Doctors and nurses aren’t the only people sick kids are putting their trust in. Now, clown doctors are a staple part of treatment for young patients at Auckland and Christchurch – and soon Wellington – hospitals. As Jennifer Van Beynen finds, sometimes laughter can be the best medicine.
Behind a curtain in the children's emergency department at Starship Hospital, a little girl with a bandaged chin waits with her mother.
In other cubicles children and their parents sit quietly. Nearby a baby wails and grizzles, and will not stop.
A face peeks around the curtain, red nose first. The visitor is dressed in short green overalls, boat-like Pinocchio shoes and a white coat. "I'm Doctor P.P. Roni," he says. Another, bedecked in voluminous pink dress and leopard print tights, elbows him aside: "I'm Doctor Strut-Her-Stuff," she announces.
The honey-haired girl sits watching, her eyes gleaming, as Strut-Her-Stuff attempts to push P.P. Roni behind the curtain, where he pops his head back around. "He's so embarrassing," confides Strut-Her-Stuff, and then attempts to give P.P. Roni a makeover. The mother laughs along just as much as her daughter, and thanks the duo when they leave.
Strut-Her-Stuff, aka Hannah McQuilkan, and P.P. Roni, aka Stephen Hollins, are not medical doctors - they are clown doctors; trained performers who work in shifts at Starship Children's Hospital to entertain and distract sick kids; amuse and relax strained parents.
"When we first went out it was a minefield - we were scared, the nurses were scared. Now they're used to us," says Hollins. "The staff are quite serious. There's tension between parents, the child, the doctor ... We try to distract the children, to take away their tension and fear and make them smile or laugh. If they're being taken for an injection or something, sometimes we'll be asked to distract them.
"It's all about being adaptable. You can have a 6-year-old, then a 16-year-old."
Clown Doctors New Zealand was founded in 2009 in Christchurch by Professor Thomas Petschner, a German health scientist who has done extensive research on the impact of humour on metabolism. Eleven clown doctors now visit Starship wards in Auckland and around four in Christchurch visit the children's emergency department and other children's wards throughout the week. Next month, auditions will be held for the first group of clown doctors to go into Wellington Hospital, with more planned for New Plymouth, Wanganui and Palmerston North.
Petschner is happy with how fast Clown Doctors have taken off in New Zealand.
"I thought, because I myself am a medical doctor but on the other side [research] and I spent the first 35 years of my life in theatre ... I thought it would be good to combine all my knowledge and establish it in New Zealand," he says.
"It's big fun, it's a great combination of using medical knowledge and medical science combined with performing arts. It's applied humour, I call it.
"It's well known that laughter limits the pain and reduces stress and boosts the immunity system, and so on. So having clown doctors is just a tool, they fit into this whole medical space and we're changing the environment in the hospitals. We also have a strong influence on the staff, doctors, nurses, because they also have a lot of stress. We give them a kind of relief and support."
Clown Doctors New Zealand is associated with Red Noses International. The paid performers receive extensive medical clown training - which involves becoming familiar with a variety of illnesses - before working in hospitals, as well as ongoing education.
Petschner says there has been extensive research over the past few decades looking at the link between humour and wellbeing.
Research suggests laughter reduces pain by releasing endorphins (the body's natural painkiller), boosts the immune system by increasing T-cell numbers (white blood cells important to the immune system), and lowers cortisol (a hormone the body releases in response to stress) levels. "It's a hormone cocktail that's boosting our immune system, and it's absolutely supportive in the process of healing."
A 2010 study at an Israeli in-vitro fertilisation clinic showed that IVF recipients who had been visited by medical clowns were nearly twice as likely to become pregnant than those who didn't receive visits. Of the 219 women involved in the study, 36 per cent overall became pregnant, as compared to 20 per cent of women who did not receive "laughter medicine" after their procedures.
Sprinkled throughout the research are some startling anecdotes. In a paper written on the Big Apple Care Unit in New York, a clown doctor tells of an 11-year-old boy in the intensive burns unit who had severe burns over half his body. As surgeons cut away his dead flesh, the clown began his work of distracting the patient from the pain - eventually the boy was laughing.
Luckily, nothing so agonising awaits the performers this Saturday. To prepare for their shift, McQuilkan and Hollins get into costume. Snapping on their red noses, "the smallest mask", says Hollins, their characters are complete and the pair instantly talk, walk and stand differently. Strut-Her-Stuff wields an iPod attached to a purple speaker sticking out of her coat pocket, and out bounces Michael Jackson.
"Let's warm up!" she says, dancing on the spot.
These clowns are not your garishly face-painted, circus type. Hannah's character, Strut-Her-Stuff, firmly believes she could win New Zealand's Next Top Model, and the show is a talking point with many of the children. Strut-Her-Stuff wears a feathered headband, and finishes her Kiwi fashionista look with a pert red-lipsticked pout.
McQuilkan, who also works as a life model, describes a clown as "an innocent fool", and her own character as an "extreme own-self. Strut-Her-Stuff is very Kiwi. She tries really hard; she's a bit misguided."
P.P. Roni ("I love my pizza," he explains - Hollins also runs a pizzeria on Waiheke Island) and Strut-Her-Stuff make their way to the emergency department, their white coats flapping behind them.
Strut-Her Stuff waves and gushes at everyone she sees. "Aren't they beautiful!" she squeals. Faces appear from the hospital windows high above, and patients wave down at them. Taxi drivers are not immune, laughing from behind the wheel. The performers lap it up. "I feel like a superstar!" cries Strut-Her-Stuff in her loud Kiwi twang, blowing kisses. "You are," P.P. Roni assures her, telling passers-by, "I'm her manager."
The image of a doctor-as-buffoon became widespread with the 1998 film Patch Adams, starring a beaming Robin Williams complete with red nose and clown shoes. The real Patch Adams, Hunter D. Adams, founded the Gesundheit Institute in 1971, with the goal of providing free and holistic healthcare with an injection of fun.
But clowning for the sick goes back as far as the ancient Greeks, with some research showing that Hippocrates' hospital on the island of Kos had players and clowns in the belief that mood influenced healing. The court jester is another comic yet therapeutic figure, as they helped to cure the monarch or noble when they were feeling melancholy.
The starting point for the modern practice of clowns in hospitals began with the Fratellini Brothers, a trio of Italian clowns who started visiting hospitals at the end of the 19th century. Professional clown doctors as we know them today began in New York under a programme called the Big Apple Circus Clown Care Unit in 1986. Clown doctors currently operate in Australia, Canada, the United States, Israel and across Europe.
Clown Doctors New Zealand is based in Christchurch and when the February earthquake hit, the organisation sprung into action, spending weeks working with relief and rescue teams.
"We were in Latimer Square with the rescue teams," says programme director Rita Noetzel. "It's a situation which is definitely not funny, and so no one's going to laugh - but they need that permission to laugh and have a release of all that tension. Some of the rescue teams said, 'please come down to Latimer Square, please come and see the rest of the rescue teams, because we just need a good laugh'."
"Actually, they need support themselves," adds Petschner. "They are heroes, but they are also human beings, so they also need a kind of relief."
Ruth Dudding, who as well as being a clown doctor (Dr Priscilla Pick Me Up), is currently making a documentary about clown doctors in New Zealand. She says sensitivity and being adaptable are key qualities in a clown doctor.
"For parents it's an incredibly stressful time. Some have got no idea what's going on with their children, some of their children are in theatre when we go in, some have just come out from operations, some have life-changing disabilities.
"So we've got to be really incredibly sensitive to that. When we go into a room we've got to gauge where the parents are at, we've got to gauge where the children are at. Most of the time the parents are really thrilled to see us. They can see their children responding, often in a way they've not seen in a while, and so that's a great relief for them."
Strut-Her-Stuff and P.P. Roni are constantly gauging their environment. One moment they are boisterously directing "traffic" as kids drive small plastic cars around the play area, while bemused doctors step around them. The next, they tiptoe in to visit the mother of the wailing baby, who has finally stopped crying and lies in her arms. The mother looks up tiredly, but then smiles. Strut-Her-Stuff switches her iPod to a lullaby and blows "magic" bubbles over the baby's head. He watches calmly, sucking at a bottle, as a green finger puppet gently snaps at the bubbles. The performers whisper goodbye, blow kisses and back out of the cubicle.
Dudding says that over time, hospital staff have become used to having cartoonish versions of themselves around.
"Some nursing staff and doctors have just welcomed us with open arms, right from the beginning and got involved with us, played with us and given us a lot of leeway - a lot of mana if you like. And then there are other doctors and nurses who have been a little bit more cautious. But definitely, as we become more of a fixture at the place, a lot of staff say, 'can't you come and work in our ward?"'
Petschner is keen to see a stronger link between humour and medical practice and is in the process of getting accreditation at Steinbeis University of Berlin to start up a Bachelor of Medical Clowning.
"What people don't really realise, [is] when you see the movement of clown doctors worldwide, in all those countries where clown doctors are active, they are visiting three million patients a year. Ten years ago no one knew about an occupation called IT specialist or web designer, because they were not there. Our society is changing, so we have to go along with that and bring something that is really necessary - and good for people."
At the moment, the main stumbling block is funding - Clown Doctors New Zealand is a charitable trust, relying on sponsors and donations to keep the programme going. A funding sponsor has just been found for Wellington hospital, allowing six clown doctors to soon start work on the wards, and there are plans to expand into rehabilitation centres and geriatric wards, says Noetzel.
"It is to the hospital's advantage ... a hospital can fundraise and get a new piece of machinery, which is a really important and valuable thing to do, but the children have no direct benefit or don't see the benefit. [With] clown doctors, it makes them laugh ... It's tangible, it's instant gratification.
"A person's attitude and how they feel while they're in hospital will have a direct [impact on] how long they're going to stay, and how quickly they're going to recover. If you have a pleasant stay, you're going to get out of there faster, you'll get better faster."
Clown Doctors NZ is holding auditions in Wellington on April 1 to fill six new clown doctor roles for Wellington Hospital and more for New Plymouth, Wanganui and Palmerston North. Those who pass the auditions will attend a 10-day intensive medical clown training course, starting on May 12. For more information visit the website above or email firstname.lastname@example.org