No one likes going to the doctor. But for Holocaust survivors, even routine healthcare can trigger feelings of extreme anxiety and fear. For survivors, the trauma they experienced in childhood is relived in the dentist chair or the doctor’s office. Tests or medical procedures, whether in the office, a lab, or a hospital can bring back unwanted memories.
Unfortunately, few medical and dental professionals have training in treating Holocaust survivors.
The healthcare personnel with whom survivors interact with usually have no or limited knowledge of their past, nor are they aware of the stress that a visit to a dentist or doctor presents. This lack of understanding creates a greater threat to the health of the survivor who may avoid essential preventative care or treatment.
Programs to educate the medical community on working with Holocaust survivors are starting to fill this gap.
An important step in this process is fostering a greater understanding of the source of the trauma.
The nonprofit I work for, The Blue Card, has widespread contact with Holocaust survivors across the country. It is a national organization that serves thousands of households of survivors by providing financial assistance and support programs. We see all too many elderly individuals with great reluctance to seek medical assistance because they associate the years of neglect and abuse they experienced in concentration camps with medical practitioners throughout their lives.
One area of particular distress is the dentist’s chair. Those who spent time in concentration camps were afraid that if they had a gold tooth it would be pulled out without anesthesia. Many Holocaust survivors find memories of the pain of unfilled cavities and abscess in teeth flooding back as if it was yesterday. The effects of starvation and malnutrition as children has had a major impact on their teeth and gums and, if not treated promptly, contributes to more serious health issues.
Survivors also have a complicated relationship to food that can interfere with proper nutrition.
Stemming from deprivation and starvation during the war, there is often the hoarding of inexpensive, unhealthy canned and processed foods or a difficulty throwing away food, even when it is spoiled. I have seen people that we work with recreate recipes from their childhood to bring back good memories of their life before and relatives they lost in the war — but these are foods that are often high in fat and sodium. Further, the high costs of dietary supplements and vitamins are also prohibitive to staying healthy, along with limited mobility hindering access to fresh fruits and vegetables.
These fears and habits are incredibly difficult for Holocaust survivors to speak about, and leads to further communication barriers between patient and doctor.
Dr. Eva Fogelman is a psychologist who specializes in working with historically traumatized patients and their descendants, and who trains medical, dental and mental health professionals to work with this population through the Blue Card: “A dentist, a doctor or other medical professionals can become triggers that bring back associations to illnesses suffered during the Holocaust, to witnessing a loved one die of a medical condition that was not treated, or to a medical experiment that was performed on them. This Post-traumatic Stress Disorder state reduces the ability to trust the helping professional. Hence, it is helpful to professionals to learn that they need to spend more time developing a trusting relationship and not jump into treating symptoms.”
Senior citizens are expected to face steadily declining health, but survivors who are now in their 80s, 90s and 100s are faced with having more than usual dental or medical problems. Studies have shown that Holocaust survivors compared to the general population are more likely to suffer from lingering effects of infectious diseases acquired during World War II, have higher rates of osteoporosis and hip fractures, an increased prevalence of cancer and chronic diseases and more psychiatric disorders, including clinical depression.
Past suffering from years of persecution and pain from untreated illnesses, combined with the increased number of medical issues today, means that the risks of triggering PTSD is compounded.
In my work with Holocaust survivors, there are additional stressors that can contribute to the reemergence of past trauma.
A common and distinct fear shared by Nazi victims is that of institutionalization. The loss of family members leave Holocaust survivors without an advocate to help them navigate complicated healthcare decisions. There is the dread that an extended hospital stay might mean never leaving, or being removed from the feeling of safety of one’s home to be put into a nursing home. Also, feelings of isolation can be debilitating, since most survivors live on their own and two-thirds of the people we work with cannot leave their homes without assistance.
Then there are the financial challenges faced by so many. Of the estimated 100,000 Holocaust survivors currently living in the United States, around one-third are living at or below the national poverty level. This makes it near impossible to afford basic necessities such as food and rent, let alone medicine or homecare help.
The Blue Card is one of the organizations helping to train medical and dental professionals on the special needs and fears of Holocaust survivor patients through person-centered, trauma-informed care (PCTI). PCTI is an approach that promotes the dignity and empowerment of trauma victims by incorporating knowledge about the role of trauma in victims’ lives into programs, policies and procedures. At its center is recognizing the signs of trauma and actively resisting re-traumatization of patients.
This program is supported by a generous grant from the Jewish Federations of North America (JFNA). JFNA launched the Center for Advancing Holocaust Survivor Care in 2015, following an award from the Department of Health and Human Services for five years to advance innovations in PCTI services for Holocaust survivors in the United States.
For a majority of medical personnel, working with the Holocaust survivor in particular is a little known area. As the survivors age, however, this knowledge, understanding and empathy in treatment will become more and more vital to the medical field, especially in geographic areas with large survivor populations.
More training could mean that the hospital intake specialist does not press when there are blanks on the patient’s family history. Being asked if there is a history of cancer or certain diseases is simple enough for most of us, but a Holocaust survivor might have to reply that they do not know the answer because their entire family was killed. More training would help ensure a nurse does not say, “That is a nice tattoo on your arm, what do those numbers mean?”
We will continue to raise money to get the medication, dental care and homecare that Holocaust survivors need to live their remaining years at home in dignity. But it’s not enough to treat the mind or body alone. They must both be cared for and actively supported.
Masha Pearl is the executive director of The Blue Card, the only organization in the United States with the sole mission of providing ongoing, direct aid to Holocaust survivors in need. To learn more about The Blue Card and its programs, or to donate to support Holocaust survivors in need, visit: www.bluecardfund.org.