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The clowns who make the elderly laugh

“I don't want to grow old in a society where just because I'm older I'm put aside and my opinion no longer counts” expresses Isabel Capelo Rosado, president of the association Palhaços d'Opital. The European population is getting older and older and by 2050 it is estimated that there will be half a million centenarians in Europe according to Eurostat. However, European societies implement few or no changes for older people. In Portugal, Palhaços d'Opital seeks to change the conditions of the elderly in hospitals.

“On the day of the first meeting with the Aveiro hospital, what the hospital staff shared with us and which was extremely striking for Jorge and I was that children spent an average of three and a half days in the hospital and seniors spent an average of 15 days. According to the staff, it was also the first time that someone offered to take care of the rest of the hospital and not just pediatrics. When we asked directly to work with internal medicine, the hospital staff was quite surprised” says Isabel Capelo Rosado.

In 2013, when she and her husband, Jorge Rosado, started thinking about the project Palhaços d'Opital, studies showed that 92% of clown organizations in the world worked with children. At that time, there was a project in Canada working with the elderly but in Europe there was nothing. Currently, there are more and more clown organizations for hospitalized children that have started to include projects for older people alongside.

But these projects have a very different approach from Palhaços d'Opital, according to Isabel. “They visit children and elderly people in the same way. For us, this makes no sense at all and is one of the topics we bring in our conversations with the European federation of clown organizations in the health sector. For me, it doesn’t make sense to infantilize older people which happens in many projects” she reveals.

At first, the couple only had the Aveiro hospital as a partner. But little by little, partnerships increased and the association now has hospitals in Figueira da Foz, Viseu, Matosinhos, São João and the IPO in Coimbra. And in June this year, Palhaços d'Opital will work with two more hospitals in Lisbon. In addition to increasing the number of partners, the association also moved this month to a new location in Coimbra to accommodate the growing team - the association went from having five clowns to ten and one person in the office to two.

But if the association grows slowly and more and more hospitals implement this type of project for the elderly, clown work with this population is still largely unknown. “Most people have no idea how much work goes into creating each clown’s character” explains Isabel.

Each year, the artists undergo 250 hours of training: twice a year with external trainers who change the areas of exploration according to the team's interests and every Wednesday they have singing and music classes in the morning, and in the afternoon they are at the Palhaços d'Opital headquarters training their artistic performances. In total, each performance takes between three to six months to be thought out, designed, rehearsed and tested.

For Isabel, the clown is perhaps one of the most misunderstood figures of all times. Although he doesn't seem serious, the clown is always very attentive to the world and lives in the now. “This figure trains a number for days but then has to do it with simplicity as if it had happened to him and was unexpected. People don't know but when he trips three times it's exactly three times! He doesn't trip twice or four times, because there is a rule that says that the third time is the one that gets the biggest laughs. The clown's performances are always structured like a crescendo where everything is increasingly ridiculous to make even the most septic people laugh” explains the co-founder of the association with a smile on her lips.

In the case of Palhaços d'Opital, the performances are designed for the hospitals' environment, an adult audience, especially for an older audience and taking into account the pathologies of dementia. People with dementia - especially in the early stages - remember the first twenty years of their life. “If we work with people aged 70, 80 or 90, it means that their life memories happen in Portugal before the 25th of April (before the revolution). For example, in the sixties and early seventies in Portugal, women didn't wear pants, just skirts unlike many European countries at the same time. For this reason none of the clowns wear pants” she describes.

The clowns' clothes, sewn by Isabel, are reminiscent of the fashion in Portugal in the sixties and seventies but with more colour. “We often enter a room and hear: "Girl! When I was younger I had a skirt just like yours!" This is a very good sign because it means we have already opened a door. And it works with those who have dementia and those who don’t, but with patients with dementia it is very important to open the doors of memories to be able to work with them” she explains.

In addition to the clothes, the music played by the clowns and the way they treat people is also adjusted depending on the age of the patients and their background. According to the co-founder, 95% of the clowns' performances is structured and the last 5% is improvised through the audience's interactions. Because the work to create the characters is immense, the clowns are not volunteers like in other associations. For this reason too, the association grows slowly. “We have many hospitals wanting our presence but we don’t have enough staff. Health professionals really see us as an added value. We receive many messages from doctors asking us to visit a particular patient on the next visit because they know it will be beneficial for that person” declares the president.

"Actors don't go to the hospital but clowns do because nothing is ridiculous or off-limits for clowns"

“One day we received a message from the health staff at the Viseu hospital saying we needed to visit a room where there were three seniors who had tried to commit suicide. One of the gentlemen in the room at the end of the clowns' performance told his wife: "wife, bring me my cavaquinho (a small Portuguese guitar)! I had forgotten how much I loved to sing and play!" And his wife told us that she had never imagined that one day he would want to sing again” says Isabel smiling. Taking into account that the Portuguese population over 75 years of age has the highest suicide rate - according to the National Statistics Institute - the work of clowns proves necessary.

For the president, Palhaços d'Opital shows people that there is still hope and that it is still worth smiling. “And even in cases where there is no hope, if we look at the day with joy, it ends up being a little better” she adds. Furthermore, the association builds a collective memory for patients and healthcare staff that does not refer to the disease but to joy, humour and affection. And sometimes, it allows healthcare staff to understand which keys open the door to the memories of patients with dementia.

“At the hospital in Viseu, there was a lady in the early stages of dementia who had been hospitalized for 15 days. She did not communicate with anyone, neither with family members nor with healthcare professionals and did not like being in the hospital. The clowns were lucky enough to arrive at the same time as lunch and asked what it was. When the staff answered that it was a rabbit meat, they saw that the patient seemed disgusted. Then the clowns started talking about eating rabbits. Doctor Risotto said he loved eating rabbit meat and Doctor Donizete Chiclete said rabbits were too cute to be eaten. After twenty minutes, they had the entire medical team at the bedroom door because the lady had been talking about rabbits with the clowns for twenty minutes. This story really impacted me because it shows me the importance of clowns and the good they do for patients” recalls Isabel before adding: “actors don't go to the hospital but clowns do because nothing is ridiculous or off-limits for clowns. If they have to talk about rabbits for twenty minutes and write a thesis about rabbits, they will do it.”

According to the association, their clowns' work has already reached 891,500 people. “The reasons why I get up every day wanting to work are the complete opposite of what I felt when I was a teacher. I stopped being a teacher because I felt like my work didn't make much of a difference. Now I feel like I don't have a job but a purpose. And there is also a part of selfishness on my side because I don't want to grow old in a society where just because I'm older I'm put aside and my opinion no longer counts. Therefore, my selfishness comes from the fact that I am working to change the world where I will grow older one day” says Isabel laughing.

In the future, she hopes to obtain more sponsorship through Amig@ d'Opital to ensure that the association continues to grow - always ensuring the quality of its interventions and work. “The dream would be for all hospitals in Portugal to have clowns for children and the elderly. For us, it would be a source of pride if we encouraged others to do the same type of work in regions where we are not present” she concludes.

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