magat, ma?
What can I do to make things comfortable for you?	Mit tudnak csinalni hogy kenyelmesebben erezne magat itt?
Do you have children?	Vannak maganak gyrerekei?
What should I bring you?	Mit hozzak maganak?	'mitt hoseak mugh-uh-nakk'
Husband	Feri	'Fare ye'
Wife	Feleseg	'Fell lesh shage'
Children	Gyerekek	'D-yerr ekk-ekk'
Sibling	Testver	'Teshware
Do you have grandchildren?	Vannak maganak unokai?
Where are you from? What town?	Honnan valo? milyen varosbol tetszik jonni?	'Hunn un one magga'
Where does it hurt?	Hol faj maganak?	'Whole fie"
blood	Ver	'Ware'
head	Fej	'hash'
feet	Lab
hand	Kez
face	Arc
stomach	Has
back	Hata
ears	Ful
eyes	Szemek
ankle	Boka	'bo-kaa'
knee	Terd	'tared'
neck	Nyak	'n-yuk'
hip	Csipo	'cheap-oh'
heart	Sziv	'sieve'
Are you thirsty?	Maga szomjas?	'maga somjash'
Are you hungry?	Maga ehes?	'maga ehesh?'
Happy	Boldog
Sad	Szomoru
Depressed	Le tort
Clean	Tiszta	Tiss-tah
Dirty	Piszkos	Piss kosh
Nice	Szep	Sape
Big	Nagy	Nud-y (as in yuk)
Good Morning	Jo reggelt	Yo regg (as in reggai) elt
Hello	Jo napot.	Yo na (as in stop) putt
How are you?	Hogy van?	Hod-y (as in yuk) vun (as in fun)
I am fine thank you.	Ko szo nom jol vagyok keu
Do you understand English?	Ert angolul?	Airt ango (as in angora) lool?
Where is the toilet?	Hol van a W.C.?	'Whole one a vay tsay?'
What would you like to have?	Mit akar?	'Mitt akkar?
Food	Ennivalo	'Annie vallo'
Water	Viz	'Whiz'
Coffee	Kaye	Kahvay
Tea	Tea	'Te Ah'
Sugar	Cukor	'tsoo-core
What time is it?	Hany ora van?	H-anye orah one?
Room	Szoba	'so-bah'
Window	Ablak	'ob lock'
Key	Kulcs	'kool-ch'\
Light	Villany	will-lon'
curtan	fuggony	f-ugh uh-nj'

Some Common Russian Words

 

 

Volume 1, Spring 2000 Articles

• Caring for the Aging Survivors of Early Life Trauma Due to War Holocaust Survivors: Case in Point Training Manual
• Train the Trainer: A Comprehensive Approach to working with Healthcare Professionals Caring for Aging Holocaust Survivors:
• A Wholistic Approach in Working with Holocaust Suvivors
• Remembering Sophie
• Training Paraprofessionals: Both In Residential Facilities and In the Community
• AMCHA the National Israeli Center for Psychosocial Support of Holocaust Survivors and the Second Generation
• Listening to Survivors and Searching for "Little Schindlers"