The Healthcare Community and Human Trafficking

It is the unfortunate truth that all forms of human trafficking can and do currently occur in the United States. While trafficking has historically been a matter for those in political and legal fields, healthcare workers can play a significant role in identifying and helping trafficking victims. Research has shown that the primary place that victims are seen while still under the control of a trafficker is in healthcare settings: specifically, urgent care centers, emergency departments, and OB clinics. All healthcare providers need to begin to recognize the signs of trafficking, learn how to intervene when opportunities present themselves, and how to obtain help for trafficked victims.
Healthcare also needs to start looking at the both the physical and mental long-term implications of a person being a survivor of human trafficking and begin to play a role in dictating the care provided. Healthcare workers should also fight to change policy and laws that would impact trafficking and those who survive it. In addition, healthcare needs to make a cultural change with language and stop blaming or re-victimizing those who have been trafficked. Healthcare cannot just dismiss someone as a “working girl” or a “drunk” or a “druggie”. Healthcare workers need to appropriately recognize, care for, and hopefully begin to prevent future cases of human trafficking.
An Overview of Human Trafficking
Human trafficking is defined by the Trafficking Victims Protection Act of 2000 as (a) the recruitment, harboring, transporting, supplying, or obtaining a person for labor or services through the use of force, fraud, or coercion for the purpose of involuntary servitude or slavery; or (b) sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform sex acts is under 18 years of age. The key elements of the Trafficking Victims Protection Act (TVPA) state that it is illegal to use force, fraud, or coercion to exploit a person for profit or for personal services. The use of coercion can be direct and physically violent, or it can be through psychological means. Although most news accounts of human trafficking focus on the violence endured by the victims of human trafficking, the powerful effects of psychological coercion play a key role in entrapment and continued enslavement.
Human trafficking occurs in four categories. The most commonly publicized form is sex traffickingBaby trafficking occurs when a baby is sold and is not typically seen in the healthcare community. Organ trafficking can have an impact on the healthcare community (most prevalently in third world countries) because of the risks to the person whose organs were trafficked. The victim may be selling their own organ(s) for a profit or may have had the organ(s) removed by force. Either way, the donor may then suffer from a lack of proper healthcare causing scaring, infections, and even loss of life, depending on what organ(s) were removed, how they were removed, and the care provided. Example of labor trafficking can be seen with child soldering, in fields and farming communities, with construction, domestic servitude, bonded servitude, and in the service industries (hotels, restaurants, etc.). Although sex trafficking is its own category, many labor trafficking victims can be sex victims as well.
Most victims of human trafficking do not receive medical care until the need impacts their ability to earn money or perform their duties. This typically means that those in healthcare will see a patient in advanced stages of infection, malnourishment, etc. Health problems can stem from living in small, cramped spaces with multiple people and from long hours of working (sex or labor) and having their bodies in uncomfortable potions. There are also the typical trauma problems from abuse. Mental health disorders are common. Two of the primary psychiatric disorders seen among those trafficked are PTSD and substance abuse. The substance abuse can come from the trafficker forcing the victim to become addicted in order to control them or from the victim using substances in order to tolerate their plight. The PTSD can come from the many violent and traumatic things done specifically to the victim, the violence they see in the world of trafficking or a combination of these.
In addition to the diagnosable disorders, victims typically experience feelings of helplessness, shame, shock, humiliation and even denial or disbelief. Sexual health complications are common in victims of sex trafficking and sometimes in labor trafficking as well, since rape is common. These include HIV & AIDS, STIs, infertility from untreated STIs, botched abortions or infertility from illegal abortions, vaginal infections, pelvic pain, urinary difficulties, and cervical cancer. There can also be trauma and/or mutilations to any and all orifices and sex organs. Child victims can also display retarded growth, malformations from growth in restricted areas, and poorly formed or rotted teeth.
What You Can Do
These are indicators that a patient you’re treating could be a victim of human trafficking:
· Being accompanied by another person who seems controlling
· The accompanying person insists on giving health information
· Visible signs of abuse or neglect
· Patient appears fearful or submissive or does not know basic information such as where they are (city, state, or building)
· Does not speak English
· Lack of identifying paperwork (ID, passport, etc.)
If you find a patient that has the above indicators or makes you think that trafficking is occurring, call the Trafficking Information and Referral Hotline @ 1-888-3737-888. They can help you determine if you have a trafficking victim in your care and guide you on next steps.
It is also very important to find a medical reason to separate the potential victim from the person they are with. (This person could be a trafficker or another victim who will report to the trafficker.) You cannot just say that you want to talk in private or the victim could “get in trouble”. Instead, you may need to say that it is policy to change without “family or visitors” present, or you may need to take them to a test that does not allow others to be in attendance, etc. Never use the person with the potential victim as your translator. Work on building a safe and trustworthy bond, and remember that the potential victims has been given every reason not to trust others. Many are told that police and others in authority will hurt them in some way.
When the potential victim is alone, you need to start to find out about their predicament. You cannot just ask if they are a victim, as many don’t see themselves as such. If they originally left an abusive environment, this situation may be better than what they had or may be their only alternative to living on the street.
Sample questions to consider are:
· Can you leave your work or job anytime you would like?
· When you are not working, can you come and go as you would like?
· Have you been threatened with harm (to yourself or other loved ones) if you don’t do what you are told/asked?
· What are your working or living conditions like?
· Do you have to ask for permission to eat, sleep or use the bathroom?
· Are you allowed to keep all of the money you make and spend it as you would like?
Depending on the answers to these questions and the guidance of the hotline, you will need to give the proper medical care while you work to ensure your patient’s safety and continue to build a bond of trust. You will also need to consider that the patient will likely need medical care past this initial phase in addition to meeting the need for mental health support and social support.
Healthcare workers can make a big impact by recognizing victims of human trafficking, treating their immediate healthcare needs, and connecting them with appropriate resources. In this way, healthcare workers can aid a victim on the road to becoming a survivor.
· Ahn, R., Alpert, E. J., Purcell, G., Konstantopoulos, W. M., McGahan, A., Cafferty, E., … & Burke, T. F. (2013). Human trafficking: review of educational resources for health professionals. American journal of preventive medicine44(3), 283-289.
· Anti-slavery International. (2002). Recommended principles and guidelines on human rights and human trafficking report of the United Nations. London:Author. Retrieved October22,2008,from pdf/UN_RecHRHT.pdf
· Barrows, J. (2008). Human Trafficking and the Healthcare Professional. Southern Medical Journal, 101(5), 521-524
· CdeBaca, L., & Sigmon, J. N. (2014). Combating trafficking in persons: a call to action for global health professionals. Global Health: Science and Practice2(3), 261-267.
· Dovydaitis, T. (2010). Human trafficking: the role of the health care provider. Journal of Midwifery & Women’s Health55(5), 462-467.
· Dharmadhikari, A. S., Gupta, J., Decker, M. R., Raj, A., & Silverman, J. G. (2009). Tuberculosis and HIV: a global menace exacerbated via sex trafficking. International Journal of Infectious Diseases13(5), 543-546.
· Eleni, T. H. E. M. E. L. I. (2011). Trafficking in Women for Sexual Exploitation. A Major Health and Human Rights Issue. International Medicine.
· Greenbaum, J., Kellogg, N., & Reena, I. (2013). APSAC Practice Guidelines: The Commercial Sexual Exploitation of Children: The Medical Provider’s Role in Identification, Assessment and Treatment.
· Isaac, R., Solak, J., & Giardino, A. P. (2011). Health care providers’ training needs related to human trafficking: maximizing the opportunity to effectively screen and intervene. Journal of Applied Research on Children: Informing Policy for Children at Risk2(1), 8.
· Kim, K. (2007). Psychological coercion in the context of modern-day involuntary labor: Revisiting U.S. v Kozminski and understanding human trafficking. University of Toledo Law Review, 38, 941-972
· Kotrla, K. (2010). Domestic minor sex trafficking in the United States. Social work55(2), 181-187.
· Lederer, L. J., & Wetzel, C. A. (2014). Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities, The. Annals Health L.23, 61.
· Logan,T.(2007).HumantraffickinginKentucky.Lexington: University of Kentucky. Retrieved July 18, 2008, from Traffick ing%20in%20Kentucky.pdf
· O’Callaghan, M. G. (2012). Human trafficking and the dental professional. The Journal of the American Dental Association143(5), 498-504.
· Sabella, D. (2011). The role of the nurse in combating human trafficking. AJN The American Journal of Nursing111(2), 28-37.
· The Human Smuggling and Trafficking Center. (2005). Fact sheet: Distinctions between human smuggling and human trafficking. Retrieved September 15, 2007, from 49875.pdf
· Tracy, E. E., & Konstantopoulos, W. M. (2012). Human Trafficking: A Call for Heightened Awareness and Advocacy by Obstetrician–Gynecologists. Obstetrics & Gynecology119(5), 1045-1047.
· U.S. Department of Health and Human Services, Administration of Children & Families. (2008). Screening tool for victims of human trafficking. Retrieved September 4, 2008, from trafficking/campaign_kits/tool_kit_social/screen_qu estions.html U.S.DepartmentofJustice.(2007,July3).Threearrestedfor involuntary servitude. Federal Bureau of Investigation press release. Retrieved July 10, 2007, from http:// U.S. Department of State. (2006, June). Trafficking in persons report. Retrieved June 30, 2008, from http://www U.S. Department of State. (2007, June). Trafficking in persons report. Retrieved February 5, 2007, from http://
· U.S.DepartmentofState.(2008,June).Traffickinginpersons report. Retrieved September 16, 2008, from http://
· Victims of Trafficking and Violence Protection Act of 2000,Pub.L.No.106-386(2000,October28).RetrievedJune30,2008,from organization/10492.pdf
· Zhang, S. X. (2012). Looking for a hidden population: Trafficking of migrant laborers in San Diego County. San Diego State University.