 The
scene: a crowded emergency room in southern Ontario. The
lineup to triage stretches to the door. The seats are
crowded with people slumped in various attitudes of distress,
leafing listlessly through magazines or staring at the
clock on the wall. In the back of the room, a baby starts
to shriek.
Suddenly, two 'doctors' in white
coats and red noses appear. "Okay, people," one of them
announces. "The official wait time to see a doctor in
Ontario is four hours. We can't do anything about that;
it's hospital policy." Behind him, his colleague is
pulling kitchen implements out of a bag: a fork, a spatula,
a corkscrew. "But if you want, we'll do your surgery
right now, on this table." Several of the patients smile.
A few laugh out loud. The atmosphere in the room lightens
perceptibly.
The 'doctor' in question is Dr
Haven't-a-Clue, the alter ego of Bernie Warren, a drama
professor at the University of Windsor and head of an
organization of professional clown doctors called Fools
for Health, which uses humour to help alleviate a little
of the gloom that attends most people's hospital visits.
"It's amazing what happens when you just walk down the
hall in a clown costume and smile at people," observes
the upbeat Prof Warren.
When he started Fools for Health
in July 2001 at the in-patient rehab program at Windsor
Regional Hospital it was originally intended as an eight-week
pilot, but the service quickly became essential. "About
week six, the hospital said, 'You can't leave'." Nowadays
Fools for Health consists of 10 clown doctors working
in four locations in the Windsor area, in wards as diverse
as adult oncology, pediatrics, emergency and palliative
care.
Most recently, the group celebrated
April Fool's Day and Windsor's Humour in Healthcare
Week (March 27 to April 2) by hosting an international
laughter symposium, with talks ranging from the profound
("Bringing Laughter to Cancer and Other Support Communities")
to the peculiar ("Merry Love Making").
MEDICAL
HERITAGE
Fools for Health wasn't just a whim for British-born
Prof Warren; it's the culmination of his lifetime obsession
with the links between humour, drama and health. Descended
from a long line of wisecracking doctors, he was supposed
to be an MD himself, and started out studying anatomy
and physiology in university. "But I realized very early
on, firstly, that I didn't like the sight of blood,
and secondly, that I was pursuing somebody else's dream."
He left Oxford after his second
year — "That didn't go down very well with my parents,"
he laughs, — and worked for several years in community
drama programs, often going into hospitals and special
schools to teach life skills through role-play.
He earned a PhD in drama, which
eventually led him from the UK to an appointment teaching
drama therapy at the University of Calgary, followed
by a joint professorship at McGill and Concordia Universities
in Montreal. In 1988, he merged his interests in drama
and medicine and set out to research the effects of
humour on health. He unexpectedly discovered a long
and rich history of clown doctoring. It seems the drama/medicine
connection is as old as medicine itself. "Hippocrates's
hospital on the island of Kos had troupes of players
in the courtyards," he reports. "And there's a reference,
in the 12th century, to one of [British king] Henry
I's fools starting St Bartholomew's Hospital." He also
found precursors in 15th century Sufis, 19th century
circus acts, and an organization from the southern US
dating back to the 1940s called Clowns for Christ.
A
'FOOL' IS BORN
In 1999 he attended a lecture by celebrated doctor/wag
Patch Adams (subject of a 1998 Hollywood film starring
Robin Williams), and another by Caroline Simonds, a
renowned street performer who was working in Paris leading
a company of clown doctors called Le Rire Médecin.
"Patch Adams was very charismatic, but he was largely
a one-man show," Prof Warren recalls. "I looked at Caroline's
work, and I thought, it's amazing — this is stuff
that I could train my students to do."
Taking further inspiration from
a New York project called the Big Apple Circus Clown
Care Unit, the two decided to collaborate on a paper,
which then grew into a book, The Clown Doctor Chronicles.
Prof Warren proposed to a Windsor hospice director that
they start a clown doctor company at one of the local
hospitals. She agreed, and Fools for Health was born.
CLOWNING
AROUND
"People often assume we're volunteers," says Prof Warren.
As contradictory as it sounds, all the clown doctors
are professionals, and the selection and training process
is quite rigorous. Many hold advanced degrees; they're
auditioned, interviewed and trained extensively to work
in different hospital units.
"Before we start the day, we meet
with our contact person on the ward, and get notes about
every patient," explains Prof Warren. "We're particularly
interested in psychosocial aspects, but we need to know
enough about their medical condition to do our work
— have they had a surgical cut in their stomach?
Should we not make them laugh?"
They quickly realized the relief
they provide isn't only of the comic variety. "The clown
doctor is the lowest of the low," says Prof Warren gravely.
"One of the things we found, in oncology for example,
was the clown doctors were often being shouted at, but
not because of anything they did. What I started to
work out was, they were playing the role of the scapegoat.
Your family member is sick, and you can't shout at the
doctor, you can't shout at the nurse, but you can shout
at the clown."
Prof Warren admits it can be emotionally
difficult for the clown doctor on the receiving end.
"But it's actually very beneficial," he insists. "We
provided a safety valve."
MAKING
A DIFFERENCE
But do clown doctors make a difference to quality of
care? Mounting evidence suggests they do. "European
research suggests that there are fewer absentee days
when clown doctors work on the ward," says Prof Warren.
"And when a clown doctor team is on the ward, healthcare
providers talk more to each other and to the patients,
and they smile more often."
The project has certainly caught
on with patients and their parents, who "perceive that
they're getting better healthcare," says Prof Warren.
The hospital brass are happy too. "We regularly get
requests from parents requesting their children's treatments
be booked at times when the clown doctors will be present,"
enthuses Joyce Chamberlain, director of the Patient
Unit — Paediatrics at Windsor's Hotel Dieu Grace
Hospital, "because they've experienced the calming effect
the clown doctors have had on their children."
Prof Warren says the most important
thing is the way clown doctoring and medicine complement
each other. "Doctors and nurses work with the parts
of the patient that are sick," he says. "We work with
everything else."
For more information visit www.foolsforhealth.ca.
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