6 minute read
Human Trafficking: Identifying and Treating Victims
By Nicole E. McAmis, Angela C. Mirabella, Elizabeth M. McCarthy, and Cara A. Cama, Frank H. Netter MD School of Medicine, Quinnipiac University on behalf of SAEM’s Residents and Medical Students
Summary
The U.S. Department of State defines human trafficking in The Trafficking Victims Protection Act of 2000 as sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age; or the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.
Human trafficking is a violation of human rights and a global pandemic. Emergency physicians are often the first group of health care professionals to interact with victims of human trafficking with over 88% of victims seeking medical care in a variety of health care settings. Emergency physicians will likely encounter victims of human trafficking at some point in their careers and will be called upon to provide not only medical care for various concerns, but also emotional and psychological support.
Victims of human trafficking may present to emergency departments for a myriad of medical complaints including infectious diseases, physical violence, sexual abuse, pelvic pain, hazardous working conditions, unintended pregnancies, abortions, malnutrition, dental disease, anxiety, chronic pain, posttraumatic stress disorder (PTSD), depression, substance use disorders, suicidal ideations, or suicide attempt. Unfortunately, many emergency physicians lack the knowledge and tools needed to recognize these victims. In this article, we will dive into some basic information that all health care providers need to identify and provide treatment to victims of human trafficking.
Risk Factors
It is often difficult to identify those individuals who may be victims of human trafficking. However, we provide certain risk factors that could assist in the identification of human trafficking victims: • Poverty • Racial/ethnic minority status • Marginalized individuals (LGBTQ, runaway youth, Native
Americans, indigenous people) • Rural location • Lack of education • Disability • Inadequate family support and protection • Migration
Red Flags and Indicators of Human Trafficking
• Someone else is speaks for the patient and refuses to let the patient have privacy • The patient exhibits fear, anxiety, or tension • The patient is reluctant to explain his/her injuries or they share a scripted/inconsistent history • Tattoos or other forms of branding are visible on the patient • The patient reports an unusually high number of sexual partners, STDs, pregnancies, miscarriages, or terminations • Language [or slang] is used that is common in the commercial sex industry (Examples of such terms can be found here: Know the Language of Human Trafficking: A
Glossary of Sex Trafficking Terms (amuedge.com))
Screening Tools and Questions
Once you have identified these red flags, the next step is to provide screening questions to your patient: • What are your working or living conditions like? • Have you ever been deprived of food, water, sleep, or medical care? • Can you leave your job or situation if you want? • Can you come and go as you please? • Who is the person who came with you today? Can you tell me about them? • Have you ever been threatened or intimidated? • Has anyone threatened to hurt you or your family if you leave? • Do you have a debt to someone you cannot pay off?
• Is someone holding your identification documents (passport, visa, driver’s license)? • Did you ever feel pressured to do something that you didn’t want to do or felt uncomfortable doing? • Have you ever been told to have sex with people you don't want to have sex with? • Have you been forced to engage in sexual acts for money or favors? • Does anyone take all or part of the money you earn? • Do you have to meet a quota of money each night before you return home?
How to Approach These Questions
It is always important to conduct the assessment in a comfortable, private location with a social worker or advocate present whenever possible. Prior to beginning the interview, be sure to start with three simple questions to ensure the safety of the victim: 1. Is it safe for you to talk with me right now? 2. Do you feel safe right now? 3. Do you feel like you are in any kind of danger for speaking with me?
When possible, conduct the interview in the victim’s native language and use a professional, neutral interpreter if needed. Be sure to use an approachable tone, demeanor, and body language to remain neutral and nonjudgmental. Always assure confidentiality, unless the situation invokes state mandatory reporting laws (the person is in grave danger, a minor under the age of 18, or has disabilities). Also, victims may find it easier to speak with a provider who is of the same sex, ethnicity, or age range. At all times, please be sure to reference existing institutional protocols for victims of abuse.
Next Steps
After addressing the immediate needs of your patient and obtaining informed consent, consider calling the National Human Trafficking Resource Center (NHTRC) hotline at 1-888-373-7888. The NHTRC can help assess the current level of danger, provide further recommendations, identify local resources, and potentially involve law enforcement. In dangerous or life-threatening situations, follow your institutional policies for reporting to law enforcement and consider the following: • the presence of the trafficker in the patient’s room, waiting room, or home • the potential that calling the hotline may put the patient or the patient’s family in danger • the age of the patient
It is vital that you help the patient memorize the phone number, so they can call 1-888-373-7888 or text HELP or INFO to BeFree (233733) at a later time. Avoid giving the patient physical materials including written notes or brochures that could place them at increased risk if detected.
Conclusion
Emergency physicians are in a unique and powerful position to serve as the first responders for victims of human trafficking. This article has provided some tips and tools to utilize in your practice to identify and serve those victims who suffer from human trafficking. Many health care professionals have shared concerns about the lack of quality training available on this topic. Because of this, we sought to identify the self-reported knowledge level of providers on the global issue of human trafficking. Further research should be conducted to further identify successful strategies in preventing and rescuing victims of human trafficking. We hope to present such results in a future publication.
ABOUT THE AUTHORS: Nicole E. McAmis, is an MS4, class of 2021, Angela C. Mirabella is an MS3, class of 2022, Elizabeth M. McCarthy is an MS2, class of 2023, and Cara A. Cama, MBA, is an MS4, class of 2021 at the Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, Connecticut.
Read More!
• U.S. Department of State Trafficking in Persons Report June 2019 • Identification of human trafficking victims in health care settings • Health Care Providers’ Training Needs Related to Human Trafficking: Maximizing the
Opportunity to Effectively Screen and Intervene • The Health Consequences of Sex Trafficking and Their Implications for Identifying
Victims in Healthcare Facilities • The health risks and consequences of trafficking in women and adolescents • Minor and Adult Domestic Sex Trafficking Risk Factors in Ohio • Identifying Victims of Human Trafficking: What to Look for in a Healthcare Setting • Comprehensive Human Trafficking Assessment • National Human Trafficking Hotline
