Medical clowns: Israel's Dream Doctors use therapeutic clowning for evacuees

WITHIN A few days after the start of the war in October, Limor Eshayek got into her car and drove four hours from Jerusalem to Eilat, where members of two of the ravaged kibbutzim in the Gaza envelope had been evacuated.

“It was like walking into a house strewn with broken glass; everyone was broken,” she recalls.

Eshayek is a medical clown, trained to bring joy and hope to sick and fearful patients. She’s worked as a medical clown for 15 years, accompanying severely, even terminally, ill children. “But nothing I experienced could have prepared me for that,” she states.

Despite the silly nose and goofy costume, medical clowning is no joke. The practice has proven effective in reducing pain, anxiety, and stress. Eshayek, 54, whose “nom de clown” is Perla and does regular shifts in Jerusalem’s Shaare Zedek Hospital, belongs to Israel’s veteran nonprofit Dream Doctors organization.

Dream Doctors: The clowns helping with trauma

Founded in 2002, Dream Doctors has more than 100 members who work with medical teams in partnership with 33 medical centers in Israel. These salaried medical clowns visit patients unaccompanied and are considered members of the medical teams. They accompany physicians on their rounds and sometimes assist in medical procedures. It is silliness in serious settings. Their wacky appearance serves to make the clowns non-intimidating members of the medical team.

The Dream Doctors’ members generally work in hospitals, but since the war that began in October they’ve been visiting communities of displaced Israelis all over the country, evacuees who have experienced unimaginable trauma.

Dressed in a crazy combination of ballooning striped pants, a colorful shirt, outsized floppy shoes, a ridiculous hat made of little girl’s shoes and, of course, a red nose, Shuli Victor’s appearance is so striking, that everyone who passes him at Soroka Hospital in Beersheba smiles. He calls out to everyone he sees – doctors, secretaries, cleaners – in various “languages” in a loud joking patter. “I don’t want anyone to feel transparent; everyone is part of the staff here,” he explains.

A professional magician, mime artist, storyteller and stand-up comedian, Victor, 60, has been a Dream Doctor since 2003. On this morning, he’s making the rounds in Soroka’s children’s wards. He tells jokes, makes silly remarks, and performs simple magic tricks: Placing a red ball in a child’s hand, he says, “Guess a number between one and three.” When the child opens his hand, there are two balls, and laughter ensues. Before he enters a patient’s room, Victor knocks on the door. “I always ask to come in,” he explains. “In the hospital you lose all privacy; everyone is always coming in and out. If I ask permission to enter, I’m somehow restoring the individual his inner strength. It’s a small thing, but the child gets to decide what he wants.”

Some of the children (nearly all Bedouin here in the Negev) look terrified when he first enters but are happily grinning by the time he leaves. “I’m distracting them from their situation,” he says.

Distraction from Victor’s own dreadful experience may be insurmountable. On October 7, his kibbutz home in Nir Oz in the Gaza envelope lost 30 percent of its residents, who were murdered, taken hostage, or declared missing.

Victor survived because he was in Tel Aviv recovering from major heart surgery. His ex-wife and daughters were also spending the weekend in Tel Aviv. When Victor started hearing the news of the terrorist invasion, he kept trying to contact friends on the kibbutz but got no replies. Subsequently, he learned that they had been murdered.

Victor also works as a medical clown in Adi Negev, the rehabilitation village for severely disabled children and adults in southern Israel. “I always work with people in extreme pain, but this time it’s much worse because you work with children who lost many of their family members, and even more difficult because I personally know those who were murdered or kidnapped. It takes a great deal of emotional strength,” he says.

Victor explains that he just tries to get people to smile or laugh, despite the horrors they’ve experienced, but admits to his own “survivor’s guilt.” “I’m the comic soldier. I’m a buffoon – always on the edge of tragedy.”

Eshayek (Perla) is wearing a brightly colored outfit, flowers in her hair, striped knee socks, and (of course) a red nose. She’s visiting a little boy post-surgery in Shaare Zedek’s children’s ward. He’s been told that he must get out of bed today, but he refuses to even sit up. Eshayek whizzes around the bed, and in a rapid-fire patter complains loudly to the child about mothers, doctors, nurses, and little boys who refuse to get out of bed as the boy’s mother looks on, giggling. Later on, the boy is being pushed in a wheelchair in the corridor. Eshayek’s shtick has made a difference; he agreed to get out of bed.

In the waiting room for day patients Eshayek makes the rounds, throwing her little purse into the air, and catching it with her feet. When she shows a child what’s in her purse, out fly a flurry of red flannel hearts.

In the intensive care ward, a three-year-old girl is recovering from brain surgery. Eshayek has been told that the child needs stimulation to start to respond to the outside world. Placing her head on the bed next to the child’s face and singing a little song, she tries to get the little girl to react or to speak. There’s a slight response, but not enough. Throughout the morning she’ll go back to the child, each time managing to elicit a reaction or a movement. “I come to her very gently; she’s half here and half there. I’m bringing her energy; this is the power of the clown,” she states.

Eshayek has also started working with an IDF project for shell-shocked soldiers. “Many soldiers are really broken; they’ve seen terrible things, without preparation.”

“A clown listens and tries to be open-minded and open-hearted,” comments medical clown Dan Grodzinski, 42, known as Piccolo, who also works at Shaare Zedek Medical Center. “Clowns aren’t insane, but we’re actually like an island of sanity. A patient will think that if a clown is here, maybe everything is okay. If they let a clown into the operating room, something must be normal.” Grodzinski believes that their mere presence has an influence, not only on the patients but also on the staff.

A professional juggler, he also went around the country to be with evacuees at the beginning of the war, then returned to the hospital. “In Shaare Zedek, we have the entire population of the city here. During the war there’s been a lot of tension – even with the staff ,which is mixed Jewish and Arab. As clowns, we relate to everyone as the same; we’re above language barriers. A kid is a kid.”

All Dream Doctors were already professional performers before going through the extensive training to become medical clowns, often coming from the world of street theater. That experience helps them establish an instant rapport with patients, even in the most frightening situations. “We have to be professional in what we do,” says Eshayek. “Just putting on a red nose doesn’t make you a clown. When you perform in front of audiences, you learn to listen.”

“This is a very specific kind of training,” explains Dream Doctors executive director Tsour Shriqui (whose father, Yaacov Shriqui, founded the organization). In 2006, there were 25 people who earned academic degrees in medical clowning from the University of Haifa. This past year, a new academic program was launched at Assaf Harofeh Hospital (now called Shamir Medical Center). “There’s nothing else like this in the world – an academic program that is associated with the Hebrew University. It’s no exaggeration to say that Israel has become a global leader in the field,” he says.

During the pandemic, Israel was the only country where medical clowns still worked regular shifts in hospitals, and directly with COVID-19 patients.

To study the method behind the madness of hospital clowning, Dream Doctors established a scientific research fund to provide grants. To date, the fund has supported over 42 studies, 33 of which have been published in scientific journals.

While the Dream Doctors are salaried professionals, the Israeli NGO Simchat Halev-Israel Medical Clown Association has some 500 volunteer medical/humanitarian clowns. Following a year-long paid course, they visit psychiatric hospitals, nursing homes, and clubs, as well as hospitals, usually working in pairs. Simchat Halev volunteers also escort ER patients. They, too, travel around the country to entertain evacuees.

“These volunteers dedicate themselves to uplifting people’s spirits in difficult situations and times, including supporting people isolated in their homes,” says Simchat Halev educational director Jeff Gordon.

One of the Dream Doctors’ projects is the Clownbulance, a specially outfitted colorful vehicle which provides terminally sick children a chance to briefly escape their routine of painful hospital treatments. The child patient makes a wish, and the Clownbulance team makes it happen – a football game, a visit to the zoo or the beach. In addition to providing trips for end of life wish fulfillment, the vehicles are now visiting children all over the country who have been evacuated. (Like all Dream Doctors projects, Clownbulance is funded by donations.)

In “normal times,” Israel sends out its IDF Medical Corps field hospitals around the world to provide medical care following disasters – earthquakes, floods, refugees. In addition to medical and rescue staff, these teams always include therapeutic clowns. They aid in communication but also offer trauma intervention techniques. Victor has been on some of these missions, such as Indonesia, Haiti, and Jordan, where he interacted with Syrian refugees. “Clowning is a universal language,” he notes.

Israel’s most recent medical missions took place following Russia’s invasion of Ukraine. For a year and a half, Dream Doctors sent 20 teams to Poland, Moldova, and inside Ukraine itself. “These missions are part of our DNA, to be wherever we are needed; it’s Israel,” states Dream Doctors CEO Shriqui.

For more than 20 years, Dream Doctors has been an integral part of Israel’s medical teams. Although they receive salaries from the hospitals, the organization’s efforts to obtain official Health Ministry recognition (and thus benefits) have been unsuccessful. “One of our main goals is to be fully integrated into the healthcare system,” states Shriqui.

“At the beginning of the war, a psychiatrist told us that we should try to connect those who were traumatized to the present, so they have something to hold on to,” says Shaare Zedek clown Grodzinski. “That’s what we do; we live in the moment, working without memory, a blank page. That was very helpful, to connect to this moment, not the past.” ■

For more information about Dream Doctors, go to https://dreamdoctors.org.il. For more information about Simchat Halev, go to https://www.simchat-halev.org.il/en/home.