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Send In The Clowns — To The Hospital

Send In The Clowns — To The Hospital

Medical clowning program at University of Haifa is serious business.

Haifa — In a few years Shira Friedlander, a young Orthodox woman from Jerusalem, wants to go into Israeli hospitals to lift the spirits of patients. So these days she’s studying such subjects as anthropology, costume design and shamanism.

Friedlander is one of 15 students enrolled at the University of Haifa in what claims to be the world’s only university-based, degree-granting undergraduate program in medical clowning. Graduates of the six-year-old program, offered by the theater department, receive a bachelor’s degree in theater as well as drama therapy certification in medical clowning. The program’s goal, says Atay Citron, chair of the university’s theater department, is to establish medical clowning, the work of people who bring humor to hospitals and other medical settings around the world — with varying degrees of outside or on-the-job training — as a paramedic profession, part of a hospital’s medical staff on par with physiotherapy or speech therapy. Or a chaplain.

In her multidisciplinary studies here, Friedlander has learned “that everything you do needs to be a conscience decision — the things you wear, the things you do and what you say,” she says. “Otherwise the patient will not be convinced by the act.”

Or, as Citron, founding coordinator of the medical clowning curriculum, says, “It’s more than a red nose.”

The program teaches clowns-in-training, currently based in pediatric, oncology and other units in Israeli hospitals, and recently branching out to visit ill and wounded soldiers, that medical clowning in serious business, he says. “It’s academic. It’s not ‘ha-ha.’ This is a very demanding job. It’s not [just] about making people laugh.”

It’s often about distracting patients, about taking away their physical or psychological pain, about assisting the medical staff in dealing with patients.

The program, Citron says, teaches “the relationship between caregiver and patient or the psychological state of a patient in pain.”

Enrollment will double to 30 students during the 2012-13 academic year; last month the university hosted the “First Advanced Medical Clowning International Summer School,” attracting 250 students from two dozen countries to a condensed, two-week version of Citron’s medical clowning program.

Medical clowning, probably best known in the United States in the guise of Dr. Hunter “Patch” Adams, the iconoclastic American physician-clown portrayed by Robin Williams in a 1998 film, is a growing field, capitalizing on the proven physiological benefits that laughter and humor bring to the infirm.

Many people, Citron says, associate medical clowns — sometimes called “clown doctors” or “therapy clowns” — with red rubber noses and floppy shoes. While a number of medical clowns do adapt such garb, the shtick is tactics, not strategy.

Citron, whose specialty is street theater and alternative theater, approached medical clowning as a professional educator, when the university, at the suggestion of the Israel’s Dream Doctors organization, considered starting the program.

“I knew nothing about medical clowns,” he says. A fast learner, he designed a curriculum that originally provided an academic grounding to a score of men and women already on the job, then expanded to train people who had no formal clowning experience.

Today, the 120 credits in the medical clowning curriculum include courses in sociology, nursing, psychology, social work, movement and dance, music therapy and physical therapy, history of medicine, hospital procedure, mechanism of pain, juggling and puppetry, theories of laughter and humor — and improvisation comedy.

Students’ field work includes time in hospital wards.

“Working in a hospital is pure improv,” Citron says. Medical clowns, who often accompany doctors on rounds in Israeli hospitals in the morning instead of working by themselves in the afternoon, as is often the case in hospitals elsewhere, encounter captive audiences of mixed religious and mixed ethnic backgrounds in situations rife with disease, stress and nervous relatives — not exactly the audience you’d find at a standup comedy club.

“On the one hand, the clown is affiliated with the medical staff. He has permission to walk into the patients’ room and engage in shill shenanigans,” wrote Citron, who studied performance theory at New York University’s department of graduate drama. “On the other hand, the clown, as an outsider, is the ally of the patient. Together, they conspire against the painful routine and its representatives.”

The Haifa program accepts students who show some feel for medical clowning, empathy and the ability to think on their feet, he says. “You have to be born with the talent. Then you can learn how to take advantage of your gift.”

“The advantage of the program is that is combines the work of performance with the establishment of therapeutic tools with the psychological knowledge that supports them,” says Nitzan Helbetz, a student in the medical clowning program who will begin working at Netanya’s Laniado Hospital next month.

Friedlander, the only Orthodox student in the program, says she brings her perspective as a religious woman, with natural boundaries of modesty, to a field that stresses the breaking of boundaries — between patient and physician, between hospital protocol and patients’ need to be in control.

“Due to the fact that I am constantly aware of certain boundaries that I have, I also think about others’ boundaries and if I am crossing them,” Friedlander says. “Being sensitive is hugely important in this field.”

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