A pair of big shoes, a red nose, an oversized suit, long mismatched socks, a colorful tie and a funny lab coat help Alejandro Ledezma to connect with pediatric patients in Venezuela. He is a specialist in therapeutic clowning.
Ledezma, better known as Dr. Sonrisa, or Dr. Smiles, recently visited Alicia, a pediatric leukemia patient. She deals with headaches, weakness, shortness of breath and usually feels cold. Her mother is struggling to get her the chemotherapy that she so desperately needs.
The scene of suffering and scarcity is not uncommon in the room's of public hospitals in Caracas. Alicia said specially trained "clown doctors" visit her regularly to try to lift her spirits. Some of them wear big jester hats and messy wigs.
"They make me laugh a lot and others always come and make me laugh too," the 14-year-old cancer patient said. "And I feel well after."
Amid medicine shortages. Ledezma's 8-year-old hospital clowning program is a ray of light in a country where the public health care's budget crisis translates into sadness, anger and frustration for many families and hospital staff.
"Sometimes they don't want to eat, and they eat with us," Ledezma said about the patients he visits. "Sometimes they are not in good spirits, and with us they get out of bed."
Frustration also fills the hallways of public children's hospitals. Doctors and nurses say they feel powerless over what they have reported as inaction by the Venezuelan health ministry. Without antibiotics, bacterial infections are a challenge.
Activists who say President Nicolas Maduro is in denial about the humanitarian crisis have been protesting the shortage of functional operating rooms. Some complain about a lack of even basic supplies such as gloves and masks.
Ledezma and his team of "clown doctors" are trying to address the increasing psycho-social needs. They are doing their part to make doctors, nurses and patients smile once a week. They are trying to comfort parents and make patients feel less alone, but he wants to do more.
"This is my life," said Ledezma who has also trained "clown doctors" in Argentina and Puerto Rico.
The "clown doctors" use magic tricks, storytelling and music to help pediatric patients deal with fear. His program is one of many "clown doctor" programs operating worldwide.
Hospital clowning started with Patch Adams' The Gesundheit Institute in the 1970s. Michael Christensen's The Big Apple Circus Clown Care Unit program was inspired by Adams' work and raised awareness about the methodology in the late '80s.
The benefits of therapeutic play to control pain and suffering in pediatric oncology continue to be studied. The integration of pharmacological and non-pharmacological methods even include the use of virtual reality computer games now.
Ledezma believes in the power of human interaction. He has many volunteers who share his passion and plenty of ideas to expand his program. He is already collecting toys to give away this Christmas.