Appleton, Wis. — "A harmonious arrangement of self and universe."

With this elegant phrase, Everett Rhodes described the American Indian approach to health. Disease, he said, is a disturbance of that harmonious arrangement.

Rhodes, an American Indian and a physician, is the former director of the US Indian Health Service and now a professor of medicine at the University of Oklahoma.

He and others spoke recently about traditional Indian medicine at a cross-cultural medicine workshop sponsored by the Association of American Indian Physicians and the Appleton Medical Center, where the conference was held.

For those with little exposure to American culture, traditional Indian medicine may conjure up Hollywood images of medicine men who trade mainly in superstition and ignorance.

But the American Indian physicians at this conference described a rich heritage, suffused with spirituality and involvement. Their picture involves an approach to the human body that is centuries older, and, they say, in some respects wiser than the relative new­comer, scientific Western medicine.

Although magic and ceremony do play a role in Indian medicine, said Rhodes, so does a sophisticated body of knowledge, including effective herbal medicine, an understanding of physiology and a tradition of good day-to-day hygiene.

As an aside, Rhodes said, modem doctors would be wise not to scoff at magic and ritual.

The detailed and elaborate procedures for surgery are full of ritual, he said.

And the time-honored practice taken four times a day is a vestige of "the days when magic ruled" and healers ordered patients to take a remedy four times a day, four days a week, for four weeks.

But it is the sense of what now often is referred to as holistic or wellness, including a recognition of the patient's spiritual nature, that truly distinguishes traditional Indian medicine from its modern counterpart, Rhodes said. Compared to it, modern medicine seems sterile.

Indeed, spirituality is "a whole chunk of health we leave out," said family practitioner Kathleen Annette, area director for Indian Health Services.

"We always ask patients their religious affiliation — are they Catholic, Protestant or Jewish? - but that's not enough," Annette said, "When I practice in Duluth, I tried to do a mini spiritual history. I'd ask, "Do you have a connection with God? Indians really opened up to that.

"Then I began to ask non-Indian patients, and the response was phenomenal. They would say, 'My spiritual health often isn't as strong as it should be.' Doctors can't provide it, but you can advise your patients that it is a part of health."

Intertwined with spirituality is the Indian sense of community, which also plays a part in healing, Annette said.

An example:  On the same day, Annette had two unmarried 15-year-old patients in labor at the hospital, one an American Indian and the other not. The non-Indian girl was accompanied by her mother during her labor. But the American Indian girl's room was filled with mother, father, brothers, a half dozen aunts and a few uncles. This was clearly a community event and a community joy.

"We try to cut back teenage pregnancy," Annette said, "but for the American Indian family, any birth is a celebration. If a teen gets pregnant, you accept it — and someone in the family is assigned to help raise the child."

Annette chuckled as she described another scene. "When someone has a heart attack, you naturally expect a few relatives to rotate through," she told her audience of health care providers, most of whom were not Indian. "But when my dad had a heart attack, I realized about 30 of us were sitting around the lobby."

If you are the physician of a patient surrounded by an extended Indian family, the first thing to do is identify the decision maker in the group, Annette said.

"How do you do that?" someone in the audience asked. "Just ask them," Annette replied. And when discussing the case with the decision maker, be sure to remember that silence is not agreement, Annette said.

"A doctor needs to continue to ask questions in a non-threatening manner," she said.

For all their talk of the strengths of traditional Indian medicine, the Indian physicians did not ignore the sorry state of Indian health today. Alcoholism is a tremendous problem, heart disease has become wide­spread, cervical cancer is proportionately higher in American Indian women than in the general population, and accidents are a major cause of death.

A shocking 33% of Indian deaths occur before the age of 45, compared with 13% in the non-Indian population, said internist Jerry Hill, immediate past-president of the Indian physician association and a professor at the University of Minnesota-Duluth.

But this decline in Indian health is a relatively recent phenomenon, he said. "We have been healthy for literally thousands of years, but something has happened, Hill said. "We lost our way; we lost our culture."

With the destruction of their language and culture, Indians have become more and more "un-Indian" — to the detriment of their health, Hill said.

"What we're realizing is that in order to be more healthy we have to be more Indian."

Hill wasn't calling for a rejection of modern medicine but rather for a return to healthy Indian foods and Indian spirituality, including healing Indian rituals, such as the sweat lodge.

"A community house for traditional religion is probably as important to health as anything we can do," he said.

When he said that, Hill turned to Hilary Waukau, 72, vice chairman of the Menominee nation. Waukau had just told the audience about how he worked to get a building constructed on the reservation for the Big Drum people, practitioners of traditional religious rituals.

Waukau, who suffers from heart disease, felt strongly about the new Big Drum home because he had been through an ancient Big Drum healing ceremony during a critical stage of his illness. At the same time, he was obtaining the best of modern medicine at the Appleton Medical Center and received the last rites of the Catholic Church at that time. His message was that American Indians can accept and integrate all these approaches to health.

As Waukau spoke, he held a large eagle feather given to him by a Canadian medicine man.

"When I am stressed, I fan myself with my eagle feather, and I can feel relief — coming not from the feather but from the Supreme Being," he said. "I always carry the feather to remind me to be honest, to tell the truth and to never say anything to hurt anyone."

"We were put on earth to promote harmony," he said.

" MEDICINE CHANT "   A painting by famed American artist Ron English, depicts a traditional 19th century Northern Plains Tribe Native American healer chanting to the Great Spirit to invoke his healing power.