“A Back-Up for Nursing Care” – IF DDR ARTICLE

Profes­sio­nal ethics and health policy do not form a dicho­tomy. An article on working condi­ti­ons in the GDR’s health care system.

Author: Max Rodermund

Origi­nally published in the May 1 insert of the junge Welt on April 27, 2022.

Karls­burg (1970): A doctor moni­tors a blood sugar check perfor­med by a tech­ni­cal school student.

If you talk to former doctors and nurses in the GDR’s health care system, you don’t just get a glowing picture of the working condi­ti­ons and the state of affairs in hospitals.


In the frame­work of the publi­ca­tion, “Socia­lism is the best prophy­la­xis!”, by the Inter­na­tio­nal Rese­arch Center GDR, we were able to talk to some of the health care profes­sio­nals. For exam­ple, we spoke with Irene, who was trai­ned as a nurse in the early 1960s and remem­bers the harsh day-to-day manual labor condii­ons in the hospi­tal. In the early days, she some­ti­mes had to boil syrin­ges and banda­ges for reuse, and on some night shifts she was single-handedly respon­si­ble for 60 pati­ents. Conver­sa­ti­ons with other former health care workers also confirm that there were actually never enough nurses. To cover second and third shifts in the hospi­tal, person­nel some­ti­mes had to be called in from the ambu­la­tory care sector.


These expe­ri­en­ces express problems that cannot simply be casually brushed aside in the day-to-day workings of the GDR’s health care system. Despite the fact that a study from 1970 does not show any signi­fi­cant devia­ti­ons in nursing care ratios from those in the Fede­ral Repu­blic at the time: given terri­to­rial and subject-rela­ted varia­ti­ons, the average is 5.8 beds per regis­tered nurse. Inclu­ding auxi­liary nurses, the study yields 3.8 beds per employee.


In order to under­stand the signi­fi­cance of the diffi­cul­ties and problems and to clas­sify them correctly, one cannot avoid exami­ning the causes. One quickly comes to the conclu­sion that a super­fi­cial, selec­tive view distracts from the essence of the diffe­rent nature of the GDR’s health care system and the prevai­ling working condi­ti­ons in it. Mate­rial shorta­ges, tech­ni­cal back­logs and labor shorta­ges can ulti­m­ately only be explai­ned in connec­tion with the gene­ral econo­mic diffi­cul­ties, which in turn depen­ded to a large extent on the foun­ding condi­ti­ons of the GDR as well as the sanc­tions and blockade poli­cies impo­sed by the West.


If one detaches ones­elf from this super­fi­cial view, the tendency toward a compre­hen­sive upgrading of the profes­sion stands out in rela­tion to the working condi­ti­ons of the mid-level medi­cal profes­si­ons in the GDR. This does not refer to pay, which was infe­rior in the GDR and, in addi­tion to shift work, was a reason for a low average length of service in the profes­sion, i.e., it contri­bu­ted to a high turno­ver of nursing staff.


The equa­liza­tion of the employ­ment condi­ti­ons of the various profes­sio­nal groups in the entire health care system redu­ced the tradi­tio­nal gapping in social status between the profes­si­ons. This meant a radi­cal change, espe­ci­ally for outpa­ti­ent care. The priva­tely prac­ti­cing physi­cian, opera­ting as a small busi­ness­man, became an employee of the state health care system, as did the nurse. Employer” and “employee” became colle­agues. But even in the inpa­ti­ent sector, in hospi­tals, labor laws ensu­red fixed working and vaca­tion hours, pay scales, health controls, access to social and cultu­ral rights, and more for ever­yone. The protec­tion and enforce­ment of these rights was guaran­teed by the health care union respon­si­ble for this sector. In 1979, with 496,081 members, 97.1 percent of all health care workers were orga­ni­zed here, 83 percent of whom were women.


The process of over­co­ming the privi­le­ges and profes­sio­nal status of physi­ci­ans did not proceed in a linear fashion. The aggres­sive recruit­ment campaigns from the Fede­ral Repu­blic forced the GDR to compro­mise with the medi­cal profes­sion. For exam­ple, at the end of 1960, a brief push was made to orga­nize physi­ci­ans, dentists and phar­macists auto­no­mously. This idea was shel­ved again when the border was secu­red in 1961 and the resul­ting decrease in the emigra­tion of physi­ci­ans who had been trai­ned in the GDR. And the joint orga­niza­tion in the health care trade union was further able to streng­then the trend toward unifi­ca­tion of the profes­si­ons and specialties.


The stan­dar­di­zed and state-finan­ced trai­ning of nurses had the same effect. Basic medi­cal subjects were as much a part of the three-year tech­ni­cal school trai­ning as direct hands-on work in a hospi­tal. Even after ente­ring the profes­sion, a compre­hen­sive system of conti­nuous educa­tion for physi­ci­ans and medi­cal staff made it possi­ble to obtain ongo­ing quali­fi­ca­ti­ons. A so-called head nurse, respon­si­ble for orga­ni­zing the nursing opera­ti­ons and over­see­ing the deve­lo­p­ment of the hospi­tal toge­ther with the medi­cal direc­tor, under­went further trai­ning in a diploma program. The high level of profes­sio­nal trai­ning supported the occu­pa­tio­nal eman­ci­pa­tion of the nursing staff.


The over­all health policy of the GDR contri­bu­ted decisi­vely to the upgrading of nursing care. The objec­tive of protec­ting public health was made possi­ble by the absence of private profit inte­rests and was given a high poli­ti­cal prio­rity, which could be reali­zed through a unified and society-wide struc­ture of the health care system. This prin­ci­pled orien­ta­tion in health policy corre­spon­ded to the concrete task of health­care workers to heal and care for pati­ents and in the process gave them strong support. The frus­t­ra­ting expe­ri­ence of not being able to fulfill one’s task of care and medi­cal atten­tion, which is common­place today, was essen­ti­ally over­come in the GDR.