Lindee Abe, APRN
Every healthcare professional should be aware of human trafficking. Most healthcare providers have had education on the topic. How many of us really consider this as a possibility when we are seeing patients? Maybe this depends on where we work in or what geographic location. I’m sure in some areas it seems less likely to occur, be we should be vigilant when considering human trafficking. This post serves as a review of some of the statistics of human trafficking and our role as healthcare professionals. We have the ability to impact change for these patients and help them get out of the situation, but only if we are considering the possibility of identifying victims.
We have all seen the television shows and read the articles discussing bystanders not wanting to speak up when a concerning situation arises. The 1964 case of a murder in Kew Gardens, New York illustrated that multiple bystanders were a witness, but none intervened. Many of those bystanders simply thought someone else would help. This may also explain why many cases of human trafficking go unreported. There may be a fear not to upset the patient if the report turns out to be false.
One study noted that approximately 50% of human trafficking victims sought healthcare while a victim. This places healthcare professionals in the unique situation that they will not only encounter victims, but also be in a position to intervene.
Basics of Human Trafficking
Human trafficking often has an underlying financial gain to the abusers. It can involve using victims to work in unethical labor conditions, sexual trafficking, and even using minors to transport drugs. It is estimated that there are over 24 million victims of trafficking world-wide and over 400,000 victims in the United States. The majority of human trafficking victims are involved in sex trafficking in the U.S. In fact, sex trafficking represents over 71% of human trafficking cases. The U.S. law defines human trafficking as using coercion, force, or fraud in order to make a victim perform sex acts or labor against their will. Human trafficking is also known to occur at large events, like sporting events conventions, etc. Some health systems get alerts from law enforcement when large events are scheduled to remind staff to be vigilant for trafficking victims.
Traffickers will often target persons that are vulnerable, whether that be from a poor financial situation, recent immigrant, physical or mental disability. Traffickers are also usually someone the victim knew prior to being forced into their current situation. These factors often prevent the victim from seeking help to get out of the situation. Victims can feel that if they had a relationship with the trafficker, that they are somehow willingly participating in the situation.
Identifying Human Trafficking in Healthcare
What does human trafficking look like in healthcare? The first thing that comes to mind would be a patient being seen for sexually transmitted infections or unplanned pregnancy. Those cases tend to be easier for healthcare professionals to detect and report. What about the ones that aren’t so easy to detect? How do these patients present? Most importantly, how do we detect these patients and report to the appropriate agency? While one of the red flags discussed may not necessarily mean the patient is a victim of human trafficking, the combination of red flags or even the gut feeling that something isn’t right about the visit are all valid reasons to get a good history during the visit and possibly report suspicions.
Victims May Not Be Alone
One of the first things to note is who is accompanying the patient. Every family has different dynamics and relationships, but sometimes those interactions seem off. The person accompanying the patient may answer all the questions for them or refuse to leave their side. They may even insist on accompanying the patient to the bathroom or diagnostic testing. There have also been some hospitals and clinics that have a system in place where a patient places a colored sticker or other form of identification on their urine cup when giving a urine specimen. There is a sign in the bathroom that explains why to put the identification on their urine cup in the bathroom. This approach been used for identifying victims of both human trafficking and domestic violence.
When it comes to getting a history from the patient, healthcare professionals should note if their history is consistent or if it changes. Also, as noted above, if the patient is giving you the history or if the person accompanying the patient is the one providing a history (assuming the patient is stable enough to provide a history) this can be a red flag. Most healthcare systems are now screening patients for domestic abuse, but are still asking the patients in front of the person accompanying them. One of the previous hospital systems I worked in made a point of only asking the question if the patient was alone. A common scenario would be the nurse or tech accompanying the patient to the bathroom and while explaining how to collect a urine sample asking about if they feel safe at home.
Signs of Abuse
The physical exam can be another clue to healthcare providers. Some findings include bruising in various stages, avoiding eye contact, poor dental hygiene, injuries that are inconsistent with the reported mechanism of injury. In addition, substance use and malnutrition can be red flags. Delayed presentation of an illness is another indicator of a potential human trafficking victim. May abusers do not allow victims to access healthcare in a reasonable amount of time, thus leading to severely progressed conditions upon presentation to a healthcare facility. Labor trafficking victims can also have skin and respiratory complications from chemical and/or toxin exposure.
Infectious diseases that typically present in crowded and unsanitary conditions, like tuberculosis or hepatitis, can also be indicators of human trafficking. Frequent sexually transmitted infections or UTIs can also be clues of sexual trafficking. This is especially concerning when education has been done with the patient on ways to reduce the risk of infection. Pregnancy in the second and third trimester without any prenatal care can also be a red flag.
Human Trafficking Management
What options do healthcare providers have if they suspect someone might be the victim of human trafficking? First, they can try to find a moment alone with the victim to ask them directly. However, some victims will deny concerns related to current situation. Law enforcement should be notified in every case. The police will interview the patient and determine what additional actions should be taken. You can also call the national hotline at 1-888-373-7888. They are available 24/7 as a resource.
There are more hospital systems placing a greater emphasis on the identification of human trafficking victims. The recent pandemic where there was less social interaction in general provided a perfect environment for the seclusion of human trafficking victims from the general public. We should be vigilant for red flag symptoms in all interactions. It isn’t always the patient that has bruising from head to toe. Sometimes the quiet young adult female being seen for her 3rd UTI in two months and has a “parent” that answers for them is the victim.
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