For the past 15 years, Paul Hooson (aka Doc Willikers), a 60-year-old clown performer, has been putting on his fake nose and glasses, oversized shoes, and a dusty old fedora. Hooson doesn’t perform at a circus, nor does he climb into a tiny car packed with other clowns.

Instead, Hooson brings his act to children’s wards in places like the B.C. Children’s Hospital, Sunny Hill Health Centre for Children, and Canuck Place Children’s Hospice. There, he interacts and plays with the children—from infants to teenagers—many of whom suffer from severe brain injuries and spinal-cord damage.

“Sometimes even the doctors don’t know the extent of a child’s injuries,” Hooson says. “You’ve no idea whether a child can laugh. Some blink, some wiggle a finger, so you have to tailor your interaction around that.

“I remember Michael Christensen [cofounder of New York’s Big Apple Circus clown care unit] saying a doctor once approached him and said that clowns have no place in a hospital. Christensen replied to that doctor: ”˜Neither do the children.’ ”

Christine Slavic, a faculty member of the early childhood education department at the University of the Fraser Valley, says doctors and nurses now accept having therapeutic clowns in hospital wards.

“We did a study several years back, and about 99 percent of medical staff accept having them around. Only one percent was neutral.”

Slavic, a former director at B.C. Children’s Hospital Child Life department, started working with Hooson in 1994. “We were cautious at first,” she says. “We obviously didn’t want a clown who was freaky or who would frighten children.

“Paul is an extremely gifted guy. He’s a very gentle clown, very sensitive, and he takes his cues from the children.”

Hooson doesn’t pretend to be a therapist. “But you need the proper approach, the proper technique,” he says. “You need to go in there with a respectful attitude.” Hooson says it’s about humanizing an environment fraught with tension, stress, and grief. It’s about developing a connection.

Hooson has an impressive bag of tricks: he mimes, employs magic, blows soap bubbles, and plays his ukulele. His alter ego, Doc Willikers, is a bumbling, goofy doctor, asking silly questions, never sure what’s going on.

“He allows the children to guide him,” says Sheila Kennedy, supervisor of therapeutic-recreation services at Vancouver’s Sunny Hill Health Centre for Children. “It’s very empowering for the children.

“I remember when I first started, over 25 years ago. The approach to child patient care was strictly a medical model,” Kennedy says. “Today, there’s a holistic approach. We realize that medical doctors aren’t gods. We want to treat the whole child, not just attend to the medical side.”

Kennedy says nowadays a team approach is used: a patient isn’t only seeing the doctor but a nurse, a psychologist, a feeding team, and maybe a speech therapist or brain-injury specialist.

Kennedy says a child’s family plays an important role in the recovery of a child. “Paul involves the family, and this is very beneficial because they’re often traumatized. Some of them have even forgotten what it’s like to have fun with their own child.”

“The physiological benefits in patients are impressive,” says UFV’s Slavic. “You see a decrease in blood pressure, the heart rate slows down, and the respiration is calm. You may have heard this: some people compare laughing to internal jogging.

“My students and I, along with Paul, did some research in pain management at the hospital, where we drew a series of faces on a chart. It’s a scale of little faces, with a sweaty, anxious face at one end, and a happy face at the other. We got the children to point out where they were on that pain scale. And after Paul’s visit, we got them to point out again where, in their perception, they were on that pain scale. We found there were some positive shifts in that pain scale.”

In May, the Globe and Mail reported on comments by Paul Brunet, head of the Council for the Protection of Patients, in relation to Quebec’s four-year, $293,000 funding of a program to send clown performers to nursing homes. “If anybody thinks this is a priority, then they must be living on Mars,” Brunet was reported as saying. “There are some elderly residents that stink. They aren’t bathed because there isn’t enough staff to do the work. They lose their dignity and, when that happens, they lose the desire to live. Their basic needs aren’t being met. And that’s what they need more than clowns.”

Hooson doesn’t think medical care should be sacrificed at the expense of paying for therapeutic-clown programs. “We should be funded from separate budgets. You can look at it as a form of therapy. You’ve got a budget for music therapy, physiotherapy, and the like. Funding for our program should be from that budget.

“We aren’t just ”˜a bunch of clowns’. I think people sometimes don’t understand what we do.”

He says he gets subsidized from the institutions, “but it’s almost a subsistence thing.” He essentially earns his living clowning professionally and acting. “I don’t charge them [hospitals] anywhere near what I charge others.”

Hooson recalls a time he visited a dementia patient at a nursing home in Edmonton. The resident had a Scottish accent, but Hooson teased her by pretending she was French. The resident reacted to that, always trying to correct Hooson.

“Then we started singing,” Hooson says. “It was amazing. She sang four or five songs, songs from her childhood. And she knew all the words. The staff was speechless.”

The work isn’t easy. “We’re in hypersensitive mode all the time. We work in very fragile situations.” When Hooson completes his visits, he debriefs with staff at the children’s wards. They talk about how each child reacted.

“You can’t take this work home. I depend on the staff as my support system. They’re faced with the same situations, with the grieving and the stress....It’s emotionally healthy to talk about all this with them.

“It takes a lot of heart to be in this line of work. I’m here to celebrate life.”