Alex Smith and Becca Chapman: How healthcare clowns are getting around no-visit rules

Alex Smith and Becca Chapman believe that laughter and human connection are an integral part of the healing process. As best friends who cofounded Prescription Joy in New Orleans in early 2018, they’ve spent years honing their clowning skills and brightening the days of children, families, and healthcare workers, but were forced to go virtual fast when the pandemic hit.

It was only fitting that we spoke from two disaster zones—the duo in full evacuation mode as hurricane Sally made landfall while wildfire smoke choked my Portland office—about the power of positivity when times are tough.

What exactly do you do as part of Prescription Joy?

Becca: We are healthcare clowns. We go into hospitals using humor and human connection to help aid in the healing process for patients, families, and the staff—honestly especially the staff right now. Sometimes that looks like I’m pretending their bed is turned into a Mario Kart or I’m throwing imaginary banana peels out as we’re dodging out of the way. And sometimes with older kids or even adults it’s just conversations that are started with an absurd prompt and it ends up transforming the environment for them because they get to play for a minute.

Alex: One of our biggest tenets is we treat the healthy part of the patient. So we’ll go into a room and they may have a condition, or a halo holding them up, or a cast, and—unless the kids are like “Hey, look at this cool cast” and then we are going to obsess about the cool cast—we don’t see it, we don’t know about it, we don’t focus on it.

Sometimes I’m pretending their bed is turned into a Mario Kart or I’m throwing imaginary banana peels as we’re dodging out of the way.

When the pandemic hit, how did it change your work and your perspective?

Becca: We’ve learned so much. Normally when you’re there physically, you go in each room for about 15, 20 minutes, and you’re in waiting rooms and kind of all over the place and can see over 100 people a day. When you’re virtual, you see less but for longer time periods, sometimes 50 minutes per child because they’re so hungry for that connection due to necessary safety restrictions in hospitals right now.

Alex: Yeah, a lot of programs have been canceled or limited. The virtual visits have made our program so flexible because it works with Child Life Specialists and within the restrictions of the hospital. Our work can help focus on the emotional healing, not just the physical.

Being in person is inherently so much more immersive than being on a screen. How has mmhmm helped change your virtual performances?

Alex: It gives them more power, which is so cool. We do this thing where we have them touch the camera on their screen or say a magic word and the background changes. So suddenly we’re getting eaten by a shark! We’re getting transported a lot.

It’s clunky to switch backgrounds using Zoom, and you can’t really order them. The new addition of tabs in mmhmm is really cool. [We use it to] switch locations really fast. We’d been asking, wouldn’t it be cool if there’s an easier way to drop virtual backgrounds into the app mid visit, like somebody talks about pineapple and we can find one on the Internet and dump it in.

Our work can help focus on the emotional healing, not just the physical.

You’d mentioned physical healing earlier. Do you see your work as emotional healing, or does it tip into the physical side of health in some ways as well?

Becca: There is specific research on this, that recovery can be faster after surgery. And also, when you’re laughing, your dopamine levels are increasing, and it can speed up the healing process depending on the situation.

Alex: We were walking around the halls one day and a physical therapy nurse grabbed us and said, “Hey, we’ve got somebody who needs to take a walk today.” But he didn’t really want to join us, so suddenly we’re having a parade, we’re creating music and bubbles and kids are joining us. In fact that kid ended up walking farther than he needed to, and he was showing me how to take big, strong steps, so we were gamifying it. Becca is brilliant at gamifying stuff.

Sometimes you end up helping with the healing process in ways you hadn’t anticipated.

Becca: Yeah. There is always space for humor. One time we entered a space where a child had passed, and we had just started and we were terrified. The elevators open to a hallway and there’s a sea of red faces, and we were like, “Oh my gosh, what can we do?” And we did some of our tricks and incorporated the sibling of the child who had passed, and because the sibling got to laugh, the whole family got to laugh for just a moment. And that allowed the next step of mourning to happen because mourning is such a cycle. Sometimes you need a break from it in order to continue it. It was short, very short, and they laughed for a second and then they got to go back to crying.

There is always space for humor. Sometimes you need a break from [mourning] in order to continue it.

What’s the best thing that’s come out of the pandemic for you?

Alex: The best thing that has happened for me is getting laid off. I worked for a theater company for six years of my life that makes good art but the stress and deadlines were kind of eating my soul. So because of Covid, Becca and I were able to spend 100% of our time making this our full-time job and we’ve moved in leaps and bounds. Our plan is that every hospital in the greater New Orleans area has clowns in it every day. So we’re a step closer to that. It’s forced us to concentrate and to throw our eggs into the basket and become a regular part of the care of one of our hospitals.

Becca: Same with me. I was teaching part-time. Now I can devote all my time to this. So I agree. That’s been the silver lining to all this, that we get to really lean into the work and see the value of it, that human connections are just desperately needed.

Alex: Virtual visits aren’t going anywhere. We’re going to keep them forever…. We see so much potential with mmhmm. There’s so much we can do that will make us better at the work.