Whoever said laughter is the best medicine was on the right track. The nurses and caregivers at the Matlosana Hospice and Khaya Tshepo Paediatric Palliative, a day-care centre in Klerksdorp, cannot start the day without a big belly laugh.
Every morning before their day starts, the staff gather in a circle and one facilitates the session and leads the group. It starts with a well-known technique — a clap and saying, “Very good, very good, yay”, and the giggles just start, according to Estelle du Toit, a nursing director at the hospice. This has become part of their daily routine.
Laughter is easily stimulated in a group and often the activities involve a great deal of eye contact, childlike playfulness and laughter exercises. Initially it was started as a pilot programme by Joygym, a lifestyle coaching programme, and the Hospice and Palliative Care Association of Southern Africa to see whether aerobic laughter therapy could reduce stress and depression among caregivers.
Du Toit said that, although most caregivers were compassionate individuals, their work puts their emotional and spiritual wellbeing and physical health at high risk. “Emotions are transmittable and they often feel the pain and sorrow of their patients, such as fear, anger, helplessness and depression,” she said.
Mpho Montsho, an assistant teacher, said: “The first time I started with it, I questioned what on earth was this laughter therapy. I also found it hard to laugh as it looked stupid and childish but, when I saw everyone laughing, I also couldn’t help myself.”
The programme involved training the nursing staff and the home careÂgivers to practise daily 15-minute peer-to-peer group therapy and to take the laughter to their patients. For many of them, the laughter in the morning influenced their mood throughout the day.
Coping
Mida Matona, a staff nurse at the hospice, said: “Working with dying people is stressful and the therapy helps me to nurse patients and communicate better with my colleagues. It lifts our spirit and helps us to cope with the grief.”
Laughter therapy originates from laughter yoga in India and was first introduced into South Africa in 2007 when the founder of laughter yoga, Dr Madan Kataria, came to the country to do laughter yoga with Bill Gee, the director of Joygym.
According to Gee, aerobic laughter uses techniques that trick the brain to give up control over laughter, which allows childlike, playful natural laughter to emerge. People can quickly get to laughing long and heartily without jokes. The laughter can go on for 30 minutes non-stop.
He said that during adolescence we are programmed by society to “stop laughing” and “stop behaving like a child”. Conditions are placed on laughter by our parents, teachers and culture. This transfers control of our laughter from our limbic brain (spontaneous laughter) to our pre-frontal cortex (intellectually controlled laughter).
Du Toit said: “I love the laughter therapy. It shows me that I don’t have to take life seriously and everything is not as bad as I make it to be. It has played an important role in lighting up our patients because, when they see us happy, they also become happy.”
For Matona, one of the most satisfying results was the impact laughter had on orphans and vulnerable children. “They respond well to the programme — they snap out of their subdued, depressed state. It recaptures their energy and enthusiasm, and they begin playing and interacting with others. It is like they get their childhood back,” she said.
Dr Raksha Balbadhur, a coordinator of values in Healthcare South Africa, said: “Laughter exercises all the core muscles and provides a great natural lymphatic massage. Some scientists call it internal jogging. In some countries laughter is now used as a weight-loss exercise.
“According to the United States study in the International Journal of Obesity, a big belly laugh uses about the same energy as walking more than half a mile. Aerobic laughter therapy uses ‘natural laughter’, meaning it’s often spontaneous. We’re born with this natural ability to laugh spontaneously. Kids laugh quite a lot without being prompted by a joke,” she said.
Malik Jaffer, a Southern Africa HIV/Aids technical officer at USAID, said laughter therapy has been an effective psychosocial support for caregivers. Before instituting the programme, the only outlet they had was support groups, which were often limited and didn’t have a positive impact on their wellbeing. As a result many of them would miss the sessions.
“We have seen tremendous change in many caregivers who do the laughter [therapy]. Unlike the others, it is immediate, it works much faster to create a dramatic increase in happiness, and it is the caregivers themselves who run it,” Jaffer said.
Balbadhur said that, although laughter had been proved to be one of the best forms of therapy, it could not be the only form of psycho-social support. It should be linked to other forms of psychology, for example, stress counselling courses.
Jane Leshotho, an assistant nurse at the hospice, said: “Though laughter doesn’t change the circumstance, the ability to laugh about it makes the problems seem smaller and often gives you a sense of hope.” More than 35 000 caregivers have been trained in laughter therapy in South Africa.