Hospitals and laughter make an unlikely combination. But peals of laughter, lively sessions of dance and music do happen in Delhi government hospitals — all part of the Happiness Therapy. It has been a little over year that Health Minister Satyendar Jain decided to lighten the tense atmosphere which pervades inside hospitals and to bring some cheer to patients and their families. What followed next was the launch of Happiness Therapy on a pilot basis at GTB Hospital in January last year.
A year on, 16 hospitals have adopted the therapy which — some stakeholders say — is the poor cousin of the well-received Happiness Curriculum that was launched a few months later in government schools. “The idea came from Happiness Curriculum which was being worked upon that time in schools. If a happy student can make a better student, then a happy patient can heal better,” says Dr Nimmi Rastogi, Coordinator of Health, Dialogue and Development Commission, Delhi government.
Group dance, music, songs, meditation, Yoga and laughter are done “under proper supervision” by hospital staff for patients in all wards barring ICU and emergency.
“Conflicts between patients and doctors are not new in government hospitals given the pressure on doctors and the anxiety of patients. A tense atmosphere prevails in hospitals. As a remedy, the Health Minister proposed experiential therapy — not only to facilitate speedy recovery, but also for cognitive and emotional healing. Experiential therapy promotes social bonding between the staff and patients,” says Jaskiran Bedi, Happiness Therapy Coordinator from the Department of Health.
Though hospitals have to hold at least two sessions a month, the rules can be flexible depending upon work pressure and rush of patients in hospitals. “The frequency (of sessions) depends on the hospitals. Smaller hospitals conduct it frequently, but larger ones may only be able to do one session. We get constant feedbacks from nodal officers. Apart from basic guidelines set by the Department of Health (including mediums that can be used), the nodal officer and the hospital authorities have discretion to decide the exact venue (of sessions) within the premises and the frequency,” Jaskiran says.
But why happiness
Chacha Nehru Bal Chikitsalay medical superintendent Dr Mamta Jajoo says the concept existed much before the therapy was initiated in hospitals. “There is as such no study or data to point how much impact it has so far on the patients, but it can be said that the immediate effect is good. Children laugh and environment lightens up, especially in post-operative period when kids are in pain. Even the staff feels good. Pain apprehension and anxiety is reduced.”
Appreciating the initiative, Jajoo adds it is a new concept which all the hospitals will implement with time. “It is important that the concept has been brought up in the system. Even if it is not done regularly now, it will happen eventually. Bringing new concepts is required and it is necessary. Health sector sees multiple problems which require immediate attention. May be more or less varying from hospitals, but it is being continued and not stopped.”
Chandrakant Lahariya, a public health expert, says the therapy is one of the new reforms in health sector amidst the usual works. “But, this should not be seen in isolation. We should look at the broader picture and consider the idea as one of its components. How such ideas can be developed in a better way and getting the hospitals more involved needs to be thought. This will also help to enhance the image of doctors. The therapy is no replacement for improving healthcare, but certainly a subtle, nuance form which can be continued along with infrastructural change.”
Psychological impact
Dr Om Prakash, Department of Psychiatry, Institute of Human Behaviour and Allied Sciences says such sessions have immediate impact on children giving them a soothing effect. “It is good. Happiness is very conceptual. Happiness has different meanings. These components do work, offer relaxation, satisfaction, and increase energy levels. And there have been studies which vouch the immediate impact of such therapies.”
Unlike Yoga, dance and dance sessions by doctors, NGO ‘Clownselors’ specialises in hospital clowning — an aspect of the therapy that it started doing much before the launch, i.e., 2015. Sheetal Aggarwal, who started Clownselors, makes patients laugh so that they feel better, in five state hospitals and private ones as well. “There are cases where the parents tell us the child was not eating and after our performance, the kid started taking food and medicine. In some cases, doctors had ruled out survival of patients but they walked back home.”
While clown therapy is usually for children, Sheetal and her team perform for adults as well. The acts are spontaneous and depend upon the situation. “At times, simple acts leave great impact. We don’t really perform. Our motto is to engage with the patients. There are always challenges and we also get nervous, because there’s no certainty it will work. We want to make patient feel better but we also see lot of pain around us. That also takes a toll on us as well,” she adds.
Not without limitations
Given its experiential basis, the Happiness Therapy comes with its own set of limitations. “It is not a well-researched programme. The Delhi government wants the hospital staff to do it. Medical clowning is sensitive and has a protocol. However, we noticed not everybody is able to follow the way things are supposed to be done. It has to benefit the patient and doing it once a month only to show it in papers is a problem because it is not patient centric then,” Sheetal notes.
Dr Shivaji Dev Burman, president of Federation of Resident Doctors Association (FORDA), asserts doctors in government hospitals are already overloaded with work. This, he says, makes it difficult to implement the therapy properly. “Doctor-patient ratio is already poor. There are a lot of things that need to be prioritised. We have been raising the issues repeatedly but to no avail. “There have been multiple cases where doctors were roughed up. Doctors are already much stressed and we also suffer from issues related to mental health. The Happiness Therapy is a good step aimed at helping patients. But it will be better if professionals are appointed rather than involving doctors,” he says.
What lies ahead
Dr Nimmi notes that the project couldn’t be taken up in the past few months as more concentration was given on improving medical infrastructure. However, the health department will bring it up on a larger scale in the second term of the AAP government. “Hospitals where the Happiness Therapy is yet to be introduced are our priority. We also want representations from hospitals, which are doing well. They can visit those hospitals where it’s yet to begin, and teach them. Half-hearted implementation will not take it anywhere. The only worry is its implementation.”
While cancer, paediatric and psychiatric wards are top in the priority list, such sessions are also being planned in mohalla clinics and polyclinics. “We cannot enforce it on doctors. But this works to reduce the stress of doctors as well. We have to device in a way that it doesn’t feel like burden. We are trying to make it more interesting,” the senior official avers.
A pilot project was conducted on January 17 last year at GTB Hospital to ensure speedy recovery and better healing of patients
The therapy through its mediums of dance, music and songs, yoga, meditation and laughter envisages better healing, speedy recovery, increased harmony and bonding between hospital staff and patients
Each hospital must appoint a nodal staff member, who will overlook implementation and facilitate with the Department of Health on matters pertaining to the Happiness Therapy
The facilitator of each session must be hospital staff members, who may conduct the sessions
Each session may have patients as well as staff participants. Members from the health department may also participate upon invitation from the hospitals
The sessions can be conducted within the hospital premises and wards, barring Intensive Care Unit and Emergency. Decision of the exact location for the happiness session will be made at the discretion of the hospitals, taking into consideration any hospital specific particularities or health services