PERSONAL ACCOUNTS BY MEMBERS OF QUEEN ALEXANDRA'S IMPERIAL MILITARY NURSING SERVICE and TERRITORIAL ARMY NURSING SERVICE
CROWN COPYRIGHT: THE NATIONAL ARCHIVES WO222/189, ITEM 1J
First evacuation of Polish Prisoners of War from Russia to Persia - Spring 1942
Account by M. E. Johnston, Sister, Queen Alexandra’s Imperial Military Nursing Service Reserve
Account by M. E. Johnston, Sister, Queen Alexandra’s Imperial Military Nursing Service Reserve
***In the winter of 1941-2 the Russians decided that they could no longer support the Poles taken prisoner by them in the autumn of 1939. By arrangement with the British Government we undertook to look after these Poles numbering some 120,000. The first 60,000 were transferred in the spring of 1942.
The official plan for the reception of these people has yet to be published I believe, but so far as I have heard it from various people who were on the spot, told the Poles – men, women and children of all ages from all over Russia. They were working as prisoners of war in the north at Archangel, in the west in parts of Siberia, and in most of the intermediate country there were scattered parties working chiefly in the mines and forests. These people were to be transported to the shores of the Caspian Sea. From there they were to be shipped by the Russians and on Russian responsibility to Pehlevi on the south-western shore of the Caspian and a Persian port. At this point the British were to take over. One big difficulty that our people had to contend with was that although the Russians were most anxious for us to take over the Poles, they did not let us know how many to expect at a time or when they were likely to arrive. As the efficient reception of large numbers naturally entails considerable preparation it will easily be understood what a great disadvantage this was. Owing to the weather it was however considered fairly certain that we could not be expected to be ready to receive them before the end of April, as the mountain roads are not easily passable through northern Persia until the middle or end of March and we should need about a month after that to get things organised.
The British plans were laid accordingly and at the end of March a small party left for Pehlevi to reconnoitre and to see what arrangements would be required. I don’t know exactly of what this party consisted, but certainly a Bath Unit, various R.A.M.C. and other Officers, some half dozen or so Anglo-Indian orderlies were among the number. The plan was to receive the Poles at Pehlevi. Bath Units, Field Ambulance Units and Staging Sections would then according to need, cleanse, clothe, feed and dispatch them as fast as possible to Teheran, a distance of some three hundred miles. There the sick would be put into prepared hospitals, the healthy would be put into camps, sorted, and again dispatched further south by rail and/or road.
At this time – end of March – there was still snow on the mountains and although there were indications of the winter breaking, it was extremely cold and the roads still difficult for motor transport. From some who were there I gather that the advance party had been at Pehlevi a few days and were getting down to planning the work of the next month of preparation when, one day, vaguely through a blizzard which was driving across the Caspian, someone saw three ships approaching. Before the day was out these ships had anchored and were rapidly disgorging their contents of humanity onto the beaches. I cannot tell you the numbers as I don’t know them and think it doubtful if anyone knows them accurately, but there must have been some thousands of those first arrivals. These people were of both sexes, all ages and in every state of physical condition from quite fit and well, to dead, the latter being a far better state than the intermediate stages. Practically every disease in medical knowledge could be found among them and particularly deficiency diseases, dysentery, typhus and malaria.
At this time I was nursing in a hospital in Bagdad. There we heard rumours that something was likely to happen concerning Poles, in Russia, but news was never definite and we were much more interested in wondering if the Germans would get through the Caucasus. On April the 1st, a friend and I were both warned that we might be wanted on a job over to the west, but it probably wouldn’t be for some time. As army life is always rather a gamble and one never knows where one will sleep the next night we didn’t think any more about it. On the evening of the third we had orders to be ready to leave on the fourth. We packed and had the usual round of goodbyes, most people feeling that it was a mare’s nest and that we should be back in a week or two, but full of envy because we were apparently going off the beaten track a bit. We reached Basra on the 5th, joined three other sisters and the matron and started off in convoy across the desert at 5 a.m. the next morning. We reached Ahvas at 5 p.m., fed at one of the hospitals and made a dispirited attempt with inadequate means to get off some of the pounds of sand collected from the desert; at 7.30 p.m. we left by train for Teheran. It is a twenty-four hour journey over the German constructed railway, a wonderful engineering achievement, through range after range of mountain gorges which looked in the moonlight like some gigantic fairyland with every now and then glowing, smoking, witches’ cauldrons formed by the continually burning disused oil wells.
We reached Teheran at 9 p.m. on the 7th and were met by the officer commanding the hospital and others. After a long delay in trying to get us billets in the local hotels, the matron and one sister were deposited, and the rest of us were at last allowed to have our wish and go straight to the hospital. This was seven miles north-west of Teheran at Doshan Tapii, one of the salty, sandy plains which surround the city and at the foot of the then snow covered mountains which led to the Caspian and the Caucasus. We arrived at the hospital at 11 p.m. and the officers almost fell on our necks with joy, and then more practically, fed us with bully beef, bread and tea and set someone to work erecting tents for us to sleep in. It was a vile night, blowing hard and sleeting, very cold and dark. By this time too, we had collected bits of information as to what we might expect to find and knew that the joy of the officers was in no way personal, but entirely concerned with the arrival of so many more working hands and feet. Eventually with the aid of hurricane lamps, we put up our camp beds and still unwashed, went to sleep.
The story of the arrival of the hospital I heard later. It was the 34th Combined General Hospital of six hundred beds and corresponding staff and equipment. It was packed up ready for return to India when they received orders to proceed immediately to Teheran, reason unknown. They arrived on the 3rd April to find patients expected at any moment, in unknown but certainly large numbers. From then on the whole personnel hardly stopped working; pitching tents, unpacking and arranging stores and the multitude of other things inseparable from the starting of such organisations. There was an Indian Officer Commanding, two British Medical Officers, fifteen Anglo-Indian orderlies, sepoys and Indian Followers. Food was eaten when and as they could get it; sleep taken as a dire necessity. One disadvantage that we all suffered from for some time was that the unit had never done any work except training, since it was formed. Many of the sepoys were under the impression that army life was one long holiday and working eighteen hours a day and then not finished, was a rude awakening for them. This was complicated by the weather which was conducive to making them retire to the ‘godown’ and stay there until the sun became warm again.
On Monday 5th, the first batch of patients arrived as the first ward was being erected and the neck and neck race between the arrival of patients and the erection of tents continued for about three weeks. We sisters started work on the Thursday after much discussion among the powers in authority over what we should wear. Finally it was decided. Gum boots for those who had them; patients’ white pyjama trousers tied round the waist and ankles; R.A.M.C. orderlies white coats tied round the waist, wrists and neck; triangular bandages tied over our heads. These were worn over our usual uniform and a good many woollen things as it was very cold when we first arrived. When not in use these outer garments were kept in a tent provided and separate from out quarters. Eventually the whole personnel working in the wards were put into these clothes, until some weeks later when the epidemic of typhus was under control and we discarded protective clothing altogether. We never wore gloves as there were none. So far as I know only two of us took the precaution of cutting our hair short and shaving elsewhere.
The arrangement of the hospital was to divide it into sections and the sections into wards. We were taking only men and boys as an American Red Cross hospital had undertaken to look after the women and children. There were five sisters – the matron did not work in the wards. One sister was allocated to the Mess and theatre; there was practically no work in the latter but I would not have exchanged her job for any number of sections. The remaining four of us divided the six sections between us. In each ward of tents, usually three slung together, thirty-two patients could be tolerably well housed when beds and lockers were in position. Anything from four to about eight of these combined tents comprised a section.
The staffing of a section was:
Trained personnel – one medical officer; one sister
Trained during the war – one Anglo-Indian R.A.M.C. orderly
Untrained – eight or ten sepoys
Followers doing the work of their caste – two ward boys; two bhesties; two sweepers plus one on night duty.
There were also a bare minimum of orderlies and sepoys to do night duty.
Of the above, the medical officers, sisters and orderlies spoke English and some Indian dialect; the sepoys and followers might speak any of the 222 dialects found in India and one or two had a smattering of English. The patients who numbered anything from one hundred to three hundred per section, and a total of just under a thousand when the hospital was most full, spoke Polish, Russian or German and very rarely a few words of French or English. In my section the medical officer spoke Tamil and English quite well, I have a working knowledge of Urdu and about two words of French and one of German. Among the patients who were usually about two hundred in number, there was only one man who spoke English of any use. Great difficulty was at first experienced in ascertaining the patients’ names and this sometimes led to difficult situations, as for example, when a Jewish patient suddenly disappeared and after three days search was discovered to have died and been duly buried in a Roman Catholic grave. The error was rectified to the satisfaction of all concerned, including I hope, the Jew. Eventually we found there was an R.A.M.C. orderly who spoke Russian, French and German, and he was made responsible for seeing every new patient and obtaining their name and religion etc.
In addition to the language difficulty there was of course the caste system among the sepoys and Indian followers. The sweepers would sweep, deal with latrines and bedpans, soiled linen and water; the bhesties would deal with clean linen and water only; the ward boys would deal with food and feeding utensils only; the sepoys would make beds but not touch soiled linen of dysentery patients, neither would they touch a bedpan or help any patient with one, no matter how ill the man might be. They could not be relied upon to wash more than the hands and face of any patient and had an intense dislike of touching dead bodies. The medical officers were fully employed doing the round of the patients. The R.A.M.C. orderly and the sister were the only people available at any time for any job from pitching tents and removing the dead to giving intravenous injections or dressing gangrenous wounds.
My impressions of the first day in the wards are still confused. They reveal principally a mass of unwashed, unshaved humanity, some in beds with the usual bedding, some on mattresses on the ground, some on blankets on the ground, and some just on the ground – there were of course no floor boards. Masses of flies, the smell of dysentery and death, mixed with the distinctive mousey smell of typhus. Many emaciated corpse-like figures, some obviously beyond human help, some delirious, some violent, many more lying quietly, only too glad that the need for movement and effort were over. My first reaction was to collect materials and spend half an hour cleaning the mouth of a man who was obviously near the end of life, but having much difficulty in breathing his last. An hour later a sepoy came to tell me he was dead. That incident snapped something in me and it was suddenly clear what, in broad outline, must be done. The individual must be sacrificed; for one trained person to cope with 200 or so in this condition it was obviously impossible to nurse even a fraction as they should be nursed, until the place was properly organised. In each section the same conclusion was reached sooner or later.
Each section was self-contained and adopted its own plan of action. In the section I was in we devised the following scheme; of the tents already in use every one had to be emptied and disinfected as they were found to be infected with lice. This meant the temporary overcrowding of some while others remained empty, also the moving of the critically ill patients and of every bed and mattress, but it could not be avoided. To stop the spread of infection we must kill the lice at whatever individual cost. Over a matter of days this was accomplished, each patient being bathed, shaved and put into fresh clothes before going into the clean tent. The tents were swept and sprayed with disinfectant twice and left open at night to air. During this process naturally the normal work of meals, medicines, washing when possible, had to continue, plus the constant interruption of attending to and removing the dead and dealing with the continuous stream of new patients.
Having cleansed the wards the problem was to keep them clean. Theoretically every patient leaving Pehlevi was shaved and disinfested, but under conditions prevailing there it was impossible to be sure of this and many arrived with a considerable amount of hair full of lice. We erected a reception tent and bath tent beside it. All new patients were taken straight to the reception tent and I inspected them for lice. Where necessary the patients were shaved and in every case they were bathed in disinfectant and given clean pyjamas before being sent to the ward where they were given a hot drink. It was with arrangements such as these that the language question and lack of experience among the personnel of the hospital caused considerable waste of time and energy. To get the non-English-speaking sepoy first to understand the arrangement and then to accept the need for such precautions was not easy, and lead to one ward having to be cleared of patients and disinfested on three successive days because a sepoy had thought a patient had looked clean, put him straight into bed and he had subsequently proved to be lousy. But in the end the system became an institution and was used throughout the time. The ideal method is of course for the patients to pass through a bath and cleansing section on arrival at the hospital and before they come to the wards, but unless there is sufficient trained staff working in the cleansing tent, and sufficient equipment to cope with large numbers, I do not think it is satisfactory, it certainly was not possible with us where we had neither of the above requirements. There is also the difficulty of transporting over a large site, numbers of pyjama clad, sick people in cold weather.
Clothes were a difficult problem. Though most of them had nothing but what they wore, the clothes of a thousand men need considerable accommodation. We could only spare one small tent and had only one temperamental steam steriliser. Disinfestation went on for weeks but was accomplished eventually, though I fear many of the clothes changed owners in the process. Dead men’s clothes were another problem for which we found a useful solution known as Dead Men’s Cupboard. Into this went all the sterilised clothes that were not wanted and from it were able to re-fit patients whose clothes I had burned as being beyond hope. Burning a patient’s property is a crime in the army, and on each occasion that it was necessary to do it the O.C. and the medical officer came to me with the most dire threats of repercussions from Whitehall, until I counter-threatened to post the next lot, unsterilized, direct to Mr. Churchill.
Meals were served three times a day. Eggs and bread for breakfast, stew and bread for lunch, pudding and bread for supper. Tea or cocoa to drink. The ward boys were supposed to serve meals but obviously needed help with such numbers. The sepoys disliked touching food because of their caste, but this difficulty was overcome in time as were others of the same type, chiefly by finding that people with no caste did the things, took no harm and did not lose their prestige. We were short of knives and plates etc., so that one section had to be fed and have the implements washed before another could start.
The removal of the dead caused some trouble. One morning I found a row of five bodies on the ground outside one tent and the sepoys responsible for moving them playing the equivalent of shove half-penny on the sand a few yards away. They replied on enquiry that they were tired of moving dead bodies and were not going to do it anymore. Eventually I found the quickest way was to start to deal with each body myself and later the sepoys would come voluntarily to help.
Red Cross Helpers When the camps of fit people became organised, it was found that there were an appreciable number of Polish A.T.S. and Red Cross nurses among them. A number of these were detailed to come to the hospital to help with the sick, but the first batch were not an unmixed blessing. They had no medical knowledge and no discipline but any amount of good intentions and anxiety to help and were delightfully cheerful and responsive to friendliness. Gradually we sorted them out, returning those who, for example, could not understand that patients suffering from typhoid must not be fed on every and any concoction which could be bought from the many Persian vendors who surrounded the camp. Here of course the language had to be almost entirely pantomime but they were amazingly quick to pick up an idea and in a few days the intelligent and reliable ones could be left to serve meals, give out harmless medicines, and make beds and wash patients. At the end of two months they were turning into useful assistant nurses and loved the work.
Fatigue parties Another plan we tried was using the men from the camps as fatigue parties to help the ward servants. It was impossible for two sweepers to cope with bedpans for two hundred patients, especially when many of them were suffering from dysentery. The same applied to the carrying of water and the serving of meals. Therefore each section was allotted a fatigue party, but the scheme did not work satisfactorily. The men were unwilling to work and apparently quite incapable of doing the obvious job. They needed constant supervision and a drink of lime juice to get anything achieved, so the idea was abandoned. They were useful though in stuffing mattresses which entailed many hours of work before we have one for every patient. The reason for this was I think both psychological and physiological. For two years they had had to work or go short of food; many were in a debilitated condition; they were tired physically and mentally and the sudden relaxation from absolute necessity to work removed temporarily, the power to do so. What they preferred to do was to sing, this they did beautifully nearly all day and most of the night, on the camp site next to our quarters.
Moral [e] improvement One feature stood out and impressed most of us who were there from the early days, namely the moral [morale] improvement in the patients as the time went on. The depression and gloom at first was marked, the wards were entirely quiet, no one laughed and seldom smiled, conversation among the patients was almost non-existent. Indiscriminate spitting and other objectionable habits were very prevalent. As time passed this definitely changed. The daily morning round took me about three times as long with about half the number of patients, everybody had something to say. Spitting etc. became almost unknown and if a new patient was found guilty, an old one would solemnly and reprovingly present him with the kerosene tin provided with disinfectant. Unlike the British troops, the Poles love inspections and on the days when we had some official coming to see the place, the wards hummed with excitement, each one competing with the other in the production of the most number of flowers, and pinching the greatest quantity of clean sheets and tablecloths with which to decorate the place.
In the third week six more sisters arrived and simultaneously the number of new patients and the death rate began to drop. By July there were only a handful of patients left from the first evacuation. After about a month or six weeks the hospital personnel were all inoculated against typhus. Not one case of typhus occurred among the personnel and so far as I know there was cross infection among the patients. At least one object was achieved, namely the prevention of the spread of typhus to our own troops in Persia and Iraq.
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