When Albert Laughter unpacks his medical supplies, preparing to treat the military veterans who are his patients, he finds no stethoscope or thermometer.
Laughter, a Navajo medicine man, cares for warriors as five generations of his forebears have: with traditional herbs, songs and ceremonies. But unlike his ancestors, he does it as a healer under contract with the federal government.
Laughter's services are part of a small assortment of programs run by the Department of Veterans Affairs to treat American Indian veterans for post-traumatic stress disorder and other maladies.
"Our culture, even though we live in the 21st century, we come back to the ceremonies, we come back to where the fire is, come back to where the herbs is, come back to where the songs is," said Laughter, who does his work in Navajo and in English at the VA medical center in Prescott and on northern Arizona reservations.
There are more than 181,000 American Indian veterans in the United States, less than 1 percent of the 24.8 million veterans nationwide, according to the VA. But officials at VA medical facilities near reservations say they have found Indian veterans have unique needs.
Deborah Thompson, director of the northern Arizona VA health care system, said providers don't have perfect understanding of how traditional practices help, but they have learned they are important for Indian veterans and can aid in treatment.
Most Indian veterans who participate in the traditional practices do so in combination with western medical treatment at VA facilities.
Standard western medical treatments, including psychotherapy, are less effective on their own for some Indians because of their unique traditions and cultural values, including a tendency to avoid drawing attention to themselves, VA officials say.
"In Native American culture _ in every culture _ one of the main things that goes against a spirit is taking a life," said Cari James, the minority veterans coordinator for the Carl T. Hayden VA Medical Center in Phoenix. The Hayden facility has an agreement with the Navajo Nation to reimburse costs for medicine man services provided to veterans on the reservation.
Navajo ceremonies can be performed to help Indian veterans recovering from combat and other trauma, said James, an Eastern woodland tribe Indian who is married to a man who is Navajo and Hopi.
Practices like hand trembling and crystal gazing _ which Laughter likens to a medical checkup _ can be used to determine what the veteran's spirit needs. Then ceremonies, some lasting days, are used to help cleanse or heal.
Laughter and other Indian practitioners provide a variety of veteran services, ranging from blessings to talking circles to elaborate ceremonies designed to bring a warrior back into the community.
Laughter and non-Indian VA officials say those who take part in the traditional ceremonies often report at least temporary relief from PTSD, a mental illness characterized by symptoms like flashbacks and nightmares that afflicts some who have experienced traumatic events.
Laughter, who served two tours in Vietnam, said he learned how beneficial traditional ceremonies could be in reducing PTSD symptoms when his own father, also a medicine man, performed ceremonies for him.
"When (veterans) go to the doctor or hospital, they give them medicine. Pretty soon, they have a bag of medicine after medicine," said Laughter, who wears a waist-length pony tail and turquoise bracelet along with two cell phones strapped to his belt. "We still come back to the ceremony."
Christopher Elia, head of the PTSD program at the VA center at Fort Mead, S.D., set up a sweat lodge 13 years ago and has seen veterans benefit from the sense of purification, forgiveness and thankfulness generated during a sweat.
Among the Lakota Sioux veterans he works with, "many of them feel they left _ for lack of a better term _ a piece of their psyche, or soul, on the battlefield," he said.
A sweat lodge ceremony, where hot rocks are doused in water to create steam, is how the Lakota welcome warriors home and how warriors reintroduce themselves to the community, Elia said.
"Traditionally, you give (your troubles) to the rock and burn them off. You no longer have to carry those burdens," he said.
Elia said he's unsure exactly why sweat lodges aid PTSD patients, but he's seen the experience of a sweat help veterans feel and express emotions and memories that other treatments, like talk therapy, have failed to uncover.
"Veterans will go into a sweat and say things they haven't said in five years of psychotherapy," Elia said.
Edward George Jr., a Navajo from Chinle, recently attended a talking circle presided over by Laughter, even recruiting a non-Indian veteran for the ceremony.
His spirits have been lifted by traditional songs, and George, a former reconnaissance Marine who struggles to be around people, has found it easier to communicate with others.
During the ceremony, George sat cross-legged on the floor of the teepee, his hands palms up. Laughter threw cornmeal onto the small fire and used pheasant feathers to swirl the smoke in a welcoming blessing over George's hands, shoulders and head.
"Coming back to our native culture in a way helps us find our way back, find our spirituality again," George said.
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