Bozo, MD—Makeshift
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Israeli clowns leave the circus tent for the pediatric ward to ease wartime trauma

— Bozo, MD

Amnon Raviv fights his battles with a giant sunflower on his head. Where tensions run high and conflict is never far away, he’s ready to trip over his medical bag or start a food fight in the cafeteria. As one of many medical clowns working throughout hospitals in Israel today, Raviv, or Professor Doctor Head of the Ward, restores joy to his patients, providing a refuge and reprieve from the anxiety of illness.

Medical clowning is changing the way Israeli doctors work. Far from your birthday party bozos, these clowns are professional actors with extensive medical training, who use their artistic craft to facilitate healing. While making patients laugh and reducing their anxiety, the clowns serve as a channel of communication among doctors, patients, and families. They transform the hospital environment—at times terrifying, depressing, and stressful—into a world of fantasy and vitality, imagining play as a point along the path to health. “When you laugh,” says Raviv, “you start to look differently at the situation you’re in.”

In 2007, Raviv was working at Barzilai Medical Center in southern Israel, when a rocket exploded next to a bus full of children in nearby Sderot. The children were rushed to the hospital to await treatment for shock, and Raviv rushed to meet them. The head doctor gestured for him to stay back, but as a clown he had “very selective hearing”. He stumbled in, scrambling for his gadgets and making faces at the kids. They quickly burst into laughter. From then on, whenever patients arrived to be treated for shock or PTSD, it was the clowns the medical staff sent in first. “In Israel,” Raviv says, “we have the unlucky opportunity of working as clowns in war.”

Since then, the clowns have fully integrated into the Israeli medical team. They now work with doctors on a multitude of procedures, from accompanying children before surgery to assisting the staff during chemotherapy and dialysis. In one technique called mirroring, a doctor will swab one arm, and the clown will swab the other. The clown provides distraction, while performing a parody that gives the patient a renewed sense of agency.

Studies have shown that techniques like this are effective. Another trick, called freezing, encourages kids to sit still during imaging. A study at a northern Israeli hospital confirmed that, in nearly all cases, freezing eliminated the need for sedatives in kids with urinary tract infections. Another found that preoperative clowning reduced the amount of anesthesia required in pediatric surgeries and sped up recovery.

Raviv sees more clowns working in different contexts, focusing on adults as well as children, in more wards of the hospital, and in outside rehab facilities and nursing homes. The practice has spread to infirmaries throughout Europe and North America, who are sending clowns to shadow Israelis.

“For someone with a life-threatening illness,” says Raviv, “humor is much more significant.” He pauses. “It is hope. An inner command to live.”

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