Dr. Sababa enters the pediatric ward of Shaare Zedek Medical Center in Jerusalem like a rock star, ukelele in hand.

His medical implements: a harmonica and bright green kazoo. Immediately, he has nurses laughing and singing with him. He walks up to a Hasidic man standing in the corner. “Can we trade hats?” The man, somewhat perplexed, agrees, and swaps the standard black for a gray-tweed fedora with a pink flower in it.

“Yafe," Dr. Sababa says, "beautiful." The man smiles.

I follow Dr. Sababa into the dialysis ward, where a young boy has been waiting for him. Dr. Sababa offers his ukelele, and the boy begins to happily strum away. More often than not, it is the nurses and staff who seek this ‘doctor’ out. Dr. Sababa (whose real name is Avi Cohen) carries his cell phone in his costume, and is on call while at work, just like the doctors he assists.

Cohen is a ‘clown doctor’ or medical clown, one of many who gathered from all over the world in Jerusalem last week for the first International Conference on Medicine and Medical Clowning. Funny antics were temporarily put on hold as hundreds sat down to very serious business: exchanging ideas about their craft, and working to make medical clowning a legitimate paramedical profession.

Medical clowning, which combines theater performance with drama therapy and elements of nursing, has grown in popularity in recent years to become a worldwide phenomenon, as evidenced by the scores of participants who flocked to Jerusalem from France, Canada, Brazil, Australia, the United States, and all over Israel.

The conference marked the 10th anniversary of the Dream Doctors Project, Israel’s first medical clowning program. Founded by Yaacov Shriqui, the project now supports 90 clown doctors in 22 hospitals across Israel, serving over 176,000 children each year.

“What makes the Dream Doctors unique is the principle of integration,” says Daniel Shriqui, the project’s current director. “The medical clown must work in the morning with the medical staff, and be part of the medical team.”

The Dream Doctors are professional theater artists, with years of performing experience in Israel and around the world, who have combined their talents with rigorous medical training. Haifa’s academic program in medical clowning, founded by Professor Atay Citron in 2006, merges courses in improvisation and physical theater with principles from psychology and medicine.

“I’m interested in theater that changes reality, that heals individuals, communities,” says Citron. “Theater not as a reflection on reality, not as pure entertainment, but a proactive tool—something that works.”

“It’s a beautiful marriage of science and art,” says Caroline Simonds, director of Le Rire Médecin, a medical clowning organization in France. “We’re the Lucille Balls of the hospital.”

The conference focused on ‘evidence-based research,' as doctors lectured on how the clowns reduce anxiety in patients and assist with a range of procedures. A routine procedure such as giving stitches, for example, has become virtually painless thanks to a topical anesthetic called EMLA, but a terrified child who kicks and screams can challenge even the most skilled physician. The clown, by relaxing and distracting the child, not only makes the experience—as well as the memory of it—better for the patient, but also allows the doctor to do a better job.

In situations that can be stressful and uncomfortable for patients, families, and staff, the clowns provide much needed relief. They empower patients with imaginative tools that transform the hospital reality, making everyday procedures that are painful or embarrassing an opportunity to laugh and celebrate. Where patients may feel abnormal, it is only the clown, bizarre and unafraid to speak his or her mind, who can restore a sense of normality and sanity.

Clown doctors must be able to respond to a constantly changing environment. They are master improvisers who are in touch with the needs of their audience, who always ask permission to be with a patient. Like all great comics, they are sensitive to how far they can go, knowing when to provoke, when to make fun, and when to pull back. And in Israel in particular, they must adapt their humor to the hospital’s diverse population: Arab, Jewish, Russian, Ethiopian, Bedouin, Muslim, Christian, etc. “The clown may act like a fool,” says Shuli Victor, one of the Dream Doctors, “but he is not stupid.”

It is an art that requires the delicacy and precision of a surgeon’s hand.
“The child is always at the center,” says Shriqui. “If the child doesn’t benefit, there is no raison d'être… like any other medical device, you don’t need it if it doesn’t work. But when you [the clown] know how to work, you become a necessity.”

When Michael Christensen founded the Big Apple Circus Clown Care Unit in 1986, he sought to create a “loving parody” of the hospital world, one which would “transform the hospital into a place of vitality and positive energy.” Medical clowning offers a critique of a healing profession driven by scientific data, a reminder that doctors are not “just a robotic compilation of skills,” says Citron, but a human being that must make direct contact with another human being in order to help. Studies have shown that better communication between doctors and patients, in addition to improving the quality of life in the hospital, actually reduces the number of medical malpractice suits, which means lower medical costs.

Medical clowning can be challenging, emotionally exhausting work. Many of the clowns work in departments like pediatric oncology, and are tasked with distracting patients from unbearably painful realities. The Dream Doctors have also worked abroad in trauma and disaster zones in Ethiopia, Indonesia, and Haiti.

At Haifa, Professor Citron is pushing for an MA that focuses on medical clowning, and eventually a PhD.

“Thirty to fourty years ago, if you wanted to be nurse, you didn’t need academic training,” says Daniel Shriqui. “We’re looking at the same model for medical clowns.”

I asked Shriqui how medical clowning became so successful in Israel.

“There are wonderful people here,” he says. “Also, we are very critical of ourselves, so when the medical staff see the possibility of doing good, even if it is only a one percent possibility, they are not afraid to take the risk if it will benefit the child.”

The clowns, too, appear to embody that spirit every chance they get, as when at lunch Avi Cohen’s phone rings. “Two stitches,” he says. “They want to know if I can come now.”

“It’s a great mitzvah,” Shriqui says. “To make people happy, to make them laugh.”