International Community

Celebrating 25 years for Canada and USA

Therapeutic Clowns International (TCI) 

Clowns 4 El Salvador

In 2005, The Ambassador for Canada living in San Salvador invited Joan, as Director of The Therapeutic Clown Program at SickKids to join her and our fellow Canadians in celebrating Canada Day. Joan was asked if she would share her knowledge of therapeutic clowning through her persona Bunky and visit an orphanage in the countryside and a shelter in downtown Sal Salvador.

Together with one of our eleven therapeutic clowns at SickKids, Lucia Cino, aka Nuula accompanied Joan on this journey of joy. From the moment we arrived in El Salvador, our gracious hosts, the Ambassador Kutz and The Bank of Nova Scotia made us feel welcome and invited us to give a presentation to an audience of ‘would be clowns’, Doctors, medical personnel and interested friends. This presentation turned out to be the largest attended ‘Awareness Seminar’ they had ever held.

Next, Ambassador Kutz organized and accompanied us to an orphanage where we visited children with HIV/AIDS. The following day we visited a drop in centre for youth and marginalized women. In downtown San Salvdore, The Bloom Hospital holds over 350 beds, and it is here where we felt most at home – bedside with children in crisis. The staff, patients and parents embraced the innocence and playful child in both Nuula and Bunky.

With this visit to El Salvador, I know we touched some very special hearts, but they too, gave us the gift of exploration and profound joy in knowing I could take this profession to any corner of this earth.

The Group of Therapeutic Clowns of Cuba

Building a Therapeutic Clown Community in Cuba

Authors: Joan Barrington, Adrienne Hunter,

Aniet Venereo


My name is Adrienne Hunter. I’m Canadian and have been living in Cuba since 1972, working mainly in the field of public health as an advisor and national coordinator of English programs for doctors.

The Cuban therapeutic clown project began as a result of an unexpected but fortuitous encounter (serendipity) when I was in Canada in the summer of 2008. Simply put, I met Joan Barrington, the Founder of The Therapeutic Clown Program at SickKids in Toronto, and currently Founder of Therapeutic Clowns International (TCI). I knew nothing about therapeutic clowning. It was a totally new concept for me and I was fascinated.  As Joan explained to me what therapeutic clowns are and what they do, I immediately thought of my American husband in Cuba who had had a severe stroke some years before. The more Joan told me about her work, the more convinced I became that her clown persona, Bunky, and Bunky’s interactive play techniques would stimulate my husband to begin to recover his speech. I immediately invited Joan, or rather Bunky, to visit us in Havana.

Soon after that, Joan showed me her video Beyond Laughter about the therapeutic clown program at SickKids Hospital. Joan should definitely come to Havana and be introduced to people in the field of health-care, so I took the video with me when I returned to Havana in September and I began to work on a Spanish version and showed it to some key people.  

Joan traveled to Havana in January 2009. Apart from indeed achieving a positive response from my husband, she met with people from the Ministry of Public Health, who were interested, but not yet ready to follow up. More importantly, she also met the director of La Colmenita, the main children’s theatre company in Cuba.  He immediately understood the potential of this type of clowning and supported the idea of training members of his company as therapeutic clowns. In 2012 Joan and her Mexican colleague, Lucy Ibarra, offered the first training workshop in Cuba to 12 instructors of La Colmenita.

This led to the Ministry of Public Health requesting a proposal from Joan, as Director of TCI, to train health-care professionals as therapeutic clowns to interact with sick children in pediatric hospitals throughout the country. The proposal was accepted in January 2013, and in March, a second workshop was held, again given by Joan and Lucy, with some of the graduates of the first workshop, thus beginning their training as therapeutic clown trainers. Eight months later, the Cuban trainers organized and led their own first workshop, using Joan´s training materials and incorporating their own ideas. At this point in time Aniet Venereo began to coordinate the Cuban therapeutic clowns.

We start organizing…

In Cuba since the year 2000, there have been volunteer clowns in hospitals, but merging into a community has been a process that began in January 2013 with the approval by the Ministry of Public Health (MINSAP) of a formal proposal submitted by TCI: Training Therapeutic Clowns (TCs) for Health Institutions in Cuba. Although this project was only for training purposes, its approval represented an institutional support of what had so far been a few isolated initiatives. 


We find each other

An important step in the formation of a therapeutic clown community in Cuba was to acknowledge and appreciate the diversity of other existing projects, in much the same way as it was paramount for our mentor, Joan Barrington, to understand cultural differences and adjust to them. Once we recognized the value of our diversity, there was a need to come together and form the Group of Therapeutic Clowns of Cuba and develop — with the presence and collaboration of TCI — our own philosophy, code of ethics, a shared horizon and integrated strategies for training, communication, and research. 


We define our practice 
The work of therapeutic clowns in Cuba is, at this time, is carried out voluntarily by persons who have the vocation and a humanitarian calling. We agree that for us in Cuba a therapeutic clown is a person who, with therapeutic intent, wears a red nose and sets about to establish a supportive relationship and connection with patients. We become compassionate playmates for hospitalized children, and our mission is to build with them, their families and hospital staff, positive emotional states, which contribute to their health and wellness. This definition is important because it unites us in our differences, gives us a sense of belonging to the group and a commitment beyond individual perspectives.

Training therapeutic clowns After the first two TCI workshops given by Joan and her Mexican colleague, Lucy Ibarra, the training process was taken over by Cubans. Essentially it was based on the TCI training materials, adjusted to the Cuban context, and enriched with the conception of Popular Education of the Brazilian educator, Paulo Freire, which uses playful methods and techniques and involves the analysis of asymmetrical relationships of power. This is important for us, as human beings, in order to examine ourselves and be equipped with the required humility to deal respectfully with hospitalized children and their families. 


After several workshops in which we progressively adjusted the training design, we reached a group consensus that the same design should be used across the country, and that to be a trainer required: more than one year’s experience as a TC on hospital units; training in Popular Education; and communication skills.

The workshops given by The Group of Therapeutic Clowns of Cuba are now accredited and certified by the Ministry of Public Health in all regions of the country.

How we organize and structure our community… 
The Group of Therapeutic Clowns of Cuba, meet at least once a year, which is important because together we share what we have accomplished and learned, and develop joint actions to spread the activity throughout the country. The fact that all the experiences of therapeutic clowns in Cuba are interrelated has made possible the coordinated care of children who travel from a provincial hospital to one in the capital. The children learn beforehand the names of the clowns they will play with when they arrive at the new hospital, and the meeting is a joyful celebration.

So far about 36% of the therapeutic clowns are people who work for the Ministry of Public Health. The rest come from the Ministry of Culture, the Ministry of Education, and from churches; there are also some housewives. We have nine ongoing projects in pediatric hospitals, distributed as follows: six in the western region (all in the capital), one in the central region, and two in the eastern region. We work with children in intensive care, and in oncology, nephrology, hematology, neurosurgery, pediatric neurology, and liver transplant wards, among others.

How we work 
We empower children by offering inclusive play. We ask permission to interact in all areas of their personal space. As clowns, we usually learn new things along with our patient friends. We offer story telling for children, and witness how they blend fantasy with reality. The therapeutic clowns bring the props and games, but ultimately it is the child who chooses and decides. In addition, we create safe spaces where children who are hospitalized for long periods feel accompanied and recognized. The therapeutic clowns are new friends and playmates, and sometimes even engage in long conversations. One of our most important activities is the celebration of birthdays when the children are in the hospital. The party is organized according to the wishes of the individual child. It becomes “party day” in the hospital ward. 


Therapeutic clowns are a means to the development of a child’s potential. When we detect a special interest in music, painting, photography, magic tricks, love of nature, etc., we cultivate and foster learning and creativity. In this way, we promote activities that bring out creativity, generally as workshops where, besides the experience of creating, they socialize, learn and laugh. 

The results are shown to the public so that the children are recognized by society for their creative capabilities beyond their disabilities: we organize exhibitions of photographs taken by children and send audiovisual materials to national and international festivals. Depending on their physical abilities, they might even sing and dance in public. Many of these events are broadcast on local and national television, where the children are interviewed, often by prestigious journalists.

How we support ourselves

In Cuba all healthcare services are free; public health is directed and financed by the State through the Ministry of Public Health. There are no private health care institutions or services. The health system is well organized, and primary care reaches every corner of the country. Its focus on prevention and its humanitarian principles prompted Adrienne – who knows the Cuban medical system well — to suggest to Joan that Cuba would be a country where therapeutic clowning would be welcomed. The work of therapeutic clowns in Cuba has, until now, been voluntary. The sustainability of each project is more or less managed by its members, and so far has not been a financial burden on the Ministry of Public Health, which gives support according to its possibilities. We receive small contributions – such as the printing of the calendars, toys, red noses, birthday cakes and gifts – from organizations, institutions, and private entities including from the emerging sector of self-employed persons. Our material needs are modest.

Becoming a national community, however, implies additional costs for which we do not yet have stable sources of funding. Nonetheless, this integration is in the interests of  both clowns and MINSAP alike, since it will ensure that therapeutic clowning grows in an organized and coordinated manner; it will foster collaboration with the institutions and among the clowns themselves, thus making better use of our limited resources. It is also a determining factor in the fulfillment of our goal to be recognized as a profession by the Ministry of Labour, which would enable MINSAP to include in its budget financial support for the work of therapeutic clowns and their future remuneration.

Currently, we are taking steps to approach the Ministries of Culture (MINCULT), and Education (MINED) as the Ministry of Public Health would like a joint partnership between MINSAP and MINCULT and MINED.

Promoting our activity 
As the project began to take off and expand, we realized that we needed to make our activity known to decision-makers, to the relevant officials of the Ministry of Public Health and to the general public. With this goal in mind, each year we design, print and distribute a calendar illustrated with photographs of our different practices. It is distributed among members of the Health and Culture Committees of the National Assembly of People’s Power [Parliament], to the leadership of the Ministry of Public Health, the pediatric hospitals and other relevant institutions. More news related to the activity of therapeutic clowns is published in local and national newspapers. There are TV shows about the work of therapeutic clowns, and people involved in this activity are interviewed. We also organize exhibitions of photographs made by the children. This raises their self-esteem and makes them and their families proud, while at the same time, therapeutic clowning is made known to the public.

The future we dream of
We dream of the day when every pediatric hospital in Cuba and every facility for the elderly and the physically and mentally disabled will have therapeutic clowns to enhance each individuals health and wellness; and that therapeutic clowning will be accredited and considered a profession that contributes to the quality of life.


The creation of a community of therapeutic clowns in Cuba came about, somewhat serendipitously, as a result of the following factors:

  1. The existence of a Canadian professional therapeutic clown willing to use her own resources and share generously, without remuneration, her knowledge and experience to train persons in a country where that specialty did not exist.

  2. Another Canadian who knows Cuba well — its culture and its health care system — and who acted voluntarily as the link between the two parties.

  3. The existence of a humanitarian health care system, organized by the State, that gives huge importance to the care of children.

  4. The immediate embracing of the idea by a Cuban institution of great prestige (La Colmenita) as well as by other relevant key personalities.

  5. People in Cuba with the capacity and willingness to work voluntarily as therapeutic clowns, translators, project designers, etc.

  6. The willingness of all these people to work together and form a community whose aim is the welfare of children.

Adrienne Hunter, Aniet Venereo



In 2010 Giselle Navaroli, aka Moska her therapeutic clown, introduced Joan to a gathering of clowns with a like-minded vision of clowning as an approach to wellness. This was our first fundraising initiative autonomous from SickKids. Giselle and Joan flew to Bogata, then to Medillin in November 2010 for the 2nd International Clown Encuentro, which focused on ‘humanitarian clowning’. Their clowning techniques are used to bring compassion, social welfare, and educational development to people often in situations of hardship and suffering. Medellin, Colombia is a city with a rich and varied cultural heritage where clowning and theatre has historically played an important social role.

The Encuentro workshops were hosted by the theatre department of the University of Antioquia and were coordinated in collaboration with Clowns Without Borders, USA, Mimame, and the NGO Arte Para la Paz. As well as the workshops for beginners and experienced clowns, the Encuentro included daily conferences and presentations by international clown artists, and performances by invited artists at specific locations around the city for a full pallet of clown professional development.

Giselle and Joan had the privilege of participating in a six day workshop taught by Wendy Ramos, a Master Clown from Peru. The participants were comprised of clowns from many South American countries.

In addition to the workshops, participants were invited on an expedition into the smaller villages in the mountains of Colombia, in conjunction with Medellin’s 13th annual clown and mime festival that, Mimame had launched in 1984. A collapsible stage was brought along, hitched on a truck and the clown troupe was transported in an open air bus where smiles, waves and hellos were received from the heart. These simple moments and gestures is what continue to inspire the work and relationship of TCI and Columbia to grow.


Our TCI Therapeutic Clown and friend, Lucy Ibarra, ‘Princesa’ was getting married in 2015! The day before the wedding, Lucy, as Manager of Special Events, invited Therapeutic Clowns International (TCI) to present with her, the profession of therapeutic clowning to approximately 100 of her colleagues at CRIT, The Centre for Rehabilitation for Children.

Another serendipity story was how Lucy and Joan met – at a Sunday afternoon Latin concert – and so the conversation and mentoring began on how Lucy would become a therapeutic clown.

 In 2012  TCI, Joan and Lucy, held the first TCI workshop in Cuba for 14 young people of La Colmenita.  In 2013 Joan and Lucy were requested by the Minister of Health to return to Havana and hold a two week workshop for psychologists, occupational therapists and professional clowns.

Under the mentorship of Joan Barrington, Lucy took the skills she learned at the two workshops in Cuba and Joan’s mentoring with her when she moved from Canada back to Mexico. With the support of TCI initiatives already in place, she 
began to teach and then partner with professional artists in the city of Hermosillo, Sonora. The interest led to the training of three more
clowns who learned the sensibilities and intricacies of becoming therapeutic clown practitioners.

The program that Lucy started has extended to senior care at FIVE facilities in the city. Residents, families and staff are witnessing the transformation that laughter and the re- discovery of lost play is bringing to a very often isolating and lonely environment.

In July of 2014, a funding grant was attained through the city of Hermosillo supporting the work of TCI. Arts and culture are highly
regarded in this country and credibility around the overlap of clowning as therapy through the arts validates our continued work.