Nepal sends in the clowns to help young patients
He may not be much of a doctor but the children's faces light up when Dush The Clown shuffles onto their ward in his floppy shoes and red nose to prescribe his unique brand of medical care.
Dush - alias 36-year-old Israeli David Barashi - is in Nepal to teach doctors and nurses that laughter really can be the best medicine, with the latest evidence suggesting clowning around in hospitals can boost patient care.
"Everyone can take something from the clown," said Barashi, who has worked as a qualified medical clown for ten years.
"When you are in a hospital, you shouldn't just see the sick and the painful side of the patient, you should see the healthy side, the side that wants to be a kid.
"We all have a child inside of us and clowning in hospital is about empowering childhood."
Studies have shown that clowning programmes can reduce pain and anxiety in children and adults, increase the success rate of in-vitro fertilisation, lower blood pressure and improve the care of elderly suffering from dementia.
Barashi, who holds a degree in medical clowning from the University of Haifa, shows doctors, nurses and lecturers how he is able to use clowning with children to make them feel better ahead of surgery.
He worked with orphans in Ethiopia, tsunami survivors in Asia and children in quake-hit Haiti before he was invited by the Israeli embassy in Nepal to visit Dhulikhel Hospital, 30 kilometres (20 miles) southeast of Kathmandu.
Clowning around really works
"It's not about making doctors and nurses into clowns. We work together. It doesn't work in the hospital if the doctors and nurses do not see me as part of the medical team," he said.
So Barashi doesn't ask medics to learn juggling or wear clown costumes, but instead encourages them to customise their white coats with a badge or scarf to which a young patient might relate.
"Find a very nice icon which works as a rope you throw to the child. They hold the rope and then you start to build a connection and the environment of a playground," he told AFP.
Nepal is one of the world's poorest countries, with more than half the population living on less than $1.25 a day.
In 2007 the government endorsed health care as a basic human right in the interim constitution, introducing a policy of free treatment for the poorest and most vulnerable.
But development agencies say nearly one in four people in Nepal still has no access to even basic health care.
Employing doctors can be an expensive business so teaching existing staff new tricks is a way of getting value for money, says Adam Levene, deputy chief of mission at the Israeli embassy in Kathmandu.
More than 10 years after the Robin Williams movie "Patch Adams" told the real-life story of a doctor who believed humour should be major part of patient care, Nepal is discovering clowning around really does work.
Levene said research had shown that pre and post-operative medical clowning could yield up to 30 percent quicker recovery rates, with the effect particularly accentuated among children.
"The training uses what is defined locally as 'funny', not what is defined as funny in Israel," Levene told AFP.
Barashi trained 30 Nepalese hospital staff a year ago and returned from Israel to train another 20 or so, with courses oversubscribed.
Clearly the trainees are inspired by Barashi as he takes them through a day of classroom games designed to make then better listeners and more intuitive thinkers.
In one exercise the group tries to get a volunteer to do their bidding -- to stand on a chair, for example -- simply by clapping when he makes a right move and remaining silent when he gets it wrong.
The idea is to get the doctors and nurses to think about how they communicate with children on the ward, and also to help them become more empathetic.
"I've been working in hospitals more than 10 years and I've seen doctors and nurses that just don't look fresh," Barashi said.
"We clowns also can get very tired and nervous about other things in our lives but when we put on our costumes we feel fresh.
"You see a nurse that has been working in a hospital for 20 years and after she has been on the programme suddenly you see a child. She starts to play."