Medical Clowning Evolves: Serving the War Wounded

April 11, 2024

This article is translated from Hebrew and was originally published in Israel National News.

David “Dush” Barashi manages the clown unit at the Hadassah Medical Organization on a daily basis, but since the outbreak of the war, he has been recruited to bring comfort to the IDF’s wounded.

We talked with him about the gap between his current work and meeting the wounded warriors, about the moments of difficulty and tension between clowning and loss.

We start the conversation with Barashi by discussing his nickname Dush, which is taken from the Kurdish word. He tells us that clowns turn their professional name into a tool in their clowning development. The names make it possible to create a personal story and a parallel fantasy world.

Against the background of his childhood story, Barashi talks about the Dream Doctors Project, which was launched in 2002 to integrate medical clowns into the world of medicine. Since then, the work is no longer just in front of children, patients, families and teams but is far broader.

"When 20 years ago, Hadassah Ein Kerem was the first of the dream houses to bring in Dream Doctors, there were many raised eyebrows,and doors were closed because they did not understand why these jokers were in the room, and they reckoned it led to a lack of calm in the therapeutic process. We had to be patient and reinvent ourselves. Professionalism and the desire to implement overcame all objections, and over the years, the organization has developed a research fund, established academic collaborations and is on a common path with the hospitals. Departments and division managers are beginning to produce regulations and standards for the work that is today a flagship in this field throughout the world."

Barashi went on to talk about the establishment of humanitarian clowning since the days of the Second Lebanon War, when clowns were sent to shelters and to summer vacation camps for the children of medical staff in northern Israel.

"That's how we started a parallel channel to the medical work of the hospitals, a channel of humanitarian clowning," he said, noting work that also went beyond the country's borders. A team of clowns were sent to help the survivors of the tsunami in Thailand, as well as the victims of the earthquake in Haiti, where there were clowns within the IDF field hospital.

"What started with three clowns in one hospital today is about 100 clowns in 30 institutions,” Barashi said. “Medical clowning is a big sister to humanitarian clowning in every disaster. Dream Doctors sent teams to the refugee camps in Ukraine. We try to succeed in reaching every place where there are people who need to lift their spirits and give them back their most important resources: humor, joy of life, optimism and looking forward.”

"Then comes October 7, the beginning of a completely different reality,” he continued. “The wounded and masses arrive in hysteria. This is a completely different operational mode. At Hadassah, we received the wounded –– soldiers and civilians. At the same time, we sent clowns to the displaced in hotels around the country. Together with street performers, we built sensitive interventions. It's just like working barefoot on a floor full of glass. We found ourselves in the reality of being “mourning clowns,” meeting people who sit with torn shirts, and we understand that they are in mourning. We don't come to make them laugh and lift their spirits, but to help them hold their sadness. There is and was no reason to raise the mood, but a strong commitment to see those who are in the place of the most pain and suffering, when the goal is to go as low as possible toward them and take away some of their sadness."

In such moments, the humor is left aside.

"It's not just humor that motivates me. Using humor is just one of the skills. I first sanctify the meeting, whether it's a 4-year-old patient in the oncology department or a parent whose child was kidnapped from Kfar Aza, we try to create trust, and when there is trust, they know I'm there for them,” he said. “When this little cell is built and there is trust, then humor can be produced in the most painful places.”

"There are quite a few people who ask how one can laugh in these moments. One cannot laugh, but one can begin to return to a tone of joy in life and optimism, despite all the difficulty," said Barashi, emphasizing that a reality like the one they encountered after October 7 was unprecedented. In his 20 years in the profession, he has not encountered such scope "in terms of the mass, in terms of the surprise, the humiliation, the evil and the horror that came. We experience it every time we see the videos of the vehicles and the victims. All of this brought us as a collective that Saturday morning to a head-on collision at 100 kilometers per hour and all of us crashed. There are those who crashed and did not experience what the residents of the south experienced that Shabbat, some crashed without experiencing what the soldiers in the outposts experienced, but all experienced a very serious trauma. We on the side of therapy need to set ourselves aside and understand that our job is to rise up, take a deep breath and get going when it is clear that there are corpses and scorched earth. You are fully prepared to sacrifice because it is the order of the day and it is your duty as a citizen. On normal days, I give of myself in hospital corridors. Here, it happens everywhere."

The work with the victims of this trauma differs from that in the hospitals in many ways.

"It's different from working in a hospital because when you work with a child with cancer, you don't see the disease, but the symptoms. You don't see the monster that took quite a few children from me over these 20 years. Here you see the cancer in your eyes through the movies and the networks. You see the disease and it's terminal. This personal and national horror and it’s all mixed up. When you meet a father with a girl my daughter's age and I hear the horror he went through in his safe room and you see his daughter in the lobby with volunteers doing art and activities with her, you see your daughter. You breathe and say what a miracle it was that I wasn't there and it didn't happen to me. But we don't stop making these comparisons."

He considers the work with soldiers to be the highlight of his enlistment for a mission that is so necessary these days.

"I am currently working in a field called restorative clowning, a field that I developed with the clinical psychologist Yoram Ben Yehuda, who lost his son Itamar on October 7 –– a Golani fighter who fell at the Pega outpost. Yoram is also a lieutenant colonel in the military and the commander of the unit that accepts all soldiers since October 7," said Barashi.

"In 2016, we began to develop a field of rehabilitative clowning for victims of hostilities and bereavement. As the son of an IDF disabled person, it was important for me to touch the invisible wounds that exist in the State of Israel, which are post-trauma, bereavement and the shock of battle. I felt it was my time to get closer to these communities in the framework of restorative clowning. We worked for years. I met fighters from Operation Protective Edge and the Second Lebanon War. Yoram would send me to workshops and meetings. No one else seemed interested in this whole journey. We asked for resources and they said it was being taken care of, but I didn't give up. I did it voluntarily. First we do and then we will see who listens. Later, Yoram built a standard for me in his unit, and when the war came, we became friends and I realized that he was in his own tragedy with his son Itamar. I waited patiently, took comfort in the shiva mourning week and realized that when he finishes the seven days of mourning, I will stand in the unit together with my clown colleague Jonam. It was important to me to have a woman by my side, because this is the first war where the number of female soldiers and supporters is so considerable. They compare this war to the Yom Kippur War, but in the Yom Kippur War, there weren't so many female soldiers facing terrible situations."

Barashi also points out the importance of the medical clown's own maturation, in order not to remain a childish clown in front of an audience that is getting older and feels disconnected from the clown and what he can and wants to convey and give. That's why his clown character is a parody that combines the IDF uniform, the ranks of chief of staff and a clown.

The initial protocol of his work is the rehabilitation protocol in which "we create meetings with the soldiers. We call these meetings '’one meets one.’ These are in-depth conversations with soldiers about everything, about life, October 7, about the horror and the nightmare, about the fallen comrades and sanctifying their memory. These conversations reach unexpected depths.” Barashi collects in his notebook quite a few sentences uttered by the soldiers that leave an impression on him. This is very meaningful to many of the soldiers.

"In the personal meetings, you learn everything about them, which makes you give them assignments. We give them tasks: ‘Surprise your younger brother and tell us later how you did it.’ On Thursdays, I tell them to come to their mother with a bouquet of flowers, challah, cake or anything that strengthens family, home, giving and appreciation. You have to keep them active all the time and bring them to the place where they return love to those who love them. They are told to surprise others and the reaction of the surprised is the one that moves them. They tell all about these exchanges and it brings them back to the same point of excitement, and that's where you want them to be, because they are in nightmares, with a lack of appetite, angry and guilty. That is our role, together with the army psychologists and the wonderful reserve professionals."

"You meet the wonderful builders of our country who gave everything they had in the most difficult moments we have known as a people,” he said. “When you meet them and realize how much of a visible miracle it is that they are here and you are obliged to return them to their best, to the desire to continue living and creating life. We do this in many ways, including through clowning.”

"When we are clowns, we run a 75-minute workshop to strengthen resources of humor, joy of life, joy, openness, standing in front of an audience, dealing with embarrassments, childhood memories, positive signs that they take with them later and it strengthens them before the difficult journey ahead of them. We see those who have left their unit, and it is important for them to come and say that they remember us well and how great it was that we met. These are ‘wow’ feedbacks.”

Read the full story in Hebrew by Israel National News.