Exclusives, Patient Care

Hidden in Plain Sight

Some call human trafficking modern-day slavery. (Photo/Robyn Orr, EMT)

What comes to mind when you hear the words “human trafficking?” Between cinema and news media, the words “human trafficking” are becoming increasingly more common. Human trafficking involves the use of force, fraud or coercion to compel a person into sexual acts, labor, or services against his or her will. Some call it modern-day slavery.  Human trafficking is the third largest criminal enterprise in the world and the fastest growing business of organized crime. It is not uncommon to think that human trafficking is a practice that would be more likely to happen outside the United States. But the reality is human trafficking is happening right outside your front door. The International Labor Organization estimates that there are hundreds of thousands of victims of human trafficking in the United States.  

The Polaris Project is a non-profit, non-governmental agency developed to combat human trafficking. They operate the National Human Trafficking Hotline. This is a 24-hour hotline that victims can call for help. They also operate a text line and an online chat. The Polaris Project reported that in 2018, the National Human Trafficking Hotline received reports on over 10,000 human trafficking cases.1 

As medical providers, how does this pertain to us? A 2014 study by Lederer & Wetzel revealed that 87.8% of all human trafficking victims accessed healthcare services while they were being trafficked. They also revealed that 63.3% of all human trafficking victims accessed emergency departments while they were being trafficked.2 

Cases of human trafficking victims have occurred in all 50 states and there is no single profile for trafficking victims. They can come from diverse socio-economic backgrounds, they have varied levels of education, and they can be foreign or domestic. However, there are risk factors that can lead to higher susceptibility including: homeless youth, runaways, and victims of physical or sexual abuse. Foreign nationals are trafficked into the United States every year. These individuals face many challenges that can place them at risk for trafficking and exploitation.  

Sex and labor trafficking victims do share a commonality. They have a need and that need is what traffickers exploit. The traffickers are probably not what you imagine either. Commonly, they are ordinary people who easily blend in with society. Just as there is no single profile for trafficking victims, there is no single profile for traffickers. They range from impoverished to high-ranking executives. 

I recently had the opportunity to interview a victim of sex trafficking. She commonly had contact with medical personnel while she was being trafficked. She advised me that her trafficker would give her a scripted story for whenever she would walk into a clinic. She, and other trafficked girls, would often become sick possibly due to their long working hours. If the clinic asked what she did for a living she would tell them that she was a waitress at a restaurant as her trafficker had scripted her to do. She said that no one ever questioned her, and they would take her answer at face value. Had anyone asked her any details about her story, they may have suspected that something was wrong because she would not have known what to say. 

Whether it is sex trafficking or labor trafficking, victims of human trafficking are commonly right in front of our eyes; we just don’t know how to identify them. Here are some indicators that your patient could be a victim of human trafficking. 

  • Your patient has no identification. It is common for traffickers to hold onto the victims’ driver’s license, passports or other forms of identification. 
  • Your patient is unsure of their whereabouts. Commonly sex trafficking victims are moved from city to city, sometimes multiple times a day, so it is not uncommon for them to be unaware of the city they are currently in. 
  • Your patient is escorted or monitored by another person. They may even look to that other person to answer questions for them. If they do not speak English, their trafficker may be translating for them. 
  • Your patient has inconsistencies in their story. 
  • Your patient is called by a name other than their legal name. 
  • Your patient may have scars or mutilations in various places on the body. 
  • Your patient presents with one or more untreated infections. 
  • You may see bruises or wounds in various stages of healing on your patient. 
  • Your patient appears malnourished. 
  • Your patient appears to have poor dental hygiene.  
  • Your patient seems to have a general lack of healthcare. 

An example of public safety encountering human trafficking can be seen in this Department of Homeland Security video.

Some physical signs of sex trafficking can include: 

  • Frequent urinary tract infections. 
  • Complaints of pelvic pain. 
  • Rectal trauma 
  • Pregnancy 
  • Branding or tattoos in places that are not hidden on the body. Sometimes pimps will tattoo or brand their victims to show ownership. 

When you encounter a victim of human trafficking here are some issues to be aware of: 

  • Your patient may not know they are a victim. Sometimes a person is unaware they are a victim of human trafficking before they can be free of the situation. Be careful with your wording when speaking with a potential victim. 
  • You patient may have been very psychologically manipulated. Traffickers go to great lengths to manipulate their victims and commonly they are psychologically tortured. 
  • Certain wording can make a victim shut down. If the victim is being trafficked by a person they love, such as their significant other, spouse or other family member. They may take offense to words like “perpetrator” or “abuser.” They may even have a “Stockholm Syndrome” type of bond with their trafficker. 
  • Your patient may be embarrassed that they are in this situation and may blame themselves.  
  • Your patient may or may not show signs of physical abuse. 

If you suspect that your patient is a victim of human trafficking what do you do? It is imperative that you take them to a hospital that has a 24-hour onsite social worker. Having an onsite social worker is extremely important because your patient, the potential victim, needs to have an advocate for him or her as soon as they enter the emergency department and once you leave. Notify both the on-duty social worker and the charge nurse of your concerns. Refer to your state laws regarding law enforcement involvement if your patient has not given you permission to report their situation. 

Education and awareness are the best tools you can use to combat human trafficking. The Blue Campaign is a national public awareness campaign designed to educate the public on how to recognize signs of human trafficking. As awareness about human trafficking increases, the number of victims found will continue to rise. The unfortunate reality is that we will not be able to identify all victims that we encounter. But when over 87% of victims have had contact with healthcare, how can we not feel obligated to try? 

The National Human Trafficking Hotline is 1-888-373-7888. Text 233733 (BEFREE). You may be the only hope for a trafficked victim. 

References 

1. 2018 Statistics from the National Human Trafficking Hotline.(n.d.)In Polaris Project. Retrieved August 29,2019, from https://polarisproject.org/sites/default/files/Polaris_National_Hotline_2018_Statistics_Fact_Sheet.pdf.

2. Lederer L. and Wetzel C. The health consequences of sex trafficking and their implications for identifying victims in healthcare facilities. Annals of Health Law. 2014;23(1):77-78.

Resources

Allies Against Slavery 
International Labor Organization 
K.W., personal communication, December 6, 2018. 
Polaris Project 
R.B., personal communication, July 5, 2019. 
Blue Campaign