Health Care and Human Trafficking , by Mindy Lause, RN, Blanchard Valley Hospital Emergency Department
Human trafficking is also known as modern day slavery. It often manifests as prostitution or other forms of sexual exploitation, forced labor, servitude and the removal of organs. Since medical care becomes necessary for trafficked victims due to poor living conditions, abuse and inadequate nutrition, health care professionals are in a unique position to identify this vulnerable patient population.
The Annals of Health Law reported that 87.8 percent of trafficking victims experienced contact with someone in the public health system. Victims of child abuse or neglect, people with disabilities, LGBTQ community members, runaways, foreign nationals, and people with substance abuse issues have been named as vulnerable populations throughout the literature, presenting with a wide-range of health issues such as burns, fractures, sexually transmitted infections, pelvic inflammatory disease, untreated chronic conditions, dental abscesses, repeated exposure to harmful chemicals and/or malnourishment. Given the crisis endured, the victim may also present with psychological distress.
Clinicians are not the only ones in the position to identify a victim. Recent research indicates victims tend to confide in support staff of emergency departments or urgent care centers because they seem “less intimidating.”
When victims present, usually it is with another person who may be or claim to be his or her boyfriend/girlfriend, uncle/aunt, husband/wife, sibling, or parent. Reluctant to leave, the person will often control the conversation by correcting the patient and answering in response to questions asked by the medical provider. The victim may exhibit fear, anger and/or anxiety, or be completely submissive.
Suspicious red flags include absence of official documents or identification, being a poor historian, having late presentation of disease/symptoms, being unable to give an address, and/or appearing to lie about their age. Minors may also be living with people other than their parents or failing to attend school.
Identifying and assisting trafficked victims can be difficult because both victims and traffickers can be from any demographic. Medical providers also risk endangering the victim if the trafficker believes they are under suspicion. This can lead health care providers to feel powerless; however, documenting the victim’s injuries and treatment in the medical record can help build a case against the trafficker.
If your suspicion is aroused, use plain language and active listening, and be sure you are asking sensitive questions away from the potential trafficker (one-on-one, in a private area). You can also reach out to trauma-informed medical professionals such as a forensic nurse or sexual assault nurse examiner (SANE).
Perhaps surprisingly, the goal in any suspected case is not for disclosure but to treat the victim’s medical condition, educate the victim of options, and empower the victim with choice. This is done while also keeping in mind that individuals rarely identify themselves as victims of human trafficking, and, due to the psychological dynamics at play, may even defend their traffickers.
If a victim has disclosed he or she has been trafficked, follow the protocol within your institution. In situations of immediate, life-threatening danger, report to law enforcement.