By Jim Burke
If an emergency room nurse or physician knows enough to spot the signs of physical or sexual abuse in a child and has been given the guidelines on how and with whom to respond, why is the aligned issue of sex trafficking so often given short shrift by the healthcare community?
It’s a troubling question. Sex trafficking is no less serious an issue than child abuse, yet fewer than 2% of all hospitals in the U.S. have put procedures in place for dealing with victims who might make their way there for care[1]. On the other hand, nearly every hospital has instituted mandatory protocols to recognize and respond to abused children.
Sex trafficking is a big part of the larger global issue of human trafficking, a modern day version of slavery. Of the $150 billion in worldwide profits human trafficking generates, $99 billion of that is from sexual exploitation[2].
In the U.S., some 15,000 to 20,000 women and girls, the majority U.S. citizens, are believed to be sex trafficking victims each year[3]. It occurs in every state. And the nature of their victimization means they come into frequent contact with healthcare workers, most commonly in emergency rooms, urgent care and walk-in clinics.
In one case, in addition to commercial sex, female and male victims with developmental disabilities were forced to have sex with each other for the purpose of conceiving children. One victim gave birth three times and was accompanied to the hospital each time to register the babies so her trafficker could secure the public benefits. Medical personnel did not identify this as a trafficking case. In a different[4] case, a victim was sexually abused and repeatedly severely physically injured so that her traffickers could secure the opioids that medical personnel, in at least three separate contacts, prescribed[5].
Not surprisingly, one survey found, 99% of victims of sex trafficking suffer from at least one physical health issue during their victimization. It also found that 98% suffered from mental health conditions and two-thirds had gynecological issues like urinary tract infections, sexually transmitted diseases and unwanted pregnancies.
Healthcare professionals need to know what to look for as they are even more likely than law enforcement to interact with victims at some stage. In one study, 88% of 100 victims dealt with a provider mainly in an emergency department, but also at pediatric clinics, orthopedic, plastic surgery and OB-GYN offices, and dental practices, as well[6].
The National Human Trafficking Resource Center (NHTRC) is among the organizations that offers protocols specifically for healthcare providers[7]. This includes a step-by-step guide on recognizing and responding to trafficking in a healthcare context, including what to look for, recommended action steps and resources and referrals. Groups like the NHTRC also emphasize training on solutions that can be accessed without risking greater danger to the victim.
The NHTRC offers a comprehensive assessment tool[8] that can help healthcare providers determine if there is cause to discretely step in. Among the critical red flags it calls out:
- Someone else (an “uncle” or “cousin”) speaks for the patient.
- The patient is not aware of his or her location, the date or time.
- The patient can’t accurately verify details on insurance or identification cards, like age or the spelling of the last name.
- The patient seems fearful, anxious and/or tense, and submissive to his or her handler.
- Signs of physical or sexual abuse, medical neglect or torture; common health issues can range from jaw and neck problems to marks hidden under clothing like stab wounds, bite marks and cigarette burns.
- The patient is reluctant to explain his or her injury.
Should red flags be raised a private conversation should be attempted. Have sex acts for money or favors been forced? Is identification being held by others? Has a family member been threatened? A social worker as well as a translator might be helpful.
Practitioners who have been worked with such victims stress that a forced disclosure or “rescue” shouldn’t be the end goal. It takes five to seven attempts for victims to leave their traffickers and if they leave prematurely, they can be back with their old trafficker or a new one instead of getting needed crisis support. That makes the goal one of establishing a trusting relationship so the victim is comfortable she will be safe coming back.
Assistance for further assessment (including the potential danger to the patient) and next steps is available through the 24-hour NHTRC hotline, 1-888-373-7888. The hotline follows all HIPAA and mandatory reporting regulations and has access to over 200 languages. The protocols developed by individual institutions should include community referral resources like law enforcement and social services, too.
About the author
Jim Burke is a Vice President/Sr. Risk Consultant on Hub International’s Risk Services team. He has over 30 years of experience in professional safety and risk control consulting with direct, practical experience in a broad range of diversified business operations.
He specializes in safety management process development, risk minimization and mitigation strategies and development of best practices across the broad range of risk considerations.
[1] https://www.tandfonline.com/doi/abs/10.1080/23322705.2016.1187965?journalCode=uhmt20
[2] https://www.ilo.org/global/lang–en/index.htm
[3] https://www.state.gov/policy-issues/human-trafficking/
[4] https://www.htlegalcenter.org/wp-content/uploads/Medical-Fact-Sheet-Human-Trafficking-and-Health-Care-Providers.pdf
[5] https://www.icmec.org/wp-content/uploads/2015/10/Health-Consequences-of-Sex-Trafficking-and-Implications-for-Identifying-Victims-Lederer.pdf
[6] https://pulitzercenter.org/reporting/health-care-providers-are-missing-chances-help-victims-sex-trafficking
[7] https://humantraffickinghotline.org/resources/framework-human-trafficking-protocol-healthcare-settings
[8] https://humantraffickinghotline.org/sites/default/files/Comprehensive%20Trafficking%20Assessment.pdf
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