The dream doctors

Medical clowns and laugh therapy specialists from around the world visit Israel for annual Advanced Medical Clowning International Summer Seminar.

By JOSH HASTEN
Medical clowns 521 (photo credit: Courtesy Carmel Medical Center)
Medical clowns 521
(photo credit: Courtesy Carmel Medical Center)
Wearing his distinctive and indispensable red nose, a silly green hat and vest and an oversized pacifier around his neck, Dr. Batata (sweet potato) is lurking in the corridor of Haifa’s Carmel Medical Center’s pediatric wing. As a wheelchair-bound young girl, not more than 10, is helped out of her chair by two nurses to stagger into the laboratory across the hall, Batata pounces, following the group inside without receiving directives from any of the other caregivers. For the next 15 minutes, the nurses draw vial after vial of blood from the patient for necessary tests, but thanks to Batata’s antics, involving blowing up animal balloons, telling jokes and a slew of other tricks, the young girl, with a constant smile on her face, is completely enamored and enthralled by the clown, unaware of what exactly the nurses are doing or how much time has gone by.
While Dr. Batata, whose real name is Itai Nachmias, isn’t a certified physician, he is nevertheless an essential part of the hospital’s medical team, serving as one of the facility’s highly trained and experienced medical clowns, whose goal, in his words, “is to cheer up young patients who are ill.”
Accompanying Batata on his rounds and observing his technique as he brings medicinal smiles and laughter to a diverse population of children is Moscow resident Julia Rayskaya, who is a medical clown in Russia. Rayskaya is visiting Israel as part of a group of 27 medical clowns and laugh therapy specialists from around the world for the first annual Advanced Medical Clowning International Summer Seminar, given by the University of Haifa’s theater department in collaboration with the Dream Doctors – Israel’s leading medical clown organization, which currently has 70 medical clowns active in 20 hospitals and clinics throughout the country.
For two weeks in July, the participants, from countries including Brazil, Canada, Germany, the Netherlands, Russia, and the US, attended an intensive program based primarily at the university, which included workshops, lectures, roundtable discussions and visits to hospitals. Some of the leading experts in the field, both from Israel and from around the world, were there to teach them the latest techniques in medical clowning.
According to Dr. Atay Citron, chair of the University of Haifa’s theater department and a senior lecturer who created the academic training program for medical clowns in 2006, “Israel has become a world leader in the medical clowning field, particularly when it comes to ‘specialties’ – or specific fields in which techniques utilized in hospitals worldwide can involve medical clowns playing a key role.” He adds that, despite perception, he feels the art of medical clowning “is less about adding laughter but more about empowering the ill through humor. In other words, there is an interactive and therapeutic relationship which is established between the clown and the patient through playfulness. It is not just about a one-sided clown performance.
” Citron came up with the idea for the seminar after receiving emails over the years from educators who expressed a desire to come and improve their craft by learning about Israel’s innovations in the field. “Because our current bachelor’s degree is in Hebrew and our new master’s program, which is in the process of receiving accreditation, is in Hebrew, the university, in partnership with Dream Doctors, essentially decided to offer the two-week intensive training seminar in English so people from abroad could benefit from our expertise,” says Citron. He adds that Israel has played a leading role in developing the use of medical clowning to assist with children suffering from post-traumatic stress disorder as a result of terror or war; young female victims of sexual abuse; children who are in need of MRI testing but find it difficult to sit completely still for up to 40 minutes in the MRI tube without sedation; as well as several other “specialties.”
MANY PEOPLE were first introduced to the concept of using clowning as a therapeutic tool in a hospital setting through the 1998 Robin Williams film Patch Adams, based on the life of Dr.
Hunter Doherty “Patch” Adams, an American physician who used clowning in an effort to bring humor to hospital patients. But professional clown doctors actually began working in hospitals in 1986, under a program called the Big Apple Circus Clown Care Unit, started by Michael Christensen in New York City. Christensen was a featured speaker for the Haifa seminar, delivering a 12-hour workshop on his experiences and innovations in the field over the course of his career.
Rayskaya says that in her mind, “the workshop led by Christensen was one of the highlights of the entire seminar.”
As she observes Dr. Batata drawing smiles and laughter from the young patients, she expresses satisfaction at witnessing how, in Israel, the medical clown is accepted as in integral part of the hospital staff like everyone else.
“At first [in Moscow] the whole concept was looked down upon, but our goal has always been to become accepted for our contributions by our colleagues. We have just now started developing good relationships with the hospital staff members as well as with the parents who are alongside their children,” she says.
According to Citron, one of the biggest breakthroughs for medical clowns in Israel has been their acceptance “not only as members of the staff but as essential caregivers and part of the overall medical team.”
One person who has played a key role in the acceptance of medical clowns in Israel is Prof. Amnon Raviv, who in addition to teaching at the university has been a medical clown for over a decade with a focus on children with PTSD. While grabbing a quick lunch in the university’s cafeteria before presenting a workshop to the group, Raviv recalls the specific incident which he cites as a key to the change in perception in the use of medical clowns in this country.
“It was September 3, 2007,” he remembers precisely, “when I was working as a clown in the Barzilai Medical Center in Ashkelon. We got word that a Kassam rocket had fallen near a school bus in Sderot, sending the children into a state of panic.
Instead of continuing to school, the bus driver drove them to Barzilai for treatment. The children were ushered into a cafeteria and the hospital mental health staff began talking to the kids, who were still in trauma. As I stuck my head in the doorway, the top psychologist motioned that I should go away and that this wasn’t the right time for my antics. But instead of leaving, I literally stumbled into the room causing a great balagan [commotion], and began entertaining these young victims. I stayed with them the entire time, keeping them laughing and keeping their spirits up as they were individually screened for mental trauma and shock. By chance, the head of the hospital walked in and saw that my shtick was helping. From that point on, not only were my methods analyzed and implemented in working with PTSD victims, but the head of the hospital had a prestigious research paper published based on the findings from that and other similar incidents.”
Raviv concludes his story by concurring with Citron that “Israel is a world leader in the medical clowning field because we are not just people who visit the ill [from] room to room, but we are involved in all aspects of their procedures.” Citron also details the effective techniques that a female Dream Doctors clown at Poriya Medical Center near Tiberias introduced while working alongside gynecologists treating young victims of sexual abuse and rape.
“After this traumatic experience, the patient is extremely anxious and it is very hard for the doctor to carry out the necessary examination properly,” says Citron. “However, one of our clowns started working hand-inhand with the doctors – earning the patients’ trust and relaxing them so that the procedure could be carried out. This is another example of Israel leading the way in specialty medical clowning.”
Another participant in the seminar is Fif Fernandes, who is the president of the Medical Clowning Associations, Canada, based in Calgary. Despite the fact that she has years of experience in the field, particularly with critically ill children receiving palliative care, Fernandes says that “I didn’t come here as a teacher but as a student.” She describes the Haifa seminar as ”fabulous” and adds that “the different styles and the subtle nuances that we are learning from experts in the field from so many different countries truly enhances our understanding and helps us to become whole as caregivers.”
Fernandes, who is visiting Israel for the first time, raves about the hospitality of the university’s faculty as well as the students who took in the guests from abroad as roommates, allowing them to receive more of a real Israeli experience, instead of staying in hotels as tourists.
Back at the Carmel hospital, another participant waiting to do rounds with Dr.
Batata is Barbara Grapstein from the New York area, who describes herself not as a medical clown but as a “‘laughter leader,’ someone who uses humor and laughter exercises to help relieve people in distress.”
Some of her clients include senior citizens, Girl Scouts and corporations that hire her to lead icebreaker exercises. Grapstein says that she has “benefited immensely from the seminar.” She adds that, “I’ve watched the sensitivities of the experts and the other participants, and how they utilize them in their work, and it has opened my eyes on how I can use therapeutic humor in other ways in my field.”
Citron is pleased with how the discipline has gained acceptance in Israel and is expanding all the time and that through the seminar he is able to reach medical clowns from all over the world.
“Thanks to our [the university’s] Avantgarde partnership with Dream Doctors, and the mutual trust between the hospital teams and the medical clowns, the protocol for carrying out medical treatments is being changed in this country to incorporate the clowns. In some cases it’s the clowns themselves who tell the doctors when a patient is ready to start a procedure, based on his or her intervention.”
He adds that “I’m confident that those who are attending the seminar will walk away with a broader view, and deeper understanding, based on what I feel is the unique Israeli contribution to the field of medical clowning, especially when it comes to our expertise in the various specialties.”