In August and September 2025, I again had the privilege to volunteer as a staff physical therapist in ADI-Negev Rehabilitation Hospital in Ofakim, Israel. As I have written on these pages previously, I am fortunate to have a skill set which is much in demand in Israel to treat our injured defense force soldiers and civilians since the war began in October 2023. This was my third stint working at the hospital, but this time was different. On this trip, I was struck by the successes of some unexpected members of the rehabilitation medicine team, ones who rarely get the recognition they deserve.
To give some perspective, ADI-Negev
Hospital is located in the Otef Aza, the
“Gaza Envelope,” just a few miles from the Gaza border. Most of the soldiers
and civilians we treated – including the ones who were injured on October 7th
in Sderot, Ofakim, and Beeri – live or work in the surrounding cities, moshavim,
and yishuvim. In fact, some staff and many of the patients know each
other from prior experiences, which further enhanced the camaraderie and
cheer-leading that went on daily in the clinic. The encouragement of one
patient to another to push further and harder was a daily mantra. The clinic’s
mood and environment were constantly upbeat despite the severity of the
injuries and trauma. A major factor in the positivity that one experiences
there is the presence of a remarkable, young, energetic, and cohesive medical
and rehabilitation staff. But perhaps the greatest influence in spreading
encouragement and cheer in the hospital are the medical clowns.
Doctor or Clown?
Not very common in the U.S., these “clown
doctors,” ubiquitous throughout Israel’s medical facilities, are not merely goofy
entertainers to distract the patients from their sorrows and pain; they are
highly trained professionals who play a pivotal and vital role in the treatment
of children and adults in Israeli hospitals and other healthcare facilities,
helping the patients, their families, and the medical staff.
Patch Adams, an American physician and
social activist who dressed as a clown in the 1980s to bring fun and humor to
hospital patients, is likely the most well-known medical clown, whom many
consider the father of medical clowning. In Israel, medical clowning began at
Hadassah Hospital in Ein Kerem in 2002. Over the past 20 years or so, medical clowns in
Israel have won the recognition of other medical professionals as accomplished,
multidisciplinary, research-backed health care professionals.
Medical clowns employ music, expressive
comedy, physical improvisation, and magic tricks to brighten the spirits of
patients and staff. During my volunteer stays, I watched our clowns use song
and dance as well as comedy skits, often using medical devices for comedic
purposes: for example, stethoscope slingshots, blood pressure cuff trumpets, thermometer
flutes, and slide whistle syringes.
Multiple scientific research
studies over the years on medical clowning have shown that clown interactions
improve a patient’s quality of life, relieve the burdens experienced by family
members and visitors, and assist the medical staff to more easily do their
jobs. There is ongoing research regarding the positive effects and great
benefits medical clowns provide, including reducing pain and anxiety, treating
distress and depression, and even shortening hospital stays.
Decibel and Adinafarina
ADI-Negev employs several medical
clowns. One clown is called Decibel, self-named for his affinity for music and its
healing powers. He frequented the inpatient orthopedic rehabilitation
department where I worked. Decibel is a young, warm, creative, smiley, and
outgoing fellow, with a guitar strapped to his back, a colorful cap on his
head, a harmonica around his neck, and, of course, a big red clown nose. Prior
to this experience, I have never worked in a facility where a medical clown was
on staff. Being a clown at heart myself and often using comedy and humor to
distract and motivate my patients, I loved Decibel’s spirit and was amazed at
the immediate responses he evoked from the patients with whom he engaged. When Decibel
was “performing” in the clinic, patients’ eyes lit up, their moods immediately
improved, and their participation in therapy was noticeably more focused. In
addition to Decibel, I met and spoke to another medical clown named Adinafarina,
a takeoff from her given name.
I was intrigued and wanted to know
more, so I sat down with Decibel and Adinafarina and interviewed them for this
article. The following are their candid responses to my myriad questions.
I was sure that medical clowns were
the typical “class clown” in high school, but I was told that most medical
clowns were, in fact, serious students, outside-the-box thinkers, passionate
about helping others, and optimists by nature. They are very articulate and linguistically
talented, love to laugh, and enjoy making others smile. Some are gifted
musicians, and all appreciate a good joke. Most are athletically inclined and many
excel at physical humor – juggling, posing, and twisting balloons – all to distract
peoples’ minds from pain, disability, trauma, or other intense situations.
Some medical clowns have a
background in theater and performance, which enhances their natural entry into
the field. Others studied social work, psychology, or other social sciences
prior to becoming a medical clown. Studying to become a professional medical
clown is rigorous and, in Israel, taken very seriously. In training, the students learn about the clown’s
therapeutic role and value inside hospitals and study various communication and
counseling skills to develop better relationships with patients and
staff.
Want
to be a Medical Clown?
There are multiple Israeli colleges
and educational programs offering training and certificates in medical
clowning. In fact, the first
university in the world to offer a full undergraduate program in medical clowning
was Haifa University in 2006. Other Israeli clown schools include David
Yellin College in Jerusalem, a respected teacher training institution, which
offers a one-year intensive certificate program in “Educational and Community Clowning.”
As with any academic department, the schools hold interviews for potential
applicants, and acceptance is competitive. There are many local and
international medical clowning organizations, including: Dream Doctors, Call Us
Clowns, Lev Leytzan, Dell’Arte International, and NFHCO (National Federation of
Healthcare Clowns Organizations), among others.
Few medical clowns work full-time.
Some are retired people, a good number are volunteers, and others do medical
clowning as their primary job yet have side gigs to augment their income. I
asked how the clowns manage their own stress and depression when they are constantly
surrounded by people with illness and tragedy, especially since October 7th.
I was told that one of the large Israeli clown professional organizations
attends to these issues by holding weekly sessions with psychotherapists and
social workers to address the clowns’ own psychosocial needs, enabling the
clowns to heal themselves and others. Some clowns also practice self-healing meditation,
deep breathing, and alternative therapies to manage their stresses.
What makes for a good medical
clown? As one would imagine, they need good interpersonal and listening skills,
high energy, a sense of humor, playfulness, and an affinity for music and performance.
Being empathetic and soulful are also desirable characteristics of a medical
clown. When asked about physical endurance, Decibel says that the work is
exhausting; he emphasizes the importance of conserving energy, both physical
and emotional, throughout the workday, and caring for oneself to avoid collapse.
In Israel, the male-female distribution in medical clowning is about 50/50. Each
clown chooses his or her name, attire, and makeup. The costume often reflects his/her
personality and talents.
Adding a Splash of Color
Like all trained medical
professionals, medical clowns face people with sadness, pain, and physical and
emotional difficulties each day. A clown naturally bonds with patients by
eliminating the so-called “white coat”-induced barriers of physicians, with a
goal of entering the
patient’s life and soul, evoking happiness and optimism for healing. Patients
soon find themselves laughing despite their pain. Injured soldiers and civilian
patients often reveal specifics of the trauma they experienced but hesitated to
share with the other medical professional staff. Patients tend to open up more
readily to the clown more than to the physician or therapist. Clowns are known
to break down barriers, making the patients feel that the clown is their friend,
their confidante, and their angel of hope with a big, red nose.
Decibel shared that the clown is
not there to eradicate distress but, rather, to paint another color on the
canvas. Even if the background is dismal and dark, the clown can magically add
a splash of color to turn the portrait brighter and more optimistic.
When asked about their optimism in
the face of October 7th, the clowns say that their upbeat attitude
comes from the knowledge that with every patient visit, with every smile, and with
each foolish prank, they sow the seeds of strength, hope, and positivity to assist
patients and their families to heal, both physically and emotionally.
Samuel Esterson is a physical
therapist who owned and operated an outpatient orthopedic private physical
therapy practice in Baltimore community for over 35 years.
Dream Doctors Foundation in Israel
has been working for over 20 years to "turn pain into light" by
integrating professional medical clowns in hospitals across Israel. To donate,
please go to https://www.jgive.com/new/en/ils/donation-targets/156503.
