HOLDING IT TOGETHER: Humour helps healthcare staff cope in a way that is therapeutic

Several centuries ago, Daniel Defoe described plague victims discovering the “tokens” on their skin as the marks that meant death was imminent. Even then, in houses built entirely around dying, grief never had the room to itself. There was a space for the whisper of a chuckle, even in places where fear and bodily indignity met sheer exhaustion.

Any South African hospital on a given day has a similar peculiarity at work. Emergencies are rarely anomalies – for most paramedics, emergency room doctors, nurses and other specialists, it is simply another day. And every so often, a laugh slips through.

But our healthcare workers walk a daily tightrope stretched thin by depleted supplies, incomplete rosters and a seemingly unending tide of trauma. In April, Dr Katlego Mothudi, managing director of the Board of Healthcare Funders, confirmed what South African frontline staff already know: the healthcare system is in crisis, plagued by shortages and inadequate facilities.

The toll these challenges take is well ­documented. For healthcare workers, acute stress tends to give way to secondary trauma, then moral injury, followed by exhaustion and eventually burnout.

Well, well, well

Institutional leadership tend to reach for familiar remedies: resilience workshops, engagement surveys and wellness webinars. But delivered to a ward that lacks basic consumables, these initiatives can feel less like support and more like a kind of administrative gaslighting.

Long-term solutions require budget allocation, infrastructure overhauls and political will – none of which will help an intern during a midnight resuscitation. What that intern needs is a mechanism to diffuse tension and protect their own mind, on shift, in real time.

This is where an old human coping tool – humour (and the cultural shorthand it carries) – starts to look less like a distraction and more like a form of psychological personal protective equipment.

Levity is a biological function before it’s a social one. To an overworked nervous system, a shared moment of absurdity signals that the immediate threat has passed. Studies show that humour lowers cortisol and resets the brain’s internal alarm. A wry joke between a paramedic and a doctor builds the unspoken trust that allows a team to approach the next situation with a fair level of confidence.

South African healthcare culture already has its own version of this. The Ithemba Foundation’s CrazySocks4Docs initiative asks healthcare workers to wear bright mismatched socks beneath their scrubs – a small but visible signal with a serious message: it’s okay not to be okay. It can cut through clinical stoicism and corporate jargon, giving staff permission to show vulnerability without fear of professional stigma.

The same instinct plays out in quieter, less official ways too: the tearoom joke, the gallows humour typed into a WhatsApp group at 3am, the skit filmed for colleagues. None of it is meant for outsiders. It exists purely to let an overwhelmed shift worker laugh before the next patient walks in.

And the boundaries are simple: humour must never target race, language or socio-
economic status, and near grieving families, empathy must take precedence.

For the patient’s sake

Humour as a protective function doesn’t end with healthcare workers – it extends directly into patient care. Trained therapeutic performers – clown doctors or laughter heroes – work alongside doctors and nurses in some of South Africa’s hospital wards, helping patients to navigate life-threatening illness and difficult treatment regimens. Popularised by figures such as Patch Adams in the 1970s, professional therapeutic clowns can measurably reduce anxiety and pain, particularly in young patients, offering comfort during high-stress situations that no amount of clinical competence alone can soften.

Consumer psychologist Dr Cathrine ­Jansson-Boyd frames it simply: “Jokes and laughter may seem frivolous on the surface, but they serve essential functions when managing overwhelming emotions, softening embarrassment and building interpersonal trust.”

In healthcare settings, that dynamic cuts both ways: levity strengthens the bond between patient and carer while giving healthcare workers relief as they navigate difficult terrain, including end-of-life care.

Top-down wellness mandates fail because a memo cannot mandate morale. Real change must move through every layer of a healthcare organisation at once. Hospital management and human resources need to move past paper policy and fund unit-level support while protecting rest. On the floor, unit heads and senior staff must set the tone by normalising 30-second team check-ins, visibly taking their own breaks and softening into laughter at times. Frontline champions keep the spirit alive – organising peer support, joining awareness drives and watching for colleagues whose jokes might be masking something heavy.

Humour in healthcare settings will not fix understaffing. It won’t repair broken infrastructure or expand a strained national health budget.

But centuries after Defoe’s plague houses, the pattern holds in modern South African hospitals: when medicine is practised on the precipice of human endurance, a shared laugh, a pair of silly socks or a brief moment of lightness can be the thread that holds together a healthcare worker and the patient in front of them. DM

This story first appeared in our weekly DM168 newspaper, available countrywide for R39.

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