Hospitals and health care providers have, over the past two decades, awakened to the importance of culturally sensitive care. But culture is lived and breathed and can be hard to define or practice in the small confines of an exam room.
So some providers, including an insurance company in Utah, are trying a new approach. Instead of bringing Todachiny or his cultural knowledge to patients, Molina Healthcare is sending patients to him.
One of two insurers administering Utah's low-income Medicaid insurance program, Molina has added a Traditional Medicine Benefit to its list of billable health care services.
The benefit actually works more like a grant. Patients apply and can get up to $100 a year to spend on traditional care, such as herbal remedies from a medicine man or a purifying sweat lodge ceremony with a spiritual healer like Todachiny.
It has been popular in New Mexico, where Molina first test-drove it in 2007; this year saw a 78 percent increase in applications. The Utah branch will try it out for a year and has budgeted $10,000, said Gooch.
To qualify, applicants need only be on Molina's Medicaid rolls and a member of a federally recognized tribe. A care manager will follow up with the patient but won't ask questions about the healer or services delivered, which are considered sacred.
"We hope the services are delivered in coordination with other care. We would like to see an improvement in health outcomes," said Hal Gooch, Molina's chief medical officer.
But the offering is mostly meant to break down barriers, said Gooch. "This is an underserved population that has, for good reason, been skeptical of modern, Western medicine. We hope to reach out to people and get them into treatment."
There are about 45,000 American Indians in Utah. Of those, 7,200, or 16 percent, are eligible for Medicaid.
American Indians have the lowest life expectancy in Utah and high rates of diabetes, obesity and alcoholism. They smoke at rates double the state's average. And they seek medical care less frequently than other ethnic groups.
In state fiscal year 2011, American Indians covered by Medicaid received an average of 32 services, from doctor visits to prescription refills. The average number of services for all other patients that year was 44, according to data from the Utah Department of Health.
Part of the problem is the remote location of tribal groups.
A good portion live in urban Salt Lake County, home to the state's major health centers. But the majority reside in rural areas, such as San Juan and Uintah counties, where the nearest hospital is hours away.
"Access to care is a huge issue," said state Indian Health Liaison Melissa Zito. "In some areas like the west desert [home to the Goshutes and Ibapah], we are only able to get a provider to come down once a month."
But trust plays a role, too. Research has shown American Indians rate their healer's advice higher than their physician's, and they don't always tell their physician that they're going to one.
There's always the risk of herbal teas, tinctures and salves reacting with medications. Molina urges patients to tell doctors about their herbs and traditional treatments, but does not explicitly ban substances such as peyote.
And randomized, double-blind studies on the measurable health benefits of prayer and traditional healers is mixed, making it something of a scientific and religious minefield.
That hasn't dampened people's appetite for less-conventional therapies, from yoga to massage.
Most of Todachiny's time at the Indian Walk-In Center in Salt Lake City is spent as a spiritual guide or counselor, helping people navigate problems at work and at home. The process evolves over days or months, inseparable from the relationship with clients.
"We talk about walking in harmony and balance. Somewhere along the line, we sometimes lose that balance and we get sick," he said.
The cultural practice is to offer tobacco or money in exchange for his services. If he can't perform a certain ceremony, he'll refer the client to someone who can.
The human need for connection lives on, he says, but the old ways are being lost as fewer American Indians grow up on reservations.
"When someone is born we used to keep the umbilical cord and bury it outside the home. Today people are just throwing it away and the youth don't know how to find their way back home," said Todachiny.
A growing number of hospitals and health care groups are teaming up with traditional healers as a way to reach underserved populations and provide culturally sensitive care.
The World Health Organization is working with healers in Africa to fight AIDS. Hospitals commonly summon pastors to pray and deliver last rites.
And today, Utah's legislative health reform task force will hear a pitch to add spiritual care to health plans sold on the state's Health Exchange, a Web-based insurance marketplace.
To inquire about Molina's Traditional Medicine benefit, call 1-888-483-0760 or visitmolinahealthcare.com.