by Michele Ellson, The Alamedan, 16 October 2012
Every Tuesday, Molly Shannon makes her rounds of patients young and old at California Pacific Medical Center in San Francisco. Her pre-visit preparation includes a light dusting of makeup and the donning of a bright red clown nose.
“It blends in, but things about it bring it up to that level of, ‘Something special is going on here,’” said the San Francisco-based performer.
Shannon is part of a group of specially trained clowns called the Medical Clown Project, whose Rx for children and seniors being cared for by the medical center is a healthy dose of play. The clowns offer an admixture of music, magic, clowning and puppetry intended to induce laughter and reduce the stress and anxiety that the children and seniors, their family members and hospital staffers can feel.
An exhibit and sale of artwork by the late Berkeley artist Mickey Spencer at the Frank Better Center for the Arts, which will benefit the project and the arts center, is up this month. It closes with a reception and auction on October 28. “Everyone is under a lot of stress and can lose their humanity in a hospital,” said Jeff Raz, an Alameda-based professional clown who started the Medical Clown Project three years ago with his wife, Sherry Sherman, a psychologist after seeking out opportunities to work together where their fields connect.
The project’s performers – all of whom are professional clowns who perform locally and around the world – seek to connect with and strengthen the healthy human beings battling the illnesses that brought them to the hospital, and to inject “humor and humanity” even in the face of death. They offer assistance to patients across “the full range of life,” from children to seniors, along with family members and staff. “We come in and we are so obviously outside of the hospital world,” said Shannon. “There’s something really refreshing about that for people.”
Medical clowning got its start in 1986, when New York City’s Big Apple Circus set up its Clown Care program to bring the circus to hospitalized children. Clown Care’s 80 performers now conduct 225,000 visits a year at 16 hospitals across the United States.
Similar programs have since sprung up all over the world, each with its own special twist on integrating humor and play with traditional hospital care. Israel’s decade-old Dream Doctors, for example, works to bridge the gap between Jewish and Palestinian children being cared for in the same hospitals as part of a mission that includes making hospital stays less traumatic; the group has set up a four-year degree program at an Israeli university. Amsterdam’s CliniClowns offer online visits and treasure chests full of clown goodies in addition to in-person visits.
One thing the programs have in common, though, is that each offers specialized training for their therapeutic work. Medical clowns must be able to size up the needs of their hospital-bound audiences – some of whom can’t speak, or move – much more quickly than those facing audiences in a more traditional performance space. And they must be cognizant of the hygienic practices and privacy rules hospitals must obey. “In a hospital, you have to be so sensitive to the environment, what the patient might be sensitive to. What might be going on with them medically,” said Shannon, part of San Francisco’s Circus Finelli. “It’s really going in, taking the temperature of the room, the environment – really trying to be exactly what they need you to be.”
Raz said the Medical Clown Project’s run started as a six-month trial at CPMC, where Sherman used to work. He and Sherman drew in performers who had trained with Raz, who taught at Ringling Bros. and Barnum & Bailey Clown College, started his own school called the Clown Conservatory and has performed with Cirque du Soleil and The Pickle Circus over his 40 years of performing.
Since its founding, the project’s work has since expanded to include regular rounds through the medical center’s pediatric intensive care unit, its Alzheimer’s unit and skilled nursing facilities, working in individual rooms or performing for groups. The project’s performers also make visits to adult day care facilities operated by On Lok Lifeways.
The services the clowns provide to each patient vary depending on their needs. The clowns coordinate their visits with hospital staff to find out who may need a visit right away and whose rooms should be avoided on any given day; a ‘key best practice’ is to allow the patients to say no to the clowns’ visits, Raz said – which offers them the power to make a choice in place where they don’t always have the opportunity to do so.
Raz said one of the project’s clowns has drafted a “clown treatment plan” for some residents scripted down to how tight they want any hugs they receive to be. Other details – including the amount of eye contact and the distance clowns should stand from their charges – are also considered. Those who do want a visit may be treated to anything from play to a full-blown performance, or they may simply want an opportunity to chat, Shannon said. “We do music, juggling or whatever show we’re working with that day. The other half of the time, they just really like to talk to us, tell us their story, stuff about their life,” said Shannon, who said children tend to seek out more imaginative play.
Research on the impact of medical clowning is limited, but what’s available shows that the clowns’ stress-busting efforts have a measurable impact on patient outcomes. A 2008 study published in Pediatric Anesthesia found that the presence of medical clowns “can significantly alleviate preoperative anxiety” for children and that the clowns were more successful at blunting stress than midazolam, which is given in advance of anesthesia to reduce anxiety. A study published by the American Society for Reproductive Medicine in 2011 found that women receiving in vitro fertilization and embryo transfer were more likely to become pregnant if they had been visited by a medical clown.
CPMC’s Astrid Reichenbach said she’s seen a number of performers come and go, but none with the combined performance skills and sensitivity to the needs of hospitalized children that the performers of the Medical Clown Project possess. “It’s one thing to be a performer, and another to be right for kids in a hospitalized setting,” said Reichenbach, a certified child life specialist. “They take the performance aspect to another level. It’s why they’re so successful here.”
She said the clowns make the hospital’s young patients more comfortable and in doing so, lighten the mood for family members and hospital staff. The end result, she said, is often a better response to the treatments and procedures the children will undergo during their stay.
When kids are more comfortable, they’re going to respond better to their treatments and procedures and their overall sense of the hospital,” Reichenbach said. “Seeing those kids’ faces, how they change when they’re being played with, makes (the staff) feel really good. And the after effect is so beneficial for everybody.”
The beneficial effect extends to the clowns who are working with the hospital’s patients. “It’s something really rewarding. It really makes a difference that you can see,” Shannon said. Raz said his mother, Spencer, was a big supporter of the project. When she died in March, she left 500 paintings and other artwork, including sculpture and mosaics behind.
After becoming allergic to her paints, Spencer, an active feminist who co-produced a magazine called Broomstick until the late 1980s, would come to incorporate the hot wax she had used to lay out the magazine into her art. Her collection of “paper paintings” includes a self-portrait made of waxed-down squares of color and a piece that captured Raz’s grandmother that used pieces of legal envelopes.
Participants in the October 28 reception can learn more about the Medical Clown Project and bid in an auction that will include Spencer’s art and potentially some additional “circus-themed stuff.”