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A Conversation About the Surprisingly Serious Role of Medical Clowns

Filmmaker Sasha Kapustina is capturing this unique profession as it becomes an integral part to hospitals in Jerusalem.
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Sasha Kapustina. (Photo: Ingie Markovich/IAM Supreme Photography)

Sasha Kapustina. (Photo: Ingie Markovich/IAM Supreme Photography)

There's a bit of a medical revolution happening in Israel currently—less of the scalpel and suture kind, and more of the red nose and big shoes sort. Medical clowning—where trained adult performers offer holistic care to patients, often younger ones, through laughter—is gaining respect within the medical community. As research has shown, it's an incredibly valuable profession.

Russian filmmakers Masha Tishkov and Sasha Kapustina are attempting to capture this clowning boom in Jerusalem hospitals by following four professional medical clowns as they empower, calm, and strengthen patients through the power of humor. Their documentary, I Clown You, currently has 24 hours to hit its goal of $24,000 on Kickstarter. We spoke with Kapustina about why Israel has embraced medical clowning, what medical benefits they actually provide, and why Western culture might be a bit apprehensive about adopting them.


Take me back: When did you first hear about medical clowning, and when did you become inspired to make a film about it?

I am from Moscow, Russia, and in 2010, my friend Masha Tishkova, who's my co-director and co-producer on this film, and I moved to Israel together. Soon after that, I got a scholarship to go to film school in Los Angeles, so I had to leave. I had this idea that we have to come up with some kind of project to stay in touch, because it's really hard to maintain a friendship if you don't have a reason to call each other. We were really impressed with Israel; we thought it was a very interesting place to explore. We started to look for a story about Israel, and it took us two years to find a story. What happened was that Masha literally bumped into one of our characters, David Barashi, who is one of the founders of medical clowning in Israel. Masha happens to have a day job in the hospital and ran into him, and she told me about him.

We were already thinking about hospitals, because in Israel hospitals are kind of a unique place—Arabs and Jews co-exist peacefully. There are Arab and Jewish doctors working together, Arab and Jewish nurses tending to Arab and Jewish patients, and people just focus on more important things then hating one another. They might not like each other, but they don't act against each other in that moment.

Do you think clowns somehow contribute to this truce?

Oh, yes. You know, clowns, they don't stop clowning, whether the nose is on or off, whatever they're doing. Medical clowning is not an act; it is a constant improvisation. As they walk through the hallway—whatever is around, whoever is around, everything and everybody is part of this improvisation. And there are moments where there's an Arab family and a Jewish family sitting in a hallway waiting for their appointment, and the clown starts clowning with all of them together. The adults might not like each other, but they can't help laughing and smiling and sharing this moment.

As far as I can tell, medical clowning isn't very big in the United States. What has allowed it to blossom in Jerusalem?

Actually, medical clowning as a movement [began in the U.S.]. There was Patch Adams in the '70s, but then in the mid '80s medical clowning was really developed in New York by Michael Christensen, who works with Big Apple Circus. But it couldn't take off here because there are so many protocols and so many limitations that insurance companies [place on] hospitals. Clowns seems unsafe [to the insurance companies], which they aren't, because those clowns are trained and they know what they're doing. Actually, hospitals benefit tremendously for them and [hospitals in Jerusalem] fight for their clowns.

What kind of training does a medical clown receive? Closer to circus clown training, nurse training, or a hybrid?

Well, there are two types of medical clowns: volunteer medical clowns, who usually go through some sort of training with the organization that helps them to be placed in hospitals, and medical clowns. But Israel is unique because they have professional medical clowns who are actually paid to work in the hospital. To become a professional medical clown, [you need an] extensive background in acting, performing, street theater, or clowning theater—less circus experience, more improv experience. [Medical clowns go through] five months of training, and then intern in a hospital with a more experienced clown mentor. [The clowns] continue training through their career. Every year, they go to seminars or some workshops or something like that.

What types of procedures will these clowns sit in on? Certainly they're not coming into surgeries, right?

Oh yes, they will! Well, they don't perform the surgery, but they accompany kids when they're given anesthesia—they are there when the kid goes to sleep, and they're with them when they wake up, because that's a traumatic experience. They help with that.

Are there studies being done on medical clowning?

Oh, yes. There's an organization called Dream Doctors. It's their goal to show that medical clowning is a valuable profession [through research]. We're actually going to be filming one of their studies that is currently underway in the bone marrow transplant ward. There's this clown duo, Dori and Noam, and they accompany adult patients who go through a bone marrow transplant and have to stay in isolation for six weeks. This study aims to get some numbers on how people experience the duration of the stay in the hospital with the clown and without the clown.

Dori and Noam are two characters you follow in your film, along with David and Fulla. David is something of a legend in medical clowning, right?

David is one of the most well-known medical clowns. He's frequently on the news. He's this rock star of a clown. He was one of the first three professional medical clowns in Hadassah Medical Center in Jerusalem, when the program was started in 2004. Since then, it's his main gig.

Then there is Fulla Jubeh, who is David's student, and her story is just crazy. She is 35 now and is Arab-Israeli. She is the first Arab female professional medical clown in Jerusalem. She was kind of David's personal project at one point—she applied for the program and he personally took her as a mentor. She worked as a [non-medical] clown before that for about 10 years, but now she's a professional medical clown.

In Jerusalem, where there's a lot of Arab kids and Arab patients, having a female Arab clown is very important. Every clown would tell you tell you "I work with everybody," and they do, absolutely, because a clown is an abstract thing. He or she doesn't really have gender or nationality or religion. They are just human. But it has value that she can address people in Arabic and she can have that short cut.

What is so unique about the joy clowns deliver in a hospital, as opposed to, say, a funny film or a silly toy?

There are many things, but probably the main thing is that, for everybody—the family and the patient—being in the hospital is very traumatic, and even if the person is trying to keep their spirits up, it's always with an effort. The patient is trying to keep [herself] together for the family; the family is trying to keep themselves together for the patient. Everybody's hurting in reality. Nobody can be fully honest with each other in that context. But if a clown comes in, sometimes, the patients tell them things that they cannot tell to their families. The patients talk to them about how they're afraid to die, or they just cry with them. It's this presence that people just don't perceive as adults. It's weird—you see that it's an adult man, he's in his 40s, but when he puts his nose on and starts acting funny, you stop thinking he's an adult. You almost stop thinking about them as a person—they are some other kind of being. Because they're so open and because when they're good they know how to make the patient feel comfortable with them; the patient opens up and can share things and feel this presence of another being that doesn't put pressure on them.

As you probably know, clowns have, in popular Western culture, become a bit demonized in recent years. It's almost fashionable nowadays to be afraid of clowns. Do you run into situations where kids are scared?

Well, that is definitely mostly an American thing. But also, the medical clowns don't really look like American circus clowns. They don't have that much facial make-up; most of the time they only use their nose because of hygiene. But yes, there are situations where kids are not comfortable with anybody, especially a stranger. But the clowns, they are improvisers, so they know how to find their way in. For example, if they see that the kid is a little weary, they will start working with the adults first. When the kid sees, [they think]: "Oh, mom is laughing. I can laugh too." And then when one kid sees it and starts playing with [the clown], the other kids want to be included immediately. It's sort of this chain effect that the clown creates in this space.

It's all much more about improvisation and psychology rather than an act. Whatever trick the clowns are doing, they're doing them with an underlying psychological current. For example, a kid who's been in the hospital for a few days and doesn't feel good about themselves—they're dirty, their hair is dirty—the clown will walk in and give the kid a brush and make the kid brush the clown's hair. The clown shows the kids that they're not the only one who feels uncomfortable about how they look. Actions are much stronger than words. Some kids won't even speak the same language. There is much more meaning that comes from physical actions.

This interview has been edited for length and clarity.