Send in the clowns

Shula Kopf spends time with Israel’s pioneering medical clowns who are leading the way in international trauma therapy.

Fifi comforts a young patient 521 (photo credit: Dream Doctors)
Fifi comforts a young patient 521
(photo credit: Dream Doctors)
Fifi spots a four-year-old boy in a hospital bed being rushed down a corridor. His eyes are wide, he is upright and gripping the metal bedrails with both hands, an IV line stuck in his arm and connected to a monitor. He is too familiar with hospitals for someone so young, a fact that does nothing to ease the look of misery on his face.
Fifi knows the boy; he is a long-term patient.
Fifi is on her way to a meeting, but takes a detour and runs next to the bed.
“Is it a spaceship?” she calls out and runs ahead, her arms outstretched like an airplane tilting from side to side. “Let’s race.”
Her pigtails, adorned with flounces of violets, bob up and down.
“Where are you flying?” she asks in a high-pitched, playful voice.
The boy watches her, transfixed, his fear forgotten for a moment.
Medical clowning is serious business in Israel. Fifi may be a red-nosed dispenser of bedside buffoonery, but her colleague, Professor Yosef Uziel, a pediatric rheumatologist at Meir Medical Center in Kfar Saba, admits that she is indispensable. And before injecting steroids into the joint of a child suffering from juvenile idiopathic arthritis, he waits for Fifi to prepare the patient.
“She is the first to meet the child, and when she tells us that the child is ready, only then do we start,” he tells The Jerusalem Report.
Fifi remains in the room as an active participant, working alongside Uziel in well-rehearsed, coordinated moves aimed to distract the child from the pain. It might seem unusual, even highly unlikely, that a professor, who also lectures at the Sackler School of Medicine at Tel Aviv University, would await the OK of a clown before proceeding, and then cooperate with the clown during the procedure. And outside of Israel, it is a rare occurrence.
“In other places in the world, medical clowns are guests, artists who come to the hospital to make children happy and entertain them,” says Daniel Shriqui, director of Israel’s Dream Doctors, as the medical clowns are known. “In Israel it’s not a performance. It’s therapeutic work in all kinds of methods and settings. It is based on Israeli culture, which is open with an informal relationship between people, and no rigid hierarchy. When doctors and hospital administrators started to see the benefits of medical clowns, everything grew very quickly.”
Among the first to spot the potential was Dr. Jacob Farbstein, General Director of the Baruch Padeh Medical Center in Poriya, near Tiberias. “It seemed strange in the beginning, but you can’t argue with success,” he says. “It’s for the benefit of the patient and that’s what counts.”
Penny Hanukah, 45, a.k.a. Fifi, is an integral part of the pediatrics department at Meir Hospital, which pays her salary. The hospital also employs three other medical clowns.
“They come every day and help in many procedures reducing pain and anxiety,” says Dr. Alon Eliakim, head of the hospital’s pediatric department. “If I could, I would have them for every blood sample drawn, every IV line put in and every painful procedure.”
Just as Uziel is a rheumatology specialist, Fifi is a funny bone specialist. It is only after she has given the child a bountiful dose of joy followed by a booster shot of empowerment that Uziel enters the room. The injection is painful and normally done under general anesthesia in young children. But at Meir Hospital, with Fifi’s aid, laughing gas is sufficient.
Fifi works with Uziel, mimicking his moves to distract the child. according to uziel, preliminary scientific evaluation shows that the intervention of the medical clown reduces pain.
Clown college
Israel is creating a global model for clowning therapy. Introduced here just 11 years ago, medical clowning has taken off like a turbocharged, Israeli start-up with an impressive list of world firsts. In 2006, Haifa University introduced the world’s first and only bachelor’s degree in medical clowning, combining courses in theater and nursing. it is currently expanding into an MA program. It took just five months to launch the program from the time the idea was first broached.
“We traveled the road as we paved it,” says Dr. Atay Citron, head of the theater department at Haifa University. “I can’t think of any other country where everything happens so fast. We don’t work by the book, we improvise.”
Last year, Israel held the first international medical clowning conference, with 250 participants from 21 countries. This summer, Haifa University hosted the first international summer seminar for professional clowns, who came from seven countries, including the US, Canada, russia, Brazil and the Netherlands.
Israel appears to be the only country in the world where medical clowns are considered part of the medical team, participate in medical procedures and publish research papers in medical journals.
Many Israeli doctors and hospital administrators unofficially recognize Israel’s Dream doctors as a paramedical profession, and there is a movement afoot to make it officially so.
“We need scientific research data to persuade the Ministry of Health that this is a legitimate paramedical profession,” says Citron.
The data is on its way, according to Shriqui, whose dream doctors organization has recently funded eight different research studies on the effectiveness of clowning therapy in various settings. Medical clowns are not confined to the pediatric ward, but also work with cancer patients, diabetics, in the intensive care unit, in HIV/AIDS clinics and psychiatric wards.
The Dream Doctors have an ally in Knesset Member Dr. Rachel Adatto of Kadima, who sits on the Labor, Welfare and Health Committee.
She is familiar with medical clowns from her former tenure as deputy director of Jerusalem’s Shaare Zedek Medical Center.
“They are enthusiastic people with a big heart and lots of patience,” she says. “I told them i’m willing to help.”
Focused fun
There are 110 Dream Doctors working in 25 Israeli hospitals, serving over 176,000 patients each year. Israel’s Dream Doctors have also volunteered abroad in trauma and disaster zones in Ethiopia, Indonesia, and Haiti.
“The kind of relations that exist between dream doctors and the medical hospital staff has no parallel in the world,” says Citron. “It is collaborative with mutual trust and respect for the clowns, as silly as they may be. The doctors and nurses realize that they are professionals and trustworthy. It’s not entertainment.
It’s not just about ‘let’s make the kids happy.’ It is about fantasy. It is about taking the mind to another place. It is about forgetting the difficulties of the here and now in order to relax and empower the patient.
“We don’t mean that we forget the fun, not at all. It’s fun, but it’s focused, very complex and rich. dream doctors are so integrated in some hospitals that there are doctors who won’t do certain procedures until the clown is present. I am seeing a wonderful trend of the clowns going from being valuable to being essential.”
Quint Amersfoort, manager of the medical clown organization in the Netherlands, is clearly taken aback. He has just spent half a day on a tour with an entourage of doctors and several medical clowns, including Fifi, in the pediatric ward at Meir Hospital. He heard another medical clown, Limor Eshayek, 42, nom de clown leefa, describe how she accompanies children into the operating theater and remains while they undergo anesthesia.
“The child falls asleep in surgery with a smile,” Eshayek says. “I’m excited about what is going on here. About two months ago I accompanied a five-year-old to surgery. She came back to the hospital for a follow-up and they called me urgently because she asked to see me. The clown is what she remembered from all the hell she went through.”
Amersfoort says that in the Netherlands medical clowns are not allowed to enter the operating room.
“I got inspired this morning,” he says.
“Here, the child is always in the center and in Holland, the procedures and the doctors are in the center and the medical clowns are not part of the medical process. Here, the atmosphere is very open and lively with contact between people and all the doors are open. in Holland there is a hierarchy with doctors at the top and the clowns at the bottom. When we started in Holland 20 years ago, we didn’t want to be associated with pain. the idea was that the clowns would be only for joy and lightness, but now we see that we can do more.”
This is precisely part of the agenda of the Dream Doctors organization. “We have already received requests from serious organizations in the U.S and europe who would like to copy the dream doctor model,” says Shriqui.
Meanwhile, Israeli medical clowns continue to pioneer new fields. Another first is the work done by medical clown Shoshi Ofir, 48, with victims of sexual abuse. Ofir, a graduate of Haifa University’s medical clowning program, accompanies the child through the interviews and traumatic forensic genital exams.
“She lets the children feel normal in such an abnormal situation,” says Dr. Nessia langfranco, director of the sexual assault unit at Poriya. She and Ofir have published a paper in a medical journal on their collaboration and lecture together in conferences abroad.
“The main thing that is injured in these children is their soul,” says Ofir. “Usually they stare in the air, as if something has died in them. i offer them an island of sanity in the chaos which they are going through.S ometimes the parents can’t go into the examination room because they can’t face what happened, so I’m there with the child. Often, when everything is finished, the kids don’t want to go home. They want to stay with the clown. I feel that i make a big difference.”
Lang-Franco and Ofir conducted a study about the children’s recollections from their visit to the sexual assault unit. Results show that when the clown was absent, the children remembered the tests and the traumatic physical examination. When Ofir was present, 85 percent of the children said they remembered the clown.
“The doctor’s oath is to do no harm,” says Lang-Franco. “The medical clowns are my way of fulfilling that oath.”