When Albert Laughter treats his patients, he needs neither stethoscope nor thermometer.
His "examination room" is a tepee enclosing a small fire ring. His supplies, which he stores in small leather pouches, include pheasant and eagle feathers, cornmeal and sage.
A Navajo medicine man, Laughter treats military veterans the way five generations of his family have treated warriors: with traditional herbs, songs and ceremonies. Unlike his ancestors, he does it as a healer under federal contract.
Laughter's services are part of a few Veterans Affairs programs to treat American Indians for post-traumatic stress disorder and other maladies.
In Indian culture, "even though we live in the 21st century, we come back to the ceremonies," the fire, the herbs, the songs, said Laughter, who conducts his work in the Navajo language and in English at the Prescott VA Medical Center and on northern Arizona reservations.
Less than 1% of the nation's 24.8 million veterans -- about 181,000 -- are Indian, according to the VA. But Indian veterans have unique needs, officials at VA medical facilities near reservations say.
Most Indian veterans who participate in the traditional Indian ceremonies also obtain standard medical treatment at VA facilities.
Medical treatment alone is less effective for some Indians because of their culture and values, including a tendency to shun attention, VA officials say.
Navajo ceremonies can be performed to help Indian veterans recovering from combat and other trauma, said minority-veterans coordinator Cari James of the Carl T. Hayden VA Medical Center in Phoenix, which reimburses the Navajo Nation for providing a medicine man to veterans on the reservation.
"In Native American culture -- in every culture -- one of the main things that goes against a spirit is taking a life," said James, herself an Eastern woodland Indian.
Practices like hand trembling and crystal gazing -- which Laughter likens to a medical checkup -- help determine the needs of the veteran's spirit. Then ceremonies, sometimes lasting days, are conducted to cleanse or heal.
Such services include blessings, talking circles and elaborate ceremonies to bring a warrior back into the community.
Laughter and non-Indian VA officials say ceremony participants often report at least temporary relief from posttraumatic stress disorder, a mental illness characterized by symptoms like flashbacks and nightmares.
Laughter, who served two tours in Vietnam, said he learned firsthand that traditional ceremonies could alleviate the disorder when his father performed rituals for him.
In South Dakota, the director of Ft. Meade VA Medical Center's post-traumatic stress disorder program set up a sweat lodge 13 years ago. Veterans benefit from the sense of purification, forgiveness and thankfulness that a sweat produces, he said.
Many Lakota Sioux veterans feel they left "a piece of their psyche or soul on the battlefield," program head Christopher Elia said.
A sweat lodge ceremony, during which 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.
The experience helps veterans express emotions and memories, Elia said. "Veterans will go into a sweat and say things they haven't said in five years of psychotherapy."
At a recent talking circle Laughter conducted in Arizona, former reconnaissance Marine Edward George Jr., a Navajo from Chinle, Ariz., sat cross-legged on a tepee floor. The medicine man threw cornmeal onto a small fire and swirled the smoke over George with pheasant feathers, a blessing of welcome.
George, who has difficulty being around people, said that his spirits were lifted by traditional songs and that he had since found it easier to communicate.
"Coming back to our native culture in a way helps us find our way back, find our spirituality again," George said.