CUBA

  Building a Therapeutic Clown Community in Cuba

Authors: Joan Barrington, Adrienne Hunter, Aniet Venereo ORIGINS OF THE THERAPEUTIC CLOWNING PROJECT: A STORY OF SERENDIPITY

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 travelled 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 coorginate 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 asymetrical 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 enhand each individuals health and wellness; and that therapeutic clowning will be accredited and considered a profession that contributes to the quality of life.

Conclusions

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