Performing a serious medical treatment

HAIFA, Israel -- Renana Ophir and her classmates have been clowning for years, entertaining on streets, at private parties, and in hospital wards.

Now these Israeli entertainers want the medical establishment to recognize their work as a vital, certified part of care-giving.

Supported by a Swiss foundation, Haifa University has designed the world's first bachelor's degree program for medical clowns, a combined curriculum with the departments of theater and nursing. With these degrees in hand, the clowns hope hospitals take their work more seriously.

Ophir, 28, continues to work twice a week in the children's wards of Shaare Zedek Hospital in Jerusalem. On Thursdays, however, she spends 10 hours taking classes at Haifa University, where 19 hospital performers have joined what they believe is the world's first degree program designed especially for medical clowns.

"Our goal is to establish this as a real profession," Ophir said. "It's a paradox, because we work within the system even though clowns are the exact opposite of the system."

At the end of an accelerated two-year course, half the time of a regular bachelor of arts course, the inaugural clown class will have studied psychology, some nursing, along with advanced theater. With degrees in hand, the clowns hope to become fully integrated in Israeli hospitals, on par with social workers.

The approach of these clowns is part of a broader movement toward holistic treatment, which includes other efforts to improve the spirits of hospital patients, like better light, food, and decor.

Atay Citron, chairman of Haifa University's Theater Department, leaped at the chance to design the program, in close cooperation with the school of nursing. All 19 students in the program have their tuition -- about $2,300 a year -- paid by the Swiss foundation.

The first class began studying in October, composed entirely of older professionals already working as hospital clowns, almost all of them in their 30s and 40s.

These veteran actors have loads of work experience but no college degrees, which they say makes it difficult to win a place in the medical establishment.

"The plan is for them to eventually become respected parts of the medical profession like physical and occupation therapists," Citron said. "A hospital is a serious place, and clowning is serious business."

The first class at Haifa's clown program is an experiment in progress, Citron said; faculty members are designing the curriculum as they go along. "It's like we're paving the road while walking on it."

A long time theater director who started working as a full-time academic two years ago, Citron bounds about his office wearing a bright scarf and talking with excitement about applying his long experience with theater into the realm of medicine.

He said Haifa University is even planning a master's degree program in art therapy, largely designed for the clowns.

During the first semester, which ended in December, students focused on theater classes, with a smattering of psychology. Coming semesters will include a heavier dose of nursing, therapy, and psychology, said.

Dozens of prospective students have applied for the program next year, Citron said, some from as far away as Australia.

In the classrooms at Haifa University's arts buildings, the clown classmates appear to be taking their work -- and themselves -- very seriously.

After a 90-minute class on costume history, they sip coffee and scarf sandwiches during a 15-minute break in the student café with a stunning view from Mt. Carmel overlooking the Mediterranean Sea and north to Lebanon.

Ayelet Shadmon, 32, a professional clown and puppeteer from Tel Aviv, said she takes her inspiration from Charlie Chaplin and Buster Keaton. Unlike the sometimes frightening circus clowns will white faces and painted grins, Shadmon said, the hospital clowns use little make up and create a character who concentrates on engaging the patient.

"I found this was my calling," Shadmon said.

In an early afternoon dance theater class, the students contort, gyrate, and breathe deeply.

"Spin like a dreidl!" shouts the instructor, Aviva Haber.

Many of the medical clowns speak Arabic, Hebrew, English, and even some Russian -- enabling them to create gibberish and patter that sounds familiar to children of all backgrounds.

Some hospitals have used clowns for decades, but are increasingly integrating clown work into treatment, for example, by having a clown on hand to keep a child calm during a procedure.

There are bitterly divided rival schools of medical clowning: The "Patch Adams" approach focuses more on entertaining patients; the "Theodora" school, embraced by the clowns in the Haifa program, views clowns more as an adjunct to doctors and nurses.

At Children's Hospital Boston, a team of nine clowns from Big Apple Circus Clown Care works in the wards. They travel in pairs, dressed in doctor's coats doing routines like "chocolate milk transfusions" and "red nose transplants," intended to demystify procedures that frighten children.

It's not too different from the approach of the Haifa clowns.

One student, Nimrod Eisenberg, 32, has worked as a clown and street performer for half his life. Four years ago, Eisenberg was recruited to join a pilot program called "Dream Doctors," which brought clowns into Israel's hospitals.

Instead of entertaining sick children during the down time, these clowns work alongside doctors conducting rounds and treating children.

"We're not there to perform. We're there to assist in the therapy," Eisenberg said.

Ophir works two mornings a week at Shaare Zedek Hospital, on the western edge of Jerusalem, in character as "Pomodora," a baffled, vaguely Italian clown character.

One recent Monday morning, she strolled from the pediatric emergency room down the hall through the crowded wards. Many of the parents recognized her from previous visits. An Arab couple motioned her over to cheer up their infant son, who was especially nervous because doctors were going to draw blood. Within minutes, he was howling with laughter and pulling long sheaths of colored cloth out of Pomodora's costume.

Dr. Ofer Merin, a cardiac surgeon whose daughter was awaiting surgery in one of Shaare Zedek's inpatient wards, said hospital clowns were as vital as social workers.

"There's no question that it makes a difference to the atmosphere, the feeling of the patient," he said.