The Komali MeDi Clown Academy wins the “YES! I am the CHANGE” 2018 Grant & Accelerator

Worldwide, the concept of medical clowning [see below] is gaining importance. In Canada and the United States it became a paid profession in 1986. Clini-Clowns and Theadora are active in The Netherlands, Hong Kong and other countries; Hearts and Minds is working in the UK; Australia has the Humour Foundation, Brazil the Doutores da Alegria (Doctors of Joy), and New Zealand the Clown Doctors. The organisation Red Nose International has clowns working in 10 countries in 273 hospitals. In Israel, the University of Haifa has a undergraduate and masters degree programme in clowning therapy and Jerusalem’s Hadassah University Medical Center has medical clowns working in almost all of its departments: internal care, surgery, intensive care, same-day clinics, diabetes clinics, HIV-AIDS clinics, rehabilitation, dialysis, day-care centers for autistic children, oncology, neonatal care units, centres for child victims of sexual abuse and psychiatric wards.

But in the rest of the world, India included, the profession hardly exists even though there is sufficient academic proof that medical clowns can bring a significant reduction of pain and stress and of feelings of depression and isolation. Research has shown that due to their intervention, hospital patients have shorter recovery times. When medical clowns take part in surgical preparations, patients need less anesthesia and less pain medication after the operation. In dealing with the elderly, clowning can bring relief in illnesses such as heart disease, diabetes, dementia, cancer and Alzheimer. Also the medical staff benefits: there is a decrease in staff burn-out leading to fewer days absence and lower staff attrition, and an increase in overall well-being.

It is in this context that the award of the Indian YES! Foundation to Auroville’s Komali MeDi Clown Academy is of importance, as it recognizes that medical clowning can bring a huge difference in the treatment of hospitalized patients. By selecting the Komali MeDi Clown Academy out of 11,500 + initial entries the Foundation showed its trust in the concept and its willingness to promote medical clowning to become part and parcel of the Indian medical profession. Aurovilians Fif Fernandes and husband Hamish Boyd received the award on September 14th, 2018.

What is medical clowning?

Fif explains that medical clowning does not mean merely entertaining children or adults or just putting smiles on faces in a stressful hospital environment. “It is not about dropping by to put on a show. We engage with patients, we share joy with all around us, but our main engagement is to work as an integral part of the medical team. The medical clown often accompanies physicians on their rounds, assists in medical procedures by using conscious redirection strategies such as laughter, pranayama, storytelling, puppetry, music, dance, play and parodying the doctor. The clown may even be asked to advise on therapeutic assessments.”

She recounts her own experience working as a therapeutic clown in a hospital in Canada. “I was part of the medical team and when a case was discussed, I would know what was being done and what needed to be done. For example, my presence was essential when dealing with rape victims and their families. The physical examination by the medical team could easily lead to a second trauma, as the rape would be re-lived by the victim, but with the clown’s interventions, use of distraction strategies and presence, it became easier for the victim and their family to deal with the whole process. I’ve observed that many victims I interacted with were not re-traumatized when they left the hospital and often only remembered their playful interaction with the medical clown.” Medical clowning, she explains, is a matter of the heart. “Humour deals with cognition, clowning and joy come from the heart. There is no need to understand the language – clowning is about heart connections and the healing of the heart.”

The work

The grant of the YES! Foundation – Rs 30 lakhs over a period of three years – is great as a start-up fund but will not be sufficient for the huge task that awaits Fif and Hamish. Their work will involve promoting the concept of medical clowning to the Indian medical establishment; convincing hospitals about the usefulness of having two or more medical clowns on their staff; doing PR work and publishing articles in medical and other journals; and interacting with large corporates to fund hospitals hiring medical clowns. In addition, for a period of three years, they will train 66 persons each year to become medical clown trainers – the first year in Tamil Nadu, the second in Kerala and the third in Karnataka. This too will be a challenge. Many parents are willing to pay the educational fees for their children to become doctors or engineers, but not to become clowns, as they believe that to be a job for misfits and those who can’t get a proper job. A real mind shift within the society will need to be promoted.

The training programme includes pranayama and laughter yoga and the science behind it; academics such as medical anthropology, basic psychology, social work, nursing and working with medical professionals in several areas of medical needs; working with specific groups such as children, aging adults, sexual abuse and PTSD victims, and those with chronic illnesses; sessions on the history and theory of medical clowning; and re-introducing traditional Indian art forms such as improvisation, storytelling, puppetry, Therukoothu [a popular folk dance drama of Tamil Nadu] and Komali [the village clown or buffoon in Tamil Nadu].

Many of these academic courses will be taught on-line by the experts in that area. Clowning, mask utilisation and puppetry will be taught in classes of 12-14 people for periods of three months, followed by an internship in a hospital where the students will shadow professional medical clowns and, afterwards, will be guided and mentored in their own interaction with staff, patients and their families. An examination will conclude the training.

Providing job opportunities

Fif says that an increasing number of Indian hospitals are open to employing Medical Clowns. However, they may not have the funds to pay for their salaries. “If a hospital has to make a budgetary decision between buying an incubator or hiring a medical clown, the choice will most likely be for the incubator. But if you compare how many people will be served by the incubator and the clown, the clown wins. The hospital has to evaluate the payback on its investment, helped by the published academic research. It should look at faster healing processes and savings in hospitalization time, the reduced need of medicines, stress levels going doing, suicidal tendencies diminishing, and students doing better in their studies. Then they have to find corporates who are willing to provide the necessary funding from their Corporate Social Responsibility budgets and underwrite the cost of the Medical Clowns.” She recounts how an anonymous philanthropist donated 1 million Canadian dollars to train clowns in ten pediatric facilities for a three year period. “I was hired under that initiative”. During that three-year process, each hospital had to secure their own future funding. This single donation firmly established the therapeutic clowning concept in Canada.

The first steps have meanwhile been taken. Fif and Hamish have started working with the Chennai based EKAM Foundation, the Aravind Eye Hospital in Pondicherry, the Stella Maris College in Chennai and Auroville’s Sustainable Livelihood Institute (an initiative of Auroville and the Government of Tamil Nadu. “The Pondicherry Institute of Medical Sciences (PIMS) and a few hospitals in Chennai and other parts of the country have already shown interest,” says Fif, “and we’ll soon approach the authorities of JIPMER”. They have also been invited to address the medical establishment in a few conferences. It’s a promising start.

The Mission of the Komali MeDi Clown Academy

+To transform health and social wellbeing through MeDi Clowning in rural and urban India.

+To develop and implement an accredited MeDi Clown Training Program recognized by the Government of India and regulatory bodies.

+To develop job opportunities and a large pool of professionally trained MeDi Clowns in every state district and Union Territory.

+To integrate MeDi Clowning into preventative and curative health settings, with MeDi Clowning recognized as a paid profession in healthcare and education by the Government of India and regulatory bodies.

+To expand and nurture relationships with rural women's and men's groups healthcare clinics and hospitals, and educational institutions by empowering them to establish sustainable preventative and curative health programs that include funding for MeDi Clowning, .

+T9 design and deliver workshops seminars, Social and conventional media coverage to educate healthcare and other professionals, government and non-governmental organzations and the general public on the substantial individual and societal benefits of MeDi Clowning. +To conduct further research on the impact of MeDi Clowning on health and wellbeing outcomes in healthcare, educational and community settings.