In Auroville, a few years ago, a bed-ridden woman was watching Fif Fernandes attentively as she sang and pranced around, playing on her ukulele. When the woman, who was living with dementia, finally smiled, Fernandes asked, “What did you do as a child?” The woman beamed and drifted into a childhood memory, when as a four-year-old she would travel on a bullock cart with her father to get an ice lolly. “The lolly melted and dripped down my chin, and then down my clothes, and then it broke and fell,” she recalled just before her thoughts meandered elsewhere.
It is established that dementia rates are rising worldwide. According to the World Health Organization, 50 million people already suffer from dementia, with 10 million new cases being added every year. India itself has about 4.1 million cases, as The World Alzheimer’s Report 2015 notes. Experts believe this number may be higher, since many cases go undiagnosed, with people ascribing forgetfulness to old age. In such a scenario, clinic clowns, or clowns working in healthcare spaces, can be harbingers of joy to the elderly. Studies show that they induce positive emotions and a sense of well-being among patients.
Fernandes is one of the handful of trained clinic clowns in India. After practising for over 30 years in Canada, she moved to Auroville and co-founded MeDiClown Academy in 2013 with her husband, Hamish Boyd, also a therapeutic clown. The academy’s work entails training and conducting workshops for individuals and organizations. The couple also visits people of all ages in hospitals and senior homes across cities. “Music is a huge part of what we do,” says Fernandes. “It brings back beautiful memories for the elderly.”
Once she is in an elderly person’s room, she observes pictures on the wall, a favourite pillow or a dress, which can be used in conversation. Once she has forged a connection, Fernandes recreates stories related to those objects through her clowning skills.
Once, for instance, an elderly woman with dementia told Fernandes that as a nine-year-old, she would walk to the village school with her four sisters. “One day, when we reached school late, we covered up by saying that the milk pot broke at home and that delayed us,” recalls Fernandes. The teacher believed the five sisters and gave them a glass of milk each. In the evening, she told their mother, who was angry with the children for lying. Fernandes took cues from the story and enacted it for the lady with her colleagues. “The elderly love to go back to their childhood and like the freedom to laugh and be silly with clowns,” chimes in Boyd.
Such exercises are significant for people with dementia; they often feel lost because they can’t remember things. “Families keep checking about facts and dates, without realizing the trauma and agitation it can cause,” explains Fernandes. “Role-playing their narratives, under their direction, gives them the power to be in control without being challenged about their memory. We never tell them something could not have happened, however surprising it may appear.”
Clowning in hospital settings was first started in North America in 1986 by Michael Christensen, co-founder of the New York-based Big Apple Circus. Karen Ridd (Robo the Clown), a child life specialist, simultaneously founded Canada’s first therapeutic clown programme at the Winnipeg Children’s Hospital. The practice later spread to Europe.
Since the 1990s, it has played a particularly significant role in Germany, where one in five citizens is over 65, and almost 10% of the seniors have dementia. Take Arnsberg, a city of 73,000 that is considered a model for inclusion of the elderly. It has nine trained clinic clowns like Julia Wille, who goes by the clown name of Mia Mumpitz and visits senior homes at least once a month.
The process has a therapeutic value for clowns too. Wille, 46, found her calling in clowning more than four years ago, during a long spell of clinical depression. “I saw a picture of a clinic clown in a newspaper and instantly knew the road ahead for myself,” she recalls. She works at an assisted living facility in Arnsberg but has been doing honorary clowning work at elderly care facilities. “Clowning has kept me in good mental health without medication,” she says.
One cheerful morning in July, Mia Mumpitz entered Helena Desol’s room at the St Anna home with a loud and affectionate “Hola”, a red clown nose covering her own, hair pulled up into ponytails and lips defined with red gloss. Spain-born Desol, who is 80, lost the ability to speak a few years ago but squealed with delight on seeing her. Like a long-lost friend, Mumpitz enclosed her in a hug. Desol wrapped her left arm around Mumpitz—it’s her good side, ever since she suffered a paralytic attack.
Mumpitz then broke into a song, placed her hands on her waist and began the footwork. Eyes brimming with joy, Desol swung back and forth in her armchair and hummed along.
“About a third of the 90 residents at St Anna have dementia, and benefit from clown visits,” says Dagmar Freimuth, the leader of social service at St Anna. Wille’s clowning gently persuades elderly people to participate in her activities. “Sometimes, though, all it takes is a gentle touch to reduce their agitation and anxiety caused by dementia,” Wille says.
One of the residents of St Anna stopped talking to everyone after his sister’s death but opened up after the clowns cajoled him, recalls Wille. “An old lady always shooed me away, however hard I tried talking to her, but one day I happened to sing a song from her childhood and that was it. I am always welcome in her room now,” Wille smiles.
Johannes Föster, who trained to be a clinic clown three years ago at the age of 72 and now volunteers as Clown Berti in Arnsberg, interjects with another story. There is a woman, Föster says, who would never respond to the clowns, but the last time she saw him in the lounge, she said, “Have a nice day!” Föster smiles, “I think she is coming around.”
Fernandes has seen similar results in India, where medical clowning is still in its infancy. There are only a handful of individuals and groups working in Mumbai, Chennai and Bengaluru. Like Sheetal Agarwal, a former teacher who got into clowning in 2016 and founded Clownselors, now heads a team of 15 regular volunteers in Delhi. Then there is Humanitarian Clowns, which has had 250 volunteers visiting hospitals and old-age homes for the past eight years in Vellore and sometimes Chennai.
Generally, however, the absence of training institutes means clinic clowns are untrained and doing voluntary work. Which is why, in August 2019, MeDiClown Academy started its first 600-hour course on medical clowning with 11 students, to educate participants on art, storytelling, yoga, music and improvisation. “We want medical clowning to become a respectable profession in the country,” says Boyd.
Students learn about patient psychology, dealing with care facilities and working in tandem with a medical team. “However,” emphasizes Fernandes, “the most important thing for clowns is to know how to make a connection with their heart.”
Priti Salian is a freelance journalist who has covered human rights, social justice, development and culture issues in India, Germany and Uganda.