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Medical clowns play a vital role among paediatric and adult patients. Healing by the use of humour is considered as therapeutic value both in alternative medicine and conventional medicine in hospitals all over the world. “Medical Clowns”, also known as “Clown Doctors”, conduct frequent rounds to these patients and aids them in alleviating the fear of hospitalisation, which in turn refines their curative process. This is considered to be an advanced therapy in the medical field of the healing process for the patients, which was formally established by Michael Christensen, co-founder of the New York-based Big Apple Circus in the year 1986.

The recent review of the meta-analysis literature regarding the “clown therapy” consolidated  their relevance and portrayed the approaches made in diminishing the uneasiness and stressors faced by the children, the inevitable mental pressure on the patients undergoing surgery, and also among children who have undergone agonizing procedures in the Emergency Department.

Physicians have anecdotally reported that the involvement of medical clowns in the rehabilitative process has brought in a vast improvement in patients, parents, staff, and everyone associated with this bubble of care.

In addition, some physicians have anecdotally reported that the involvement of medical clowns in the rehabilitative process has brought in a vast improvement in patients, parents, staff, and everyone associated with this bubble of care.  Laughter is the best plan of care in medicine. This concept is currently inculcated in the hospital practices as newer researches pinpoints that “clown therapy” lowers stress and anxiety in children and their parents.

PIsraeli Medical Clown Visited Ramaiah Memorial Hospital, Bangalore

An Israeli Medical Clown named Nir Raz from Schneider Children’s Medical Center, Israel had visited Ramaiah Memorial Hospital, Bangalore, and conducted a workshop for the MD Paediatric students, Paediatric Dentistry Consultants, and PG Paediatric Dentistry students, Professors of Paediatric Department, Hospital Administration staff and students of the Ramaiah institute, hence conceiving  “Medical Clowning” a portal of entry to adopt in healthcare organizations. He enlightened about the concept of healing through laughter & humour. His visit to the Paediatric Ward at the Ramaiah Medical College Hospital brought in smiles to children through his fun-filled interaction with the paediatric patients.

While speaking to the Consulate General of Israel to South India, Ms. Dana Kursh, gave the insight about the leadership of the faculty, Doctors, Nurses, and staff showed its an inspiration on how important aspects can be introduced to render smiles and laughter to sick children and adults. In addition, he also stated that adopting futuristic goals for medical tourism between India and Israel will be done by shuffling the health care teams through MASHAV to have an international collaboration where they are trained and to broadcast this concept on how the therapy can be applied as medical means for healing patients to unmask their “healthy and smiling faces”.

The event was co-hosted and organized by the Consulate General of Israel to South India together with the Ramaiah University of Applied Sciences in collaboration with the Paediatric Department of the Ramaiah Medical College Hospital. Mr. Nir Raz is a Medical Clown, Director, Group Conductor, and Stage Artist, who has been employed for twenty years in the theatre, group facilitation, and improvisation. He is also the Founder and Co-founder of the Institute of Psychotherapy in Playback Theatre.

In Israel, medical clowns undergo two-year training in medical procedures, communication skills, games, magic tricks, and more. After their graduation, they are employed by the hospitals, as an intrinsic side of the medical staff. “The view ahead is not only confined to make the children laugh but also to give them a sense of discipline and influence over their precious lives, support them in battling with their emotions of powerlessness due to hospitalization. As defined by Mr. Nir Raz it also help in explaining the complex medical conditions in a humorous way that young children can relate.

In Israel, Medical Clowning has developed into an authorized workout that is no more to be laughed at. These Magician Doctors boost their confidence and rejuvenates children in hospital wards and are present during the surgeries. One Israeli study revealed that the presence of clowns benefits a woman’s likelihood of getting pregnant during IVF fertility treatment from 20.2% to 36.4%. Studies showed that the accomplishment of medical clowning has been disseminated all over the world and numerous humanitarian managements back up this humorous healing process.

Clown Therapy and Health:

The notion of clown care is in trends these days as many physicians and researchers have made allegations on laughter and humour benefits on health for centuries. A study conducted by Norman cousins in 1979, the study validated the favours of humour in healthcare by resuming ankylosing spondylitis patients using self-imposed remedy focusing on daily laughter and vitamin C . Moreover the healthcare industry began to get gradually legitimate the healing potential of humour and make specific reactions channeled with humour in 2004. This conceived a legal formulation in the form of clown therapy and licensed its authoritative access to the hospitals. The hospital environment is distinctive from the home environment; disease and loss are the shadows of the hospital environment interfering with the full scope of feelings. It has been said that a person laughs about 15 times a day and that figure can get to zero in hospitals. Hospitalization causes distress and anxiety apart from that it may be traumatic, especially for hospitalized children. It is also considered an adverse event in their lives. Anxiety among parents and caretakers is also most common during hospital stays. This is caused due to the very thought of the children patient conditions and the pain suffered by them during their treatment, so to reduce their anxiety and stress clown care is introduced. Clowns and their senses of humour have entertained human beings for centuries. In treating paediatric patients, humour plays a very important role it should be a must in the hospital setting as researchers believe that humour can be combined with the treatment for well-being.

Clown doctors also use medical devices or teddy bear that is found in a patient room and utilize it as a dramatic device to add humour to children.

Clown Doctor Appearance:

Clown doctors have their outfits to match their identity, each clown doctor has an individual and designed white medical coat. This makes them part of the clinical team and also makes the white coat less terrifying for the patients. Besides, the clown doctor’s clinical concept has the objective of assisting children to cope with daily clinical practice and to assist children with their new condition and the scary clinical language and procedures. To assist them in this situation, Clown doctors carry an array of props their “doctor’s bags” and in their side pockets (e.g., soft toys, whistles made using syringes, puppets, phones made using stethoscopes, musical instruments of various types, magic show items and so on. Clown doctors also use medical devices or teddy bear that is found in a patient room and utilize it as a dramatic device to add humour to children. The main identity of clown doctors is a red nose that is also called “the smallest mask in the world”. This is the main unique feature found among clown doctors that  truly adds essence to their benevolent role. The red nose or make-up mask of the clown, like a sensational character or role, is both insightful and rejunevanting, empowering the statement of what lies covered beneath our real-life roles. A clown doctor chooses characters that are attractive to children and that is easily related to children’s life. This gives a channel to start interaction with sick patients and to bring out their emotions. Children usually open up to the clown doctors regarding their pain and feelings. 

Abilities Required for a Clown Doctor:

Clown doctors must possess a good sense of humour, be compassionate and be cheerful clowns. Clown doctors must be good listeners and be able to listen empathically to the emotional state of people in the hospital. They also should adapt to the situation and immerse themselves in the emotional level of the patient and their families. Second important ability is represented by the playing around abilities (e.g., slapstick, jugglery, mime, and so on. In summing up Clown Doctor required being artistic skills and also possessing psychological skills to interact with others.

Clown interventions are proved to induce positive emotions, they will directly impact the patient’s well-being and reduces psychological symptoms and emotional reactivity.

Impact of Clown Care in Quality and Patient Safety

Clown care is an added benefit to healthcare. In a study the results of the study revealed the patient outcomes improve, the hospital staff work is efficient in the presence of medical clown and even reduces hospital costs. The decreased in cost is mainly from the reduced need for sedation and anaesthesia before and during procedures like radio imaging or radiotherapy – in both paediatric patients and adults. Clown doctors’ cost is less when compared with the total cost of using an anaesthesiologist and the drugs required to sedate the patient for this kind of procedure. Clown interventions are proved to induce positive emotions, they will directly impact the patient’s well-being and reduces psychological symptoms and emotional reactivity. It will aid in treating patients with anxiety and fear related to medical treatment. Clown doctors are also well accepted by patients relatives and healthcare staff and their presence appear to be useful in creating a lighter atmosphere in the health setting.

The process of “hospital clowning” works in four different levels of impact – 

  • Psychological level – the immune system is modulated with the release of endorphins
  • Emotional level – where laughing substitutes negative emotions with positive feelings
  • Cognitive level – it distracts the mood of the person or changes the patient from his situation, where levels of thoughts are gathered and new ways of learning to express oneself are identified.
  • Social level –connection is created between clowns and children/patients by laughing and thus, increasing further trust and interaction between them.

Medical Clown in COVID-19 Ward: COVID-19 pandemic brought a challenging situation in the hospital setting in managing fear and emotional distress. In Israeli hospitals, medical clowns were working in regular shifts in hospitals during the coronavirus outbreak, and directly interacting with COVID-19 patients. Medical Clowns decorated their PPE with stickers and created a unique covid clowning dress code. They attached a red nose on the N95 mask behind the plastic face shield, which added smiles to the patients and staff. The major challenge during the covid pandemic was to build intimacy with the patient while staying at least 2 meters away, wearing a mask. The medical clowns had to speak loud and also ensure physical gestures to add humoUr amidst covid panic and anxiety. Lessons learned from COVID-19 is an opportunity for the healthcare organizations to reconsider the role of medical clowns to support the vulnerable groups in holistic well-being, especially children in hospitals, medical staff, and the elderly in the healthcare setting.

Composed by: “Aileen J, is an Assistant Professor at Ramaiah University of Applied Sciences, Faculty of Life and Allied Health Sciences, Bangalore. She is a young researcher and her current research interests include patient safety, hospital environment, and utilization of equipment in hospitals.”

InnoHEALTH magazine digital team

Author InnoHEALTH magazine digital team

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