Hospital clowns bring joy to young Ukrainian cancer patients who survived Russian missile attack

KYIV, Ukraine (AP) — Their costumes are put on with surgical precision: Floppy hats, foam noses, bright clothes, and a ukulele with multicolored nylon strings.

Moments later, in a beige hospital ward normally filled with the beeping sounds of medical machinery, there are bursts of giggles and silly singing.

As Ukraine’s medical facilities come under pressure from intensifying attacks in the war against Russia's full-scale invasion, volunteer hospital clowns are duck-footing their way in to provide some badly needed moments of joy for hospitalized children.

The “Bureau of Smiles and Support” (BUP) is a hospital clowning initiative established in 2023 by Olha Bulkina, 35, and Maryna Berdar, 39, who already had more than five years of hospital clowning experience between them. “Our mission is to let childhood continue regardless of the circumstances,” Bulkina, told The Associated Press.

BUP took on new significance following a Russian missile strike on Okhmatdyt Children’s Hospital in Kyiv in July. The attack on Ukraine’s largest pediatric facility forced the evacuation of dozens of young patients, including those with cancer, to other hospitals in the capital – and the clowns did not stand aside.

Together with first responders, Berdar and Bulkina helped with clearing the rubble after the attack and attended to the children who were relocated to other medical facilities. But even for them, the real heroes there were young patients.

“When the children were evacuated from Okhmatdyt after the missile attack, many of them were in extremely difficult medical conditions, but even in this situation they tried to support the adults,” said Berdar, recalling the events after the strike.

The hospital clowns, who use traditional clown noses and bright costumes, are now visiting multiple hospitals in the Ukrainian capital region, including the National Cancer Institute, where patient numbers have surged after the Okhmatdyt attack.

Tetiana Nosova, 22, and Vladyslava Kulinich, 22, are volunteer hospital clowns who go by Zhuzha and Lala and joined BUP more than a year ago. For them, hospital clowning is as challenging as it is rewarding.

“I volunteer so that children don’t think about their illness, even for a short moment, so that laughter replaces tears, and joy replaces fear, especially during medical procedures,” Kulinich said. In her practice, she stays together with children, sharing all their feelings, whether they are fear, pain, or joy.

For Nosova, the process itself is what made her start clowning. “I am motivated by joy. I simply enjoy it. All my life I studied to be an actress, all my life I enjoyed making people laugh. That’s enough motivation for me," she said.

In a city grappling with nightly air raid alerts and power outages, overworked doctors say the presence of the volunteers brings a much-needed distraction, often helping children who had been undergoing painful medical treatment to feel happy again.

“Clowns play a very important role in the treatment of children. They help distract the children, they help them forget about the pain, they help them not pay attention to the nurses or doctors who come to treat them,” Valentyna Mariash, a senior nurse on the Okhmatdyt cancer ward, told AP.

The July attack complicated treatment plans for many families. Daria Vertetska, 34, was in Okhmatdyt with her 7-year-old daughter, Kira, when the missile exploded just outside their ward. Kira, who was diagnosed with rhabdomyosarcoma of the nasopharynx, was asleep, medicated with morphine.

“It saved her that she was covered with a blanket during the strike, but still, her head, legs, and arms were cut with small glass shards,” said Vertetska. She and Kira returned to Okhmatdyt in less than a week after the attack.

Not all the children returned to the hospital. Some stayed in the medical facilities where they had been evacuated, while others were moved to apartments paid for by charity organizations and located in the hospital’s vicinity.

Despite hospital clown initiatives like BUP across Ukraine, the need for their work grows exponentially. “When I see how our work is needed in the large children’s hospitals located in Kyiv, I can only imagine what a great need there is in regional and district hospitals, where such (clown) activity, as for example in Okhmatdyt, to be honest, simply does not exist,” Berdar said.

The World Health Organization, earlier this month, warned that the country faces a deepening public health crisis, largely due to devastating missile and drone strikes on the country’s electricity system as well as hospital infrastructure.

Since the start of Russia’s full-scale invasion in February 2022, WHO has recorded nearly 2,000 attacks on Ukraine’s health care facilities and says they are having a severe impact.

Children are among the most vulnerable, but a mental health crisis affects the whole country. It means the clowns’ work has won broad support from medical professionals.

Parents are simply happy to see a smile return to their children’s faces.

“With clowns, children learn to joke, they play with soap bubbles, their mood lifts. Today, Kira saw clowns playing the ukulele, now she wants one, too,” said her mother, Daria.

Associated Press writer Derek Gatopoulos contributed to this report.

Follow AP's coverage at https://apnews.com/hub/russia-ukraine

Kira Vertetska, 8 and her mother Daria inside their room at Okhmatdyt children's hospital in Kyiv, Ukraine, Thursday Sept. 19, 2024. (AP Photo/Anton Shtuka)

Kira Vertetska, 8 and her mother Daria pose for a photo in a corridor at Okhmatdyt children's hospital in Kyiv, Ukraine, Thursday Sept. 19, 2024. (AP Photo/Anton Shtuka)

FILE - Rescuers work together to clear debris during a search operation for survivors at the Okhmatdyt children's hospital that was hit by a Russian missile, in Kyiv, Ukraine, July 8, 2024. (AP Photo/Evgeniy Maloletka, File)

Michael Bilyk, is held by his mother Antonina Malyshko, as he is visited by Zhuzha and Lala from the volunteer group the "Bureau of Smiles and Support" at Okhmatdyt children's hospital in Kyiv, Ukraine, Thursday Sept. 19, 2024. (AP Photo/Anton Shtuka)

Maryna Berdar, 39, co-founder of the "Bureau of Smiles and Support" sits in front of Okhmatdyt children's hospital in Kyiv, Ukraine Saturday Sept. 14, 2024 which was destroyed after a Russian missile strike on July 8. (AP Photo/Anton Shtuka)

Tetiana Nosova, who goes by the clown name of Zhuzha, a volunteer from the "Bureau of Smiles and Support" watches as Kira Vertetska, 8, plays a ukulele at Okhmatdyt children's hospital in Kyiv, Ukraine, Thursday Sept. 19, 2024. (AP Photo/Anton Shtuka)

Vladyslava Kulinich, right, Tetiana Nosova, who have the clown names Lala and Zhuzha, pose for a photo as they prepare to perform at Okhmatdyt children's hospital in Kyiv, Ukraine, Thursday Sept. 19, 2024. (AP Photo/Anton Shtuka)

FILE - Rescuers, medical staff and volunteers clean up the rubble and search for victims after a Russian missile hit the country's main children's hospital Okhmatdyt in Kyiv, Ukraine, Monday, July 8, 2024. (AP Photo/Anton Shtuka, File)

Kira Vertetska, 8, who is undergoing treatment in the oncology department at Okhmatdyt children's hospital in Kyiv, Ukraine, paints a clay figure Thursday Sept. 19, 2024. (AP Photo/Anton Shtuka)

Olha Bulkina, 35, co-founder of the "Bureau of Smiles and Support" sits in front of Okhmatdyt children's hospital in Kyiv, Ukraine Saturday Sept. 14, 2024 which was destroyed after a Russian missile strike on July 8. (AP Photo/Anton Shtuka)

Vladyslava Kulinich, rear, and Tetiana Nosova, who have the clown names Lala and Zhuzha, prepare to perform at Okhmatdyt children's hospital in Kyiv, Ukraine, Thursday Sept. 19, 2024. (AP Photo/Anton Shtuka)

A view of the damage to Okhmatdyt children's hospital in Kyiv, Ukraine Saturday Sept. 14, 2024 which was destroyed after a Russian missile strike on July 8. (AP Photo/Anton Shtuka)

Kira Vertetska, 8, who is undergoing treatment in the oncology department at Okhmatdyt children's hospital in Kyiv, Ukraine, paints a clay figure, Thursday Sept. 19, 2024. (AP Photo/Anton Shtuka)

FILE - Emergency workers remove rubble and look for survivors at the site of Okhmatdyt children's hospital hit by Russian missiles, in Kyiv, Ukraine, Monday, July 8, 2024. (AP Photo/Evgeniy Maloletka, File)

FILE - Emergency workers respond at the Okhmatdyt children's hospital hit by Russian missiles, in Kyiv, Ukraine, Monday, July 8, 2024. (AP Photo/Alex Babenko, File)

Vladyslava Kulinich, right, Tetiana Nosova, who have the clown names Lala and Zhuzha, prepare to perform at Okhmatdyt children's hospital in Kyiv, Ukraine, Thursday Sept. 19, 2024. (AP Photo/Anton Shtuka)

Vladyslava Kulinich, right, Tetiana Nosova, who have the clown names Lala and Zhuzha, prepare to perform at Okhmatdyt children's hospital in Kyiv, Ukraine, Thursday Sept. 19, 2024. (AP Photo/Anton Shtuka)

Olha Bulkina, 35, co-founder of the "Bureau of Smiles and Support" sits in front of Okhmatdyt children's hospital in Kyiv, Ukraine Saturday Sept. 14, 2024 which was destroyed after a Russian missile strike on July 8. (AP Photo/Anton Shtuka)

Tetiana Nosova, who goes by the clown name of Zhuzha, a volunteer from the "Bureau of Smiles and Support" plays a ukulele as she stands with Michael Bilyk, who is held by his mother Antonina Malyshko, and Kira Vertetska, 8, at Okhmatdyt children's hospital in Kyiv, Ukraine, Thursday Sept. 19, 2024. (AP Photo/Anton Shtuka)

ABOARD THE PAPAL PLANE (AP) — Pope Francis wrapped up a troubled visit to Belgium on Sunday by doubling down on his traditional views on women and abortion and demanding that Catholic bishops stop covering up for predator priests — a scandal that has devastated the church’s credibility around the globe.

Francis revisited the key thorny topics of his trip to Belgium during his in-flight press conference coming home, praising Belgium's late King Baudouin as a “saint” for having abdicated for a day in 1990 rather than sign legislation legalizing abortion.

“You need a politician who wears pants to do this,” Francis said, using a Spanish expression. “You need courage,” he said, adding that Baudouin's beatification process was moving along.

Francis drew criticism from some in Belgium for having prayed at Baudouin's tomb and for calling the abortion law “homicidal,” given that abortion remains a political issue in Belgium, with new proposals to extend the legal limit on an abortion from 12 to 18 weeks.

“Doctors who do this are – allow me the word – hitmen. They are hitmen," Francis said. “And on this you cannot argue. You are killing a human life.”

It was the second time in as many weeks that Francis has been asked about his views on abortion during an in-flight press conference. Returning from Asia earlier this month and asked about the upcoming U.S. election, Francis said voters should chose the “lesser evil” when picking between a candidate who wants to deport migrants and one who supports abortion rights — a reference to Donald Trump and Kamala Harris.

Francis used his only Mass in Belgium to publicly demand that priests who abuse young people be punished, and that the church hierarchy stop covering up their crimes. He praised the courage of victims who came forward about their abuse in improvised remarks to a crowd of some 30,000 at Brussels’ King Baudouin stadium.

“Evil must not be hidden. Evil must be brought out into the open,” Francis said to repeated rounds of applause as the crowd took in what he was saying.

Francis deviated from his prepared homily Sunday to respond to the meeting he held with 17 abuse survivors on Friday night, where he heard first-hand of the trauma and suffering they endured and the tone-deaf response of the church when they reported the crimes.

Belgium has had a wretched legacy of abuse and cover-up, none more symbolic of the church's hypocrisy than the case of Bruges Bishop Roger Vangheluwe. He was allowed to quietly retire in 2010 after he admitted that he had sexually abused his nephew for 13 years.

Francis only defrocked him this year — 14 years later — in a move clearly seen as finally dealing with a problem before his arrival in Belgium.

The victims gave Francis a letter with several requests, including establishing a universal church system of reparations since many say the financial settlements they have received from the church don’t even cover the costs of therapy many require.

Francis praised the victims' courage and acknowledged that the settlements many have received in civil judgements — which he said he believed were capped at 50,000 euros — were not enough.

“We have the responsibility to help the abused and take care of them,” he said. "Some need psychological help: (We must) help them with this.”

Francis’ visit to Belgium was always going to be difficult, given the country’s history of clerical sexual abuse and overall secularizing trends which have emptied its majestic cathedrals and churches.

But it’s unclear if he or his entourage expected such sharp public expressions of outrage or the pointed calls for reform from Belgium's intellectual elite.

The main reason for the trip was to celebrate the 600th anniversary of the Leuven/Louvain Catholic University, the oldest Catholic university in the world and long the Vatican’s academic fiefdom in Belgium.

But the rector of the Dutch-speaking campus told Francis that the abuse scandal had so harmed the church’s moral authority that it would do best to reform if it wants to regain credibility and relevance. Luc Sels suggested that opening up greater roles for women — including the priesthood — and being more welcoming to LGBTQ+ Catholics would be a good place to start.

Francis heard a similar call from the French-speaking campus, where students staged a reading of an articulated critique of his landmark environmental encyclical “Praised Be” in which they called for a “paradigm shift” in the way the church views women.

They noted that the encyclical virtually ignores women, cites no female theologians and contributes to women's “invisibility” in the church and society. Women have long complained they have a second-class status in the church, barred from the priesthood and positions of power despite doing the lion’s share of the work educating the young, caring for the sick and passing on the faith.

Francis, an 87-year-old Argentine Jesuit, said he liked what they said. But he repeated his frequent refrain about women being the “fertile” nurturers who complement men, and that regardless “the church is woman.”

His words drew a remarkable rebuke from the Catholic university that invited him. As soon as he finished speaking, Louvain issued a statement expressing its “incomprehension and disapproval” of his views on women, which it said were “deterministic and reductive.”

“We cannot agree on his position for sure,” said rector Françoise Smets. “We are fighting against discrimination for women, and we would like women to have another role in the society and in the church also.”

During the in-flight press conference, Francis doubled down on women and criticized the Louvain students for what he said was a “pre-made” communique, which was distributed as soon as his remarks finished.

Francis has insisted that women's focus on ordained ministry was misplaced given his claims that they already are more important than men.

"I always speak about the dignity of women, and I said something that I can’t say about men: The church is woman," Francis said. “Women are more important than men because the church is woman.”

Associated Press religion coverage receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content.

Queen Paola, mother of King Philippe listens Pope Francis as he presides the holy mass , at the King Baudouin stadium in Brussels, Belgium, Sunday, Sept. 29, 2024. (AP Photo/Omar Havana)

Queen Paola, mother of Queen Mathilde listens Pope Francis as he presides the holy mass , at the King Baudouin stadium in Brussels, Belgium, Sunday, Sept. 29, 2024. (AP Photo/Omar Havana)

Pope Francis presides over the Sunday mass at King Baudouin Stadium, in Brussels Sunday, Sept. 29, 2024. (AP Photo/Omar Havana)

Queen Mathilde, left, and King Philippe listen Pope Francis as he presides the holy mass , at the King Baudouin stadium in Brussels, Belgium, Sunday, Sept. 29, 2024. (AP Photo/Omar Havana)

Kids listen Pope Francis as he presides the holy mass , at the King Baudouin stadium in Brussels, Belgium, Sunday, Sept. 29, 2024. (AP Photo/Omar Havana)

Pope Francis presides over the Sunday mass at King Baudouin Stadium, in Brussels Sunday, Sept. 29, 2024. (AP Photo/Omar Havana)

A faithful prays as Pope Francis presides the holy mass , at the King Baudouin stadium in Brussels, Belgium, Sunday, Sept. 29, 2024. (AP Photo/Omar Havana)

Pope Francis waves as he arrives to lead the holy mass , at the King Baudouin stadium in Brussels, Belgium, Sunday, Sept. 29, 2024. (AP Photo/Omar Havana)

Pope Francis holds the pastoral staff as he presides over the Sunday mass at King Baudouin Stadium, in Brussels Sunday, Sept. 29, 2024. (AP Photo/Andrew Medichini)

Faithful wait for the start of a mass presided by Pope Francis at King Baudouin Stadium, in Brussels Sunday, Sept. 29, 2024. (AP Photo/Andrew Medichini)

Faithful wait for the start of a mass presided by Pope Francis at King Baudouin Stadium, in Brussels Sunday, Sept. 29, 2024. (AP Photo/Andrew Medichini)

Priests wait for the start of a mass presided by Pope Francis at King Baudouin Stadium, in Brussels Sunday, Sept. 29, 2024. (AP Photo/Andrew Medichini)

Faithful wait for the start of a mass presided by Pope Francis at King Baudouin Stadium, in Brussels Sunday, Sept. 29, 2024. (AP Photo/Andrew Medichini)

Pope Francis delivers his message as he meets with students of the Louvain Catholic University in Ottignies-Louvain-la-Neuve, Belgium, Saturday, Sept. 28, 2024. (AP Photo/Andrew Medichini)

Pope Francis delivers his message as he meets with students of the Louvain Catholic University in Ottignies-Louvain-la-Neuve, Belgium, Saturday, Sept. 28, 2024. (AP Photo/Andrew Medichini)

Pope Francis wears a traditional hat at the end of his meeting with students of the Louvain Catholic University in Ottignies-Louvain-la-Neuve, Belgium, Saturday, Sept. 28, 2024. (AP Photo/Andrew Medichini)

Pope Francis cheers faithful at the end of his meeting with students of the Louvain Catholic University in Ottignies-Louvain-la-Neuve, Belgium, Saturday, Sept. 28, 2024. (AP Photo/Geert Vanden Wijngaert)

Pope Francis attends the Hope Happening youth festival at the Brussels Expo, Belgium, Saturday, Sept. 28, 2024, on the third day of his four-day visit to Luxembourg and Belgium. (AP Photo/Andrew Medichini)

A priest holds a rosary prior to the start of a mass presided by Pope Francis at King Baudouin Stadium, in Brussels Sunday, Sept. 29, 2024. (AP Photo/Andrew Medichini)

Pope Francis attends the Hope Happening youth festival at the Brussels Expo, Belgium, Saturday, Sept. 28, 2024, on the third day of his four-day visit to Luxembourg and Belgium. (AP Photo/Andrew Medichini)

Pope Francis kisses a child during the Hope Happening youth festival at the Brussels Expo, Belgium, Saturday, Sept. 28, 2024, on the third day of his four-day visit to Luxembourg and Belgium. (AP Photo/Andrew Medichini)

Pope Francis attends the Hope Happening youth festival at the Brussels Expo, Belgium, Saturday, Sept. 28, 2024, on the third day of his four-day visit to Luxembourg and Belgium. (AP Photo/Andrew Medichini)

Pope Francis attends the Hope Happening youth festival at the Brussels Expo, Belgium, Saturday, Sept. 28, 2024, on the third day of his four-day visit to Luxembourg and Belgium. (AP Photo/Andrew Medichini)

Pope Francis attends the Hope Happening youth festival at the Brussels Expo, Belgium, Saturday, Sept. 28, 2024, on the third day of his four-day visit to Luxembourg and Belgium. (AP Photo/Andrew Medichini)

Pope Francis attends the Hope Happening youth festival at the Brussels Expo, Belgium, Saturday, Sept. 28, 2024, on the third day of his four-day visit to Luxembourg and Belgium. (AP Photo/Andrew Medichini)

Pope Francis kisses a child during the Hope Happening youth festival at the Brussels Expo, Belgium, Saturday, Sept. 28, 2024, on the third day of his four-day visit to Luxembourg and Belgium. (AP Photo/Andrew Medichini)

Pope Francis attends the Hope Happening youth festival at the Brussels Expo, Belgium, Saturday, Sept. 28, 2024, on the third day of his four-day visit to Luxembourg and Belgium. (AP Photo/Andrew Medichini)

Pope Francis attends the Hope Happening youth festival at the Brussels Expo, Belgium, Saturday, Sept. 28, 2024, on the third day of his four-day visit to Luxembourg and Belgium. (AP Photo/Andrew Medichini)

Faithful wait for the start of a mass presided by Pope Francis at King Baudouin Stadium, in Brussels Sunday, Sept. 29, 2024. (AP Photo/Andrew Medichini)

Pope Francis attends the Hope Happening youth festival at the Brussels Expo, Belgium, Saturday, Sept. 28, 2024, on the third day of his four-day visit to Luxembourg and Belgium. (AP Photo/Andrew Medichini)

Pope Francis delivers his message as he meets with students of the Louvain Catholic University in Ottignies-Louvain-la-Neuve, Belgium, Saturday, Sept. 28, 2024. (AP Photo/Andrew Medichini)

Pope Francis is cheered by faithful as he arrives to preside over the Sunday mass in King Baudouin Stadium, in Brussels Sunday, Sept. 29, 2024. (AP Photo/Andrew Medichini)

Pope Francis is cheered by faithful as he arrives to preside over the Sunday mass in King Baudouin Stadium, in Brussels Sunday, Sept. 29, 2024. (AP Photo/Andrew Medichini)

Pope Francis is cheered by faithful as he arrives to preside over the Sunday mass in King Baudouin Stadium, in Brussels Sunday, Sept. 29, 2024. (AP Photo/Andrew Medichini)